immunology and rhuemotilseos

methotrexate: brand

trexall

methotrexate: trexall: indication

rheumatoid arthritis [RA], psoriasis, non-hodgkin lymphoma

methotrexate: trexall: MOA

reversibly inhibits dihydrofolate reductase [DHFR] and blocks DNA synthesis, repair, and cell replication

methotrexate: trexall: contraindications

alcohol use disorder, chronic liver disease, pregnancy, nursing, preexisting blood dyscasias in patients treated for psoriasis and rheumatoid arthritis, NSAIDs

methotrexate: trexall: BBW

pregnancy, BMS, renal impairment, hepatotoxicity, pneumonitis, GI toxicity, secondary malignancy, tumor lysis syndrom, dermatologic toxicity, opportunisitic infections, radiotherapy, hypersensitivity

methotrexate: trexall: common side effects

N/V/D/stomatitis, alopecia/hair loss, photosensitivity, rash, LFTs abnormalities, myelosuppression

methotrexate: trexall: rare side effects

opportunitistic infetions, interstitial lung disease, stevens johnson syndrome, acute renal failure, secondary malignancies [lymphomas]

methotrexate: trexall: counseling

once wkly for rheumatic conditions, daily folic acid to lessen risk of common ADRs, avoid live vaccine, must use contraception during/after treatment, avoid direct sun exposure

methotrexate class

antimetabolite [antifolate]

azathioprine: brand

[imuran, azamun]

azathioprine: imuran, azamun: indications

rheumatoid arthritis [RA], renal transplantation

azathioprine: imuran, azamun: MOA

halts DNA synthesis thru incorporation into replication DNA inhibition of purine synthesis

azathioprine: imuran, azamun: contraindications

pregnancy [if RA treatment], prior alkylating therapy

azathioprine: imuran, azamun: BBW

malignancy

azathioprine: imuran, azamun: common side effects

nausea, leukopenia, infection, diarrhea, malaise, myalgia, increased LFTs

azathioprine: imuran, azamun: rare side effects

pancreatitis, neoplasia

azathioprine: imuran, azamun: counseling

take with food; don't crush tablet; can increase risk of infections; report any new mass, fatigue, ez bruising; may decrease vaccine efficacy

azathioprine: imuran, azamun: class

immunosuppressant

hydroxochloroquine: brand

plaquenil

hydroxochloroquine: plaquenil: indications

rheumatoid arthritis [RA[, lupus, malaria

hydroxochloroquine: plaquenil: MOA

unknown; may inhibit locomotion of neutrophils and chemotaxis of eosinophils; impairs immune rxns

hydroxochloroquine: plaquenil: contraindications

retinal or visual field changes from prior hydroxychloroquine, long-term use in children, gold compound

hydroxochloroquine: plaquenil: BBW

none

hydroxochloroquine: plaquenil: common side effects

N/V/D/abd pain, hyperpigmentation, headache, dizziness

hydroxochloroquine: plaquenil: rare side effects

retinopathy, QT prolongation/arrhythmias/cardiomyopathy, SJS, agranulocytosis, seizures, psychosis

hydroxochloroquine: plaquenil: counseling

take with food/milk, daily or weekly [same day/time], aurothioglucose, ammonium chloride

hydroxochloroquine: plaquenil: class

aminoquinoline

etanercept: brands

- enbrel mini

- enbrel sureclick

- erelzi

etanercept [enbrel mini, enbrel sureclick, erelzi]: indications

rheumatoid arthritis [RA], psoriasis, psoriasis arthritis [PsA], ankylosing spondylitis [AS], polyarticular juvenile idiopathic arthritis [jIA]

etanercept [enbrel mini, enbrel sureclick, erelzi]: MOA

recombinant DNA-derived protein, binds to soluble human TNF and blocks its interaction with its receptor

etanercept [enbrel mini, enbrel sureclick, erelzi]: contraindications

hypersensitivity, sepsis

etanercept [enbrel mini, enbrel sureclick, erelzi]: BBW

serious infections, malignancies

etanercept [enbrel mini, enbrel sureclick, erelzi]: common side effects

injection site reaction [ISR], headache, skin rash, infections

etanercept [enbrel mini, enbrel sureclick, erelzi]: rare side effects

serious infections, reactivation of latent infection, malignanies, heart failure

etanercept [enbrel mini, enbrel sureclick, erelzi]: counseling

don't administer if signs/symptoms of active infection; refrigerate [don't use if thawed after frozen]; protect from light; don't shake; proper handling; contact HCP if SOB, infections, signs of cancer

