Which of the following medications acts by inhibiting vascular endothelial growth factor (VEGF)?

Appeared in: AIIMS Nagpur NO- 2020

Explanation

Ranibizumab is a recombinant humanized monoclonal antibody fragment.
It works by binding to and inhibiting the biologic activity of human vascular endothelial growth factor A (VEGF-A).
By neutralizing VEGF, it suppresses angiogenesis (the formation of new blood vessels), which is a key process in the pathology of conditions like neovascular (wet) age-related macular degeneration.

Option B: Pembrolizumab is an immune checkpoint inhibitor, not a VEGF inhibitor. Its target is the Programmed Death 1 (PD-1) receptor on T-cells.
Option C: Ipilimumab is an immune checkpoint inhibitor. Its target is the Cytotoxic T-Lymphocyte-Associated protein 4 (CTLA-4) on T-cells.
Option D: Dostarlimab is also an immune checkpoint inhibitor that targets the PD-1 receptor, similar to Pembrolizumab.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Targeted Therapy: VEGF Inhibitors vs. Immune Checkpoint Inhibitors as background academic context rather than a clinical decision trigger.
Understanding the difference between VEGF inhibitors and immune checkpoint inhibitors is critical for nurses to anticipate and manage distinct adverse effect profiles.
VEGF inhibitors (like Ranibizumab and Bevacizumab) are associated with risks of hypertension, bleeding, impaired wound healing, and arterial thromboembolic events.
Immune checkpoint inhibitors (like Pembrolizumab, Ipilimumab, Dostarlimab) can cause a wide range of immune-related adverse events (irAEs), such as colitis, dermatitis, hepatitis, and endocrinopathies, as they essentially 'take the brakes off' the immune system.

How to Approach the Question

First, identify the key term in the question: 'inhibiting vascular endothelial growth factor (VEGF)'. This points to a specific mechanism of action.
This is a pharmacology recall question. You need to match the drug to its mechanism.
Analyze the options. All end in '-mab', indicating they are monoclonal antibodies.
Recall or deduce the drug classes. Ranibizumab is known for its use in eye conditions caused by abnormal blood vessel growth, linking it to VEGF.
Recognize that Pembrolizumab, Ipilimumab, and Dostarlimab are prominent drugs in cancer immunotherapy, which works by modulating the immune system (checkpoint inhibition), not by blocking blood vessel growth directly.
By eliminating the three immune checkpoint inhibitors, you can identify Ranibizumab as the correct VEGF inhibitor.

Concept Tested & Keywords

Concept Tested: Targeted Therapy: VEGF Inhibitors vs. Immune Checkpoint Inhibitors
Stem keywords: medication, inhibiting, vascular endothelial growth factor, VEGF
Lead-in keywords: Which

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E6 Medicine Harrison 22e Part 1 p. 575-577

E6 Pharmacology Nursing Lilley 11e Part 3 pp. 80-82, 103-105

Practise the full AIIMS Nagpur NO- 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.