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Drugs, Biologics, Dermatology, DCNP Exam Lahey dermatology NP Fellows > Biologics Psoriasis > Flashcards

Biologics Psoriasis Flashcards

1
Q

What are TNF Alpha Inhibitors?

A

A class of medications used to treat autoimmune diseases by blocking tumor necrosis factor alpha

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2
Q

Name TNF Alpha Inhibitors

A

Etanercept (enbrel)
Adalimumab (humira)
Cetrolizumab (cimzia) ok preg
Golimumab (simponi)
Infliximab (remicade)

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3
Q

What is the trade name for Adalimumab?

A

Humira

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4
Q

Which TNF Alpha Inhibitors are indicated for both Psoriasis (PsO) and Psoriatic Arthritis (PsA)?

A

Entanercept
Adalimumab
Cetrolizumab
Infliximab

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5
Q

What are common side effects (SEs) of TNF Alpha Inhibitors?

A

All: Infections, Injection Site Reactions (ISR)

Rash:Adalimumab and Cetrolizumab

HTN: golimumab

Infusion related reaction and abdominal pain: infliximab

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6
Q

Which TNF Alpha Inhibitor has the indication for PsO and is associated with the lowest risk in pregnancy and lactation?

A

Certolizumab pegol

Known by the trade name Cimzia

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7
Q

What serious adverse effects (AEs) are associated with TNF Alpha Inhibitors?

A

Serious infections, Fungal infections, Hepatitis B reactivation, New/worsening heart failure, Low blood count, Lupus-like syndrome, Lymphoma, other malignancies

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8
Q

What are the absolute contraindications for TNF Alpha Inhibitor therapy?

A

Hypersensitivity, Active infection, Chronic infection (including TB), Concurrent administration with anakinra

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9
Q

Fill in the blank: The trade name for Infliximab is _______.

A

Remicade

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10
Q

What are relative contraindications for TNF Alpha Inhibitor therapy?

A

Congestive heart failure, Family history of demyelinating disease (ie MS), History of malignancies or lymphoma

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11
Q

What common side effects are associated with Infliximab?

A

Infections, Headache, Infusion-related reactions, Abdominal pain

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12
Q

What type of therapy is Ustekinumab (Stelara)?

A

IL-12/23 inhibitor
Targeted Biologic Therapy

Approved for Psoriasis (PSO) and Psoriatic Arthritis (PsA) for patients ≥ 6 years.

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13
Q

What are common side effects of Ustekinumab ( stelara)?

A

Cold or flu-like symptoms, URI, HA, fatigue

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14
Q

What are the types of IL-17a inhibitors mentioned?

A
  • Secukinumab (Cosentyx)
  • Ixekizumab (Taltz)
  • Brodalumab (Siliq)

IL-17a inhibitors are used in the treatment of psoriasis and psoriatic arthritis. Except brodalimumab

Cosentyx and taltz >6

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15
Q

What are the names of IL-23 inhibitors listed?

A
  • Tildrakizumab (Ilumya)
  • Risankizumab (Skyrizi)
  • Guselkumab (Tremfya)

IL-23 inhibitors are utilized for treating psoriasis and PsA except tildrakizumab

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16
Q

What is the generic name for Xeljanz?

A

Tofacitinib

Tofacitinib is a Janus Kinase (JAK) inhibitor for Psoriatic Arthritis (PsA).

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17
Q

What are common side effects of Tofacitinib?

A

HA, nausea, URI, vomiting

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18
Q

What are the warnings/precautions for IL12/23?

A
  • Serious infections (especially mycobacteria, salmonella, BCG vaccinations)
  • Malignancies
  • Posterior leukoencephalopathy

Patients should be screened for infections including TB.

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19
Q

What are the absolute contraindications for IL-17a inhibitor?

A
  • Known hypersensitivity
  • Active infection
  • Chronic infection including TB
  • patients with inflammatory bowel disease.

Other- bridalumab-rems- depression si

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20
Q

True or False: Brodalumab has a risk of depression and requires a REMS program.

A

True

REMS stands for Risk Evaluation and Mitigation Strategy.

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21
Q

Fill in the blank: IL-17a inhibitors are used in the treatment of _______.

A

psoriasis and psoriatic arthritis

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22
Q

What serious risks are associated with JAKs?

