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Flashcards in 3 - Autoimmune Drugs Deck (35):
1

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

  • Inherited genes (MHC)
  • Environmental trigger

2

What are autoantibodies active against?

Self-antigens and not foreign antigens

3

How do autoantibodies initiate disease?

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

4

What is the treatment of autoimmune disease aimed at?

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

5

When does damage to bone occur in rhematoid arthritis?

During first several years

6

What is the pharmacologic model for autoimmune disease management?

Treatment of RA

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

7

What are the corner stones of treatments for RA?

Aspirin and NSAIDS

8

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

sulfasalazine (Azulfidine)

9

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

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

10

What is celebrex contraindicated in?

  • Aspirin/NSAIDs allergic patients
  • Those allergic to sulfonamides

11

What are DMARDS?

Disease-Modifying Anti-Rheumatic Drugs

12

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

DMARDS

13

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

methotrexate (Rheumatrex, Trexall)

14

What are the 2 indications for use of methotrexate?

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

15

What's the most common adverse effect of methotrexate?

  • Mucosal ulcerations, nausea

16

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

leflunomide (Arava)

17

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

  • IL-1b
  • TNF-alpha

18

What kind of drug is etanercept (Enbrel)?

TNF-alpha blocker

19

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

infliximab (Remicade)

20

What kind of drug is adalimumab (Humira)?

TNF-alpha blocker

21

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

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

22

What are the common preps of antimalarials?

  • chloroquine (Aralen)
  • hydroxychloroquine (Plaquenil)

23

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

Anti-malarials (and gold compounds)

(chloroquine or hydroxychloroquine)

24

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

penicillamine

25

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

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

26

How can you identify the gold compounds?

contain the "aur" in the name

27

What are the main immunosuppressive drugs?

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

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?

azathioprine (Imuran)

29

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

cyclosprine (Sandimmune)

30

What drug is known to cause gingival hyperplasia?

Cyclosporine

31

What are the pathophysiologies of Sjorgren's Syndrome?

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

32

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

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

33

What test measures tear production?

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

34

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

50%

35

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

Immunoglobins