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NAPLEX review 2024 RXPrep Book > Endocrine Conditions: Systemic Steroids & Autoimmune Conditions > Flashcards

Endocrine Conditions: Systemic Steroids & Autoimmune Conditions Flashcards

1
Q

Cortisol replaced by giving…..

A

any steroids

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2
Q

Aldosterone replaced by giving…..

A

fludrocortisone

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3
Q

Fludrocortisone info

A

mimis aldosterone
helps keep balance of water and electrolytes

FDA approved for Addison’s disease and off-label for orthostatic hypotension

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4
Q

Suppression of Hypothalamic-pituitary-adrenal axis (HPA)

A

systemic steroids can cause adrenal gland to stop producing cortisol due to feedback inhibition

need to be tapered off when stoping long term steroids

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5
Q

Cushings syndrome

A

can develop when adrenal gland produces too much cortisol or too many steroids taken at higher doses

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6
Q

Addison’s disease

A

opposite of Cushings

adrenal gland not making enough cortisol

if stop taking steroids used to help inc cortisol, can have addisonian crisis = volume depletion and hypotension = can be fatal

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7
Q

Cushings Syndrome signs

A

fat depsits in face = moon face or buffalo hump
poor done health
diabetes
Acne
Pink-purple stretch marks and skin that bruises easily
Thin arms/legs relative to body
impaired wound healing

Women: hair growth on face + irregular or missed periods

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8
Q

Cortisone: Hydrocortisone PO:IV

A

25mg Cortisone = 20mg Hydrocortisone

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9
Q

Prednisone/Prednisolone : Methylprednisolone/Triamcinolone PO:IV conversion

A

5mg of either = 4mg of either

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10
Q

Dexamethasone: Betamethasone PO:IV conversion

A

0.75mg Dexamethasone = 0.6mg Betamethasone

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11
Q

Glucocorticoid contraindications

A

Live vaccines, serious systemic infections

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12
Q

Glucocorticoid warnings

A

Adrenal suppression, if taking more than 14 days, taper off steroids slowly

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13
Q

Glucocorticoid side effects

A

Short term (use < 1 month)
inc appetite, weight gain, emotional instability, insomnia

Long term: Cushing’s syndrome

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14
Q

Immunosuppresion from steroids is when….

A

using > 2mg/kg/day or 20mg/day of prednisone or prednisone equivalent for > 2 weeks

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15
Q

How to taper steroid dose

A

reduce dose by 10-20% every few days

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16
Q

Strong immunosuppressants can increase risk of…..

A

reactivation of TB and Hep B/C, have to test prior to start of immunosuppressive drugs

Viruses, live vaccine have to be given before starting therapy

Lymphomas and certain cancers

infections

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17
Q

RA vs OA

A

OA = Osteoarthritis, usually presents one side of body
RA = Rheumatoid arthritis, usually both sides, symmetrical

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18
Q

RA symptoms

A

Joint swelling
pain
stiffness
bone deformity

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19
Q

Symptomatic RA should be treated with….

A

methotrexate = first choice (Disease modifying antirheumatic drug)

if moderate/high disease activity after methotrexate, can add TNFi or non TNF biologic

** never use two biologic DMARDs in combo **

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20
Q

RA flares

A

Steroids often used, should be used for lowest dose and shortest time possible

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21
Q

Traditional DMARDs

A

Methotrexate
Hydroxychloroquine

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22
Q

Methotrexate boxed warnings

A

Hepatotoxicity
myelosuppresion
mucositis/stomatitis
teratogenic in pregnancy

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23
Q

Methotrexate CI

A

pregnancy
breastfeeding
alcohol use disorder
chronic liver disease

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24
Q

Methotrexate side effects

A

N/V/D
inc LFTs
alopecia

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25
Q

Methotrexate monitoring

A

CBC
LFTs
Chest Xrays
Hep B/C tests

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26
Q

Giving folate with methotrexate

A

5mg weekly on day following max admin

can dec hematological, GI and hepatic side effects

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27
Q

Hydroxychloroquine warnings

A

irreversible retinopathy

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28
Q

Hydroxychloroquine side effects

A

N/V/D
vision changes

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29
Q

Hydroxychloroquine monitoring

A

CBC
LFTs
Eye exam at baseline and Q3 months **

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30
Q

Hydroxychloroquine risk of liver toxicity compared to MTX is….

A

lower, can be used as alternative if concern for liver disease

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31
Q

Sulfasalazine info

A

yellow-orange coloration of skin/urine
give with folate supplement
CI sulfa allergy

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32
Q

Leflunomide boxed warnings

A

dont use in pregnancy
hepatotoxicity, dont use in existing liver disease

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33
Q

Leflunomide CI

A

pregnancy

34
Q

Leflunamide notes

A

2 forms of birth control, wait for 2 years after stopping to get pregnant or use accelerate drug elimination procedure

35
Q

accelerated drug elimination procedure Leflunomide

A
  1. Cholestyramine 8grams PO TID X 11 days
  2. Activate charcoal suspension 50grams PO Q12h X 11 days
36
Q

JAK inhibitors

A

Tofacitinib (Xeljanz)
Baricitinib (Olumiant)
Upadacitinib (Rinvoq)

37
Q

JAK inhibitors boxed warnings

A

serious infections ie TB, fungal, viral, bacterial etc
Inc risk lymphomas and other malignancies
Inc risk thrombosis

38
Q

JAK inhibitors warnings

A

inc LFTS
avoid live vaccines
hematologic toxicities

39
Q

Methotrexate drug interactions

A

dont take with alc, can inc risk of liver toxicity
renal elim dec by aspirin/NSAIDs
avoid w/ sulfonamides + topical tacro
inc MTX/cyclosporine levels when used together

