Pulmonary System Lecture #3: Monoclonal Antibodies & Inhaled Combinations

Vocabulary flashcards for Pulmonary System Lecture #3: Monoclonal Antibodies & Inhaled Combinations.

Bind to target on cell surface.

Monoclonal antibodies

Mouse monoclonal antibody.

-omab

Chimeric monoclonal antibody.

-ximab

Human monoclonal antibody.

-zumab

IgG Monoclonal Antibody that Inhibits IgE binding to the IgE receptor on mast cells and basophils

Omalizumab (Xolair)

Add on treatment for moderate to severe allergic asthma not adequately maintained with inhaled corticosteroids. (Allergic asthma must be documented with a positive skin test or in vitro reactivity to perennial aeroallergen)

Omalizumab (Xolair)

This monoclonal antibody has a BBW of anaphylaxis, presenting as bronchospasm, hypotension, syncope, urticaria, and/or angioedema of the throat or tongue.

Omalizumab (Xolair)

Major cytokine responsible for the growth and differentiation, recruitment, activation, and survival of eosinophils.

IL-5

Bind to increased IL-5 in the blood, decreasing pro-inflammatory signaling.

Mepolizumab and Resliozumab:

Binds to the IL-5 receptor on eosinophils and basophils, allowing natural killer cells to bind to eosinophil and cause apoptosis in antibody-dependent cell-mediated cytotoxicity (ADCC).

Benralizumab

Add on maintenance treatment for patients with severe asthma (eosinophilic phenotype).

Interleukin-5 Receptor Antagonists

What is a major warning and precaution for Mepolizumab? Hint: consider certain vaccination.

Herpes Zoster (shingles)

IgG4 monoclonal antibody that Binds to IL-4 receptor inhibiting IL-4 and IL-13 leading to decrease inflammatory response.

Dupilumab (Dupixent)

Add on maintenance treatment for patients with severe asthma (eosinophilic phenotype) or oral glucocorticoid dependent and/or have coexisting type 2 inflammatory conditions. Prevention of exacerbations in COPD

Dupilumab (Dupixent)

Human thymic-stromal lymphoprotein blocker. Monoclonal antibody IgG2λ that binds to human thymic stromal lymphopoietin (TSLP) causing reduce inflammation

Tezepelumab (Tezspire)

Add-on therapy in patients with severe asthma (with or without inflammatory markers) and a history of severe exacerbations

Tezepelumab (Tezspire)

Anti-inflammatory properties

Inhaled Corticosteroids

causes bronchodilation by binding to the beta-2 receptor in the lungs

Beta-2 Agonists

causes bronchodilation by blocking acetylcholine at M3 receptor in bronchial smooth muscle

Muscarinic Antagonists

Local effects: Thrush, Dysphonia, Cough, URTIs. Systemic effects

Inhaled Corticosteroids

Decrease potassium, Cough, Nervousness, Tremor, Palpitations, tachycardia

Beta-2 Agonists

Dry mouth, Cough, URTI

Muscarinic Antagonists

Albuterol-Budesonide (Airsupra). Used as reliver therapy only

ICS+SABA

Budesonide + Formoterol (Symbicort), Fluticasone + Salmeterol (Advair Diskus, Advair HFA), Mometasone + Formoterol (Dulera), Fluticasone + Vilanterol (Breo Ellipta)

ICS + LABA

Albuterol + Ipratropium (Combivent Respimat, Duoneb)

SAMA + SABA

Aclidinium + Formoterol (Duaklir Pressair), Glycopyrrolate + Formoterol (Bevepsi Aerosphere), Tiotropium + Olodaterol (Stiolto Respimat), Umeclidinium + Vilanterol (Anoro Ellipta)

LAMA + LABA

Umeclidinium + Vilanterol + Fluticasone (Trelegy Ellipta), Glycopyrrolate + Formoterol +Budesonide (Breztri Aerosphere)

ICS + LAMA + LABA

What are some adverse affects of Reslizumab?

oropharyngeal pain, transient increase CPK in blood specimen, and antibody development

What is a significant warning/precaution for Reslizumab?

malignancy (within 6 months of use)

What is a the BBW for Reslizumab?

Risk of anaphylaxis

What are significant adverse effects of Dupilumab?

dermatologic and hypersensitivity reactions (uticaria, skin rash, EM&N, angioedema, ITP), ocular surface disorders, eosinophilia such as conjunctivitis and keratitis, and possible systemic effects.

What is a significant side effect of thrush?

Oral candidiasis (thrush) leading to discomfort and difficulty swallowing.

Can LAMA + LABA be used as monotherapy in asthma?

No.