Therapeutics 1 Flashcards

1
Q

what does DMARDs stand for?

A

disease modifying drugs

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2
Q

DMARDs are the first line treatment for what?

A

autoimmune conditions

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3
Q

what do DMARDs do?

A

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

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4
Q

what 3 pre-treatment checks are required for DMARDs

A

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

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5
Q

these are the names of some DMARDs

which of the following need to be closely monitored?

Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate

A

azathioprine

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6
Q

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

Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate

A

methotrexate

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7
Q

common side effects of DMARDs

A

bone marrow suppression
thrombocytopoenia
neutropenia
leucopenia

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8
Q

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

Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate

A

Hydroxychloroquine

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9
Q

what is a dental consideration of DMARDs due to immunosuppression?

A

increased risk of infection

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10
Q

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

A

mouth ulcers - methotrexate

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11
Q

should DMARDs be routinely be stopped in the perioperative period?

A

no
though individualised decisions for high risk procedures

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12
Q

what is the difference between biologics and DMARDs?

A

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

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13
Q

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

A

proteins
living organisms
bioengineering
IV infusions

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14
Q

how do biologics evade the immune response?

A

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

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15
Q

biologics have specific targets what does this result in?

A

produce a specific response

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16
Q

name the 3 groups of biologics

A

monoclonal antibodies
fusion proteins
cytokines

17
Q

what is a monoclonal antibody?

A

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

18
Q

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

A

Murine
Chimeric
Humanised
Human

19
Q

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 ?

A

mouse
antigen
spleen
antibody
antigen
myeloma
clone
harvested

20
Q

what can monoclonal antibody biologics treat? 2

A

cancer
autoimmune conditions

21
Q

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)

22
Q

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

A

pt who have failed therapy with at least 2 DMARDs

23
Q

what is the first line treatment for severe rheumatoid arthritis

A

monoclonal antibody biologics

24
Q

what do monoclonal antibody drugs end in?

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
26
how are monoclonal antibodies (biologics) monitored?
Full blood count, renal and liver function Lipid profile Screening before commencing treatment -> Hep B/C, HIV, urinalysis and TB
27
what are fusion proteins (biologics)?
ransmembrane proteins that are connected to another molecule
28
what can fusion proteins (biologics) treat?
cancer autoimmune diseases
29
fusion proteins (biologics) mechanism of action to treat cancer Vascular endothelial growth factor inhibitor
30
fusion proteins (biologics) mechanism of action to treat autoimmune diseases Anti-TNF T-cell activation inhibitor
31
name the cytokine that is a biologic?
erythropoietin
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
infection bone marrow suppression neutropenia thrombocytopenia heart cancer liver renal MRONJ
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