Chapter 10: Pharmacology and Therapeutics

Antimicrobials

• The reader is directed to Chapter 9: Antimicrobial Therapy for review of antibiotics, antivirals, and antifungal medicinal therapies.

Chemotherapy

• The reader is directed to Chapter 46: Chemotherapy for Head and Neck Cancer for review of chemotherapeutic drugs and their applications and indications.

Perioperative Drugs

• The reader is directed to Chapter 4: Anesthesia for Head and Neck Surgery for review of local anesthetics, narcotics, sedatives, and the various other perioperative drugs.

Allergy Medications

• The reader is directed to Chapter 59: Immunology and Allergy for review of antihistamines, decongestants, corticosteroid, mast cell stabilizers, leukotriene antagonists, and the treatment of anaphylactic conditions.

Biologic Agents

• Medicinal agents originating from biologic sources used to prevent and treat cancers or autoimmune diseases, which includes the use of antibodies, interleukins, and vaccines.

Cetuximab

• Recombinant humanized monoclonal antibody approved for squamous cell carcinoma (SCCA) of the head and neck.

• Mechanism includes selective binding of epidermal growth factor (EGF) receptor to competitively inhibit EGF resulting in cell growth inhibition, cellular apoptosis, and reduction of vascular endothelial growth factor (VEGF) production.

• Indicated in the initial treatment of locally or regionally advanced SCCA and recurrent or metastatic SCCA.

• May be used as monotherapy after platinum-based therapy for metastatic disease or in combination with platinum-based therapy or with radiation therapy.

• Most common side effects include rash, fatigue, and hypomagnesemia.

Rituximab

• Humanized monoclonal antibody used for the treatment of granulomatosis with polyangiitis (GPA) (Wegener granulomatosis) and Non-Hodgkin lymphoma.

• Mechanism of action involves binding of CD20 surface protein on B cells, which allows natural killer (NK) cell-mediated destruction of B cells through antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity.

• It also promotes CD20+ cell apoptosis.

• Indicated in the treatment of moderate to severe forms of GPA and has generally replaced the use of methotrexate and cyclophosphamide as the secondary treatment of this disease.

• Generally well tolerated by patients but may include leukopenia, thrombocytopenia, and neutropenia with increased infection rates.

Infliximab

• Recombinant human-mouse IgG monoclonal antibody used to treat relapsing polychondritis.

• Mechanism through the neutralization of TNF-α thereby reducing pro-inflammatory cytokine production, reduction of endothelial permeability, and reducing adhesion molecule release.

• Up to 50% of patients may have formation of antinuclear antibodies with use.

Tocilizumab

• Recombinant humanized monoclonal antibody targeting the interleukin-6 receptor, which inhibits transduction of inflammatory mediators that summon T and B cells.

• Initiated with glucocorticoid therapy as the glucocorticoid is tapered until Tocilizumab is used as long-term monotherapy.

• Used to treat inflammatory autoimmune diseases, it is indicated for giant cell arteritis (temporal arteritis), which is a large-vessel vasculitis that can also affect medium and small arteries.

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