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HY points about each drug followed by a quiz at the end
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Anti-TNF-alpha monoclonal antibodies
- Annoyingly, there are five you just need to memorize straight-up:
- Adalimumab, infliximab, certolizumab pegol, golimumab.
- “Adolf on NetFlix is Certainly a Golden piece of shit.”
MOA of the above antibodies? –> answer = inhibit soluble TNF-alpha (not TNF-alpha receptor).
- Etanercept is equally as HY as the above antibodies. However it is not technically an antibody; it is a TNF-alpha recombinant receptor.
- In other words, etanercept can bind to and mop up soluble TNF-alpha floating around in the plasma.
- Remember that etanercept is the odd one out from the TNF-alpha drugs because it is a receptor, not an antibody.
Two notable uses of anti-TNF-alpha drugs?
- Inflammatory bowel disease (IBD) when NSAIDs and steroids are not sufficient to control disease.
- Second-line DMARD in rheumatoid arthritis if methotrexate alone is not effective or contraindicated.
When should anti-TNF-alpha drugs notably not be used? –> answer = patients with silicosis (silicon ↓ alveolar macrophage function) because they increase the risk of TB.
- Low threshold for performing a PPD test on patients with silicosis who have pulmonary symptomatology.
Eculizumab
MOA of eculizumab? –> answer = monoclonal antibody against complement protein C5.
What do we use eculizumab for? –> paroxysmal nocturnal hemoglobinuria (PNH).
- PNH is characterized by episodes of hematuria first thing in the morning. It is caused by deficiency of GPI anchor or CD55/59 on RBCs, resulting in increased complement-mediated hemolysis of RBCs. Sounds weird, but it’s not. This is HY for USMLE.
Ixekizumab, Secukinumab
MOA of ixekizumab + secukinumab? –> answer = both are monoclonal antibodies against IL-17a.
How the fuck to remember these names? –> “Ixe plays the kazoo in Secaucus.”
Notable use for ixekizumab and secukinumab? –> answer = psoriasis.
Natalizumab
MOA of natalizumab? –> answer = monoclonal antibody against alpha-4 integrin.
Notable use for natalizumab? –> multiple sclerosis.
- Natalie is a woman’s name. Multiple sclerosis usually occurs in women.
Natalizumab notably increases the risk for which opportunistic infection? –> answer = progressive multifocal leukoencephalopathy (PML), caused by JC polyoma virus.
- Rituximab (monoclonal antibody against CD20 on B cells in Hodgkin lymphoma) also notably increases the risk.
Ustekinumab
MOA of uztekinumab? –> answer = monoclonal antibody against IL-12/-23.
What is uztekinumab used for? –> answer = psoriasis.
- Uztekinumab, ixekizumab, and secukinumab are all used for psoriasis.
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