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PHRM 864 > E4 Lupus > Flashcards

E4 Lupus Flashcards

jesus christ

1
Q

3 main etiologies of lupus

A

genetics, hormonal, environment

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2
Q

T or F:
2nd degree relatives w/ lupus equates to 20 times more likely to develop it

A

false, 1st degree (dumb card im sorry)

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3
Q

hormonal etiology:
_______ production may modulate the incidence and severity SLE

A

estrogen

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4
Q

weird environmental factor contributing to lupus etiology

A

UV light, so sunscreen is imporTENT (also pesticides but she didnt talk about that as much)

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5
Q

DILE acronym for lupus

A

My
Pretty
Malar
Probably
Has
A
TransIent (capital I too)
Quality

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6
Q

drugs for that acronym for DILE

A

Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine
Anti-TNF agents (infliximab and etanercept)
Terbinafine
Isoniazid
Quinidine

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7
Q

Which medication is most likely contributing to KB’s lupus-like syndromes?
Tylenol
Sprintec
Sertraline
Minocycline

A

minocycline

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8
Q

what is malar?

A

butterfly rash thing, resembles the wings, typically on face and shit i think

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9
Q

2 musculoskeletal s/sxs

A

arthralgias and myalgias

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10
Q

mucocutaneous s/sxs (5)

A

butterfly rash
photosensitivity
ulcers
discoid rash
raynauds pheno

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11
Q

1 ophthalmologic sx of lupus

A

lupus retinopathy (is this different than other retinopathies lol)

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12
Q

1 renal sx lupus

A

lupus nephritis*

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13
Q

3 pulmonary sxs lupus

A

dyspnea
pleuritis
pleural effusion

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14
Q

thrombosis sx lupus

A

antiphospholipid antibodies (say that 5 times fast)

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15
Q

immunologic sx lupus

A

autoantibodies

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16
Q

What is a classic skin manifestation of lupus?
A. Butterfly-shaped rash on the face
B. Blisters on the hand
C. Scaling on the scalp
D. Darkening around the eyes

A

A

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17
Q

Which of the following is a common trigger for lupus flare-ups?
A. Regular exercise
B. High sodium intake
C. Sun exposure
D. High cholesterol

A

C

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18
Q

2 very important diagnostic tools for lupus

A

SLICC
EULAR/ACR

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19
Q

SLICC:
Must meet ≥ __ total features with 1 from each group
OR?

A

4
or biopsy proving lupus nephritis (ANA+ and Anti-dsDNA+)

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20
Q

EULAR/ACR:
Patient’s score is ≥ __ AND at least 1 clinical criterion is fulfilled

A

10

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21
Q

T or F:
EULAR/ACR
Only the highest-weighted criterion score within a single domain is used

A

true

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22
Q

4 “very important” key labs for lupus

A
  • Anti-Nuclear Antibody (ANA)
  • Anti-double-stranded DNA (Anti-dsDNA)
  • Anti-Smith Antibody (Anti-SM)
  • Antiphospholipid antibody
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23
Q

not specific for diagnosis:
A. ANA
B. Anti-dsDNA
C. Anti-SM
D. Antiphospholipid antibody

A

A

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24
Q

High specificity for diagnosis of lupus
A. ANA
B. Anti-dsDNA
C. Anti-SM
D. Antiphospholipid antibody

A

B and C

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25
Q

important marker in lupus nephritis*
A. ANA
B. Anti-dsDNA
C. Anti-SM
D. Antiphospholipid antibody

A

B

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26
Q

Anti-SM AB binds to __ proteins that are attached to _______

A

SM, DNA

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27
Q

found in smaller % of patients
A. ANA
B. Anti-dsDNA
C. Anti-SM
D. Antiphospholipid antibody

A

C

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28
Q

increase clotting factors
A. ANA
B. Anti-dsDNA
C. Anti-SM
D. Antiphospholipid antibody

A

D

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29
Q

T or F:
in healthy patients each of the four key labs is typically negative

A

tru

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30
Q

what is the medication yasmin said ALL patients can use for lupus?

