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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
Q

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

A

c. triamcinolone acetonide
d. betamethasone valerate

26
Q

high-potency topical glucocorticoid used for scalp sores and palms

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

A

e. clobetasol

27
Q

glucocorticoids place in therapy for SLE

A

adjunctive tx, if not responsive to NSAIDs/hydroxychloroquine

28
Q

which labs for glucocorticoids do we NOT check routinely?

a. BP
b. BMP
c. FLP
d. bone mineral density

A

a. BP (check BMP, FLP every 6 months; check bone mineral density every year)

29
Q

4 immunosuppressants for SLE (slide 45)

A

methotrexate (MTX)
azathioprine (AZA)
cyclophosphamide (CYC)
mycophenolate mofetil (MMF)

30
Q

initial dose 5-15 mg PO once weekly

a. methotrexate (MTX)
b. azathioprine (AZA)
c. cyclophosphamide (CYC)
d. mycophenolate mofetil (MMF)

A

a. methotrexate (MTX)

31
Q

initial dose 1-1.5 g PO twice daily

a. methotrexate (MTX)
b. azathioprine (AZA)
c. cyclophosphamide (CYC)
d. mycophenolate mofetil (MMF)

A

d. mycophenolate mofetil (MMF)

32
Q

initial dose 1-1.5 mg/kg PO once daily

a. methotrexate (MTX)
b. azathioprine (AZA)
c. cyclophosphamide (CYC)
d. mycophenolate mofetil (MMF)

A

c. cyclophosphamide (CYC)

33
Q

initial dose 50 mg PO daily

a. methotrexate (MTX)
b. azathioprine (AZA)
c. cyclophosphamide (CYC)
d. mycophenolate mofetil (MMF)

A

b. azathioprine (AZA)

34
Q

which drug should we monitor for TPMT deficiency?

a. methotrexate (MTX)
b. azathioprine (AZA)
c. cyclophosphamide (CYC)
d. mycophenolate mofetil (MMF)

A

b. azathioprine (AZA)

35
Q

initial IV dose for cyclophosphamide (CYC)

A

IV 0.5 mg/m2 BSA every 1-6 months

36
Q

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

a. methotrexate (MTX)

37
Q

which drug has acute inflammatory syndrome as a SE/toxicity?

a. methotrexate (MTX)
b. azathioprine (AZA)
c. cyclophosphamide (CYC)
d. mycophenolate mofetil (MMF)

A

d. mycophenolate mofetil (MMF)

38
Q

2 clinical pearls of biologics

A

-no live vaccines 30 days before starting therapy OR during therapy
-don’t use more than 1 biologic at the same time

39
Q

3 biologics for SLE

A

belimumab
rituximab
anifrolumab

40
Q

for which biologic should we definitely premedicate ~ 30 min prior to administration?

a. belimumab
b. rituximab
c. anifrolumab

A

b. rituximab

41
Q

which biologic can cause Hep B reactivation?

a. belimumab
b. rituximab
c. anifrolumab

A

b. rituximab

42
Q

3 calcineuron inhibitors

A

tacrolimus
pimecrolimus
voclosporin

43
Q

first FDA-approved oral med for lupus nephritis

a. tacrolimus
b. pimecrolimus
c. voclosporin

A

c. voclosporin

44
Q

cutaneous lupus first line (3)

A

topical agent (GC or CNI)
HCQ
systemic GC

45
Q

which is NOT a tx for REFRACTORY cutaneous lupus?

a. high dose GC
b. HCQ
c. MMF
d. MTX

A

b. HCQ

46
Q

mild/mod lupus nephritis tx (2 things)

A

GC +/- immunosuppressant (AZA, MMF, CNI

47
Q

severe lupus nephritis tx: ____ (preferred) or CYC +/- GC

A

MMF

48
Q

CNI’s need eGFR > ____

A

> 45

49
Q

which 3 drugs for SLE are CI in pregnancy and should be d/c 3-4 months prior to conception?

A

MMF, CYC, MTX

50
Q

pregnancy and SLE: pts should be screened for _________ syndrome

A

antiphospholipid

51
Q

which drug in SLE and pregnancy can inc risk of intrahepatic cholestasis of pregancy (ICP)?

a. HCQ
b. MMF
c. MTX
d. AZA

A

d. AZA

52
Q

antiphospholipid syndrome prophylaxis with no fetal loss tx

a. aspirin 81 mg
b. aspirin 81 mg +/- LMWH
c. LMWH

A

a. aspirin 81 mg

53
Q

antiphospholipid syndrome prophylaxis with fetal loss tx

a. aspirin 81 mg
b. aspirin 81 mg +/- LMWH
c. LMWH

A

b. aspirin 81 mg +/- LMWH

PHRM 864 Therapeutics (28 decks)

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