Systemic Immunomodulators

Question 1

Name 3 TNF-Alpha inhibitors

Answer 1

Infliximab, Etanercept, Adalimumab

Question 2

MOA of Apremilast (Otezla)

Answer 2

PDE4 inhibitor which increases cAMP which inhibits TNF-ā, IL17 and IL23

Question 3

MOA of Methotrexate

Answer 3

inhibits DHF Reductase, inhibiting purine synthesis in S phase

Question 4

Which labs need to be monitored in MTX?

Answer 4

CBC, CMP, hep panel, preg test, HIV

Monitor CBC on week 2 and 4

Monitor LFTs in months 1 and 2

Monitor CBC/CMP Q3 months

Question 5

Cyclosporine MOA and side effects?

Answer 5

complex with cyclophilin to inhibit calcineurin and reduce IL2

causes you to BULK UP:

Hyper → bilirubinemia, uricemia, lipidemia, Kalemia

Question 6

Lab monitoring for cyclosporin INITIALLY

Answer 6

CBC, CMP, hep panel, preg test, quant gold, Mg2+, Uric acid, fasting lipids, UA, blood pressure initially

Question 7

Screening labs for cyclosporin

Answer 7

CBC, CMP, lipids, UA, Mg, BP monthly x2 months then q3 months

Question 8

Guselkumab, Tildrakizumab and Risankizumab block ____ of which interleukin?

Answer 8

block the p19 subunit of IL23 ( inhibits TH17)

Question 9

Which TNF alpha inhibitor is approved for kids >4 yo

Answer 9

Etanercept (enbrel)

Question 10

Name 3 IL17 inhibitors

Bonus: which one is different and how

Answer 10

Ixekizumab (TAltz) - Inhibits IL17a

Secukinumab (Cosentyx)- Inhibits IL17a

Brodalumab (Siliq) - inhibits IL17 receptor

Question 11

Which Biologics affect IL23? (4 total)

three of them act the same, one acts different

Answer 11

Ustekinumab (Stelara) → blocks p40 subunit common to IL12 and 23

Guselkumab (Tremfya), Tildrakizumab (Ilumya), Risankizumab (Skyrizi) - inhibit p19 subunit on IL23 only

Question 12

How does Calcipotriene work?

Answer 12

Vit D analog, decreases keratinocyte proliferation via blockage of IL2, IL6, IFN Gamma