Pharmacological Aspects of Immunology: Biological Therapies

Question 1

In a patient who is having a flare up and requires symptom relief from RA requires a bridging therapy in RA, what are the 2 groups of drugs patients can be prescribed?

1 - NSAIDs and biologicals (anti-TNF-a)
2 - NSAIDs and Glucocorticoids
3 - NSAIDs and DMARDs
4 - Glucocorticoids and DMARDs

Answer 1

2 - NSAIDs and Glucocorticoids

Question 2

In a patient who is having a flare up and requires symptom relief from RA requires a bridging therapy in RA, they can be prescribed NSAIDs and Glucocorticoids. What are the 4 core glucocorticoids that we need to be aware of?

1 - Cortisone, Beclometasone, Prednisolone, Hydrocortisone
2 - Methylprednisolone, Beclometasone, Prednisolone, Hydrocortisone
3 - Methylprednisolone, Cortisone, Prednisolone, Hydrocortisone
4 - Methylprednisolone, dexamethasone, Prednisolone, Hydrocortisone

Answer 2

2 - Methylprednisolone, Beclometasone, Prednisolone, Hydrocortisone

Question 3

What is the core antimetabolite drug that we need to be aware of that is a disease modifying anti-rheumatic drug (DMARD)

1 - Methotrexate
2 - Adalimumab
3 - Tocilizumab
4 - Rituximab

Answer 3

1 - Methotrexate

• 1st line gold standard core drug for RA
• no contraindications for prescribing this

Question 4

Before a patient can be prescribed a biologic they need to me one of 2 criteria. What are these 2 criteria?

1 - >2 DMARDs and a score >3.2 using the DAS score
2 - immediately when diagnosis with RA and a score >3.2 using the DAS score
3 - >4 DMARDs and a score >3.2 using the DAS score
4 - >2 DMARDs and a score >5 using the DAS score

DAS = disease activity score

Answer 4

1 - >2 DMARDs and a score >3.2 using the DAS score

Question 5

Do biologics work better alone or as part of combined therapy with DMARDs?

Answer 5

• generally with DMARDs

Question 6

DMARDs can lead to bone marrow suppression, which is why folic acid is encouraged to be taken as a supplement alongside this drug. How often should a patients blood samples be tested when they are 1st started on the medication?

1 - weekly, monthly, yearly
2 - 2 weeks for 6 week, every month then yearly
3 - every week
4 - every week for 12 week, then yearly

Answer 6

2 - 2 weeks for 6 week, every month then yearly

Question 7

Biologic drugs use that use human DNA that help them target specific cytokines, rather than all cytokines. There are 3 core biologics that we need to be aware of. Which of the drugs below is a anti-TNF-a medication?

1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - Methotrexate

Answer 7

1 - Adalimumab

- remember a in TNF-a and A in name

Question 8

Biologic drugs use that use human DNA that help them target specific cytokines, rather than all cytokines. Why do these drugs need to be given intravenously or intramuscularly?

Answer 8

• its a protein

- proteins would be degraded in the GIT

Question 9

Biologic drugs use that use human DNA that help them target specific cytokines, rather than all cytokines. There are 3 core biologics that we need to be aware of. Adalimumab is an anti-TNF-a medication. What is the mechanism of action of this drug?

1 - binds to soluble receptors for anti-TNF-a
2 - binds directly to TNF-a receptors on cells
3 - binds directly to TNF-a and inhibiting the cytokine
4 - binds to TNF-a that can then not bind to TNF-a receptors on cells

Answer 9

4 - binds to TNF-a that can then not bind to TNF-a receptors on cells

Question 10

Adalimumab is a biological DMARDs that binds and inhibits TNF-a. What is the key side effect from this drug?

1 - increased risk of cardiovascular event
2 - increased risk of renal disease
3 - increased risk of infection
4 - increased risk of cancer

Answer 10

3 - increased risk of infection

- TNF-a is part of the immune system so reducing it increases the risk of infection

Question 11

Adalimumab is a biological DMARDs that binds and inhibits TNF-a. Prior to administering Adalimumab, what 3 conditions should patients be screened for as this drug can accentuate these conditions?

1 - TB, heart failure, T1DM
2 - TB, heart failure, CKD
3 - TB, heart failure, multiple sclerosis
4 - CKD, heart failure, multiple sclerosis

Answer 11

3 - TB, heart failure, multiple sclerosis

• been shown to damage myocardium
• increases risk of infection so TB

Question 12

Which biological DMARDs that is a core drug is ant-B cell?

1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - Abatacept

Answer 12

3 - Rituximab

- partially humanised CD20 drug

Question 13

Rituximab, a partially humanised CD20 drug is the biological DMARDs that is ant-B cell. CD20 is important for B cell maturation and development. What is the mechanism of action of this drug?

1 - binds to CD20 receptors causing opsonisation of B cell
2 - binds to CD20 receptors and induces apoptosis of B cell
3 - binds to CD20 receptors and inhibits B cell activity
4 - binds to CD20 receptors and stops antigen B cell activation

Answer 13

1 - binds to CD20 receptors causing opsonisation of B cell

- undergoes phagocytosis, complement system is activated and Antibody-dependent cell mediated cytotoxicity

Question 14

Which biological DMARDs that is a core drug is ant-IL-6S?

1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - Abatacept

Answer 14

2 - Tocilizumab

• IL-6 relates to the protein
• S relates to soluble forms of the IL-6 receptor

Question 15

Tocilizumab is a humanised IL-6S receptor biological DMARDs that is able to inhibit IL-6. What is the mechanism of action of this drug?

1 - binds directly to IL-6 and induces proteolysis
2 - binds directly to IL-6 and inhibits its activity
3 - binds directly to soluble and cell based IL-6 receptor ensuring IL-6 cannot bind
4 - binds directly to IL-6 receptors on cells and inhibits its activity

Answer 15

3 - binds directly to soluble and cell based IL-6 receptor ensuring IL-6 cannot bind

Question 16

Combination therapy is when 2 or more drugs are combined with the same aim. In regards to immunotherapy combination therapy, what are the 2 drugs are generally combined?

1 - DMARD and biologic
2 - 2 biologics
3 - DMARDs and glucocorticoid
4 - glucocorticoid and biologic

Answer 16

1 - DMARD and biologic

Question 17

Over a long period if a patient is only taking a biological drug for immunosuppression, such as Adalimumab, Tocilizumab and Rituximab, the body may start producing antibodies against these drugs. Why is taking the biologic alongside DMARDs as part of combination therapy a good thing for the biologics?

1 - DMARDs inhibit complement pathway
2 - DMARDs suppress bone marrow and induce CD4 and CD8 apoptosis
3 - DMARDs inhibit B cells directly so no antibodies
4 - DMARDs reduce anti-inflammatory cytokines

Answer 17

2 - DMARDs suppress bone marrow and induce CD4 and CD8 apoptosis
- ultimately reduces the immunes systems ability to create antibodies