Immunomodulating Agents Flashcards
what is the general immunosuppressant?
glucocorticoid
what are the calcineurin inhibitors?
cyclosporine (Neoral, Sandimmune), tacrolimus (Envarsus XR, Protopic)
what are the mTOR inhibitors?
everolimus (Zortress, Afinitor), sirolimus (Rapamune)
what are the types of immunosuppressants?
1) general immunosuppressant
2) calcineurin
3) mTOR inhibitor
4) TNF-alpha inhibitor
5) interleukin (IL) inhibitor
are vaccines immunosuppressants or immunostimulants?
immunostimulants
what are the goals of immunosuppressants?
1) limit immune-mediated damage to tissues
2) treat autoimmune diseases
3) prevent rejection of transplanted organs
t/f: there is an increased risk for viral infections (esp upper resp infections) with immunosuppressants
true
what are the indications for immunosuppressants?
organ transplant
chemotherapy
various autoimmune/autoinflammatory syndromes (RA, ankylosing spondylitis, Crohn’s disease, psoriasis)
what are the TNF-alpha inhibitors?
Adalimumab (Humlia), infliximab (Remicode), etanercept (Enbrel)
what are the interleukin inhibitors?
Anakinra (Kineret), canakinumab (Ilaris), Rinonacept (Arcalyst)
what are the side effects of immunosuppressants?
GI distress, loss of appetite
increased risk of bacterial and macrophage-dependent infections (resp infections, sepsis, tuberculosis, fungal infections, etc)
increased risk of malignancies
jt pain, injection site rxn
bone marrow suppression - anemia
rash at beginning of Rx
neurotoxicity and vestibular dysfxn
insulin resistance
CV risks
catabolic effects with glucocorticoids
a rash at the beginning of using an immunosuppressant can increase the risk of what?
skin cancer
increased risk of skin cancer from a rash from immunosuppressants is especially associated with what type of med?
TNF inhibitors
what is one of the most common early signs of immunosuppressants side effects?
neurotoxicity (weakness, headache, memory issues, etc)
what are the CV risks associated with immunosuppressants?
hyperlipidemia, HTN, hyperglycemia leading to stroke risk
do immunosuppressants or immunostimulants have lower risks associated with them?
immunostimulants
what is immune globulin G (IgG)?
the most common immunostimulant in the body that can be given as an IV injection
what are the indications for IgG use?
immunodeficiency syndromes (HIV)
Kawasaki disease
leukemia
demyelinating polyneuropathies
what is Kawasaki disease?
inflammation of coronary arteries in young children
what are some demyelinating polyneuropathies?
GBS, MS
what are the side effects of IgG?
jt and musc pain
general malaise
GI discomfort
allergic rxn
what is the dif bw RA and OA?
RA is an autoimmune disease
OA is a degenerative disease
when RA is first diagnosed, what is the primary Rx for RA to control inflammation and prevent further boney erosions and helps manage s/s?
pharmacotherapy
which pharmacotherapy is the first line of Rx bc of its anti-inflammatory properties?
NSAIDs
how does acetaminophen treat RA?
symptomatic management bc it doesn’t have anti-inflammatory effects
what are the pharmacotherapy options for RA?
NSAIDs
acetaminophen
corticosteroids
DMARDs
are corticosteroids for RA physiologic or pharmacologic dose?
pharmacologic dose
what are DMARDs (disease modifying anti-rheumatic drugs)?
anti-inflammatory drugs used in RA Rx to slow disease progression
how long does it take for DMARDs to show effects?
weeks to months
bc DMARDs take some time to take affect, what may be given in the meantime to manage pain?
aspirin or NSAIDs
what are traditional DMARDs?
nonbiological
nonspecific
antimalarial drugs
gold compunds
methotrexate
are traditional DMARDs biological or nonbiological?
nonbiological
are nonbiological or biological DMARDs older generation drugs?
nonbiological
what kind of DMARD is antimalarial drugs, gold compounds, and methotrexate?
traditional (nonbiological)
what are biological DMARDs?
newer generation drugs
drugs that target specific mediators in the immune system
TNF inhibitors
IL inhibitors
are traditional or biological DMARDs specific to some mediators in the immune system?
biological DMARDs
what are the biological DMARDs?
