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NAPLEX > Chapter 46: Systemic Steroids and Autoimmune Conditions > Flashcards

Chapter 46: Systemic Steroids and Autoimmune Conditions Flashcards

1
Q

Cushing’s syndrome

A

When the adrenal gland produces too much cortisol or if exogenous steroids are taken in doses higher than endogenous cortisol

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2
Q

Addison’s disease

A

Adrenal gland is not making enough cortisol. Can cause Addison’s crisis if steroids are stopped suddenly and cause volume depletion and hypotension which can be fatal

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3
Q

Steroids Least Potent to Most Potent

A

“Cute Hot Pharmacists and Physicians Marry Together and Deliver Babies”

Cortisol
Hydrocortisone
Prednisone
Prednisolone
Methylprednisolone
Triamcinolone
Dexamethasone
Betamethasone
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4
Q

Steroid Dose Equivalencies to Prednisone

A 
Cortisol 25mg
Hydrocortisone 20mg
Prednisone 5mg
Prednisolone 5mg
Methylprednisolone 4mg
Triamcinolone 4mg
Dexamethasone 0.75mg
Betamethasone 0.6mg
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5
Q

Rheumatoid Arthritis Presentation

A

Bilateral, symmetrical joint pain. Stiffness and pain are worse after rest and “morning stiffness” is common.
Anti-citrullinated peptide antibody (ACPA) and rheumatoid factor (RF) are useful for diagnosis

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6
Q

RA Drug Tx

A

Symptomatic RA should be started on a disease-modifying antirheumatic drug (DMARD) regardless of the severity of disease

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7
Q

RA Preferred Initial Therapy

A

Methotrexate

Low-dose steroids (<=10mg/day) can be added for moderate to severe disease

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8
Q

Methotrexate Dosing

A

Trexall is po tab

7.5-20mg po once weekly (IM, SC, PO)

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9
Q

MTX Boxed Warning

A

Hepatoxicity, myelosuppression, mucositis/stomatitis, pregnancy (teratogenic)

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10
Q

MTX Monitoring and Notes

A

CBC, LFTs, chest x-ray, hep b and c serologies

Notes: can give folate to decrease hematological, GI, and hepatic SE

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11
Q

Hydroxychloroquine Warnings and Monitoring

A

Warnings: irreversible retinopathy
Monitoring: eye exam q3 months

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12
Q

Sulfasalazine CI

A

Aspirin or Sulfa allergy

Can cause yellow-orange coloration of skin/urine

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13
Q

Leflunomide MOA

A

inhibits pyrimidine synthesis resulting in anti-proliferative and anti-inflammatory effects

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14
Q

Leflunomide Boxed Warnings and Notes

A

Boxed warnings: Do not use in pregnancy (teratogenic), hepatotoxicity
CI: pregnancy

Notes: Accelerated drug elimination with cholestyramine.
Must have negative pregnancy tests and use 2 forms of birth control during tx. Must wait 2 years after d/c to get pregnant or do accelerated drug elimination

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15
Q

Janus Kinase Inhibitors (JAK) MOA

A

Inhibit JAK enzymes which stimulate immune cell function

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16
Q

JAK inhibitors Drugs

A

Tofacitinib, Baricitinib, Upadacitinib

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17
Q

JAK inhibitors boxed warnings

A

Serious infections (TB, fungal, viral, OI etc)
Increased risk for malignancies (lymphomas)
Increased risk for thrombosis

Do not use with biologic DMARDs

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18
Q

Anti-TNF Biologic DMARDs and pregnancy

A

Tumor necrosis factor alpha inhibitors

All have pregnancy warnings and registry due to unknown effects

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19
Q

Etanercept

A

Enbrel SC weekly

+/- MTX

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20
Q

Adalimumab

A

Humira SC QOW

+/- MTX

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21
Q

Infliximab

A

Remicade IV only
Only stable in NS, must use filter
Infusion reactions and delayed hypersensitivity rxns

+ MTX

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22
Q

Certolizumab pegol

A

Cimzia SC QOW

+/- MTX

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23
Q

Golimumab

A

Simponi SC qmonthly
IV requires a filter

+MTX

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24
Q

Anti-TNF Biologic DMARDs Boxed Warnings and Warnings

A

Boxed: serious infections, latent tb (treat it), lymphomas and other malignancies

Warnings: Can cause demyelinating disease, HBV reactivation, HF, hepatotoxicity, lupus-like symptoms

Do not use with other biologic DMARDs or live vaccines

25
Q

Anti-TNF Biologic DMARDs Monitoring and Notes

A

Monitoring: prior to initiation TB test and HBV; routine look for signs of infection

Notes: Do not shake or freeze, requires refrigeration. MTX is 1st line and biologics are add on but if initial presentation is severe can be use an initial therapy

26
Q

Rituximab

A

Non-TNF Biologic DMARD
Works by depleting CD20 B cells
+MTX
Premedicate with steroid, apap, and an antihistamine

