Autoimmune Disease Flashcards
What mineralcorticoid acts like ALDOSTERONE and is approved for Addison’s disease?
Fludrocortisone
What are symptoms of Cushing’s Syndrome? What is the cause?
Too much Cortisol!!!
-Acne
-Glaucoma
-Moonface
-Buffalohump
-Psych changes
-Pink-purple stretch marks
-Diabetes
-Infection or impaired wound healing
What is Addison’s disease?
Lack of cortisol
What are the short-acting systemic steroids?
Hydrocortisone
Cortisone
What are the intermediate systemic steroids?
Prednisone
Prednisolone
Methylprednisolone
Triamcinolone
What are the Long-Acting systemic steroids?
Betamethasone
Dexamethasone
Decadron SE
Dexamethasone
Short term
increased appetite
weight gain
emotional instability
insomnia
increased IOP
fluid retention
increased BP and BG
Long-term
Osteoporosis
Diabetes
Impaired wound healing
Psych disorders
growth retardation
Warning: Adrenal suppression, if taking longer than 14 days, taper SLOWLY
Deltasone
Prednisone
Millipred
Prednisolone
Orapred ODT
Prenisolone
Solu-Cortef
Hydrocortisone
Kenalog
Triamcinolone
What a patient considers immunosuppresed on systemic steroid use?
When using >/= 20 mg/day of prednisone equivalent dose for 2 weeks
non-biologic DMARDs
Disease Modifying Anti-rheumatic Drugs
- methotrexate
- hydroxychloroquine
- sulfalazine
- leflunomide
*slow disease progression and prevent further joint damage
JAK inhibitors:
Tofacitinib
Baricitinib
Upadacitinib
**do not use these with bioilogic DMARDs
What testing is more specific to rheumatoid arthrisis?
RF
CRP
CPK
ACPA
ACPA
**RF is positive for other immune disorders like SLE
What is the preferred initial therapy for rheumatoid arthritis? What situations would you NOT want to use this medication?
Methotrexate (Trexall)
-Pregnancy patient (teratogenic)
-breastfeeding
-Alcoholic
-Chronic liver disease
- Blood Dyscrasias
SE: hepatotoxicity! myleosuppression! mucositis!
**give with FOLATE to help with myleosuppresion and hepatic side effects
What can be added on to DMARD therapy when insufficent for a disease flare?
Low-dose systemic steroid
(</= 10 mg/day of prednisone equivalant)
What medication is dosed once weekly in RA when it is dosed daily for other conditions?
Methotrexate (Trexall)
**doses daily in cancer!
MOA: irreversibly binds to dihydrofolate reductase to block folate
JAK inhibitors
BUT JAK
Baricitinib
Upadacitinib
Tofacitinib
increase risk for infections, malignancy, thrombosis!
What is the MAIN side effect with DMARD Plaquenil?
Hydroxychloroquine
Irreverible retinopathy
**get eye exam every 3 months!
What non-biologic DMARD can cause yellow-orange coloration?
Sulfasalazine
What non-biologic DMARDs are Contraindicated in pregnancy?
Trexall
Lefunomide
What non-biologic DMARDs are Contraindicated in pregnancy?
Trexall
Lefunomide
Lefunomide
non-biologic DMARD
***avoid in pregnancy, wait 2 years after treatment to get pregnant OR use the accelerated drug elimination for 11 days
- Cholestyramine
- Activated Charcoal
SE: hepatotoxicity
biologic DMARDs
Anti-TNF Biologics:
Adalimumab (Humira)
Etanercept (Enbrel)
Infliximab (Remicade)
Certolizumab (Cimzia)
Golimumab (Simponi)
CD20 Biologic
Rituximab (Rituxan)
Anti-TNF Biologics
“Go InCert Humira and Enbrel to avoid a Tumor Necrosis Factor”
Golimumab (Simponi)
Infliximab (Remicade)
Certolizumab (Cimzia)
Adalimumab (Humira)
Etanercept (Enbrel)
BW: serious infections
**do not use with other biologics or JAK inhibitors, malignances
Warning: causes demyelinating, hep B reactivation, HF, Hepatotoxicity, lupus-like syndrome
**do not use with LIVE vaccines!!!!
***these are usually add-on therapy to MTX
CD20 biologic DMARD
Rituximab (Rituxan)
**HBV reactivation
**premedicate with steroid, APAP, antihistamine due to serious infusion related reactions
Counseling points for Enbrel and Humira
Weekly SC injections
Cause: HF, liver damage, infection
Store in fridge, can be stored at room temp for a MAX of 14 days
Humira - inject into ab or thigh
Enbrel - inject into ab, thigh, or upper arm
Which drugs are DILE drugs?
My Pretty Malar Mark Probably Has A TransIent Quality
Minocycline
Proylthiouracil (hyperthroidism)
Methimazole (hyperthyroidism)
Methyldopa (alpha 2 agonist)
Procainamide (Class 1a)
Hydralazine
Anti-TNF (Humira, Simponi, Enbrel, Remicade)
Terbinafine
Isoniazid
Quinidine
What are the common treatments of SLE?
Hydroxychloroquine (Plaquenil)
Cyclophosphamide (antimetabolite)
Transplant meds:
Azathioprine
Mycophenolate mofetil
Cyclosporine
***may take up to 6 months to see improvement!
What are common labratory findings for Lupus?
Antinuclear Antibodies (ANA)
anti-ssDNA
anti-dsDNA
What is a biologic DMARD that is approved for SLE?
Belimumab (Benlysta)
What are the signs and symptoms of multiple sclerosis?
fatigue
numbness
blurred vision
deterioration of cogn
muscle spasms
pain
incontinence
What are the mainstay treatments for multiple sclerosis?
Glatiramir Acetate (Copaxone)
and
Interferon beta
What multiple sclerosis therapy is preferred in pregnancy?
glatiramir acetate (Copaxone)
warning: chest pain
Pyrimidine synthesis inhibitors and there uses
lefunomide use in RA
teriflunomide use in MS
**both have hepatotoxicty and CI in pregnancy!
Interfern beta
Warning: psych, hepatotoxicity, thyroid dysfunction
**do not expel air bubble due to loss of drug!!!!!
What monoclonal antibody is approved for MS that is also approved for IBD?
Natalizumab (Tysabri)
**PML —– need REMS
What is the DOC for Reynaud’s Phenomenon (cyanosis and cold extremities)?
Nifedipine (Procardia)
What is myasthenia gravis?
autoimmune disease affecting nerves and muscles that control the face and eyes
-vision loss
-ptosis (dropping eyelid)
-problems chewing or swallowing
Tx: pyridostigmine (anticholinergic)
What drugs worsen myasthenia gravis?
AG or Quinolones
BB or CCB
Magnesium
Muscle relaxants
Sjogren’s Syndrome is?
autoimmune disease marked by DRY eyes and DRY mouth
Tx: eye drops
-Cyclosporine (Restasis)
oral med for dry mouth
pilocarpine (cholinergic)
