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DUAL AGENTS
1. Chronic Inflammatory Disease
  1. Remicade (Infliximab)
    1. Pharmacological Class & Indications
      1. Class
        Biologic Agents
      2. Indications
        Tumor necrosis factor (TNF) inhibitors
    2. Main Disease State
      1. Rheumatoid Arthritis
        Physiological Concepts
        Autoimmune disease where the immune system attacks the joints. Joint pain, tenderness, swelling and stiffness for 6 weeks or longer, morning stiffness for 30 minutes or longer, more than 1 joint is affected, the same joints on both sides of the body are affected, fatigue, loss of appetite, and a low-grade fever
        Non-Drug Treatments/Lifestyles Modifications
        Heat & cold therapies, Orthotics & splints, Therapeutic exercise, Healthy eating with an anti-inflammatory diet and plenty of rest
        Ongoing Monitoring
        Periodic labs for Serum C-reactive protein levels, X-rays for progression or remission of disease activity, Reduction of signs & symptoms, TB testing prior to & during treatment and Monitor for skin cancer
    3. Alternative Disease States
      1. Crohn's Disease, Psoriasis, Ankylosing Spondylitis, Psoriatic Arthritis
    4. Routes of Administration & Appropriate Populations
      1. Adults & Geriatrics
      2. Dosed using body surface area (BSA) or weight-based so doses can vary
      3. Pediatric & Juvenile - orphan drug designation
      4. IV Only. Must be infused using 0.9% NS. Not compatible with dextrose
    5. Drug & Food Interactions
      1. Drug Drug Interactions
        Anakinra, Tacrolimus, Cyclosporine, Tocilizumab, Paclitaxel, Abatacept, Sirolimus, Warfarin, Quinidine, Rilonacept, Phenytoin, Live Vaccines
      2. Food Interactions
        NONE
    6. Black Box Warnings & Adverse Effects
      1. Black Box Warnings
        Increased risk for serious infections including TP, sepsis & fungal infections
        Lymphoma & possible other malignancies in children & juveniles
      2. Adverse Effects
        Acute Coronary Syndrome, Cardiorespiratory Arrest, Chest Pain, Heart Failure, Hypertension, Hypotension, Myocarditis, Peripheral Edema, Systemic Vasculitis
2. CANCER
  1. Herceptin (Trastuzumab)
    1. Main Disease State
      1. Breast Cancer
        Physiological Concepts
        Breast lump, Abnormal mammograms, Visual or feel changes in the breast, Blood-stained or clear fluid discharge from nipple
        Non-Drug Treatments/Lifestyle Modifications
        Seek emotional support, Eat healthy, Reduce stress, Limit or eliminate alcohol consumption, Exercise regularly, Maintain healthy weight
        Ongoing Monitoring
        During Treatment: Labs & Cardiac assessments; Post Treatment: Regular health screening, Vitamin D levels checked regularly & Continue mammograms
    2. Alternative Disease States
      1. Gastric Cancer, Stomach Cancer & Pancreatic Cancer (Off label/Orphan)
    3. Pharmacological Class & Indications
      1. Class
        Biologic Agents
      2. Indications
        Human epidermal growth factor receptor (HER2) inhibitor
    4. Drug & Food Interactions
      1. Drug Drug Interactions
        Warfarin, Dexamethasone, Tamoxifen, Vitamin D3 & Zofran
      2. Food Interactions
        Grapefruit
    5. Routes of Administration & Appropriate Populations
      1. IV Only. Must be infused using 0.9% NS. Not compatible with dextrose.
      2. Adults & Geriatric Only
      3. Dosed using body surface area (BSA) or weight-based so doses can vary
    6. Black Box Warnings & Adverse Effects
      1. Black Box Warnings
        Cardiomyopathy - more common when used in conjunction with other cytotoxic agents
        Fatal Infusion Reactions & Pulmonary Toxicity - usually seen within 24 hours of infusion
        Embryo-Fetal Toxicity - Should not be used during pregnancy
      2. Adverse Effects
        Heart Failure, Edema, Tachycardia, Rash, Abdominal Pain, Diarrhea, Loss of Appetite, Nausea, Vomiting, Anemia, Backache, Headache, Dizziness, Insomnia, Cough, Neutropenia, Thrombosis
AKA MABs
1. Additional MABS
  1. Avastin/Bevacizumab
    1. Rituxan/Rituximab
      1. Stelara/Ustekinumab
        Adcetris/Brentuximab
        Erbitux/Cetuximab
        Yervoy/Ipilimumab
        Vectibix/Panitumumab
        Cyramza/Ramucirumab
        Humira/Adalimumab
        Cimzia/Certolizumab pegol
        Simponi/Golimumab
        Opdivio/Nivolumab
        Vectibix/Panitumumab
        Keytruda/Pembrolizumab
        Actemra/Tocilizumab
        Kadcyla/Ado-Trastuzumab Emtansine

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MONOCLONAL ANTIBODIES

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	Created by Jodie Evans about 8 years ago