27
Q

Rituximab Boxed Warnings

A

Serious and fatal infusion reactions, HVB reactivation, screen for HBV and HCV

Do not give with other Biologic DMARDs or live vaccines

28
Q

Systemic Lupus Erythematosus Clinical Presentation

A
  • Fatigue
  • Depression
  • Anorexia
  • Weight loss
  • Muscle pain
  • Malar (butterfly) rash
  • Photosensitivity
  • Joint pain and stiffness
29
Q

SLE Labs

A

Anti-ssDNA
Anti-dsDNA
ANA (antinuclear antibodies)

30
Q

Drugs that cause DILE

A

“My Pretty Malar Marking Probably Has A TransIent Quality”

Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine
31
Q

SLE 1st line Tx

A
  • Hydroxychloroquine
  • Cyclophosphamide
  • Azathioprine
  • Mycophenolate mofetil
  • Cyclosporine
32
Q

Belimumab

A

Benlysta
FDA approved for tx of Lupus
Warnings: serious infections, do not give with other biologic DMARDs or live vaccines

33
Q

Voclosporin

A

Lupkynis
FDA approved for lupus and lupus nephritis
Warnings: serious infections and malignancies, nephrotoxicity, hypertension, do not give with live vaccines.
SE: HA, HTN, diarrhea, renal impairment

34
Q

Multiple Sclerosis (MS) background

A

Chronic progressive autoimmune disease, where the patients immune system attacks the myelin sheath, the fatty substance that surrounds and insulates nerve fibers of the brain and spinal cord axons.

35
Q

MS Clinical Presentation

A

Early symptoms include: fatigue, numbness, and blurred vision.
As condition worsens deteriorating cognitive fx, muscle spasms, pain, incontinence, walking with gait instability

36
Q

Glatiramer acetate

A

Copaxone 20mg SC qd or 40mg SC TIW

For relapsing MS

37
Q

Glatiramer acetate Warnings, SE

A

Warnings: chest pain
SE: injection site rxns, flushing, diaphoresis, dyspnea
Note: preferred tx if necessary during pregnancy

38
Q

Interferon beta 1a dosing

A

Avonex: 30mcg IM qw
Rebif: 44mcg sc tid

39
Q

Interferon beta 1b dosing

A

0.25mg sc QOD

40
Q

Peginterferon beta 1a dosing

A

125mg sc q14 days

41
Q

Interferon Beta Products warnings and notes

A

Warnings: psychiatric disorder, injection site necrosis, increased LFTs, thyroid dysfunction,
SE: flu-like symptoms
Notes: If refrigerated let stand at room temp prior to injection. Do not expel air bubble

42
Q

Sphingosine 1-phosphate receptor modulator

A

-imod
Caution with other drugs that slow HR, monitor CBC, macular edema, eye exam, LFTs
MS can become worse when tx is stopped

43
Q

Nuclear Factor Activators

A

Dimethyl fumarate
Diroximel fumarate
Do not crush, chew or sprinkle cap contents on food

44
Q

Natalizumab

A

Tysabril (MAB)

Boxed warmings: progressive multifocal leukoencephalopathy

45
Q

Alemtuzumab

A

Lemtrada
Recombinant humanized MAB
REMs program

46
Q

Raynaud’s Phenomenon

A

Condition triggered by cold and/or stress leading to vasospasm in the extremities (fingers/toes) that causes the skin to turn white and then blue

47
Q

Raynaud’s tx

A

Includes vasodilation CCB (nifedipine)

48
Q

Drugs that cause or worsen Raynaud’s

A

BB
Bleomycin, cisplatin
Smypathomimetics (amphetamines, cocaine)

49
Q

Gluten found in

A

Wheat, barley, rye

50
Q

Celiac Disease symptoms

A

Diarrhea, abdominal pain, bloating, and weight loss

51
Q

Myasthenia Gravis Background

A

Attacks the connection between nerves and muscle resulting in weakness in skeletal muscle. In most cases immune system targets ACh receptors. Symptoms include eyes/vision

52
Q

Pyridostigmine

A

Blocks breakdown of ACh

Can cause cholinergic effects (salivation, lacrimation etc)

53
Q

Sjogren’s Syndrome Background

A

Commonly characterized by dry eyes and mouth. Complications include dental cavities, corneal ulcerations, and chronic oral infections

54
Q

Restasis

A

Cyclosporine emulsion

Can cause ocular burning

55
Q

Lifitegrast

A

Xiidra

SE: unusual taste

56
Q

Non-pharm for dry mouth

A
  • sugar free chewing gum (xylitol)
  • Lozenges
  • Daily rinses with antimicrobial mouthwashes
57
Q

Psoriasis background

A

Most common is plaque psoriasis appears as raised, red patches covered with a silvery white buildup

58
Q

Non-pharm for Psoriasis

A

UV light exposure causes activated t-cells in the skin to die

59
Q

Topicals for Psoriasis

A

Include steroids, vitamin d analogs, etc if these fail topical CN inhibitors (protopic and elidel) can be tried

NAPLEX (45 decks)

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