A

Hydroxychloroquine (every card after this it will just be HCQ)

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31
Q

HCQ MOA

A

antimalarial -> inhibit overactive immune cells

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32
Q

HCQ place in therapy

A

recommended for all patients with lupus

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33
Q

2 benefits for HCQ

A

reduce flares
help manage pain

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34
Q

dosing for HCQ
normal and max

A

fuck her for this shit but its 200-400 mg PO daily with max of 400

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35
Q

HCQ side effects (theres a lot but ill * the ones i think are most important)

A
  • retinal toxicity (bulls eye maculopathy) *
  • CNS effects
  • QT prolongation*
  • myopathy
  • hypersensitivity reaction
  • Hypoglycemia*
  • G6PD deficiency***
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36
Q

G6PD deficiency is a(n) (X/Y) linked disorder that causes what?

A

x-linked and causes RBCs to prematurely break down

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37
Q

G6PD converts what to what?

A

NADP+ to NADPH

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38
Q

G6PD conversion is important for production of _________

A

glutathione

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39
Q

what does glutathione do?

A

antioxidant that gets rid of free radicals that damage blood cells

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40
Q

avoid giving in pt with G6PD deficiency:
A. NSAIDs
B. Cyclophosphamide
C. Prednisone
D. HCQ

A

D

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41
Q

4 baseline monitoring parameters for HCQ

A

CBC
LFTs
SCr
EKG - bc qt prolongation

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42
Q

1 periodic monitoring parameter for HCQ

A

Eye exam. 3 months after starting, yearly after that

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43
Q

NSAIDs MOA

A

inhibit COX 1 and COX 2 and decrease prostaglandin precursor

44
Q

NSAIDs particularly helpful with what 4 things in lupus

A

fevers
serositis
myalgias
arthralgias

45
Q

NSAIDs place in therapy for lupus

A

1st line for mild symptoms

46
Q

ibuprofen dosing on slide

A

400-600 mg PO q6-8 hr

47
Q

naproxen dosing from slide

A

500 mg PO BID

48
Q

5 baseline monitoring parameters for NSAIDs

A

CBC
LFTs
SCr
BP
(also s/sx of fluid retention and bleeding duh)

49
Q

Glucocorticoids MOA

A

inhibit B and T cell responses

50
Q

3 benefits of glucocorticoids

A

anti-inflam
helpful during flares
variable dosage forms (PO, topical, IV)

51
Q

Glucocorticoids place in therapy for lupus

A

adjunctive treatment if not responsive to NSAIDs/HCQ

52
Q

T or F:
If a pt does not improve on HCQ and NSAIDs you can add on glucocorticoids no problem

A

true, can take all together

53
Q

Mild/moderate disease oral glucocorticoid drug and strength

A

prednisone 5-30 mg/day *

54
Q

severe disease oral glucocorticoid drug and strength

A

prednisone 1mg/kg/day

55
Q

IV glucocorticoid drug and regimen *

A

methylprednisolone 500-1000 mg IV daily 3-6 days, then PO prednisone after (no timeline for that one shown on slide)

56
Q

when are the topical GCs used in lupus?

A

cutaneous lupus (rash shit), ulcers, raynauds (do we actually do that for raynauds? seems like it wouldnt do anything)

57
Q

Topical GCs use:
Fluocinolone valerate & hydrocortisone butyrate (face)
A. Low-potency
B. Mod-potency
C. High-potency

A

A

58
Q

Topical GCs use:
Triamcinolone acetonide & betamethasone valerate (trunk and extremities)
A. Low-potency
B. Mod-potency
C. High-potency

A

B

59
Q

topical GCs use:
Clobetasol (scalp sores and palms)
A. Low-potency
B. Mod-potency
C. High-potency

A

C

60
Q

3 topical GC side effects (these are typically with long term use)

A

skin atrophy
rosacea
telangiectasis -> blood vessels more shallow

61
Q

4 baseline monitoring parameters for GCs

A

BP
BMP
FLP
Bone mineral density

62
Q

routine monitoring parameters for GCs:
BMP: every _ months
FLP: every _ months
Bone mineral density: _______

A

6
6
annually

63
Q

4 immunosuppressants used in lupus

A
  • Methotrexate (MTX)
  • Azathioprine (AZA)
  • Cyclophosphamide (CYC)
  • Mycophenolate mofetil (MMF)
64
Q

Immunosuppressants MOA

A

suppression of immune function from attacking healthy cells

65
Q

Immunosuppressants place in therapy (2)

A
  • adjunct to steroid therapy to lower the dose
  • insufficient response to HCQ
66
Q

