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Pharm Part II > E3: Drugs for AutoImmune Disease > Flashcards

E3: Drugs for AutoImmune Disease Flashcards

1
Q

What type of T Cell is the major player in autoimmune disease?

A

Suppressor T Cells..they keep cytotoxic and helper T cells at bay. When they go bad, you have autoimmunity

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2
Q

Auto immunity is more common in these 3 groups of people. how much of the population presents with an autoimmune disease?

A

1.WOMEN 2.elderly 3.genetically sucsceptable peeps…2% of pop

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3
Q

Hypothesis: some T and B lymphocytes escape ________ mechanisms in the ______ gland, and undergo activation and demonstrate self-reactivity out in the periphery

A

central tolerance…thymus

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4
Q

What are the 2 factors necessary for the development of autoimmune disease?

A

1.Inherited susceptibility genes 2.Environmental TRIGGERS (infection, fever, trauma)

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5
Q

What are two common familial autoimmunity diseases?

A

1.Thyroid 2.Type I DM

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6
Q

Auto-antibodies can initiate disease by altering/inhibiting receptor function like in ________

A

myasthenia gravis

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7
Q

Auto-antibodies can initiate disease by stimulating receptors normally stimulated by a hormone like in ________

A

hyperthyroidism

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8
Q

Organ SPECIFIC autoimmune diseases are mediated by what cell type??? What is the main goal of Tx?

A

T lymphocytes….REDUCE inflammation

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9
Q

Large doses of steroids to reduce inflammation will cause significant atrophy of what type of tissue in the body?

A

lymphoid tissue

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10
Q

What are the two REALLY general types of drugs in the Tx of autoimmune diseases?

A

1.Reduce inflammation (steroids) 2.Block cytokines (antagoinists)

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11
Q

What is the major gene that predisposes to autoimmune disease? What does it do?

A

Major Histocompatability Complex (MHC) genes…encode cytokines

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12
Q

What is the pharmacologic model for Treatment?

A

Rheumatoid Arthritis

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13
Q

Goal of autoimmune tx is _______ and not curative :(

A

pallative

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14
Q

What are the two drugs that are CORNERSTONES of autoimmune treatment??

A

Aspirin and NSAIDS

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15
Q

What is the main sign of aspirin toxicity?

A

Tinnitus

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16
Q

What are 2 really common NSAIDS? What are 2 STRONGER NSAIDS?

A

Common: 1.ibuprofen 2.naproxen…..STRONGER: 1. Pir-ox-icam 2.na-bum-et-one

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17
Q

Oral complications of Aspirin and NSAIDS (2)

A

1.prolonged bleeding (not siginificant) 2.apthous ulcers

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18
Q

What do we give RA patients with inadequate response to aspirin/NSAIDS?

A

SULFA-SAL-AZINE-interferes with prostaglandin (Cox1 AND 2) synthesis

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19
Q

What is the COX-2 inhibitor?

A

celebrex (cox 2 takes care of the inflammatory prostaglandins and not the cytoprotective/homeostasis prostaglandins)

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20
Q

Celebrex is CONTRAINDICATED in patients allergic to ________ and ________.

A

Aspirin/NSAIDS and Sulfonamides

21
Q

What family of RA drugs is used for those who do not respond to COX-2 inhibitors?

A

DMARDS-Disease Modifying Anti Rheumatic DrugS

22
Q

How long do DMARDS take to kick in?

A

3 to 4 months

23
Q

What are the 4 classes of DMARDS?

A

1.Immune Modulators 2.AntiMalarials 3.Penicillamine 4.GOLD compounds

24
Q

What is the immune modulator DMARD that everyone MUST MUST MUST know? What are the 2 indications?

A

meth-o-trex-ate (autoimmune disease and Chemo)

25
Q

What is the DRUG OF CHOICE for severe RA or psoriatic arthritis?

A

Methotrexate

26
Q

How long does Methotrexate take to kick in?

A

3-6 weeks (faster than the normal 3 to 4 months like other DMARDS)

27
Q

What are the 2 most common adverse effects of methotrexate?

A

1.mucosal ulcerations 2. Nausea

28
Q

What are the 6 immune modulating DMARDS?

A

1.MethoTrexate 2.Le-flu-no-mide 3.E-taner-cept (Enbrel) 4.in-flix-imab 5.a-dal-im-u-mab 6.ana-kin-ra

29
Q

Which immune modulator inhibits pyrimidine synthesis, resulting in anti-proliferative and anti-inflammatory effects….Reduces pain and inflammation…and Slows progression of structural damage

A

LE-FLU-NO-mide

30
Q

__________ causes skin rashes and alopecia. it is also ________ so its contraindicated in pregnant women and women of child-bearing years

A

le-flu-no-mide…teratogenic

31
Q

Phil Mickelson’s ________ is a _____ blocker indicated for moderate to SEVERE RA.

A

e-taner-cept (Enbrel)…TNFa blocker

32
Q

Which TNFa blocker can I give with Methotrexate to help with moderate to severe RA?

A

in-flix-imab

33
Q

TNFa blocker that Treatment of moderate to severe RA in patients with inadequate response to one or more DMARDS

A

ADDD…..ad-a-lim-umab (mab-monoclonal antibody)

34
Q

What is the ONLY, the ONE Interleukin-1 receptor antagonist (blocker) we discussed? its for the Treatment of moderate to severe RA in patients who have failed one or more DMARDS….Slows degradation of cartilage and bone loss

A

ANAKIN-ra (anakin skywalker)

35
Q

What are the two AntiMalarial Preps?

A

1.ChloroQuine 2. HydroxyChloroquine

36
Q

Which 2 drugs can cause BLUE-BLACK intramural pigmentation and severe eye damage?

A

Anti-Malarials…(chloroQuine/hydroxyChloroquine) AND Gold compounds

37
Q

Which RA med is ALSO a CHELATING agent and is given as an ANTIDOTE for Heavy Metal (Van Halen) poisoning?

A

Penicillamine

38
Q

Penicillamine: Used for RA treatment after _______ have failed, but before use of _________

A

gold salts….corticosteroids

39
Q

What do all the Gold combinations have in their name?

A

“aur”

40
Q

Gold combinations have High incidence of _______ = requires intensive monitoring

A

toxicity

41
Q

What are the 3 immunosuppressive drugs used in Refractory RA?

A

1.AzaThioPrine 2.CycloPhosphamide 3.CycloSporine

42
Q

Immunosuppressent: Used also in dentistry with prednisone for severe erosive lichen planus, major aphthous stomatitis, erythema multiforme, benign mucous membrane pemphigoid

A

aza-thio-prine

43
Q

Immunosuppressant (also an antineoplastic drug)…Used for SEVERE RA…Side effects: alopecia, infertility, GI, blood dyscrasias

A

Cyclo-phosphamide (CHEMO drug!)

44
Q

Which immunosuppressant is used primarily to prevent rejection of organ transplants AND SEVERE ACTIVE RA?

A

CycloSporine

45
Q

How much of CycloSporine users get Gingival Hyperplasia?

A

16% or less

46
Q

SS: Patients with severe oral and ocular dryness show that ___% of their glandular cells remain intact…SO what two drugs can help stimulate saliva?

A

50%…pilocarpine and cevi-me-line

47
Q

Elevated BP may be due to chronic _______

A

pain

48
Q

Antibiotic Premed: New ADA Task Force recommendations for patients with __________

A

prosthetic joints

Pharm Part II (28 decks)

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