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Pharm Exam 2 (ASL) > DMARDs (Lauren🌭) > Flashcards

DMARDs (Lauren🌭) Flashcards

1
Q

Are DMARDs analgesics?

A

No

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2
Q

Do DMARDs have any immediate effects?

A

No. Used to slow the progression of the disease.

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3
Q

What is the main effect of Gold Salts?

A

Suppress cellular immunity

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4
Q

What are the main toxicities of Gold Salts?

A

Bone marrow damage

Enterocolitis

PRETTY TOXIC

NOT USED MUCH

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5
Q

What kind of drug is Penicillamine (Cuprimine)

A

A chelating drug that works for RA and Wilson’s disease

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6
Q

What are the toxicities of Penicillamine (Cuprimine)

A

It fucks up everything

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7
Q

What are the main toxicities of Hydroxychloroquine (Plaquenil)?

A

Hemolysis (G6PD deficient)

Ototoxicity

Retinopathy

Peripheral neuropathy

Pruritus

Methemoglobinemia

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8
Q

Sulfasalazine (Azulfidine) is a prodrug that is metabolized into _________ and ________

A

Sulfonamide

Salicylate

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9
Q

The adverse effects of sulfasalazine are related to it being metabolized into (sulfonamide/salicylate/both)

A

Both

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10
Q

What DMARDs act on TNFα?

A

Infliximab (Remicade) 👩🏻‍🦲🐁

Adalimumab (Humira)👩🏻‍🦲

Cetrolizumab (Cimiza)

Golimumab (Simponi)

Etanercept (Enbrel)

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11
Q

What are the old school DMARDs that aren’t used much

A

Gold Salts

Penicillamine (Cuprimine)

Hydroxychloroquine (Plaquenil)

Sulfasalazine (Azulfidine)

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12
Q

Every drug in this lecture has pretty much the same set of adverse effects since they all inhibit some part of the immune system.

What are those side effects?

A

Basically anything that comes along with a decreased immune system:

Increased risk of infection

TB

Valley fever

Development of cancer

Etc

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13
Q

Infliximab (Remicade) and Adalimumab (Humira) are both what kind of drugs?

A

Monoclonal antibodies against TNFα

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14
Q

Infliximab (Remicade) and Adalimumab (Humira) are both monoclonal antibodies against TNFα. What is the main difference between them?

A

Infliximab (Remicade) is chimeric. (Mix of human and murine regions) 👩🏻‍🦲🐁

Adalimumab (Humira) is fully human 👩🏻‍🦲👩🏻‍🦲

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15
Q

What does chimeric mean?

A

Mix of animals

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16
Q

What is the benefit of Adalimumab (Humira) being 100% human peptide sequences?

A

Decreased risk of sensitivity reactions

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17
Q

What are the 2 “Me-too” drugs that are pretty much the same thing as adalimumab (Humira)? 🤑

A

Certrolizumab (Cimiza)

Golimumab (Simponi)

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18
Q

How does Etanercept (Enbrel) target TNFα?

A

It is a fusion protein that is a FAKE TNFα receptor.

Uses up all the TNFα so it cant bind to the real receptor

(EtanerCEPT= looks like “receptor’)

19
Q

Which DMARD inhibits B cell differentiation by binding to CD20?

A

Rituximab (Rituxan)

20
Q

Which DMARD inhibits T cell activation?

A

Abatacept (Orencia)

21
Q

All of the drubs that are monoclonal antibodies end in “___”

A

“mab”

Infliximab

Adalimumab

Certrolizumab

Golimumab

Rituximab

22
Q

All of the drugs that are fusion proteins end in “_____”

A

“cept”

Etanercept

Abatacept

23
Q

Which two drugs inhibit the synthesis of nucleic acid in WBCs?

A

Leflunomide (Arava)

Mycophenolate mofetil (Cellcept)

24
Q

Leflunomide (Arava) inhibits nucleic acid synthesis by inhibiting the enzyme that does de novo (purine/pyramidine) synthesis

A

Pyrimidine

25
Q

Mycophenolate mofetil (Cellcept) inhibits nucleic acid synthesis by inhibiting the enzyme that makes (purines/pyrimidines)

A

Purines

26
Q

If Leflunomide (Arava) and Mycophenolate mofetil (Cellcept) are preventing the production of purines and pyrimidines, why doesn’t it kill us?

A

Because they SPECIFICALLY affect the pathways in WBCs and nowhere else. (the “de novo” pathways are the ones used by WBCs)

27
Q

Other than inhibiting the production of de novo pyrimidine synthesis, Leflunomide has 2 other MOAs. What are those?

A

Inhibits induction of COX-2 = antiinflammatory effect

Inhibits tyrosine kinase (not important)

28
Q

What is the unique adverse effect of mycophenolate mofetil (Cellcept) that Dr Kerecsen mentioned in the review (but nowhere else in his lectures or handouts lol)

A

A “very nice rash”

29
Q

WHat are the two DMARDs that are Interleukin receptor antagonists?

A

Anakinra (Kineret) IL-1

Tocilizumab (Actemra) IL-6

30
Q

Which DMARD drug will block IL-1?

A

Anakinra (Kineret)

31
Q

Which DMARD drug will block IL-6?

A

Tocilizumab (Actemra)

32
Q

Interleukins are (strong/weak) promoters of the immune response

A

Strong

33
Q

Almost all DMARD drugs are combined with _________

A

Methotrexate

34
Q

If someone is intolerant to Methotrexate, but they need a DMARD, which drug can be used all by itself without methotrexate?

A

Tofacitinib (Xeljanz)

(Baricitinib (Olumiant) can also be used as monotherapy, but he barely talked about it and it was not mentioned in the review)

35
Q

All DMARD drugs open you up to higher risks for infection and malignancy, but which drug has the WORST risk for this?

SERIOUS!!!

HUGE

REALLY BAD INFECTIONS AND CANCERS

A

Tofacitinib (Xeljanz)

36
Q

Which two DMARD drugs are Janus Kinase (JAKs) inhibitors?

A

Tofacitinib (Xeljanz)

Baricitinib (Olumiant)

37
Q

What is the MOA of sulfasalazine?

A

Inhibits dihydrofolate (DHF) synthesis

38
Q

Which drug primarily inhibits JAK1 and JAK3?

A

Tofacitinib (Xeljanz)

39
Q

Which drug is a fully human TNFα blocker?

A

Adalimumab (Humira)

40
Q

Which DMARD will increase your risk of TB?

A

ALL OF THEM

41
Q

Which drug is a chimeric monoclonal antibody that binds CD20?

A

Rituxumab (Rituxan)🐀

42
Q

What are the two chimeric drugs that use mouse parts

A

Infliximab (Remicade)

Rituximab (Rituxan)

43
Q

Which DMARDs pride themselves on containing 100% human parts

A

Adalimumab (Humira)

Certrolizumab (Cimiza)

Golimumab (Simponi)

Abatacept (Orencia)

Pharm Exam 2 (ASL) (8 decks)

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