Therapeutics 1

Question 1

what does DMARDs stand for?

Answer 1

disease modifying drugs

Question 2

DMARDs are the first line treatment for what?

Answer 2

autoimmune conditions

Question 3

what do DMARDs do?

Answer 3

suppress the immune system allowing them to slow or stop disease progression and treat the autoimmune disease not just the symptoms

Question 4

what 3 pre-treatment checks are required for DMARDs

Answer 4

baseline blood investigations
viral infection screening
chest x-ray - TB

Question 5

these are the names of some DMARDs

which of the following need to be closely monitored?

Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate

Answer 5

azathioprine

Question 6

which of the following DMARD needs to be checked its taken properly as its taken once per week?

Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate

Answer 6

methotrexate

Question 7

common side effects of DMARDs

Answer 7

bone marrow suppression
thrombocytopoenia
neutropenia
leucopenia

Question 8

which of the following DMARD requires baseline and annual ophthalmological examination due to risk of retinopathy?

Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate

Answer 8

Hydroxychloroquine

Question 9

what is a dental consideration of DMARDs due to immunosuppression?

Answer 9

increased risk of infection

Question 10

what dental side effects are there from DMARDs, name the specific drug also?

Answer 10

mouth ulcers - methotrexate

Question 11

should DMARDs be routinely be stopped in the perioperative period?

Answer 11

no
though individualised decisions for high risk procedures

Question 12

what is the difference between biologics and DMARDs?

Answer 12

biologics target one part of the immune system which is in contrast to suppressing the entire immune system like conventional DMARDS

Question 13

DMARDs are ? produced by ?? or ? -> need to be administered as ??

Answer 13

proteins
living organisms
bioengineering
IV infusions

Question 14

how do biologics evade the immune response?

Answer 14

Don’t carry antigenic segments that might elicit our immune response

Question 15

biologics have specific targets what does this result in?

Answer 15

produce a specific response

Question 16

name the 3 groups of biologics

Answer 16

monoclonal antibodies
fusion proteins
cytokines

Question 17

what is a monoclonal antibody?

Answer 17

○ Antibodies that target a specific antigen, once this antibody is made many copies of it are made

Question 18

what are the 4 main categories of monoclonal antibodies (biologics) based on whether mouse derived, part mouse / part human, human derived

Answer 18

Murine
Chimeric
Humanised
Human

Question 19

Most monoclonal antibodies are produced by injecting a ? with an ?, extracting ? cells that are producing ? to the ? and infusing these with ? cell lines, producing a ? of antibody producing cells that produce the antibody that can then be ?

Answer 19

mouse
antigen
spleen
antibody
antigen
myeloma
clone
harvested

Question 20

what can monoclonal antibody biologics treat? 2

Answer 20

cancer
autoimmune conditions

Question 21

monoclonal antibodies mechanism of action to treat cancer

Anti-programmed death Ligand 1 (PDL-1)

Programmed death receptor 1 (PD-1) blocking antibody
- Upregulates immune system to attack cancer cells
- Pembrolizumab treats head and neck squamous cell carcinoma

Anti-B lymphocytes

Anti-epidermal growth factor receptor
- Cetuximab - head and neck squamous cell carcinoma

Vascular endothelial growth factor inhibitor - inhibit tumour growth

Anti-RANKL
- Denosumab - antiresorptive drug prevents skeletal related events in patients with bone metastases

Anti-CTLA-4 (activated T cells)

Question 22

when is monoclonal antibody (biologics) used to treat autoimmune diseases?

Answer 22

pt who have failed therapy with at least 2 DMARDs

Question 23

what is the first line treatment for severe rheumatoid arthritis

Answer 23

monoclonal antibody biologics

Question 24

what do monoclonal antibody drugs end in?

Answer 24

mab

Question 25

monoclonal antibodies mechanism of action to treat autoimmune disease

TNF alpha inhibitors

IL-6 receptor blockers

Interleukin inhibitors

B cells activation inhibitors

Anti-B lymphocyte

Question 26

how are monoclonal antibodies (biologics) monitored?

Answer 26

Full blood count, renal and liver function

Lipid profile

Screening before commencing treatment -> Hep B/C, HIV, urinalysis and TB

Question 27

what are fusion proteins (biologics)?

Answer 27

ransmembrane proteins that are connected to another molecule

Question 28

what can fusion proteins (biologics) treat?

Answer 28

cancer
autoimmune diseases

Question 29

fusion proteins (biologics) mechanism of action to treat cancer

Vascular endothelial growth factor inhibitor

Question 30

fusion proteins (biologics) mechanism of action to treat autoimmune diseases

Anti-TNF
T-cell activation inhibitor

Question 31

name the cytokine that is a biologic?

Answer 31

erythropoietin

Question 32

dental considerations of biologics

Increased risk of ?

Look out for latent/atypical dental infections

Can cause ??? leading to ? (increased risk of infection) and ? (increased risk of bleeding)

Side effects
○? failure
○ Increased ? risk

Pt need to be dentally fit before commencement

Consider ? and ? function when prescribing

? - RANKL inhibitors (denosumab) and anti-angiogenic drugs -> SDCEP guidance

Mucosal disease as a side effect

Answer 32

infection

bone marrow suppression
neutropenia
thrombocytopenia

heart
cancer

liver
renal

MRONJ

Question 33

Pre-operative dental considerations

Discuss dental treatment with prescriber

Discuss the benefit of preventing post-op infections by stopping the drug and risk of peri-operative flare in disease activity

Planning surgery for when at least one dosing interval has elapsed for that specific drug

Drug can be recommenced when there is good wound healing and no evidence of infection