Pharmacological Aspects of Immunology: Biological Therapies Flashcards
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
2 - NSAIDs and Glucocorticoids
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
2 - Methylprednisolone, Beclometasone, Prednisolone, Hydrocortisone
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
1 - Methotrexate
- 1st line gold standard core drug for RA
- no contraindications for prescribing this
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
1 - >2 DMARDs and a score >3.2 using the DAS score
Do biologics work better alone or as part of combined therapy with DMARDs?
- generally with DMARDs
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
2 - 2 weeks for 6 week, every month then yearly
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
1 - Adalimumab
- remember a in TNF-a and A in name
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?
- its a protein
- proteins would be degraded in the GIT
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
4 - binds to TNF-a that can then not bind to TNF-a receptors on cells
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
3 - increased risk of infection
- TNF-a is part of the immune system so reducing it increases the risk of infection
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
3 - TB, heart failure, multiple sclerosis
- been shown to damage myocardium
- increases risk of infection so TB
Which biological DMARDs that is a core drug is ant-B cell?
1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - Abatacept
3 - Rituximab
- partially humanised CD20 drug
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
1 - binds to CD20 receptors causing opsonisation of B cell
- undergoes phagocytosis, complement system is activated and Antibody-dependent cell mediated cytotoxicity
Which biological DMARDs that is a core drug is ant-IL-6S?
1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - Abatacept
2 - Tocilizumab
- IL-6 relates to the protein
- S relates to soluble forms of the IL-6 receptor
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
3 - binds directly to soluble and cell based IL-6 receptor ensuring IL-6 cannot bind
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
1 - DMARD and biologic
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
2 - DMARDs suppress bone marrow and induce CD4 and CD8 apoptosis
- ultimately reduces the immunes systems ability to create antibodies
