Chapter 46: Systemic Steroids & Autoimmune Conditions Flashcards
Which steroid drug mimics aldosterone
fludrocortisone
Fludrocortisone is FDA approved for ____ & used off-label for ____
Addison’s disease
Orthostatic hypotension
Steroids such as prednisone and hydrocortisone have more ____ activity, which has more ____ effects
glucocorticoid; anti-inflammatory
Systemic steroids can cause the adrenal gland to stop producing ____, which is called ____
cortisol; suppression of the HPA axis
Cushing’s Syndrome develops when the adrenal gland produces too much ____, or when exogenous (i.e., taken as a drug) steroids are taken in high doses
cortisol
In Addison’s disease:
the adrenal gland is not making enough cortisol
If exogenous steroids are stopped suddenly, it can cause
Addisonian Crisis, which can be fatal
What are ways to reduce systemic steroid risks
- use alternate day dosing
- for a condition in the gut, use a steroid with low systemic absorption, such as Budesonide
- For joint inflammation, inject into the joint so the drug stays local
- For treatment of asthma, use inhaled steroids that mostly stay in the lungs
- For conditions that require long-term steroids, use the lowest possible dose for the shortest possible time
Rank steroids from least to most potent
Remember: Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies Cortisone Hydrocortisone Prednisone Prednisolone Methylprednisolone Triamcinolone Dexamethasone Betamethasone
What is the brand name for dexamethasone
DexPak 6, 10 or 13 day, Decadron
What is the brand name for hydrocortisone
Solu-Cortef
What is the brand name for methylprednisolone
Medrol, Solu-Medrol
What is the brand name for prednisone
Deltasone
What is the brand name for prednisolone
Millipred, Orapred ODT
What is the brand name for Triamcinolone
Kenalog
If taking steroids once daily, take between ____ to mimic the natural diurnal cortisol release
7-8 AM
Should steroids be taken with or without food?
With food
Steroid-induced medical conditions include:
- diabetes
- hypertension
- glaucoma
- psychiatric conditions
Must taper steroids if taking longer than ___ days
14
Short-term side effects of steroids can lead to:
increased appetite/weight gain, emotional instability, insomnia
Cortisone is a prodrug of
cortisol
prednisone is a prodrug of
prednisolone
A patient is immunosuppressed when using >/= __ mg/kg/day or >/= __ mg/day of prednisone or prednisone equivalent
2; 20
Common way to taper steroids
Reduce the dose by 10-20% every few days. Tapers can last 7-14 days
Nonspecific lab blood tests that can be useful in detecting inflammation include:
ESR, C reactive protein, rheumatoid factor, and antinuclear antibody
The use of strong immunosuppressants can increase the risk of certain conditions including:
- Reactivation of TB and Hep B and C
- Viruses
- Lymphomas and certain skin cancers
- Infections
_____ is consistent with a rheumatoid arthritis diagnosis
Bilateral, symmetrical disease
What are common symptoms of RA
Joint swelling, pain, stiffness, bone deformity
Which lab tests are useful to help diagnose RA
rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA)
Patients with symptomatic RA should be started on ____, regardless of the severity
DMARD
What is the preferred initial DMARD for most patients with RA
Methotrexate
Which class of medication are used for RA flares
steroids (low-dose)
What is the brand name for MTX oral tab
Trexall
What is the brand name for MTX SC auto-injectors
Otrexup and Rasuvo
What is the MOA of MTX
Irreversibly binds and inhibits dihydrofolate reducatse, inhibiting folate
What is the dosing for MTX for RA
7.5-20 mg once weekly (PO, SC, IM)
Why should MTX not be dosed daily in RA
Numerous incidences of ADE (e.g, mouth sores, intestinal bleeding, liver damage) have occurred in patients taking daily
Boxed warnings for MTX
hepatotoxicity, myelosuppression, mucositis/stomatitis, pregnancy
What should be monitored when using MTX
CBC, LFTs, CXR, hepatitis B and C serologies
Why is folate given with MTX
To decrease hematological, GI and hepatic SE
Brand name for hydroxychloroquine
Plaquenil
Warning for hydroxychloroquine
irreversible retinopathy
When would you use hydroxychloroquine over MTX
If there is a concern for liver disease
What is a CI for sulfasalazine
sulfa or salicylate allergy
What color can sulfasalazine turn the skin/urine
yellow-orange
What is the MOA for leflunomide
Inhibits pyrimidine synthesis resulting in anti-proliferative and anti-inflammatory effects
Boxed warnings for leflunomide
Do not use in pregnancy (teratogenic); hepatotoxicity
What are the accelerated drug elimination options for leflunomide
- Cholestyramine 8 grams PO TID x 11 days
2. activated charcoal suspension 50 grams po Q12H x 11 days
If pregnancy is desired when using leflunomide, you must wait ___ after discontinuation or use accelerated drug elimination procedures
2 years
Boxed warnings for Janus Kinase Inhibitors
Serious infections including TB, fungal, viral, bacterial and others; malignancies; thrombosis