3 - Autoimmune Drugs

Question 1

What are the 2 factors necessary for development of an autoimmune disease?

Answer 1

• Inherited genes (MHC)
• Environmental trigger

Question 2

What are autoantibodies active against?

Answer 2

Self-antigens and not foreign antigens

Question 3

How do autoantibodies initiate disease?

Answer 3

• Alter/inhibit receptor function
  
  • Myasthenia gravis
• Stimulate receptors that would normally be stimulated by a hormone
  
  • Hyperthyroidism

Question 4

What is the treatment of autoimmune disease aimed at?

Answer 4

• **Reducing inflammation (steroids) **
• Antagonists (blockers) to cytokines
• Immunosuppressive drugs used to inhibit T cell responses

Question 5

When does damage to bone occur in rhematoid arthritis?

Answer 5

During first several years

Question 6

What is the pharmacologic model for autoimmune disease management?

Answer 6

Treatment of RA

• Reduce joint inflammation and swelling
• Relieve pain and stiffness
• Encourage normal function

Question 7

What are the corner stones of treatments for RA?

Answer 7

Aspirin and NSAIDS

Question 8

What is used in treatment of RA in patients with inadequate response to aspirin and NSAIDS?

Answer 8

sulfasalazine (Azulfidine)

Question 9

What is the adverse risk for taking celebrex (Celecoxib)?

Answer 9

• Cardiovascular risks
  
  • Monitor BP when used with antihypertensives = decreases effectiveness of BP meds

Question 10

What is celebrex contraindicated in?

Answer 10

• Aspirin/NSAIDs allergic patients
• Those allergic to sulfonamides

Question 11

What are DMARDS?

Answer 11

Disease-Modifying Anti-Rheumatic Drugs

Question 12

What is used for pts that dont respond to COX-2 inhibitors?

Answer 12

DMARDS

Question 13

What is the drug of choice for severe RA or psoriatic arthritis (unresponsive to NSAIDS)?

Answer 13

methotrexate (Rheumatrex, Trexall)

Question 14

What are the 2 indications for use of methotrexate?

Answer 14

1. High dose - chemotherapy
2. Low dose - immune modulator for autoimmune diseases

Question 15

What’s the most common adverse effect of methotrexate?

Answer 15

• Mucosal ulcerations, nausea

Question 16

What immune modulator inhibits pyrimidine synthesis, resulting in anti-proliferative and anti-inflammatory effects?

Answer 16

leflunomide (Arava)

Question 17

What are the pro-inflammatory cytokines involved in the pathogenesis of RA?

Answer 17

• IL-1b
• TNF-alpha

Question 18

What kind of drug is etanercept (Enbrel)?

Answer 18

TNF-alpha blocker

Question 19

What drug is a TNF-alpha blocker that, when used long term is associated with developing antibodies against the drug?

Answer 19

infliximab (Remicade)

Question 20

What kind of drug is adalimumab (Humira)?

Answer 20

TNF-alpha blocker

Question 21

What drug is an interleukin-1 receptor antagonist? And what does it do?

Answer 21

anakinra (Kineret) - slows degradation of cartilage and bone loss

Question 22

What are the common preps of antimalarials?

Answer 22

• chloroquine (Aralen)
• hydroxychloroquine (Plaquenil)

Question 23

Which type of drugs will cause blue-black intraoral pigmentation with severe side effects or toxicity?

Answer 23

Anti-malarials (and gold compounds)

(chloroquine or hydroxychloroquine)

Question 24

Name a chelating agent that slows the progression of bone destruction and RA?

Answer 24

penicillamine

Question 25

What are the problems with gold compounds to treat auto-immune diseases?

Answer 25

* Preps are expensive to buy and administer * High incidence of toxicity - requires intensive monitoring

Question 26

How can you identify the gold compounds?

Answer 26

contain the "aur" in the name

Question 27

What are the main immunosuppressive drugs?

Answer 27

* Used in cases of refractory RA * azathioprine (Imuran) * cyclophosphamide (Cytoxan) * cyclosporine (Sandimmune)

Question 28

What drug is an immunosuppressant that is used in dentistry with prednisone for severe erosive lichen planus, major aphtous stomatitis, erythema mutliforme, and pemphigoid?

Answer 28

azathioprine (Imuran)

Question 29

What immunosuppressant is used primarily to prevent rejection of organ transplants?

Answer 29

cyclosprine (Sandimmune)

Question 30

What drug is known to cause gingival hyperplasia?

Answer 30

Cyclosporine

Question 31

What are the pathophysiologies of Sjorgren's Syndrome?

Answer 31

* Primary - not associated with any other disease * Secondary - associated with other connective tissue diesease (RA, SLE, scleroderma)

Question 32

What are the diagnostic blood tests given to test for Sjorgren's?

Answer 32

* ANA (Anti-nuclear antibody) * RF * SSA (or Ro) and SSB (or La) * ESR (Erythrocyte sedimentation rate) * IGs

Question 33

What test measures tear production?

Answer 33

* Schirmer Test * Rose Bengal and Lissamine Green - for dry spots

Question 34

In a pt with sjogren's, with severe oral and ocular dryness, how much of their glandular cells remain intact?

Answer 34

50%

Question 35

What destroys eye muscles in exopthalmos in Grave's Disease?

Answer 35

Immunoglobins