Biological Response-Modifiers and Antirheumatic Drugs

Question 1

What are biological response modifying drugs (BRMs)

Answer 1

They alter the body’s response to diseases such as cancer and autoimmune, inflammatory, infectious disease

Question 2

What are the 2 classes of BRMs

Answer 2

Hematopoietic drugs
Immunomodulating drugs (IMDs)

Question 3

What are the 4 subclasses of IMDs

Answer 3

Interferons (IFNs)
Monoclonal antibodies (MABs)
Interleukin(IL) receptor agonists and antagonists
Miscellaneous drugs

Question 4

What are immunomodulating drugs

Answer 4

They alter a patients immune response to malignant tumour cells

Question 5

What part of cancer therapy are IMDs

Answer 5

Fourth part

Question 6

What other diseases are IMDs used for

Answer 6

Autoimmune
Inflammatory
Infectious

Question 7

What is the MOA of BRMs

Answer 7

Enhancement of hematopoietic functions
Enhancement or regulation of the host’s immune system defenses against the tumor
Inhibition of metastases, prevention of cell division, or inhibition of cell maturation

Question 8

What are the two components of the immune system and briefly describe them

Answer 8

Humoral immunity (B-cell functions)
Cell-mediated immunity (T-cell functions)

Question 9

Where do B cells originate from

Answer 9

Bone marrow

Question 10

What do B cells do?

Answer 10

They create the antibodies

Question 11

What are Monoclonal antibodies

Answer 11

Identical cells derived from a single cell

Question 12

What are the five major types of naturally occurring immunoglobulins

Answer 12

A, D, E, G, and M

Question 13

Where do T cells originate and mature

Answer 13

Originate from bone marrow but mature in thymus

Question 14

What are the 3 types of T cells

Answer 14

Cytotoxic T cells
T-helper cells
T-suppressor cells

Question 15

What is the ratio of T-helper cells to T-suppressor cells in a healthy immune system

Answer 15

T-helper cells are twice as many as T-suppressor cells

Question 16

Name 2 hematopoietic drugs and what type they are

Answer 16

Darbepoetin alfa is an erythropoietic drugs
Filgrastim is a colony-stimulating factor

Question 17

What is the MOA of hematopoietic drugs

Answer 17

Decreases the duration of chemotherapy-induced anemia, neutropenia, thrombocytopenia
Enable higher doses of chemo to be given
Decrease bone marrow recovery time after bone marrow transplantation or irradiation
Stimulate other cells in the immune system to destroy or inhibit the growth of cancer cells and virus or fungus infected cells

Question 18

What does filgrastim do?

Answer 18

Stimulates precursor cells for granulocytes

Question 19

When is filgrastim administered?

Answer 19

Before the patient develops an infection

Question 20

Which form is filgrastim administered?

Answer 20

SQ injections for 7-14 days

Question 21

T/F: Do not start filgrastim until 18 hrs after chemo is completed

Answer 21

False: Do not start until 24 hours after chemo is completed

Question 22

How is filgastrim stored and what should you do before use?

Answer 22

Refrigerated
Take out minimum 30 minutes before use

Question 23

When should you discontinue

Answer 23

When the absolute neutrophil count (ANC) reaches 1 x 10^9/ L

Question 24

What is Nadir

Answer 24

When blood counts are at their lowest

Question 25

How long does Nadir last

Answer 25

As long as 28 days

Question 26

What are the indications for hematopoietic drugs

Answer 26

Patients who have experienced destruction of bone marrow cells as a result of cytotoxic chemo Decreasing the duration of low neutrophil counts, thus reducing the incidence and duration of infections

Question 27

What are the adverse effects of hematopoietic drugs

Answer 27

Fever Muscle aches Bone pain Flushing

Question 28

What are interferons

Answer 28

Proteins with 3 basic properties Antiviral Antitumor IMD

Question 29

What are the 3 groups of interferon drugs

Answer 29

Alfa Beta Gamma

Question 30

What is the MOA of interferons

Answer 30

Enable cells to produce enzymes that protect human cells from viral attacks Prevent cancer cells from dividing and replicating Increase the activity of other immune system cells (NK, macrophages, etc.)