T F inhibitors
IL inhibitors
what are some common DMARDs?
Methotrexate (Trexall)
Leflunomide (Arava)
Abatacept (Orencia)
Rituximab (Rituxan)
what is the 1st and most common DMARD a pt would have?
Methotrexate (Trexall)
what is methotrexate (Trexall)?
nonbiological DMARD
immunosuppressant
antimetabolites
antineoplastic
what does antineoplastic mean?
anti-cancer
what is Leflunomide (Arava)?
nonbiological DMARD
immunosuppressant
antirheumatic
antineoplastic
what is Abatacept (Orencia)?
biological DMARD
immunosuppressant
what is Rituximab (Rituxan)?
biological DMARD
monoclonal antibody
what are the neurological disorders that use immunomodulatory drugs and corticosteroids?
MS
neuromyelitis optica (Devic’s disease)
transverse myelitis
myasthenia gravis
what immunomodulators and corticosteroids are used for MS?
disease modifying drugs for initial stage
corticosteroids for acute exacerbations or relapse
what immunomodulators and corticosteroids are used for neuromyelitis optica?
corticosteroids mainly
plasmapheresis
what is plasmapharesis?
exchange of plasma hoping it will get rid of the antibodies the body has produced
t/f: the immunomodulators and corticosteroids for transverse myelitis depend on the subtype
true
what are the immunomodulators and corticosteroids for transverse myelitis?
corticosteroid
plasmapharesis
what are the immunomodulators and corticosteroids used for myasthenia gravis?
immunosuppressants more than corticosteroids
plasmapheresis
are immunosuppressants or corticosteroids more commonly used with myasthenia gravis?
immunosuppressants
what are the side effects of DMARDs?
diarrhea
rash
hepatotoxicity
leukopenia and anemia
inc risk of infection
HTN
what are the most common symptoms of DMARD use?
GI symptoms
hepatotoxicity is indicated by a rise in what?
liver enzymes
t/f: hepatotoxicity is frequently seen with higher doses of DMARDs
true
bc of the increased risk of infection, how long should a pt avoid live vaccines after stopping a biological DMARD?
at least 3 months after stopping
what are the PT implications for DMARD use?
infection control
CV fitness
recognize and manage s/s of peripheral neuropathy (Dec sensation, numbness, tingling) , vestibular dysfxn (dizziness, balance issues) bc they increase fall risk
prevent breakdown of MSK (more related to corticosteroid use)
exercise modification
management of chronic disease and pain
how can we manage chronic disease and pain?
modalities
TENS
massage
manual therapy
low intensity aerobic exercises like swimming, Tai chi, and low stress yoga
what are the pharmacotherapy options for OA?
NSAIDS (selective or non-selective)
acetaminophen for pain management
topical capsaicin for pain management
corticosteroid
disease-modifying OA drugs (DMOADs)
are there more approved DMARDs or DMOADs?
DMARDs
what are the DMOADs?
viscosupplementation (hyaluronic acid chicken shots)
glucosamine
chondroitin sulfate
t/f: DMOADs are more for structural improvements than symptoms management
true
what is hyaluronic acid?
lubricant and shock absorber
where is the largest amount of hyaluronic acid?
in articular cartilage and synovial fluid
what is the mechanism of action of hyaluronic acid?
restoring lubricating properties of synovial fluid
t/f: hyaluronic acid may be antioxidative, anti-inflammatory, analgesic
true
what are some trade names for hyaluronic acid?
Euflexxa, Gel-one, Hyalgon, Hylan G-F20, Monovisc, Orthovisc
what are the side effects of hyaluronic acid?
muscles pain/stiffness
joint pain/swelling/redness
how long does it take for pts to see pain reduction with hyaluronic acid?
a few days
how long do hyaluronic acid shots last?
6-12 months
t/f: hyaluronic acid shots may be 1 or a series of shots
true
t/f: common arthritis treatment may actually accelerate disease progression
true
should we suggest our pts with arthritis use corticosteroid injection? why or why not?
no! bc it has been associated with significant progression of OA up to 2 years post-injection
