Home' Australian Pharmacist : Australian Pharmacist January 2013 Contents 48
Australian Pharmacist January 2013 I ©Pharmaceutical Society of Australia Ltd.
COUNSELLING IN PRACTICE
1. Approximately what proportion of a
chimeric murine/human monoclonal
antibody consists of human
2. What is the mechanism of action
of the monoclonal antibody
a) It binds to vascular endothelial growth
factor (VEGF), inhibiting angiogenesis.
b) It binds to epidermal growth factor
receptor (EGFR), inhibiting growth in
c) It binds to the glycoprotein IIb/
IIIa receptor on the surface of
blood platelets, blocking platelet
d) It binds to interleukin-2 receptors
expressed on activated T and B
lymphocytes, preventing transplanted
3. How does adalimumab work
to reduce the symptoms and
progression of rheumatoid arthritis?
a) It inhibits the action of tumour
necrosis factor alpha, a cytokine
involved in inflammatory and immune
b) It inhibits the activity of interleukin-1,
a pro-inflammatory cytokine involved
in the regulation of inflammation.
c) It reduces B lymphocyte-induced T cell
activation and the associated release
of pro-inflammatory cytokines
d) It blocks the activity of interleukin-6,
a pro-inflammatory cytokine
involved in the pathogenesis of
4. What is the MOST common adverse
effect of adalimumab?
a) Reactivation of latent tuberculosis.
b) Skin cancers.
d) Injection site reactions.
5. Which of the following precautions
recommended before initiation of
adalimumab therapy is CORRECT?
a) Before starting adalimumab all
patients should be screened for TB,
hepatitis B and C and HIV infection.
b) If a patient tests positive for latent or
active TB, adalimumab should not be
commenced until the patient has been
taking anti-TB treatment for at least
c) Adalimumab should not be started
within 4 weeks of treatment with
abatacept, rituximab or tocilizumab.
d) Before starting adalimumab, patients
should have their full blood count, ALT,
AST and creatinine checked.
modulator (e.g. TNF-alpha antagonist,
abatacept, rituximab, tocilizumab).
Adalimumab (and other TNF-alpha
antagonists) should not be given within
8 weeks of treatment with abatacept,
rituximab or tocilizumab.10,23
You explain to Janet that Humira is a type
of medicine called a monoclonal antibody.
It reduces symptoms and slows the
worsening of joint damage in rheumatoid
arthritis by reducing the activity of
certain substances in the body that cause
inflammation. Taking both Humira and
methotrexate has been found to be more
effective than taking either medicine alone.
You tell her that the most common side effect
is a reaction at the injection site. To avoid
this, injection sites should be rotated. If
necessary, Mona can take an antihistamine
before she receives her injection. Other
possible side effects of the medicine are
nausea, headaches and muscle aches. If Mona
experiences any of these side effects to a level
which she is unable to tolerate, she should
inform her doctor. You advise Janet that
Mona may be more susceptible to infections
while she is being treated with adalimumab.
She should ensure that she is up-to-date
with her vaccinations, and visit her doctor
if she starts feeling unwell or experiencing
any troublesome symptoms (e.g. fever,
cough, rash, chest pains, difficulty breathing).
She should also visit her doctor regularly as
advised for check-ups and blood tests.
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