40
Q

TNF inhibitors

A

Etanercept = Enbrel
Adalimumab = Humira
Infliximab = Remicade
Certolizumab peg = Cimzia
Golimumab = Simponi

41
Q

TNF inhibitor boxed warnings

A

serious infections, screen for latent TB and treat
Lymphomas and other malignancies

42
Q

TNF inhibitor warnings

A

can cause demyelinating disease
Hep B reactivation
HF
Hepatotoxicity
lupus-like syndrome
dont sue with other DMARDs or Live vaccines

43
Q

TNF inhibitor monitoring

A

Prior to start = TB test, treat if needed

During: signs of infection, CBCs, LFTs, TB, HBV

44
Q

TNF inhibitor notes

A

dont freeze, keep in fridge

Enbrel and Humira can be at room temp for 14 days

TNFi add on, but first line in severe RA

45
Q

Non TNF inhibitors

A

Rituximab = Rituxan
Anakinra = Kineret
Abatacept = Orencia
Tocilizumab = Actemra
Sarilumab = Kevzara

46
Q

Rituxan boxed warnings

A

serious/fatal infusion related reactions = premed w/ tylenol+benadryl+ steroid

HBV reactivation

47
Q

Other non TNF inhibitor warnings

A

malignancies and serious infections

48
Q

Enbrel dosing

A

once weekly

49
Q

Humira dosing

A

every other week

50
Q

Simponi dosing

A

monthly

51
Q

Cimzia dosing

A

every other week after starting phase

52
Q

Common symptoms of SLE

A

fatigue
depression
anorexia
weight loss
muscle pain
malar rash = butterfly rash
photosensitivity
joint pain and stiffness

53
Q

IgG1-lambda monoclonal antibody for SLE

A

Belimumab = Benlysta

54
Q

Calcineurin inhibitor for SLE

A

Voclosporin (Lupkynis)

55
Q

Lupkynis info

A

Boxed warning: infections, malignancies

Warnings: Nephrotox, HTN, dont give with live vaccines

Side effects: HTN, Diarrhea, headache, renal impairment, ab pain, UTI

56
Q

treatment of MS relapse is often with….

A

IV steroids, usually 3-7 days IV methylpred

57
Q

Glatiramer acetate (Copaxone) warnings

A

chest pain
injection reaction

58
Q

Glatiramer acetate (Copaxone) side effects

A

injection site reactions
flushing
diaphoresis
dyspnea

59
Q

Glatiramer acetate (Copaxone) in pregnancy

A

Preferred treatment if necessary

60
Q

Interferon beta products

A

Avonex = Interferon beta-1a
Betaseron = Interferon beta-1b
Plegridy = Peginterferon beta-1a

61
Q

Interferon beta product warnings

A

psychiatric disorders
injection site necrosis
inc LFTs, thyroid dysfunction

62
Q

Interferon beta product side effects

A

flu-like symptoms

63
Q

S1P receptor modulators

A

Fingolimod = Gilenya
Ozanimod = Zeposia
Ponesimod = Ponvory
Spinonimod = Mayzent

64
Q

S1P receptor modulators CI

A

Ozanimod = dont use with MAOi
Siponimod = CYP2C93/3 genotype testing

65
Q

S1P receptor modulator side effects

A

can cause slow HR - monitor

pts on Fingolimod have to be monitored for atleast 6hrs ECG

inc risk of infection, screen VZV and monitor CBC

malignancies, macular edema (monitor w/ eye exam), monitor LFTs

66
Q

If treatment stopped with S1P receptor modulators then….

A

MS can get much worse

67
Q

Teriflunomide (Aubagio) contraindicated in…

A

pregnancy

68
Q

Natalizumab (Tysabri) info

A

for MS

Boxed warning for PML and has REMS program

69
Q

Alemtuzumab (Lemtrada) info

A

for MS

Has REMS program

70
Q

Raynaud’s phenomenon

A

triggered by cold and or stress, leading to vasospasm in commonly fingers/toes.

causes skin to turn white - then blue - followed by painful swelling

71
Q

Celiac disease symptoms

A

diarrhea
abdominal pain
bloaing
weight loss

72
Q

Myasthenia Gravis treatment

A

Pyridostigmine

warning: cholinergic effect, symptoms of excess ACh can occur

73
Q

Sjögren’s syndrome characterized by

A

dry eyes and mouth

no cure

74
Q

Eye drops for Dry eyes

A

Cyclosporine = Restasis
Lifitegrast = Xiidra

75
Q

Restasis info

A

side effects = ocular burning/stinging/redness/etc

can take 3-6 months to have inc tear production

76
Q

Xiidra info

A

Side effects = unusual taste, eye irritation

77
Q

Drugs for dry mouth

A

OTC = sugar free gum, mouth washes, lozenges

Rx = pilocarpine (salvaged) or cevimeline (Evoxac) = CI in narrow angle glaucoma and uncontrolled asthma patients

78
Q

Types of Psoriasis treatment

A

light therapy
topical meds
systemic meds

79
Q

Topical Psoriasis txm

A

Steroids
Tazarotene
Coal Tar products
Anthralin = Zithranol
CAlcipotriene
Tapinarof

80
Q

Retinoid for Psoriasis

A

Acitretin

only used in severe cases

Boxed warning: pregnancy and hepatotoxicity

81
Q

Otezla for psoriasis info

A

warning: weight loss, depression, suicidal thoughts

most common se are D/N/V, HA

82
Q
A

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