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DPT 530 > Immunomodulating Agents > Flashcards

Immunomodulating Agents Flashcards

1
Q

what is the general immunosuppressant?

A

glucocorticoid

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2
Q

what are the calcineurin inhibitors?

A

cyclosporine (Neoral, Sandimmune), tacrolimus (Envarsus XR, Protopic)

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3
Q

what are the mTOR inhibitors?

A

everolimus (Zortress, Afinitor), sirolimus (Rapamune)

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4
Q

what are the types of immunosuppressants?

A

1) general immunosuppressant
2) calcineurin
3) mTOR inhibitor
4) TNF-alpha inhibitor
5) interleukin (IL) inhibitor

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5
Q

are vaccines immunosuppressants or immunostimulants?

A

immunostimulants

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6
Q

what are the goals of immunosuppressants?

A

1) limit immune-mediated damage to tissues
2) treat autoimmune diseases
3) prevent rejection of transplanted organs

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7
Q

t/f: there is an increased risk for viral infections (esp upper resp infections) with immunosuppressants

A

true

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8
Q

what are the indications for immunosuppressants?

A

organ transplant

chemotherapy

various autoimmune/autoinflammatory syndromes (RA, ankylosing spondylitis, Crohn’s disease, psoriasis)

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9
Q

what are the TNF-alpha inhibitors?

A

Adalimumab (Humlia), infliximab (Remicode), etanercept (Enbrel)

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10
Q

what are the interleukin inhibitors?

A

Anakinra (Kineret), canakinumab (Ilaris), Rinonacept (Arcalyst)

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11
Q

what are the side effects of immunosuppressants?

A

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

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12
Q

a rash at the beginning of using an immunosuppressant can increase the risk of what?

A

skin cancer

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13
Q

increased risk of skin cancer from a rash from immunosuppressants is especially associated with what type of med?

A

TNF inhibitors

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14
Q

what is one of the most common early signs of immunosuppressants side effects?

A

neurotoxicity (weakness, headache, memory issues, etc)

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15
Q

what are the CV risks associated with immunosuppressants?

A

hyperlipidemia, HTN, hyperglycemia leading to stroke risk

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16
Q

do immunosuppressants or immunostimulants have lower risks associated with them?

A

immunostimulants

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17
Q

what is immune globulin G (IgG)?

A

the most common immunostimulant in the body that can be given as an IV injection

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18
Q

what are the indications for IgG use?

A

immunodeficiency syndromes (HIV)

Kawasaki disease

leukemia

demyelinating polyneuropathies

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19
Q

what is Kawasaki disease?

A

inflammation of coronary arteries in young children

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20
Q

what are some demyelinating polyneuropathies?

A

GBS, MS

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21
Q

what are the side effects of IgG?

A

jt and musc pain

general malaise

GI discomfort

allergic rxn

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22
Q

what is the dif bw RA and OA?

A

RA is an autoimmune disease
OA is a degenerative disease

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23
Q

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?

A

pharmacotherapy

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24
Q

which pharmacotherapy is the first line of Rx bc of its anti-inflammatory properties?

A

NSAIDs

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25
Q

how does acetaminophen treat RA?

A

symptomatic management bc it doesn’t have anti-inflammatory effects

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26
Q

what are the pharmacotherapy options for RA?

A

NSAIDs

acetaminophen

corticosteroids

DMARDs

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27
Q

are corticosteroids for RA physiologic or pharmacologic dose?

A

pharmacologic dose

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28
Q

what are DMARDs (disease modifying anti-rheumatic drugs)?

A

anti-inflammatory drugs used in RA Rx to slow disease progression

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29
Q

how long does it take for DMARDs to show effects?

A

weeks to months

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30
Q

bc DMARDs take some time to take affect, what may be given in the meantime to manage pain?

A

aspirin or NSAIDs

31
Q

what are traditional DMARDs?

A

nonbiological

nonspecific

antimalarial drugs

gold compunds

methotrexate

32
Q

are traditional DMARDs biological or nonbiological?

A

nonbiological

33
Q

are nonbiological or biological DMARDs older generation drugs?

A

nonbiological

34
Q

what kind of DMARD is antimalarial drugs, gold compounds, and methotrexate?

A

traditional (nonbiological)

35
Q

what are biological DMARDs?

A

newer generation drugs

drugs that target specific mediators in the immune system

TNF inhibitors

IL inhibitors

36
Q

are traditional or biological DMARDs specific to some mediators in the immune system?

