Immunomodulatory agents Flashcards
MOA apremilast:
- Phosphodiesterase-4 inhibitor (PDE-4 inhibitor)
- Ricky bobby voice: “if you “4th (PDE-4)” you’re “last (apremilast)”
Name the Janus kinase inhibitors:
- Tofacitinib
- Ruxolitinib
JAK- RT, pronounce “JAKeRT”
Tofacitinib MOA:
- JAK 1 and 3 inhibitor
Ruxolitinib MOA:
- JAK 1 and 2 inhibitor
Azathioprine MOA:
- inhibits purine metabolism and cell division (particularly in fast growing cells like lymphocytes)
What converts azathioprine into inactive metabolites?
- Xanthine oxidase and thiopurine methyltransferase (TPMT)
Most common AE of azathioprine?
- GI upset (nausea, vomiting, diarrhea)
AE’s of azathioprine:
- immunosuppression
- leukopenia, thrombocytopenia
- SCC and lymphoma
Azathioprine is pregnancy category ____
- D
- get pregnancy test before starting any woman of childbearing age
Cyclosporine MOA:
- inhibits calcineurin, which downstream will decrease IL-2 production—> decreased numbers of CD4 and CD8 cells
AE’s of cyclosporine
- nephrotoxicity and HTN are the two most notable AE’s and are dose dependent.
- gingival hyperplasia
- hypertrichosis
Cyclosporine should be _____ adjusted and should not be prescribed for more than ____ amount of time in a row
- renally adjusted at it is nephrotoxic
- maximum of one year of continual treatment
Psoriasis patients on cyclosporine therapy for >2 years have increased risk of _____
- NMSC
Lab/vitals to check prior to cyclosporine administration:
- kidney function (nephrotoxic)
- Blood pressure (can cause HTN)
- uric acid (can cause hyperuricemia/gout)
How often to recheck labs when on cyclosporine?
- every 2 weeks for first 2 months, then once monthly
Methotrexate MOA:
- inhibits dihydrofolate reductase–> decreased purine synthesis—> cell division)
“Antidote” for Methotrexate overdose:
- Leucovorin rescue
______ decreases MTX AE’s
- folic acid supplementation
AE’s of MTX:
- GI upset
- pancytopenia
- stomatitis
- hepatic fibrosis
- photosensitivity
MTX is pregnancy category ____
- X
- MT”X”
Baseline labs for MTX:
- CBC with diff (can cause agranulocytosis/myelosuppresion)
- LFT’s (liver fibrosis)
- BUN/Cr
- viral hepatitis screen
What to do when MTX causes myelosuppresion?
- Leucovorin rescue
Mycophenalate Mofetil MOA:
- inhibits inosine monophosphate dehydrogenase (which leads to decreased purine synthesis)
Mycophenalate mofetil requires____ to get into its active form.
- gastric acidity
most common AE’s of mycophenalate mofetil:
- GI upset (diarrhea, nausea, vomiting, abdominal pain)
Baseline labs for mycophenalate mofetil:
- CBC w/ diff
- BMP
- LFT’s
- hep B, C panel
- TB screen
- pregnancy test
Mycophenalate mofetil is pregnancy category ___
- D
