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HY points about each drug followed by a quiz at the end
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Abciximab
MOA of abciximab? –> answer = monoclonal antibody against GpIIb/IIIa on platelets.
- GpIIb/IIIa on platelets mediate platelet aggregation (in contrast, adhesion is GpIb; no testable antibody targets this).
- The normal physiologic entity that binds GpIIb/IIIa on platelets is fibrinogen. In other words, fibrinogen is the molecule that bridges GpIIb/IIIa on adjacent platelets and enables their ability to stick together (i.e, aggregation). Therefore, USMLE wants you to know that abciximab is considered a fibrinogen analogue.
- Students often confuse abciximab with adalimumab (also HY), which is instead a monoclonal antibody against soluble TNF-alpha.
- Eptifibatide and tirofiban are two agents that are not monoclonal antibodies that also target GpIIb/IIIa.
What is the clinical use for abciximab? –> answer = administered to patients undergoing percutaneous coronary intervention (i.e., angioplasty +/- stenting).
Basilixumab, Daclizumab
MOA of basilixumab and daclizumab? –> answer = both are monoclonal antibodies against IL-2 receptor.
- Daclizumab was withdrawn from the market in 2018 after reports of encephalitis, but USMLE still wants you to know it’s MOA.
What’s the main use for basilixumab and daclizumab? –> answer = prevention of transplant rejection.
Denosumab
MOA of denosumab? –> answer = monoclonal antibody against RANK-L.
Clinical use for denosumab? –> answer = advanced osteoporosis with history of pathologic fractures; also used to prevent fractures in those with bone metastases.
Omalizumab
MOA of omalizumab? –> answer = monoclonal antibody against the Fc region of IgE (prevents IgE binding to FcεRI).
Clinical use for omalizumab? –> answer = severe asthma refractory to all other therapies.
Palivizumab
MOA of palivizumab? –> answer = monoclonal antibody against F-protein of RSV (prevents syncytia formation).
- Should be noted that palivizumab will only ever be an answer on the USMLE if the vignette asks specifically about the MOA. Or the vignette might ask which antibody could be used in theory against RSV. However if you are asked blindly how to treat RSV, “supportive care” is the correct answer; ribavirin and palivizumab are almost always wrong answers.
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