MTX initial dose *

A

PO
5-15 mg once weekly

67
Q

Mycophenolate mofetil initial dose *

A

PO
1-1.5g twice daily

68
Q

Does not have a side effect/toxicity of malignancy
A. MTX
B. MMF
C. CYC
D. AZA

A

A *

69
Q

BMS/Infection
A. MTX
B. MMF
C. CYC
D. AZA

A

all of them

70
Q

Androgen insensitivity syndrome (AIS)
A. MTX
B. MMF
C. CYC
D. AZA

A

B

71
Q

only one that is both IV and oral
A. MTX
B. MMF
C. CYC
D. AZA

A

C

72
Q

Monitor TPMT deficiency
A. MTX
B. MMF
C. CYC
D. AZA

A

D

73
Q

CYC initial dose

A

1-1.5mg/kg once daily (is this oral or IV?)

74
Q

AZA initial dose

A

50 mg po qd

75
Q

Do not give if TPMT deficient
A. MTX
B. MMF
C. CYC
D. AZA

A

D

76
Q

3 biologics used in lupus

A

Belimumab
Rituximab
Anifrolumab

77
Q

MOA of biologics in lupus

A

mabs that block B-cell mediated immunity

78
Q

Biologics place in therapy for lupus (2)

A
  • inadequate response to HCQ and immunosuppressants
  • severe disease*
79
Q

2 pearls for biologics (super hard)

A

no live vaccines 30 days prior to starting therapy or during
and
dont use more than one at same time (woah fr)

80
Q

specific for lupus
A. Belimumab
B. Rituximab
C. Anifrolumab

A

A and C

81
Q

belimumab initial dose (IV btw)

A

10mg/kg every 2 weeks for 3 doses

82
Q

anifrolumab initial dose (IV)

A

300 mg every 4 weeks

83
Q

side effect/toxicity of malignancy *
A. Belimumab
B. Rituximab
C. Anifrolumab

A

C

84
Q

does not have infusion reactions listed in slides:
A. Belimumab
B. Rituximab
C. Anifrolumab

A

C

85
Q

absolutely premedicate
A. Belimumab
B. Rituximab
C. Anifrolumab

A

B

86
Q

Risk of Hep B reactivation
A. Belimumab
B. Rituximab
C. Anifrolumab

A

B

87
Q

rituximab initial dose (IV)

A

1 g on days 0 and
15 or
375 mg/m2 once
weekly
for 4 doses
no idea wtf this is but its on the slides so idk someone correct me if its too fucked up

88
Q

PML risk
A. Belimumab
B. Rituximab
C. Anifrolumab

A

B

89
Q

CNI drugs (additional therapies)

A

tacroLIMUS
pimecroLIMUS
vocloSPORIN

90
Q

3 non pharm things to help lupus

A

rest+exercise
smoking cessation
sun exposure + sunscreen

91
Q

first lin cutaneous lupus

A

Topical agents

92
Q

refractory cutaneous lupus

A

Higher dose GC
MTX
MMF

93
Q

therapy for mild/mod lupus nephritis *

A

GC +/- another immunosuppressant (AZA, MMF, or CNI)

94
Q

treatment for severe lupus nephritis

A

MMF (preferred) *
OR CYC +/- GC
could also consider triple therapy being:
Belimumab + MMF or CYC +/- GC
or
CNI + MMF +/- GC
wtf

95
Q

review slide 61 with someone smart

A

this is a call for help

96
Q

The best prognosis is when the patient achieves remission for ≥ _ months before pregnancy

A

6

97
Q

avoid what kind of contraception for lupus

A

estrogen-containing

98
Q

basically the only 3 drugs we want to use in pregnancy

A

HCQ
NSAIDs
GC

99
Q

which drug is drug of choice in pregnancy

A

HCQ

100
Q

when to d/c NSAIDs in pregnancy

A

at 20 weeks or later due to risk of premature closing of ductus arteriosus

101
Q

T or F:
antiphospholipid syndrome is an autoimmune disorder

A

true

102
Q

what two things can antiphospholipid syndrome cause?

A

blood clots
miscarriages

103
Q

drug therapy for antiphospholipid syndrome prophylaxis with no prior fetal loss

A

aspirin 81 mg

104
Q

drug therapy for antiphospholipid syndrome prophylaxis with prior fetal loss (does this mean a previous miscarriage?)

A

aspirin 81 mg +/- LMWH

105
Q

therapy for acute thrombotic event/hx of thrombosis in antiphospholipid syndrome

A

LMWH (enox or dalte)

PHRM 864 (28 decks)

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