A
  • Serious infections
  • Mortality
  • Malignancy
  • Major adverse cardiovascular events (MACE)
  • Thrombosis
    Elevated liver enzymes, whipped, anemia, lymphoma, and other malignancies. G.I. perforations and ulcerations.
    Close monitoring is advised for patients on these therapies.
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23
Q

What type of infection screening is required before starting treatment?

A

Screening for tuberculosis (TB)

This is crucial for patients receiving immunosuppressive therapies.

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24
Q

What is the risk associated with combining targeted therapies with TNF inhibitors?

A

Increased risk of serious infections

This combination therapy should be approached with caution.

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25
Q

What is the mechanism of action of TNF alpha inhibitors?

A

Binds to TNF-alpha receptors, reducing circulating levels of TNF alpha, a key cytokine in psoriasis pathogenesis

TNF alpha is involved in inflammatory processes and psoriasis development.

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26
Q

What is the dosing regimen for Etanercept?

A

50mg SC twice weekly x 3 months, then once weekly thereafter

For patients 4 years or older and less than 63 kg, the dose is 0.8 mg/kg subQ once weekly.

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27
Q

What is the dosing regimen for Adalimumab?

A

80mg SC day 0, then 40mg day 7, then 40mg every 14 days thereafter

This regimen is used for the treatment of psoriasis.

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28
Q

What is the dosing regimen for Infliximab?

A

5mg/kg IV week 0, 4, then Q 8 weeks thereafter

Infliximab is administered intravenously.

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29
Q

What is the dosing regimen for Certolizumab?

A

400mg every other week

For patients less than 90kg, the initial dosing can be 400mg at Week 0, 2, 4, then 200mg every other week.

30
Q

What is notable about the use of Certolizumab in pregnancy?

A

Safest to use in pregnancy (doesn’t cross the placenta)

This characteristic makes Certolizumab a preferred option for pregnant patients requiring treatment.

31
Q

What baseline tests should be conducted for TNF alpha considerations?

A

TB, hepatitis B and C, HIV, CBC, LFTS, Chem 7

CBC refers to complete blood count; LFTS refers to liver function tests; Chem 7 refers to a basic metabolic panel.

32
Q

What are some risks associated with TNF alpha treatments?

A

New or worsening CHF, neurological disorders, infections, malignancies, reactivation of hepatitis B

CHF stands for congestive heart failure.

33
Q

What types of screenings should be done for patients receiving TNF alpha treatments?

A

Infections, skin cancer

Regular screenings help in early detection and management of potential complications.

34
Q

How often should TB testing be conducted for patients on TNF alpha therapies?

A

Annually

Annual testing is crucial for preventing TB reactivation.

35
Q

How frequently should labs be re-evaluated for patients on TNF alpha treatments in the first year?

A

Every 4 months

After the first year, re-evaluation can occur every 6 months.

36
Q

True or False: Patients on TNF alpha therapies should only be screened once for infections.

A

False

Ongoing screening is necessary due to the risk of infections.

37
Q

What is the mechanism of action of IL-17 inhibitors?

A

Binds to IL-17, a key cytokine in psoriasis pathogenesis

IL-17 plays a crucial role in inflammatory processes related to psoriasis.

38
Q

What is the initial dosing for Ixekizumab (taltz)?

A

160mg SC initially

SC stands for subcutaneous.

39
Q

What is the dosing schedule for Ixekizumab (taltz) through week 12?

A

80mg SC every 2 weeks

This dosing is to maintain therapeutic levels in the body.

40
Q

What is the dosing for Ixekizumab after week 12?

A

80mg every 4 weeks thereafter

This adjustment helps in long-term management of psoriasis.

41
Q

What are IL-17 inhibitors used for?

A

They are used in the treatment of various autoimmune conditions

IL-17 inhibitors target the interleukin-17 pathway, which is involved in inflammation.

42
Q

What baseline testing is recommended before starting IL-17 inhibitors?

A

TB, Hepatitis B and C, HIV, CBC, CMP

Baseline testing is crucial to identify any underlying infections that may be exacerbated by treatment.

43
Q

How often should patients be tested for TB while on IL-17 inhibitors?

A

Yearly

Regular testing helps to monitor and manage potential latent TB infections.

44
Q

In which patients should IL-17 inhibitors be used cautiously?

A

Patients with a history of IBD

Inflammatory bowel disease (IBD) may be exacerbated by IL-17 inhibition.

