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PHRM 864 Therapeutics > Exam 4 - Lupus Siwy > Flashcards

Exam 4 - Lupus Siwy Flashcards

1
Q

lupus is more common in which gender?

A

females (9 in 10 lupus pts are female)

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2
Q

3 main classes of pre-disposing factors for lupus etiology

A

genetics; hormonal; environment

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3
Q

drug-induced lupus erythematosus (DILE) sx occurs after ___-___ months of drug initiation

A

3-6 months

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4
Q

around ___% of SLE cases are drug-induced

a. 1%
b. 10%
c. 50%
d. 99%

A

b. 10%

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5
Q

DILE examples pneumonic

A

My Pretty Malar Marking Probably Has A Transient Quality

(Methimazole, Propylthiouracil, Methyldopa, Minocycline, Procainamide, Hydralazine, Anti-TNF agents, Terbinafine, Isoniazid, Quinidine)

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6
Q

KB is a 21 YOF who presents to the PCP with a new onset of joint pain, fatigue, and rash on her face covering her cheeks and nose.
PMH: Acne and depression
Medications:
* Tylenol 325 mg PO Q6H PRN
* Sprintec PO daily (started 1 year ago)
* Sertraline 50 mg PO daily (started 1 year ago)
* Minocycline 100 mg PO BID (started 4 months ago)

Which medication is most likely contributing to KB’s lupus-like syndrome?

a. tylenol
b. sprintec
c. sertraline
d. minocycline

A

d. minocycline

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7
Q

what is a “Malar” rash?

A

butterfly shaped rash

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8
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. Butterfly-shaped rash on the face

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9
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. Sun exposure (photosensitivity)

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10
Q

first-degree relatives are ___ times more likely to develop SLE

A

20 times

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11
Q

_______ production may modulate the incidence and severity of SLE

a. testosterone
b. estrogen

A

b. estrogen

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12
Q

~ how many meds can cause drug-induced lupus erythematosis (DILE)?

A

~46

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13
Q

must meet 4 or more total features with 1 from each group
OR
Biopsy-proven Lupus Nephritis WITH systemic lupus(+ Anti-dsDNA antibodies or + ANA)

a. SLICC
b. EULAR/ACR

A

a. SLICC

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14
Q

Patient’s score is ≥ 10 AND at least 1 clinical criterion is fulfilled

a. SLICC
b. EULAR/ACR

A

b. EULAR/ACR

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15
Q

4 key labs to look at for Lupus

A

ANA (anti-nuclear antibody)
Anti-dsDNA (anti-double-stranded DNA)
Anti-SM (Anti-Smith Antibody)
Antiphospholipid Antibody

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16
Q

which labs have HIGH specificity for SLE diagnosis? SELECT ALL THAT APPLY (2 of them)

a. ANA
b. Anti-dsDNA
c. Anti-SM
d. Antiphospholipid Antibody

A

b. Anti-dsDNA
c. Anti-SM

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17
Q

important marker for lupus nephritis, correlates with disease activity

a. ANA
b. Anti-dsDNA
c. Anti-SM
d. Antiphospholipid Antibody

A

b. Anti-dsDNA

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18
Q

which lab is positive in lupus pts but NOT SPECIFIC?

a. ANA
b. Anti-dsDNA
c. Anti-SM
d. Antiphospholipid Antibody

A

a. ANA

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19
Q

which drug should not be given in pts with a G6PD deficiency?

a. hydroxychloroquine
b. NSAIDs
c. glucocorticoids

A

a. hydroxychloroquine

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20
Q

X-linked disorder that causes RBCs to prematurely break down

A

G6PD deficiency

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21
Q

oral glucocorticoids dose for mild-moderate SLE

A

prednisone 5-30 mg/day

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22
Q

oral glucocorticoid dose for severe SLE

A

prednisone 1 mg/kg/day

23
Q

IV glucocorticoid dose for pulse therapy

A

methylprednisolone 500-1000 mg IV daily x 3-6 days, then PO prednisone

24
Q

low-potency topical glucocorticoids that can be used on face (2 of them)

a. fluocinolone valerate
b. hydrocortisone butyrate
c. triamcinolone acetonide
d. betamethasone valerate
e. clobetasol

