Drug Topics - March 2009 - (Page 47) CONTINUING EDUCATION Role of the pharmacist Among the most accessible and trusted healthcare providers, pharmacists are in a pivotal position to assist patients with RA management despite the practice setting. Some pharmacists will actually be involved in the preparation of the medication. Medications being given intravenously should be prepared according to aseptic technique and manufacturer speciļ¬cations. Other pharmacists may be involved in patient counseling and education, essential components of proper care. Patients and family members may need to be educated about the disease state and what to expect with the medications. In addition, patients should be counseled on rare but serious adverse effects and what to do should they occur. They should also be encouraged to maintain medication adherence for optimal response. Because these agents increase the risk of infection, patients receiving biologic agents may be counseled about the importance of routine hand-washing and avoidance of people who are extremely sick. It is also prudent to TABLE 2 provide the warning signs of infections such as fever, night sweats, and weight loss, and to emphasize the importance of seeking medical care should this occur. Patients should be encouraged to maintain healthcare appointments (e.g., rheumatology follow-ups, etc.) so that providers can assess the presence of adverse effects as well as monitor response to therapy. Immunizations, especially live vaccines, should be received prior to treatment with biologic agents, and in many states, pharmacists are involved with provision of immunizations. Women of childbearing age should be questioned about potential pregnancies, as many agents should not be used by this special population. In various settings, pharmacists play an important role in ensuring that patients with RA receive optimal care to improve outcomes and quality of life. Full references and a bibliography are available at www.drugtopics.com. A Comparison of Biologic Agents for RA Drug Etanercept (Enbrel) In iximab (Remicade) Mechanism of Action TNF- fusion protein TNFchimeric monoclonal antibody Route of Dosage Administration SQ IV 25 mg twice weekly or 50 mg once weekly 3 mg/kg (up to 10 mg/kg for incomplete response) at weeks 0,2,6, and then Q8 weeks (Q4 weeks may occur with incomplete response.) 40 mg every other week (up to 40 mg/week) Adverse Drug Reactions Increased risk of infections (sepsis, TB, invasive fungal infections, reactivation of hepatitis B, etc.), heart failure, demyelinating disorders, malignancies, injection site/infusion reactions Adalimumab Human (Humira) anti TNFrecombinant monoclonal antibody Anakinra (Kineret) Human recombinant IL-1 receptor antagonist Selective T cell costimulation modulator SQ SQ 100 mg daily Injection-site reactions, increased risk of infections, neutropenia Abatacept (Orencia) IV 100 kg = 1,000 mg given at weeks 0,2,4, and then Q4 weeks 1,000 mg + methotrexate, acetaminophen, IV glucocorticoid, and antihistamine on day 1 and day 15, then Q15-18 months for 2-7 years Increased risk of infections, infusion reactions, nausea, headache Rituximab (Rituxan) CD20directed chimeric monoclonal antibody IV Fatal infusion reactions, increased risk of infections, hepatitis B reactivation, severe mucocutaneous reactions, arthralgias, hypertension, cardiac arrhythmias, severe cytopenias, bowel obstruction and perforation, progressive multifocal leukoencephalopathy Adapted from package inserts for Enbrel, Remicade, Humira, Kineret, Orencia, Rituxan W W W.D R U GTO P I C S .C O M March 2009 DRUG TOPICS 47 http://www.drugtopics.com http://WWW.DRUGTOPICS.COM
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.