Biologics, Mabs, & Gout

Question 1

older, small molecule drugs

Answer 1

DMARDS

Question 2

larger molecular weight drugs of biologic origin with recombinant DNA technology

Answer 2

biologics

Question 3

what are the 4 DMARDS?

Answer 3

methotrexate
leflunomide
hydroxychloroquine
gold salts

Question 4

what must be monitored regularly if a patient is using methotrexate?

Answer 4

liver and kidney

Question 5

in which patients is methotrexate CI in?

Answer 5

pregnant patients

Question 6

what are the uses of methotrexate? (2)

Answer 6

when NSAIDs are ineffective
chemotherapy

Question 7

what are the 6 ADR of methotrexate?

Answer 7

fibrosis/cirrhosis
stomatitis
hepatic dysfunction
immunosuppression
neutropenia
teratogenic

Question 8

how does methotrexate treat RA? (2)

Answer 8

inhibits T and B cells
reduces ICAM

Question 9

an alternative drug to methotrexate in patients who cannot tolerate methotrexate and is also teratogenic

Answer 9

leflunomide

Question 10

an immunosuppressive that inhibits terminal glycosylation of ACE2 (receptor that COVID targets for cell entry)

Answer 10

hydroxychloroquine

Question 11

DMARD that is an immunosuppressive that has an ADR of severe immunosuppression

Answer 11

gold salts

Question 12

drugs that bind tumor necrosis factor (TNF)-alpha (who is produced by synovial macrophages and lymphocytes to mediate tissue damage in cartilage and bones)

Answer 12

biologic DMARDS

Question 13

ADR of biologic DMARDS? (2)

Answer 13

increase risk of infection
reactivate latent TB

Question 14

what are the 5 uses of biologic DMARDS?

Answer 14

RA
psoriasis
psoriatic arthritis
ankylosing spondylitis
crohn’s disease

Question 15

which biologic DMARDS is a fusion protein between the TNF receptor and IgG?

Answer 15

“etanercept between TNF and IgG”

etanercept

Question 16

administration of etanercept?

Answer 16

SQ biweekly

Question 17

monoclonal antibody that is given IV at 1, 2, 6 weeks and then every 8 weeks

Answer 17

indliximab

Question 18

administration of adalimumab?

Answer 18

SQ q 2 weeks

Question 19

administration of certolizimab?

Answer 19

SQ q 2 weeks

Question 20

administration of golimumab?

Answer 20

SQ monthly

Question 21

monoclonal antibody that blocks the IL-6 receptor

Answer 21

tocilizumab

Question 22

ADR of tocilizumab? administration?

Answer 22

increased risk of infection

IV infusion 1/month

Question 23

T-cell costimulatory inhibitor that prevents T cell activation by the antigen-presenting cells = leading to less autoinflammation

Answer 23

abatacept

used for “auto” inflammation

Question 24

ADR of abatacept? administration?

Answer 24

increased risk of infection

IV infusion 1/month

Question 25

T cell receptor inhibitor that binds CD25

Answer 25

basiliximab

Question 26

T cell receptor inhibitor that binds CD3

Answer 26

moromonab

Question 27

an antibody that is engineered to recognize a specific tumor cell and can initiate other immune processes that target the cell for death

Answer 27

naked antibody

Question 28

cargo is added to the antibody to disrupt gene expression but will not distinguish between rapidly dividing tumor cells or rapidly dividing neural cells

Answer 28

conjugated antibodies

Question 29

takes T cells from donor, engineer them invitro against tumor cell and the place them back so they can specifically target the tumor

Answer 29

antibody fusion to modified T cell

Question 30

half of the antibody that is specific to T cell is put with other half that is specific for tumor cell, pull the specific agent toward the T cell to target the specific tumor cell

Answer 30

bridging antibody to recruit cytotoxic T cells

Question 31

IL-1 receptor antagonist, (IL-1 is a proinflammatory cytokine that potentiates inflammation and tissue damage)

Answer 31

anakinra

Question 32

administration of anakinra?

Answer 32

SQ

Question 33

JAK inhibitor that blocks excessive cytokine signaling in autoimmune/inflammatory diseases

Answer 33

tofacitinib

Question 34

ADR of tofacitinib? (2) administration?

Answer 34

neutropenia increased cholesterol oral

Question 35

B cell depletor that binds to antigen found on B cell precursors and mature B cells = blocks B cell differentiation and division, and leads to B cell apoptosis

Answer 35

rituximab

Question 36

what are the 2 uses for rituximab?

Answer 36

RA non-hodgkins lymphoma

Question 37

2 ADR of rituximab?

Answer 37

increased risk of infection reactivation of viral infections

Question 38

how does gout cause arthritis?

Answer 38

urate crystal collection in joints

Question 39

what is gout therapy aimed at? (3)

Answer 39

suppressing leukocyte activation increase renal excretion of urate decrease urate production

Question 40

drug that binds tubulin to prevent polymerization, leading to inhibition of leukocyte migration in gout

Answer 40

colchicine

Question 41

what are the 2 uses for colchicine?

Answer 41

acute attacks prophylaxis of recurrent episodes when uricosuric drug + allopurinol is not effective

Question 42

4 ADR of colchicine?

Answer 42

"a **DAAN** would have gout" **D**iarrhea **A**bdominal pain **A**lopecia **N**eutropenia

Question 43

what can be used instead, to avoid diarrhea in colchicine use?

Answer 43

indomethacin

Question 44

prevent phagocytosis of crystals and transcription of inflammatory genes; initial therapy for gout

Answer 44

NSAIDs

Question 45

increases renal excretion of urate since 75% of urate is reabsorbed in gout; reduces whole body urate levels

Answer 45

uricosuric drugs (probenicid)

Question 46

use for probenicid?

Answer 46

after several acute attacks + plasma urate elevation

Question 47

ADR of probenicid?

Answer 47

increase renal urate crystals

Question 48

what is probenicid usually combined with to make urine alkaline?

Answer 48

acetazolamide

Question 49

inhibits xanthine oxidase (enzyme that forms urate)

Answer 49

allopurinol

Question 50

4 uses for allopurinol?

Answer 50

chronic gout elevated plasma urate recurrent urate stones leukemia/lymphoma

Question 51

what gout drug should be used in a patient with poor renal function?

Answer 51

allopurinol

Question 52

why should we use a combo treatment when using allopurinol for gout?

Answer 52

can cause acute attacks on its own

Question 53

more effective in decreasing plasma urate than allopurinol, so is used in the long-term treatment to reduce gout flares

Answer 53

febuxostat