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Week 2 - Inflammation and Infection > Immunotherapeutics > Flashcards

Immunotherapeutics Flashcards

1
Q

what are NSAIDs?

A

-the initial therapy
-reduce inflammation and pain

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2
Q

what are COX 1 and COX 2?

A

-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

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3
Q

what are some examples of COX-2 inhibitors?

A

etoricoxib

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4
Q

how are steroids used?

A

as initial therapy
reduce inflammation quickly
but affect multiple signal pathways

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5
Q

what are DMARDs?

A

-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

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6
Q

what is methotrexate?

A

-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

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7
Q

what are the side effects of methotrexate?

A

increased infections
hepatitis
ulcers
rare but pneumonitis

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8
Q

what is Sulfasalazine?

A

-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

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9
Q

what are the side effects of sulfasalazine?

A

GI upset, headache, rash, (step up dosing), increased infection

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10
Q

what is hydroxychloroquine?

A

-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

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11
Q

what are the side effects of hydroxychloroquine?

A

headache
muscle pain
nausea
rash

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12
Q

how does mycophenolate work?

A

-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

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13
Q

what are the side effects of mycophenolate?

A

increased infections
bone marrow suppression
GI upset
increased malignancy

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14
Q

how does pathogenesis work?

A
  1. antibody;antogen complex
  2. attach to toxins
  3. attach to receptors
  4. agglutination (attach and clump)
  5. act as opsonins
  6. antibody dependent cell mediated cytoxicity
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15
Q

what are monoclonal antibodies?

A

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

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16
Q

how does B cell depletion work?

A

-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

17
Q

how does T cell inhibition work?

A

-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

18
Q

what are the side effects of T cell inhibition?

A

increased cancer risk
increased infections
GI upset
bone marrow suppression

19
Q

how do tumour necrosis factor inhibitors work?

A

-adalimimab, etanercept, infliximab, golimumab
-pro inflammatory
-used for RA, PsA, PsO, IBD
-monitoring requirements of 6 monthly bloods

20
Q

what are the side effects of TNF inhibitors?

A

MS activation
increased cancer risk
infections

21
Q

how do interleukin blockers work?

A

-type of glycoprotein produced by leukocytes for regulating immune response
-IL17i, IL12/23, IL1, IL6
-secukinumab
-used in psoriasis and psoriatic arthritis

22
Q

what are the side effects of interleukin blockers?

A

infections
bone marrow suppression
IBD activation

23
Q

how do small molecules work?

A

-janus kinase inhibitors
-pass through cell membrane to reach intracellular targets
-oral not IV
-quicker acting
-monitoring every 6 months

24
Q

what are the common side effects associated with Immunotherapy?

A

infections
small increase in malignancy
liver disruption (drug induced hepatitis)
bone marrow supression
injection site reactions
GI upset

24
Q

what are the side effects of small molecules?

A

infections
bone marrow supression
emerging increased evidence of blood clots and cardiovascular events

25
Q

what are the treatment aims for RA?

A

-pain reduction
-inflammation reduction
-maintain joint function
-prevent progression

26
Q

how is RA generally treated?

A

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

Week 2 - Inflammation and Infection (5 decks)

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