E3: Drugs for AutoImmune Disease Flashcards
What type of T Cell is the major player in autoimmune disease?
Suppressor T Cells..they keep cytotoxic and helper T cells at bay. When they go bad, you have autoimmunity
Auto immunity is more common in these 3 groups of people. how much of the population presents with an autoimmune disease?
1.WOMEN 2.elderly 3.genetically sucsceptable peeps…2% of pop
Hypothesis: some T and B lymphocytes escape ________ mechanisms in the ______ gland, and undergo activation and demonstrate self-reactivity out in the periphery
central tolerance…thymus
What are the 2 factors necessary for the development of autoimmune disease?
1.Inherited susceptibility genes 2.Environmental TRIGGERS (infection, fever, trauma)
What are two common familial autoimmunity diseases?
1.Thyroid 2.Type I DM
Auto-antibodies can initiate disease by altering/inhibiting receptor function like in ________
myasthenia gravis
Auto-antibodies can initiate disease by stimulating receptors normally stimulated by a hormone like in ________
hyperthyroidism
Organ SPECIFIC autoimmune diseases are mediated by what cell type??? What is the main goal of Tx?
T lymphocytes….REDUCE inflammation
Large doses of steroids to reduce inflammation will cause significant atrophy of what type of tissue in the body?
lymphoid tissue
What are the two REALLY general types of drugs in the Tx of autoimmune diseases?
1.Reduce inflammation (steroids) 2.Block cytokines (antagoinists)
What is the major gene that predisposes to autoimmune disease? What does it do?
Major Histocompatability Complex (MHC) genes…encode cytokines
What is the pharmacologic model for Treatment?
Rheumatoid Arthritis
Goal of autoimmune tx is _______ and not curative :(
pallative
What are the two drugs that are CORNERSTONES of autoimmune treatment??
Aspirin and NSAIDS
What is the main sign of aspirin toxicity?
Tinnitus
What are 2 really common NSAIDS? What are 2 STRONGER NSAIDS?
Common: 1.ibuprofen 2.naproxen…..STRONGER: 1. Pir-ox-icam 2.na-bum-et-one
Oral complications of Aspirin and NSAIDS (2)
1.prolonged bleeding (not siginificant) 2.apthous ulcers
What do we give RA patients with inadequate response to aspirin/NSAIDS?
SULFA-SAL-AZINE-interferes with prostaglandin (Cox1 AND 2) synthesis
What is the COX-2 inhibitor?
celebrex (cox 2 takes care of the inflammatory prostaglandins and not the cytoprotective/homeostasis prostaglandins)
Celebrex is CONTRAINDICATED in patients allergic to ________ and ________.
Aspirin/NSAIDS and Sulfonamides
What family of RA drugs is used for those who do not respond to COX-2 inhibitors?
DMARDS-Disease Modifying Anti Rheumatic DrugS
How long do DMARDS take to kick in?
3 to 4 months
What are the 4 classes of DMARDS?
1.Immune Modulators 2.AntiMalarials 3.Penicillamine 4.GOLD compounds
What is the immune modulator DMARD that everyone MUST MUST MUST know? What are the 2 indications?
meth-o-trex-ate (autoimmune disease and Chemo)
What is the DRUG OF CHOICE for severe RA or psoriatic arthritis?
Methotrexate
How long does Methotrexate take to kick in?
3-6 weeks (faster than the normal 3 to 4 months like other DMARDS)
What are the 2 most common adverse effects of methotrexate?
1.mucosal ulcerations 2. Nausea
What are the 6 immune modulating DMARDS?
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
Which immune modulator inhibits pyrimidine synthesis, resulting in anti-proliferative and anti-inflammatory effects….Reduces pain and inflammation…and Slows progression of structural damage
LE-FLU-NO-mide
__________ causes skin rashes and alopecia. it is also ________ so its contraindicated in pregnant women and women of child-bearing years
le-flu-no-mide…teratogenic
Phil Mickelson’s ________ is a _____ blocker indicated for moderate to SEVERE RA.
e-taner-cept (Enbrel)…TNFa blocker
Which TNFa blocker can I give with Methotrexate to help with moderate to severe RA?
in-flix-imab
TNFa blocker that Treatment of moderate to severe RA in patients with inadequate response to one or more DMARDS
ADDD…..ad-a-lim-umab (mab-monoclonal antibody)
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
ANAKIN-ra (anakin skywalker)
What are the two AntiMalarial Preps?
1.ChloroQuine 2. HydroxyChloroquine
Which 2 drugs can cause BLUE-BLACK intramural pigmentation and severe eye damage?
Anti-Malarials…(chloroQuine/hydroxyChloroquine) AND Gold compounds
Which RA med is ALSO a CHELATING agent and is given as an ANTIDOTE for Heavy Metal (Van Halen) poisoning?
Penicillamine
Penicillamine: Used for RA treatment after _______ have failed, but before use of _________
gold salts….corticosteroids
What do all the Gold combinations have in their name?
“aur”
Gold combinations have High incidence of _______ = requires intensive monitoring
toxicity
What are the 3 immunosuppressive drugs used in Refractory RA?
1.AzaThioPrine 2.CycloPhosphamide 3.CycloSporine
Immunosuppressent: Used also in dentistry with prednisone for severe erosive lichen planus, major aphthous stomatitis, erythema multiforme, benign mucous membrane pemphigoid
aza-thio-prine
Immunosuppressant (also an antineoplastic drug)…Used for SEVERE RA…Side effects: alopecia, infertility, GI, blood dyscrasias
Cyclo-phosphamide (CHEMO drug!)
Which immunosuppressant is used primarily to prevent rejection of organ transplants AND SEVERE ACTIVE RA?
CycloSporine
How much of CycloSporine users get Gingival Hyperplasia?
16% or less
SS: Patients with severe oral and ocular dryness show that ___% of their glandular cells remain intact…SO what two drugs can help stimulate saliva?
50%…pilocarpine and cevi-me-line
Elevated BP may be due to chronic _______
pain
Antibiotic Premed: New ADA Task Force recommendations for patients with __________
prosthetic joints
