Rheum- RA (Biologics) Flashcards Preview

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

What are biologic agents?

•Genetically engineered protein molecules block the proinflammatory cytokines

2

What are the 4 different groups of biologic agents?

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

What are the 5 TNF-α biologic agents?

1. Adalimumab

2. Certolizumab

3. Etanercept

4. Golimumab

5. Infliximab

4

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

1.Tocilizumab

2. Sarilumab

5

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

–Block the proinflammatory cytokins TNF-α

6

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

(KNOW)

CHF

 

7

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

MS-like illness or exacerbate MS

–Increased risk of lymphoproliferative cancer

TNF-α Biologics

(limumab, Certolizumab, Entanercept, Golimumab, Infliximab)

8

Which TNF-α Biologic DMARD?

  • Fusion protein
  • Binds to TNF making it biologically inactive

Etanercept

9

Which TNF-α biologic DMARD?

  • Chimeric antibody combining portions of mouse and human IgG1

Infliximab

10

What should be given concurrently w/ Inliximab?

Oral methotrexate

11

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

1. RA

2. Psoriatic arthritis

3. Ankylosing spondylitis

12

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

methotrexate or another non-biologic DMARD

13

ADEs of which biologic?

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

IL-6: Tocilizumab and Sarilumab

14

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

NO

15

______ should be continued wtih Rituximab

Methotrexate

16

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

–patients who have failed methotrexate or TNF-α

17

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

1. Methylprednisolone

2. Acetaminophen

3. Antihistamines

18

ADEs of which med?

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

Abatacept (T cell biologic)

19

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

Killed vax:

  • Pneumococcal
  • IM influenza
  • Hep B

Recombinant:

  • HPV

20

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

True

21

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

Herpes Zoster vaccine 

22

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

True