Small molecules

Question 1

tofacitinib MOA

Answer 1

JAK inhibitor

Question 2

tofacitinib indication

Answer 2

UC

Question 3

tofacitinib place in therapy

Answer 3

inadequate response or who are intolerant to TNF blockers

Question 4

tofacitinib ADRs

Answer 4

Diarrhea
elevated cholesterol, headache
shingles
increased creatine phosphokinase
nasopharyngitis, rash
URI

Rare: malignancy, serious infection, neutropenia, hypersensitivity

increase mortality in RA pts 50 years and older with at least one CV risk factor

thrombosis

Question 5

tofacitinib monitoring

Answer 5

CXR, PPD
Hep B,C
ANC
CBC
Lipids
LFTs
Infection s/s
Skin exam

Question 6

tofacitinib pearls

Answer 6

Should not be used with immunosuppressants or biologics

Avoid in severe hepatic impairment

Avoid CYP3A4 inhib, and strong CYP3A4 inducer

Use lowest effective dose to maintain response

Question 7

upadacitinib MOA

Answer 7

JAK inhibitor

Question 8

upadacitinib indication

Answer 8

UC, CD

Question 9

upadacitinib place in therapy

Answer 9

Induction and maintenance for pts with inadequate response

Question 10

upadacitinib ADRs

Answer 10

increase mortality in RA pts 50 years and older with at least one CV risk factor

increase risk of serious infections

Upper RTIs, acne, increase creatine phosphokinase, elevated cholesterol, headache, shingles

potentially teratongenic

JAK: class ADRs

Question 11

upadacitinib monitoring

Answer 11

Class monitoring

Question 12

upadacitinib pearls

Answer 12

Should not be used with immunosuppressants or biologics

Dose adjustments required in renal impairment mild-moderate hepatic impairment

Not recommended in ESRD or severe hepatic impairment

Drug interactions with strong CYP3A4 inhib and inducers

Question 13

ozanimod MOA

Answer 13

Selective S1P receptor modulator

Question 14

ozanimod indication

Answer 14

UC

Question 15

ozanimod place in therapy

Answer 15

Mod-severe active UC

Question 16

ozanimod ADRs

Answer 16

Increased risk of infections

Potential PML

Bradycardia

AV conduction delays

Question 17

ozanimod monitoring

Answer 17

CXR, PPD
Hep B, C
CBC
LFTs
Infection
BP
Spirometry
ECG
Optho

Question 18

ozanimod pearls

Answer 18

Should not be used with non-corticosteroid immunosuppressive or immune modulating drugs

Dose titration, if dose is missed must restart regimen

CI in pts who in last 6 months experienced MI, unstable angina, stroke, TIA, decompensated HF requiring hospitalization, Class III, or IV HF

CI in pts with Mobitz type II 2nd or 3rd degree AV block, untreated sleep apnea, taking MAO inhibitor

Question 19

estrasimod MOA

Answer 19

Selective S1P receptor modulator

Question 20

estrasimod indication

Answer 20

UC

Question 21

estrasimod place in therapy

Answer 21

mod-severe active UC

Question 22

estrasimod ADRs

Answer 22

class ADRs

Question 23

estrasimod monitoring

Answer 23

class monitoring