Immunomodulatory agents

Question 1

MOA apremilast:

Answer 1

• Phosphodiesterase-4 inhibitor (PDE-4 inhibitor)

- Ricky bobby voice: “if you “4th (PDE-4)” you’re “last (apremilast)”

Question 2

Name the Janus kinase inhibitors:

Answer 2

• Tofacitinib
• Ruxolitinib

JAK- RT, pronounce “JAKeRT”

Question 3

Tofacitinib MOA:

Answer 3

• JAK 1 and 3 inhibitor

Question 4

Ruxolitinib MOA:

Answer 4

• JAK 1 and 2 inhibitor

Question 5

Azathioprine MOA:

Answer 5

• inhibits purine metabolism and cell division (particularly in fast growing cells like lymphocytes)

Question 6

What converts azathioprine into inactive metabolites?

Answer 6

• Xanthine oxidase and thiopurine methyltransferase (TPMT)

Question 7

Most common AE of azathioprine?

Answer 7

• GI upset (nausea, vomiting, diarrhea)

Question 8

AE’s of azathioprine:

Answer 8

• immunosuppression
• leukopenia, thrombocytopenia
• SCC and lymphoma

Question 9

Azathioprine is pregnancy category ____

Answer 9

• D

- get pregnancy test before starting any woman of childbearing age

Question 10

Cyclosporine MOA:

Answer 10

• inhibits calcineurin, which downstream will decrease IL-2 production—> decreased numbers of CD4 and CD8 cells

Question 11

AE’s of cyclosporine

Answer 11

• nephrotoxicity and HTN are the two most notable AE’s and are dose dependent.
• gingival hyperplasia
• hypertrichosis

Question 12

Cyclosporine should be _____ adjusted and should not be prescribed for more than ____ amount of time in a row

Answer 12

• renally adjusted at it is nephrotoxic

- maximum of one year of continual treatment

Question 13

Psoriasis patients on cyclosporine therapy for >2 years have increased risk of _____

Answer 13

• NMSC

Question 14

Lab/vitals to check prior to cyclosporine administration:

Answer 14

• kidney function (nephrotoxic)
• Blood pressure (can cause HTN)
• uric acid (can cause hyperuricemia/gout)

Question 15

How often to recheck labs when on cyclosporine?

Answer 15

• every 2 weeks for first 2 months, then once monthly

Question 16

Methotrexate MOA:

Answer 16

• inhibits dihydrofolate reductase–> decreased purine synthesis—> cell division)

Question 17

“Antidote” for Methotrexate overdose:

Answer 17

• Leucovorin rescue

Question 18

______ decreases MTX AE’s

Answer 18

• folic acid supplementation

Question 19

AE’s of MTX:

Answer 19

• GI upset
• pancytopenia
• stomatitis
• hepatic fibrosis
• photosensitivity

Question 20

MTX is pregnancy category ____

Answer 20

• X

- MT”X”

Question 21

Baseline labs for MTX:

Answer 21

• CBC with diff (can cause agranulocytosis/myelosuppresion)
• LFT’s (liver fibrosis)
• BUN/Cr
• viral hepatitis screen

Question 22

What to do when MTX causes myelosuppresion?

Answer 22

• Leucovorin rescue

Question 23

Mycophenalate Mofetil MOA:

Answer 23

• inhibits inosine monophosphate dehydrogenase (which leads to decreased purine synthesis)

Question 24

Mycophenalate mofetil requires____ to get into its active form.

Answer 24

• gastric acidity

Question 25

most common AE’s of mycophenalate mofetil:

Answer 25

• GI upset (diarrhea, nausea, vomiting, abdominal pain)

Question 26

Baseline labs for mycophenalate mofetil:

Answer 26

• CBC w/ diff
• BMP
• LFT’s
• hep B, C panel
• TB screen
• pregnancy test

Question 27

Mycophenalate mofetil is pregnancy category ___

Answer 27

• D