Question 31

What effects do interferons have on the immune system

Answer 31

Restore immune systems function if it's impaired Augment the immune systems ability to function as the body's defense Inhibit the IS from working (autoimmune disorders)

Question 32

What are the indications of interferons

Answer 32

Viral infections Cancer Autoimmune disorders

Question 33

What are the adverse effects of interferons

Answer 33

Flulike symptoms Anorexia Dizziness Vomiting Diarrhea

Question 34

What is a dose limiting adverse effect of interferons

Answer 34

Fatigue

Question 35

Name 4 interferon drugs and their indications

Answer 35

IFN alfa-2b (Hep B and C, cancer, etc) PegIFN alfa-2a (chronic Hep C) IFN beta-1a (MS) IFN beta -1b (MS)

Question 36

What are the indications for Monoclonal antibodies

Answer 36

Treatment of cancer, rheumatoid arthritis, MS and organ transplantation

Question 37

What is the MOA of MABs

Answer 37

Target cancer cells and have minimal effect on healthy cells

Question 38

What are the contraindications of MABs

Answer 38

Active TB and other infections because of its immunosuppressive qualities

Question 39

MABs are anti TNF properties. What is TNF

Answer 39

Tumor Necrosis Factor is a cytokine involved in systemic inflammation It is produced mainly by activated macrophages

Question 40

What are TNF inhibitors

Answer 40

Drugs that help stop inflammation

Question 41

What are they also known as?

Answer 41

TNF blockers or anti-TNF drugs

Question 42

Name 4 MAB drugs

Answer 42

Adalimumab Infliximab Rituximab Natiluzumab

Question 43

Name an Interleukin(IL) drug

Answer 43

Aldesleukin

Question 44

What is the MOA of interleukins (IL)

Answer 44

It binds to receptors in the T cells, which stimulates the T cells to multiply. Lymphokine-activated killer (LAK) cells LAK cells recognize and destroy only cancer cells

Question 45

What is capillary leak syndrome?

Answer 45

Capillaries lose ability to retain vital colloids. Capillaries become leaky and substances migrate into surrounding tissues

Question 46

What are adverse effects of IL

Answer 46

Fluid retention as a result of capillary leak syndrome Respiratory distress HF MI Dysrhythmias

Question 47

Is capillary leak syndrome reversible?

Answer 47

Yes, after IL therapy is discontinued

Question 48

What are the contraindications of aldesleukin

Answer 48

Organ transplants

Question 49

What does aldesleukin treat?

Answer 49

Metastatic renal cell carcinoma and metastatic melanoma

Question 50

What is the difference between osteoarthritis and RA

Answer 50

RA is autoimmune related Osteoarthritis is not an auto-immune related condition

Question 51

Disease-modifying antirheumatic drugs (DMARDs)

Answer 51

Inhibit the movement of various cells into an inflamed, damaged area, such as a joint

Question 52

Name 2 nonbiological disease-modifying antirheumatic drugs

Answer 52

Methotrexate Leflunomide

Question 53

What is the first line therapy for RA

Answer 53

Methotrexate

Question 54

What are the doses for methotrexate and what is the onset of action?

Answer 54

7.5mg to 20 mg per week It is always per week 3-6 weeks

Question 55

What is taken concurrently with methotrexate to lessen adverse effects

Answer 55

Folic acid supplement

Question 56

Biological Disease-modifying antirheumatic drugs

Answer 56

Adalimumab Etanercept Infliximab Abatacept

Question 57

What is etanercept

Answer 57

Used to treat RA and moderate to severe chronic plaque psoriasis Onset is 1 to 2 weeks Contraindicated in presence of active infections

Question 58

What is abatacept

Answer 58

Used to treat RA Caution if the patient has a history of recurrent infections or COPD May decrease response to dead or live vaccines Patients must be up to date on immunizations before starting therapy

Question 59

Watching for febrile neutropenia; it needs ________________________

Answer 59

urgent treatment and monitoring