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22 Cards in this Set
- Front
- Back
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Name the 3 TNF alpha inhibitors (generic and brand name)
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AEI
Eternercep (enbrel) Adalimumab (humira) Infliximab (remicade) |
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what pregnancy category are the biologics?
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preg category B
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are there any drug interactions with the biologics?
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No
No concurrent use with anakinra (IL-1 antagonist) |
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what are absolute and relative contraindications?
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absolute
-hypersensitivity -concurrent use with anakinra (IL1 R antagonist) -active infx (esp HBV) -chronic or local infx relative -famhx of demyelinating dz (MS) -CHF (decr dose) |
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When should live vaccinations be given with biologics?
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Ideally before starting
-make sure they have: flu shoot, penumovax, shingles If need to take, stop 10days before and wait 10 days |
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what are possible adverse effects?
-major -most common |
MAJOR:
-malignnacy risk (lymphoma) -skin cancer -infx (TB, hepB, histo, candidiasis, aspergilsis) -neurologic dz -CHF -autoimmunity COMMON: -anti-drug Ab -injection site rxn -hepatotoxicity |
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what is the screening blood work to do before starting biologic?
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-Hx: CHF, infx, malignancy, neurologic
-famHx: demyelinating dz CBC, lytes, renal fn, LFT TST CXR ANA HepBsAg, HepBcAb (dr pratt - screen - HepA, C) then q3months - CBC, LFT (infliximab) q6-12 months - CBC, LFT (etanercept, adalimumab) |
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how are they metabolized?
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proteolysis
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What are some off label uses of biologics?
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neurtrophilic dermatoses (PG, subcorneal pustular dermatosis, behcets dz, acute uveitis)
-vasculitis (ANCA-assoc systemic vasculitis) -granulomas (diss GA, ulcerated NBL, granulomatous cheilitis, sarcoidosis -bullous (cic pemphigoid) -A/I CTD (relapsing polychondritis, scleroderma, lupus) -SAPHO syndrome -PRP -H.S -multicentric reticulohistiocytosis -reiter’s dz -TEN -acute and chronic GvHD |
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Which one is a fully human IgG1 Ab?
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Humira (Adalimumab)
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what are the 3 most common infectious to get on TNF alpha inhibitiors (ie enbrel)?
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histoplasmosis
candidaisis (yeast) aspergilliosis (mold) |
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what TNF alpha inhibitor can be decreased clearance when MTX given at same time?
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Adalimumab
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What biologic has the best PASI - short term vs longer term?
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Short term - infliximab (PASI at 10wks = 80%)
Long term - stellara (ustikinumab) Etanercept - PASI75 at 12wks = 49%, at 24wks 54% Adalimumab - PASI 75 at 24wks, 64% q2wk dose, 72% qwk dose |
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what are the bioavail for the biologics?
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etanercept - 58%
infliximab - adalimumab - 64% |
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what preg category are the biologics?
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biologics = preg cat B
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TNF alpha receptors?
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p55 = most imp't
p75 |
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is it contraindication to use biologics with hep C infection?
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no
can still use get ID doc involved! |
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what's the new name for wegner's disease?
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granulomatosis with polyangitis
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which biologic doesn't go into breast milk?
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infliximab
-IV |
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what are two methods to prevent anti drug antibiodies from forming?
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combo with MTX or prednisone
-btu MTX can incr risk of lymphoma, NMSC |
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which 2 biologics have recently been found to cause psoriasiform scalp alopecia?
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inflixumab
adaliumab |
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what are 3 tests for latent TB?
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CXR
PPD Quat gold |