etanercept [enbrel mini, enbrel sureclick, erelzi]: class

tumor necrosis factor inhibitor [TNFi]

prednisone: brand

deltasone

prednisone [deltasone]: indications

allergic states, dermatologic disease, endocrine disorders, GI diseases, hematologic disorders, neoplasmic disease, nervous system disorders, renal diseases, respiratory diseases, rheumatic disorders

prednisone [deltasone]: MOA

bind to glucocorticoid receptors, gene transcription altered, decrease inflammatory mediators (COX-2, PLA₂, cytokines) and suppress immune cell activation

prednisone [deltasone]: contraindications

fungal infections, administration of live vaccine, hypersensitivity, sepsis

prednisone [deltasone]: BBW

serious infections, malignancies

prednisone [deltasone]: common side effects

GI side effects, hypertension, atrophic condition of skin, impaired skin healing, osteoporosis, depression, euphoria, pulmonary tuberculosis, hyperglycemia

prednisone [deltasone]: rare side effects

primary adrenocortical insufficiency, cushing's syndrome, decrease body growth, increased risk of infection

prednisone [deltasone]: counseling

take with food/milk to prevent GI upset; take in morning to help prevent insomnia; for high dose/long term, monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection; avoid abrupt discontinuation treatment duration >2 wks and dose 20 mg prednisone eq.

prednisone [deltasone]: class

glucocorticoids

prednisone [deltasone]: other examples

- methylprednisolone [medrol]

- dexamethasone [decadron]

- prednisolone [orapred, prelone]

anastrazole: brand

arimidex

anastazole: arimidex: indications

breast cancer [postmenopausal]

anastazole: arimidex: MOA

Blocks conversion of androgens into estrogen required for tumor growth

anastazole: arimidex: contraindications

Pregnancy, breastfeeding

anastazole: arimidex: BBW

none

anastazole: arimidex: common side effects

N/V/GI tract disorder, edema,hypertension, arthralgia, arthritis, osteoporosis,hot flashes, depression

anastazole: arimidex: rare side effects

Myocardial infarction,endometrial cancer, cerebrovascular accident(CVA)

anastazole: arimidex: counseling

- May lead to bone loss and increased risk offracture- Seek medical attention if shortness ofbreath, swelling, chest pain, vaginal bleeding,blistering rash, rapid weight gain, severe N/V,yellowing of the eyes or skin

anastazole: arimidex: class

antineoplastic: aromatase inhibitor

tamoxiden: brand

soltamox

tamoxiden: soltamox: indications

Breast cancer (pre and postmenopausal)

tamoxiden: soltamox: MOA

Inhibits tumor growth by competitively bind to estrogen receptors on tumors, inhibiting tumor growth

tamoxiden: soltamox: contraindications

Pregnancy, breastfeeding, concurrent warfarin, history of deep vein thrombosis (DVT) or pulmonary embolism (PE)cancer, retinopath

tamoxiden: soltamox: BBW

Stroke, pulmonary embolism (PE), uterine malignancies

tamoxiden: soltamox: common side effects

Flushing, HTN, edema, hot flashes, vaginal discharge, amenorrhea, rash, nausea

tamoxiden: soltamox: rare side effects

Endometrial hyperplasia, uterine cancer, retinopathy

tamoxiden: soltamox: counseling

seek medical care if s/sx of thrombotic event (shortness of breath, leg pain), irregular menstruation, abnormal vaginal bleeding, pelvic pain or pressure - Avoid black cohosh as supplement

tamoxiden: soltamox: class

selective estrogen receptor modulator, estrogen receptor antagonist

tacrolimus: brand

- prograf

- astagraf XL

- envarsus XR

tacrolimus: prograf, astagraf XL, envarsus XR: indications

rejection prophylaxis [heart, lung, liver, kidney]

tacrolimus: prograf, astagraf XL, envarsus XR: MOA

inhibits immune response and limits inflmmation by binding to cyclophilin, blocks t cell activation and decreases in IL-2 and interferon gamma