A

a. fluocinolone valerate
b. hydrocortisone butyrate

25
moderate-potency topical glucocorticoids used on trunks and extremities (2 of them) a. fluocinolone valerate b. hydrocortisone butyrate c. triamcinolone acetonide d. betamethasone valerate e. clobetasol
c. triamcinolone acetonide d. betamethasone valerate
26
high-potency topical glucocorticoid used for scalp sores and palms a. fluocinolone valerate b. hydrocortisone butyrate c. triamcinolone acetonide d. betamethasone valerate e. clobetasol
e. clobetasol
27
glucocorticoids place in therapy for SLE
adjunctive tx, if not responsive to NSAIDs/hydroxychloroquine
28
which labs for glucocorticoids do we NOT check routinely? a. BP b. BMP c. FLP d. bone mineral density
a. BP (check BMP, FLP every 6 months; check bone mineral density every year)
29
4 immunosuppressants for SLE (slide 45)
methotrexate (MTX) azathioprine (AZA) cyclophosphamide (CYC) mycophenolate mofetil (MMF)
30
initial dose 5-15 mg PO once weekly a. methotrexate (MTX) b. azathioprine (AZA) c. cyclophosphamide (CYC) d. mycophenolate mofetil (MMF)
a. methotrexate (MTX)
31
initial dose 1-1.5 g PO twice daily a. methotrexate (MTX) b. azathioprine (AZA) c. cyclophosphamide (CYC) d. mycophenolate mofetil (MMF)
d. mycophenolate mofetil (MMF)
32
initial dose 1-1.5 mg/kg PO once daily a. methotrexate (MTX) b. azathioprine (AZA) c. cyclophosphamide (CYC) d. mycophenolate mofetil (MMF)
c. cyclophosphamide (CYC)
33
initial dose 50 mg PO daily a. methotrexate (MTX) b. azathioprine (AZA) c. cyclophosphamide (CYC) d. mycophenolate mofetil (MMF)
b. azathioprine (AZA)
34
which drug should we monitor for TPMT deficiency? a. methotrexate (MTX) b. azathioprine (AZA) c. cyclophosphamide (CYC) d. mycophenolate mofetil (MMF)
b. azathioprine (AZA)
35
initial IV dose for cyclophosphamide (CYC)
IV 0.5 mg/m2 BSA every 1-6 months
36
which drug does NOT have malignancy listed as a SE or toxicity? a. methotrexate (MTX) b. azathioprine (AZA) c. cyclophosphamide (CYC) d. mycophenolate mofetil (MMF)
a. methotrexate (MTX)
37
which drug has acute inflammatory syndrome as a SE/toxicity? a. methotrexate (MTX) b. azathioprine (AZA) c. cyclophosphamide (CYC) d. mycophenolate mofetil (MMF)
d. mycophenolate mofetil (MMF)
38
2 clinical pearls of biologics
-no live vaccines 30 days before starting therapy OR during therapy -don't use more than 1 biologic at the same time
39
3 biologics for SLE
belimumab rituximab anifrolumab
40
for which biologic should we definitely premedicate ~ 30 min prior to administration? a. belimumab b. rituximab c. anifrolumab
b. rituximab
41
which biologic can cause Hep B reactivation? a. belimumab b. rituximab c. anifrolumab
b. rituximab
42
3 calcineuron inhibitors
tacrolimus pimecrolimus voclosporin
43
first FDA-approved oral med for lupus nephritis a. tacrolimus b. pimecrolimus c. voclosporin
c. voclosporin
44
cutaneous lupus first line (3)
topical agent (GC or CNI) HCQ systemic GC
45
which is NOT a tx for REFRACTORY cutaneous lupus? a. high dose GC b. HCQ c. MMF d. MTX
b. HCQ
46
mild/mod lupus nephritis tx (2 things)
GC +/- immunosuppressant (AZA, MMF, CNI
47
severe lupus nephritis tx: ____ (preferred) or CYC +/- GC
MMF
48
CNI's need eGFR > ____
> 45
49
which 3 drugs for SLE are CI in pregnancy and should be d/c 3-4 months prior to conception?
MMF, CYC, MTX
50
pregnancy and SLE: pts should be screened for _________ syndrome
antiphospholipid
51
which drug in SLE and pregnancy can inc risk of intrahepatic cholestasis of pregancy (ICP)? a. HCQ b. MMF c. MTX d. AZA
d. AZA
52
antiphospholipid syndrome prophylaxis with no fetal loss tx a. aspirin 81 mg b. aspirin 81 mg +/- LMWH c. LMWH
a. aspirin 81 mg
53
antiphospholipid syndrome prophylaxis with fetal loss tx a. aspirin 81 mg b. aspirin 81 mg +/- LMWH c. LMWH
b. aspirin 81 mg +/- LMWH

PHRM 864 Therapeutics (28 decks)

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