Immunotherapeutics Flashcards
(27 cards)
what are NSAIDs?
-the initial therapy
-reduce inflammation and pain
what are COX 1 and COX 2?
-increase prostaglandin production
-role in pain, inflammation protection of gastric mucosa, cell proliferation and angiogenesis
-ibuprofen, naproxen and diclofenac
-contraindicated in renal impairment and anti-coagulation
-unnattractive in elderly patients and those with CV risk
what are some examples of COX-2 inhibitors?
etoricoxib
how are steroids used?
as initial therapy
reduce inflammation quickly
but affect multiple signal pathways
what are DMARDs?
-used for longer term management
-reduce inflammation but takes time to work
-often used as a steroid sparing agent due to the litany of steroid side effects with long term use
what is methotrexate?
-csDMARD
-folate antagonist ultimately leading to reduce B and T cell function by inhibiting intracellular actions
-used in numerous AI conditions
-monitoring requirements of FBC/LFTs
what are the side effects of methotrexate?
increased infections
hepatitis
ulcers
rare but pneumonitis
what is Sulfasalazine?
-conventional DMARD
-immunomodulatory, several actions including against folate, T and B cells
-safe in pregnancy
-monitoring requirements (FBC/U&Es/LFTs)
-used in RA and PsA
what are the side effects of sulfasalazine?
GI upset, headache, rash, (step up dosing), increased infection
what is hydroxychloroquine?
-conventional DMARD
-blocks toll like receptors (TLRs) on plasmacytoid dendritic cells thus reducing DC activation
-used in RA, CTD
-monitoring requirements (ocular, retinopathy)
-safe in pregnancy
what are the side effects of hydroxychloroquine?
headache
muscle pain
nausea
rash
how does mycophenolate work?
-inhibits iodine 5’ monophosphate dehydrogenase enzyme that when inhibited leads to inhibition of DNA replication of T and B cells
-used in CTD, post transplant, ILD, vasculitis
what are the side effects of mycophenolate?
increased infections
bone marrow suppression
GI upset
increased malignancy
how does pathogenesis work?
- antibody;antogen complex
- attach to toxins
- attach to receptors
- agglutination (attach and clump)
- act as opsonins
- antibody dependent cell mediated cytoxicity
what are monoclonal antibodies?
a type of antibody that targets a single antigen/protein
-developed in a lab
-there are numerous examples used in autoimmune conditions which essentially hack that persons immune system in a targeted way
how does B cell depletion work?
-rituxumab CD20 receptor inhibitor
-used in a wide variety of auto immune conditions (vasculitis, autoimmune renal disease, RA)
-also used in cancers related to B cells
-associated with risk of infections and infusion reactions
how does T cell inhibition work?
-abatacept -binds to co simulatory moleucles on antigen presenting cells this then blocks their interactions with T cells
-used in RA in trails for other AI conditions
what are the side effects of T cell inhibition?
increased cancer risk
increased infections
GI upset
bone marrow suppression
how do tumour necrosis factor inhibitors work?
-adalimimab, etanercept, infliximab, golimumab
-pro inflammatory
-used for RA, PsA, PsO, IBD
-monitoring requirements of 6 monthly bloods
what are the side effects of TNF inhibitors?
MS activation
increased cancer risk
infections
how do interleukin blockers work?
-type of glycoprotein produced by leukocytes for regulating immune response
-IL17i, IL12/23, IL1, IL6
-secukinumab
-used in psoriasis and psoriatic arthritis
what are the side effects of interleukin blockers?
infections
bone marrow suppression
IBD activation
how do small molecules work?
-janus kinase inhibitors
-pass through cell membrane to reach intracellular targets
-oral not IV
-quicker acting
-monitoring every 6 months
what are the common side effects associated with Immunotherapy?
infections
small increase in malignancy
liver disruption (drug induced hepatitis)
bone marrow supression
injection site reactions
GI upset