45
Q

What is a notable side effect of Ixekizumab?

A

More severe injection site reactions

Patients may experience increased pain, swelling, or redness at the injection site.

46
Q

What monitoring is required for Brodalumab?

A

REMS monitoring for suicidality

The Risk Evaluation and Mitigation Strategy (REMS) program is in place due to potential psychiatric side effects.

47
Q

How often should patients be re-evaluated after starting IL-17 inhibitors?

A

Every 4 months for 1 year, then every 6 months thereafter

Regular evaluations help assess treatment efficacy and safety.

48
Q

What do IL-12/23 inhibitors bind to?

A

IL-12 and IL-23 receptors

49
Q

What is the mechanism of action of IL-12/23 inhibitors?

A

Reduces levels of IL-23, a key cytokine in psoriasis pathogenesis

50
Q

What is the weight-based dosing for Ustekinumab (stelara) for patients less than 100 kg?

51
Q

What is the weight-based dosing for Ustekinumab (stelara) for patients greater than 100 kg?

52
Q

What is the Ustekinumab (stelara) dosing for patients aged 6 years or older and less than 60 kg?

A

0.75 mg/kg subQ at weeks 0 and 4, then every 12 weeks

53
Q

What is the Ustekinumab dosing for patients aged 6 years or older and between 60 to 100 kg?

A

45 mg subQ at weeks 0 and 4, then every 12 weeks

54
Q

What is the Ustekinumab dosing for patients aged 6 years or older and greater than 100 kg?

A

90 mg subQ at weeks 0 and 4, then every 12 weeks

55
Q

True or False: IL-12/23 inhibitors increase levels of IL-23.

56
Q

What is the only IL 12/23 inhibitor currently on the market?

A

Ustekinumab (stelara)

57
Q

What are IL-12/23 inhibitors used for?

A

They are used for various immunological conditions.

IL-12/23 inhibitors target specific cytokines involved in inflammatory responses.

58
Q

What baseline testing is required before starting IL-12/23 inhibitors?

A

TB, Hepatitis B and C, HIV, CBC, CMP

These tests help assess the patient’s eligibility and safety for treatment.

59
Q

How often should patients be tested for TB while on IL-12/23 inhibitors?

A

Yearly

Regular TB testing is crucial due to the risk of reactivation.

60
Q

What is a notable characteristic of the safety profile of IL-12/23 inhibitors?

A

Favorable safety profile

This indicates a lower incidence of adverse effects compared to other treatments.

61
Q

How frequently are IL-12/23 inhibitors administered?

A

4 times a year

This dosing schedule enhances patient compliance and convenience.

62
Q

How often should treatment be re-evaluated during the first year of IL-12/23 inhibitor therapy?

A

Every 4 months

This allows for timely adjustments based on patient response.

63
Q

After the first year, how often should IL-12/23 inhibitor therapy be re-evaluated?

A

Every 6 months

This reflects a more stable assessment of the patient’s condition.

64
Q

What is the dosing regimen for Il-23 inhibitors?

A

Four times a year dosing.
Favorable safety profile consider reevaluating every four months for one year and then every six months thereafter

65
Q

What is required for all biologic agents at baseline?

A

TB testing

Tuberculosis (TB) testing is essential to ensure patient safety before starting treatment with biologic agents.

66
Q

How often is TB testing required after the initial baseline for most biologic agents?

A

Annually

Regular annual testing helps to monitor and manage potential TB infections.

67
Q

Which class of biologic agents requires testing for Hepatitis B at baseline?

A

TNF alpha inhibitors

Testing for Hepatitis B is crucial to prevent reactivation during treatment.

68
Q

What is the dosing schedule for IL 12/23 and IL 23 biologic agents?

A

Week 0, 4 then Q12W

This dosing schedule helps maintain therapeutic levels of the medication.

69
Q

What special requirement does Brodalumab (siliq) have?

A

Registration in REMS program

The Risk Evaluation and Mitigation Strategy (REMS) program is designed to ensure safe use of the medication.

70
Q

Which biologic agent is considered favorable in pregnancy?

A

Certolizumab (cimzia)

Certolizumab has a favorable safety profile for use during pregnancy.

Drugs, Biologics, Dermatology, DCNP Exam Lahey dermatology NP Fellows (8 decks)

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