A

biological DMARDs

37
Q

what are the biological DMARDs?

A

T F inhibitors

IL inhibitors

38
Q

what are some common DMARDs?

A

Methotrexate (Trexall)

Leflunomide (Arava)

Abatacept (Orencia)

Rituximab (Rituxan)

39
Q

what is the 1st and most common DMARD a pt would have?

A

Methotrexate (Trexall)

40
Q

what is methotrexate (Trexall)?

A

nonbiological DMARD

immunosuppressant

antimetabolites

antineoplastic

41
Q

what does antineoplastic mean?

A

anti-cancer

42
Q

what is Leflunomide (Arava)?

A

nonbiological DMARD

immunosuppressant

antirheumatic

antineoplastic

43
Q

what is Abatacept (Orencia)?

A

biological DMARD

immunosuppressant

44
Q

what is Rituximab (Rituxan)?

A

biological DMARD

monoclonal antibody

45
Q

what are the neurological disorders that use immunomodulatory drugs and corticosteroids?

A

MS

neuromyelitis optica (Devic’s disease)

transverse myelitis

myasthenia gravis

46
Q

what immunomodulators and corticosteroids are used for MS?

A

disease modifying drugs for initial stage

corticosteroids for acute exacerbations or relapse

47
Q

what immunomodulators and corticosteroids are used for neuromyelitis optica?

A

corticosteroids mainly

plasmapheresis

48
Q

what is plasmapharesis?

A

exchange of plasma hoping it will get rid of the antibodies the body has produced

49
Q

t/f: the immunomodulators and corticosteroids for transverse myelitis depend on the subtype

A

true

50
Q

what are the immunomodulators and corticosteroids for transverse myelitis?

A

corticosteroid

plasmapharesis

51
Q

what are the immunomodulators and corticosteroids used for myasthenia gravis?

A

immunosuppressants more than corticosteroids

plasmapheresis

52
Q

are immunosuppressants or corticosteroids more commonly used with myasthenia gravis?

A

immunosuppressants

53
Q

what are the side effects of DMARDs?

A

diarrhea

rash

hepatotoxicity

leukopenia and anemia

inc risk of infection

HTN

54
Q

what are the most common symptoms of DMARD use?

A

GI symptoms

55
Q

hepatotoxicity is indicated by a rise in what?

A

liver enzymes

56
Q

t/f: hepatotoxicity is frequently seen with higher doses of DMARDs

A

true

57
Q

bc of the increased risk of infection, how long should a pt avoid live vaccines after stopping a biological DMARD?

A

at least 3 months after stopping

58
Q

what are the PT implications for DMARD use?

A

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

59
Q

how can we manage chronic disease and pain?

A

modalities

TENS

massage

manual therapy

low intensity aerobic exercises like swimming, Tai chi, and low stress yoga

60
Q

what are the pharmacotherapy options for OA?

A

NSAIDS (selective or non-selective)

acetaminophen for pain management

topical capsaicin for pain management

corticosteroid

disease-modifying OA drugs (DMOADs)

61
Q

are there more approved DMARDs or DMOADs?

A

DMARDs

62
Q

what are the DMOADs?

A

viscosupplementation (hyaluronic acid chicken shots)

glucosamine

chondroitin sulfate

63
Q

t/f: DMOADs are more for structural improvements than symptoms management

A

true

64
Q

what is hyaluronic acid?

A

lubricant and shock absorber

65
Q

where is the largest amount of hyaluronic acid?

A

in articular cartilage and synovial fluid

66
Q

what is the mechanism of action of hyaluronic acid?

A

restoring lubricating properties of synovial fluid

67
Q

t/f: hyaluronic acid may be antioxidative, anti-inflammatory, analgesic

A

true

68
Q

what are some trade names for hyaluronic acid?

A

Euflexxa, Gel-one, Hyalgon, Hylan G-F20, Monovisc, Orthovisc

69
Q

what are the side effects of hyaluronic acid?

A

muscles pain/stiffness

joint pain/swelling/redness

70
Q

how long does it take for pts to see pain reduction with hyaluronic acid?

A

a few days

71
Q

how long do hyaluronic acid shots last?

A

6-12 months

72
Q

t/f: hyaluronic acid shots may be 1 or a series of shots

A

true

73
Q

t/f: common arthritis treatment may actually accelerate disease progression

A

true

74
Q

should we suggest our pts with arthritis use corticosteroid injection? why or why not?

A

no! bc it has been associated with significant progression of OA up to 2 years post-injection

DPT 530 (14 decks)

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