Rheum- RA (Biologics) Flashcards Preview

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Flashcards in Rheum- RA (Biologics) Deck (22)
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1
Q

What are biologic agents?

A

•Genetically engineered protein molecules block the proinflammatory cytokines

2
Q

What are the 4 different groups of biologic agents?

A

TNF-α (Adalimumab, etc)

IL-6 (Tocilizumab, etc)

Deplete B cells (Rituximab)

–Bind to CD80/86 on T cells to prevent activation of T cells (Abatacept)

3
Q

What are the 5 TNF-α biologic agents?

A
  1. Adalimumab
  2. Certolizumab
  3. Etanercept
  4. Golimumab
  5. Infliximab
4
Q

What are the names of the 2 IL-6 biologics?

A
  1. Tocilizumab
  2. Sarilumab
5
Q

What is the mechanism of the TNF-α biologic DMARDS?

A

–Block the proinflammatory cytokins TNF-α

6
Q

What is the 1 contraindication of the TNF-α biologic DMARDs?

(KNOW)

A

CHF

7
Q

The following are the ADEs of which group of biologic DMARDs?

MS-like illness or exacerbate MS

–Increased risk of lymphoproliferative cancer

A

TNF-α Biologics

(limumab, Certolizumab, Entanercept, Golimumab, Infliximab)

8
Q

Which TNF-α Biologic DMARD?

  • Fusion protein
  • Binds to TNF making it biologically inactive
A

Etanercept

9
Q

Which TNF-α biologic DMARD?

  • Chimeric antibody combining portions of mouse and human IgG1
A

Infliximab

10
Q

What should be given concurrently w/ Inliximab?

A

Oral methotrexate

11
Q

What are the 3 uses of Golimumab (TNF-α biologic)

A
  1. RA
  2. Psoriatic arthritis
  3. Ankylosing spondylitis
12
Q

The two IL-6 biologic DMARDS, Tocilizumab and Sarilumab, should be used in monotherapy or in combo with either of what 2 meds?

A

methotrexate or another non-biologic DMARD

13
Q

ADEs of which biologic?

  • Increased infection risk
  • Elevated plasma lipids
  • Elevated liver enzymes
  • Risk of GI perforation
  • Inducer of CYP450 3A4 (warfarin)
A

IL-6: Tocilizumab and Sarilumab

14
Q

Should live vaccines be given during RA treatment with any of the biologics?

A

NO

15
Q

______ should be continued wtih Rituximab

A

Methotrexate

16
Q

Rituximab (B cell biologic) is indicated for what 2 reasons

A

–patients who have failed methotrexate or TNF-α

17
Q

What 3 meds are given prior to Rituximab to reduce reaction?

A
  1. Methylprednisolone
  2. Acetaminophen
  3. Antihistamines
18
Q

ADEs of which med?

  • HA, nasopharyngitis, cough
  • dizziness
  • back pain
  • HTN
  • dyspepsia
  • UTI
  • rash
  • extremity pain
A

Abatacept (T cell biologic)

19
Q

Which 4 vaccines can be given during RA therapy with Biologic DMARDs?

A

Killed vax:

  • Pneumococcal
  • IM influenza
  • Hep B

Recombinant:

  • HPV
20
Q

T/F: Live vaccines can be given to patients already on DMARD therapy, but NOT biologics

A

True

21
Q

For patients > 50y/o who will be starting a biologic or Tofacitinib, ACR recommends giving which vaccine?

A

Herpes Zoster vaccine

22
Q

T/F: After failure of anti-TNF agent, subsequent tx may include trialing an alternative anti-TNF agent or changing to a non-TNF biologic

A

True