tacrolimus: prograf, astagraf XL, envarsus XR: contraindications

ziprasidone, hypersensitivity to polyoxyl 60 hydrogented castor oil

tacrolimus: prograf, astagraf XL, envarsus XR: BBW

infection, malignancies, increased morality in female transplant patients, astagraf XL in liver cancer

tacrolimus: prograf, astagraf XL, envarsus XR: common side effects

chest pain, htn, alopecia, diabetes, hyperglycemia, hyperkalemia, hypomagnesemia, hyperlipidemia, constipation, diarrhea, nausea, anemia, leukopenia, thrombocytopenia, infection, arthralgia, dizziness, headache, insomnia, neuropathy, myoclonus, seizure, nephrotoxicity, dyspnea, pleural effusions

tacrolimus: prograf, astagraf XL, envarsus XR: rare side effects

arrhythmia, cardiomegaly, stevens-johnsons syndrome, malignancy, pancreatitis, acute renal failure

tacrolimus: prograf, astagraf XL, envarsus XR: counseling

drug absorption is affected by food, be consistent in how u take dose [w/o dose preferred, may take w/ meal to mitigate GI symptoms]; avoid grapefruit juice/grapefruit, ROH; many OTC/Rx meds, food may interact with this medication

tacrolimus: prograf, astagraf XL, envarsus XR: class

calcineurin inhibitor

epoetin: brand

- epogen

- procrit

- retacrit

epoetin: epogen, procrit, retacrit: indications

anemia secondary to kidney disease or chemotherapy, perioperative collection of allogeneic infusion [epoetin]

epoetin: epogen, procrit, retacrit: MOA

binds to the erythropoietin receptor on erythroid progenitor cells, stimulates production/differentiation of mature RBCss

epoetin: epogen, procrit, retacrit: contraindications

uncontrolled HTN, pure red cell aplasia, albumins

epoetin: epogen, procrit, retacrit: BBW

increassed CV, stroke, mortality risk, cancer recurrence, thromboembolic event

epoetin: epogen, procrit, retacrit: common side effects

injection site thrombosis, myalgia, fastigue, diarrhea, edema, HTN: darbepoetin -> dyspnea + cough; epoetin: skin rash/puritis

epoetin: epogen, procrit, retacrit: rare side effects

purse rsed cell aplasias, seizures, tumor progressions

epoetin: epogen, procrit, retacrit: counseling

don't shake, dilute, or expose to light; store in box in fridge -> don't freeze; single use vial/syringe, don't combine remainders from diff. vials/syringes; may take several weeks to see max. effects of these medications

epoetin: epogen, procrit, retacrit: class

hematopoietic: erythropoesis-stimulating agent

epoetin: similar medications

darbepoetin [aranesp]

allopurinol: brand

zyloprima

allopurinol: zyloprim: class

xanthine oxidase inhibitora

allopurinol: zyloprim: indications

gout, hyperuricemia, tumor lysis syndrome [TLS], kidney stonesa

allopurinol: zyloprim: MOA

decrease uric acid [UA] production

allopurinol: zyloprim: contraindications

hypersensitivity, HLA-B 5801 (+)

allopurinol: zyloprim: BBW

none

allopurinol: zyloprim: common ADRs

rash, maculopapular eruption, acute attacks of gout with initiation

allopurinol: zyloprim: rare ADRs

stevens-johnson syndrome, toxic epidermal necrosis [TEN], aplastic anemia, agranulocytosis, thrombocytopenia, renal failure, granulomatous hepatitis, hepatotoxicity, immune hypersensitivity rxn

allopurinol: zyloprim: counseling

take after meals to alleviate GI symptoms, drink plenty of water to prevent kidney stones, avoid alcohol and caffeine

febuxostat: brand

uloricfe

febuxostat: uloric: indications

hyperuricemia

febuxostat: uloric: class

xanthine oxidase inhibitor

febuxostat: uloric: MOA

decrease uric acid [UA] production

febuxostat: uloric: contraindications

concurrent azathioprine [AZA] or mercaptopurine [6-MP]

febuxostat: uloic: BBW

increased risk of death [cardiac, all-cause]

febuxostat: uloric: common ADRs

rash, nausea, elevated LFTs, arthralgia

febuxostat: uloric: rare ADRs

ECG abnormalities, hypersensitivity, stroke, mood changes, drug rxn rash with eosinophilia and systemic symptoms