Drugs for ILD (Iszard)

Question 1

Prednisone, an anti-inflammatory and immunosuppressive may lead to suppresion of what pathway?

What should be monitored for?

Answer 1

Suppression of the HPA

Monitor for Cushing’s Syndrome and Hyperglycemia

Question 2

What type of drug is Mycophenolate (MPA)?

What is the Black Box Warning?

Answer 2

Immunosupressive Drug

Embryotoxic

Question 3

What are the indications for mycophenolate (MPA)?

Answer 3

RA, resistant to methotrexate

Prophylaxis of organ rejection, should be used in combination with other immunosuppresant drugs

Question 4

What are the side effects of mycophenolate?

Answer 4

Diarrhea

leukopenia

infections

Question 5

What are the drug interactions of mycophenolate?

Answer 5

efficacy is reduced by antacids, PPIs, or drugs that enter enterohepatic circulation

May diminish efficacy of OCPs

Question 6

Which drug is very successful in treating RA?

Answer 6

Mycophenolate

Question 7

What is the black box warning for methotrexate?

Answer 7

Careful use as indicated by physicians with knowledge and experience using the drug

Deaths have been reported in using MTX

Used to treat malignancy, psoriasis and RA

Question 8

Indications for MTX

Answer 8

Neoplastic dz

Psoriasis

RA and Poly-articular Juvenile RA

Question 9

What are some main concerns of MTX outside of the black box warning?

Answer 9

fetal death

reduced elimination in renal pt’s

bone marrow suppression and aplastic anemia

hepatotoxicity with prolonged use

lung disease

diarrhea and hemorrhagic enteritis

Fatal skin reaction

Opportunistic infections (p. carinii)

Question 10

What are some drugs to avoid mixing with MTX?

Answer 10

NSAIDs (causes MTX toxicity)

Oral Abx (interferes with enterohepatic circulation)

Hepatotoxic drugs (accelerates hepatoxicity)

Theophylline (decreases clearance)

Question 11

Should women of childbearing potential use MTX?

Answer 11

No, not until pregnancy is excluded and they’re counseled on risks

Question 12

MTX is especially toxic to which two major organs?

Answer 12

Liver

Kidneys

Question 13

The incidence and severity of acute side effects of MTX is related to what two things?

Answer 13

Dose

Frequency of administration

Question 14

What are the two main indications for azathioprine?

(besides ILD)

Answer 14

Renal Homotransplantation

RA

(and ILD obviously)

Question 15

What are the contraindications for the immunosuppressive antimetabolite, azathioprine?

Answer 15

HSN to the drug itself

Pregnant women with RA

Question 16

What are the two adverse reactions of azathioprine?

Answer 16

Hematologic and GI issues

Question 17

What is the black box warning for azathioprine?

Answer 17

Chronic immunosuppression with azathioprine

increases risk of malignancy

Question 18

Which drug is a kinase inhibitor used for IPF?

What are the main contraindications?

Answer 18

Nintedanib

No significant contraindications

Question 19

What are some GI sx to watch for on nintedanib?

Answer 19

elevated liver enzymes

N/V/D

GI perforation during surgery

Question 20

What are some hematologic concerns to watch for on nintedanib?

Answer 20

arterial thromboembolic events

bleeding

Question 21

Should nintedanib be given to pregnant women?

Answer 21

No

Question 22

What are the common side effects of nintedanib?

Answer 22

N/V/D

elevated liver enzymes

HA

HTN

Question 23

Co-administration of P-gp and CYP3A4 inhibitors may increase what drug levels?

Answer 23

nintedanib

Monitor pt’s closely for tolerability