Antimalarials

Question 1

Plaquenil C/I?

Answer 1

hypersensitivity

PHONE
Porphyria, psoriasis
heme abn esp G6PD deficiency
ocular abn, retinopathy
neuro deficits - significant
eye retinal/visual field changes

CAN : KIDS <6 (tablets difficult to divide)

WARn ABOUT DIRVING/OPERATING MACHINERY as can cause loss of accommodation and blurry vision

Question 2

what are risks for poor plaquenil response ?

Answer 2

extensive
/\ hypertrophic verrucous
S - SMOKING, SLE

Question 3

plaquenil half life?

Answer 3

40-50 days

Question 4

Plaquenil - skin changes?

Answer 4

PPP for PPPlaquenil - Porphyria (can induce or worsen, also used in treatment), PsO, pigmentation

Pigmentation = break down
blue grey pigmentation on shins, face, PALATE
nail pigmentation - transverse bands
bleaching of hair roots

Psoriasis -> also AGEP and also exfoliative erythroderma

Big 5 of drug here: eczematoid drug, psoriasiform drug, lichenoid drug, urticaria, erythroderma exfoliative (think PsO),

Question 5

Plaquenil - canadian indications?

Answer 5

SLE, DLE, RA

Question 6

MOA of plaquenil?

Answer 6

A LLIIST (a phone list)
antiviral (COvid!)
Lipid lowering 
light filtration
immunosuppressive (blocks TLRs and IL 2 production)
anti-inflammatory
synthesis of DNA/RNA reduced
THROMBO/antiplatelet (helpful for APLA)

Question 7

what are risk factors for worsening ocular dz? (drug monograph)

Answer 7

255 yo

> 200 g cumulative dose
5 mg/kg
5 years of use

elderly (bad eyes!)
renal insufficiency (increased levels -> higher retinal buildup)
tamoxifen and other ocular tox drugs

Question 8

5 ocular s/e of tamoxifen?

Answer 8

CAPP = reversible
corneal deposits
loss of accomodation
Premaculopathy  with
    Pigment deposition and Paracentral/Pericentral scotoma

irreversible:
true retinopathy
visual acuity changes, central scotoma, bulls eye pigment deposits

Question 9

S/E of plaquenil - outline all for pt?

Answer 9

go with PHONE + GC
P - Pso, Porphyria, eczema, lichenoid drug, morbilliform, AGEP, exfoliative erythroderma
Heme - agranulocytosis, pancytopenia, hemolysis with G6PD
Ocular - true retinopathy, Pseudomaculopathy
Neuro and MSK - mood changes, irritability, headaches, psychosis, seizures, vertigo, tinnitus (rare)
muscle weakness (can deposit in muscles)

GI: N/V/D, abdo pain&raquo_space;> LFT changes
cardiac: QT prolongation, AV block, etc -> CANADIAN MONOGRAPH RECOMMENDS ECG “baseline/periodic ECGs”

Question 10

Plaquenil - what labs would you order?

Answer 10

CBC, preggo, Cr, LFTs, BUN, G6PD if at risk
optho year 1 and then per optho guidance (at least one in 5 yrs, but could be Q year)

CBC Q month x 3, then Q6 mo
CR/LFTs 1 mo, 3 mo, Q6 mo