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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
Anti-TNF Biologic DMARDs Monitoring and Notes
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
Rituximab
Non-TNF Biologic DMARD Works by depleting CD20 B cells +MTX Premedicate with steroid, apap, and an antihistamine
27
Rituximab Boxed Warnings
Serious and fatal infusion reactions, HVB reactivation, screen for HBV and HCV Do not give with other Biologic DMARDs or live vaccines
28
Systemic Lupus Erythematosus Clinical Presentation
- Fatigue - Depression - Anorexia - Weight loss - Muscle pain - Malar (butterfly) rash - Photosensitivity - Joint pain and stiffness
29
SLE Labs
Anti-ssDNA Anti-dsDNA ANA (antinuclear antibodies)
30
Drugs that cause DILE
"My Pretty Malar Marking Probably Has A TransIent Quality" ``` Methimazole Propylthiouracil Methyldopa Minocycline Procainamide Hydralazine Anti-TNF agents Terbinafine Isoniazid Quinidine ```
31
SLE 1st line Tx
- Hydroxychloroquine - Cyclophosphamide - Azathioprine - Mycophenolate mofetil - Cyclosporine
32
Belimumab
Benlysta FDA approved for tx of Lupus Warnings: serious infections, do not give with other biologic DMARDs or live vaccines
33
Voclosporin
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
Multiple Sclerosis (MS) background
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
MS Clinical Presentation
Early symptoms include: fatigue, numbness, and blurred vision. As condition worsens deteriorating cognitive fx, muscle spasms, pain, incontinence, walking with gait instability
36
Glatiramer acetate
Copaxone 20mg SC qd or 40mg SC TIW | For relapsing MS
37
Glatiramer acetate Warnings, SE
Warnings: chest pain SE: injection site rxns, flushing, diaphoresis, dyspnea Note: preferred tx if necessary during pregnancy
38
Interferon beta 1a dosing
Avonex: 30mcg IM qw Rebif: 44mcg sc tid
39
Interferon beta 1b dosing
0.25mg sc QOD
40
Peginterferon beta 1a dosing
125mg sc q14 days
41
Interferon Beta Products warnings and notes
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
Sphingosine 1-phosphate receptor modulator
-imod Caution with other drugs that slow HR, monitor CBC, macular edema, eye exam, LFTs MS can become worse when tx is stopped
43
Nuclear Factor Activators
Dimethyl fumarate Diroximel fumarate Do not crush, chew or sprinkle cap contents on food
44
Natalizumab
Tysabril (MAB) Boxed warmings: progressive multifocal leukoencephalopathy
45
Alemtuzumab
Lemtrada Recombinant humanized MAB REMs program
46
Raynaud's Phenomenon
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
Raynaud's tx
Includes vasodilation CCB (nifedipine)
48
Drugs that cause or worsen Raynaud's
BB Bleomycin, cisplatin Smypathomimetics (amphetamines, cocaine)
49
Gluten found in
Wheat, barley, rye
50
Celiac Disease symptoms
Diarrhea, abdominal pain, bloating, and weight loss
51
Myasthenia Gravis Background
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
Pyridostigmine
Blocks breakdown of ACh | Can cause cholinergic effects (salivation, lacrimation etc)
53
Sjogren's Syndrome Background
Commonly characterized by dry eyes and mouth. Complications include dental cavities, corneal ulcerations, and chronic oral infections
54
Restasis
Cyclosporine emulsion | Can cause ocular burning
55
Lifitegrast
Xiidra | SE: unusual taste
56
Non-pharm for dry mouth
- sugar free chewing gum (xylitol) - Lozenges - Daily rinses with antimicrobial mouthwashes
57
Psoriasis background
Most common is plaque psoriasis appears as raised, red patches covered with a silvery white buildup
58
Non-pharm for Psoriasis
UV light exposure causes activated t-cells in the skin to die
59
Topicals for Psoriasis
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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