Therapeutics 1 Flashcards
what does DMARDs stand for?
disease modifying drugs
DMARDs are the first line treatment for what?
autoimmune conditions
what do DMARDs do?
suppress the immune system allowing them to slow or stop disease progression and treat the autoimmune disease not just the symptoms
what 3 pre-treatment checks are required for DMARDs
baseline blood investigations
viral infection screening
chest x-ray - TB
these are the names of some DMARDs
which of the following need to be closely monitored?
Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate
azathioprine
which of the following DMARD needs to be checked its taken properly as its taken once per week?
Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate
methotrexate
common side effects of DMARDs
bone marrow suppression
thrombocytopoenia
neutropenia
leucopenia
which of the following DMARD requires baseline and annual ophthalmological examination due to risk of retinopathy?
Hydroxychloroquine
Methotrexate
Azathioprine
Mycophenolate
Hydroxychloroquine
what is a dental consideration of DMARDs due to immunosuppression?
increased risk of infection
what dental side effects are there from DMARDs, name the specific drug also?
mouth ulcers - methotrexate
should DMARDs be routinely be stopped in the perioperative period?
no
though individualised decisions for high risk procedures
what is the difference between biologics and DMARDs?
biologics target one part of the immune system which is in contrast to suppressing the entire immune system like conventional DMARDS
DMARDs are ? produced by ?? or ? -> need to be administered as ??
proteins
living organisms
bioengineering
IV infusions
how do biologics evade the immune response?
Don’t carry antigenic segments that might elicit our immune response
biologics have specific targets what does this result in?
produce a specific response
name the 3 groups of biologics
monoclonal antibodies
fusion proteins
cytokines
what is a monoclonal antibody?
○ Antibodies that target a specific antigen, once this antibody is made many copies of it are made
what are the 4 main categories of monoclonal antibodies (biologics) based on whether mouse derived, part mouse / part human, human derived
Murine
Chimeric
Humanised
Human
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 ?
mouse
antigen
spleen
antibody
antigen
myeloma
clone
harvested
what can monoclonal antibody biologics treat? 2
cancer
autoimmune conditions
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)
when is monoclonal antibody (biologics) used to treat autoimmune diseases?
pt who have failed therapy with at least 2 DMARDs
what is the first line treatment for severe rheumatoid arthritis
monoclonal antibody biologics
what do monoclonal antibody drugs end in?
mab
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
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
what are fusion proteins (biologics)?
ransmembrane proteins that are connected to another molecule
what can fusion proteins (biologics) treat?
cancer
autoimmune diseases
fusion proteins (biologics) mechanism of action to treat cancer
Vascular endothelial growth factor inhibitor
fusion proteins (biologics) mechanism of action to treat autoimmune diseases
Anti-TNF
T-cell activation inhibitor
name the cytokine that is a biologic?
erythropoietin
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
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
