Immunotherapeutics Flashcards
what are NSAIDs?
-the initial therapy
-reduce inflammation and pain
what are COX 1 and COX 2?
-increase prostaglandin production
-role in pain, inflammation protection of gastric mucosa, cell proliferation and angiogenesis
-ibuprofen, naproxen and diclofenac
-contraindicated in renal impairment and anti-coagulation
-unnattractive in elderly patients and those with CV risk
what are some examples of COX-2 inhibitors?
etoricoxib
how are steroids used?
as initial therapy
reduce inflammation quickly
but affect multiple signal pathways
what are DMARDs?
-used for longer term management
-reduce inflammation but takes time to work
-often used as a steroid sparing agent due to the litany of steroid side effects with long term use
what is methotrexate?
-csDMARD
-folate antagonist ultimately leading to reduce B and T cell function by inhibiting intracellular actions
-used in numerous AI conditions
-monitoring requirements of FBC/LFTs
what are the side effects of methotrexate?
increased infections
hepatitis
ulcers
rare but pneumonitis
what is Sulfasalazine?
-conventional DMARD
-immunomodulatory, several actions including against folate, T and B cells
-safe in pregnancy
-monitoring requirements (FBC/U&Es/LFTs)
-used in RA and PsA
what are the side effects of sulfasalazine?
GI upset, headache, rash, (step up dosing), increased infection
what is hydroxychloroquine?
-conventional DMARD
-blocks toll like receptors (TLRs) on plasmacytoid dendritic cells thus reducing DC activation
-used in RA, CTD
-monitoring requirements (ocular, retinopathy)
-safe in pregnancy
what are the side effects of hydroxychloroquine?
headache
muscle pain
nausea
rash
how does mycophenolate work?
-inhibits iodine 5’ monophosphate dehydrogenase enzyme that when inhibited leads to inhibition of DNA replication of T and B cells
-used in CTD, post transplant, ILD, vasculitis
what are the side effects of mycophenolate?
increased infections
bone marrow suppression
GI upset
increased malignancy
how does pathogenesis work?
- antibody;antogen complex
- attach to toxins
- attach to receptors
- agglutination (attach and clump)
- act as opsonins
- antibody dependent cell mediated cytoxicity
what are monoclonal antibodies?
a type of antibody that targets a single antigen/protein
-developed in a lab
-there are numerous examples used in autoimmune conditions which essentially hack that persons immune system in a targeted way
how does B cell depletion work?
-rituxumab CD20 receptor inhibitor
-used in a wide variety of auto immune conditions (vasculitis, autoimmune renal disease, RA)
-also used in cancers related to B cells
-associated with risk of infections and infusion reactions
how does T cell inhibition work?
-abatacept -binds to co simulatory moleucles on antigen presenting cells this then blocks their interactions with T cells
-used in RA in trails for other AI conditions
what are the side effects of T cell inhibition?
increased cancer risk
increased infections
GI upset
bone marrow suppression
how do tumour necrosis factor inhibitors work?
-adalimimab, etanercept, infliximab, golimumab
-pro inflammatory
-used for RA, PsA, PsO, IBD
-monitoring requirements of 6 monthly bloods
what are the side effects of TNF inhibitors?
MS activation
increased cancer risk
infections
how do interleukin blockers work?
-type of glycoprotein produced by leukocytes for regulating immune response
-IL17i, IL12/23, IL1, IL6
-secukinumab
-used in psoriasis and psoriatic arthritis
what are the side effects of interleukin blockers?
infections
bone marrow suppression
IBD activation
how do small molecules work?
-janus kinase inhibitors
-pass through cell membrane to reach intracellular targets
-oral not IV
-quicker acting
-monitoring every 6 months
what are the common side effects associated with Immunotherapy?
infections
small increase in malignancy
liver disruption (drug induced hepatitis)
bone marrow supression
injection site reactions
GI upset
what are the side effects of small molecules?
infections
bone marrow supression
emerging increased evidence of blood clots and cardiovascular events
what are the treatment aims for RA?
-pain reduction
-inflammation reduction
-maintain joint function
-prevent progression
how is RA generally treated?
initial - NSAIDs and steroid (intramuscular and oral)
long term
-csDMARDS - methotrexate, sulphasalazine and hydroxychloroquine started
-used in combination to achieve low disease activity
-if still active use of biologics
