Immunologic agents

Question 1

hydrochloroquine (Plaquenil)
sulfasalazine
lefluonomide (Arava)

Answer 1

Continue as long as the gut is functional, can miss a few days

Question 2

rituximab (Rituxan)

Answer 2

Schedule surgery around when next dose should be given (4-6 months after last dose)
UtD - sx in the 7th month post-dose

Question 3

Biologic DMARDS

infliximab Remicade
anakinra Kineret
certolizumab Cimzia
golimumab Simponi
tocilizumab Actemra

Answer 3

Schedule surgery at end of skipped dosing cycle for the specific med.
Restart when wound healing is complete, usually POD 14

Question 4

Anti-rejection rx/immune suppressants

azathioprine
6 mercaptopurine
cyclosporine (Neoral)
mycophenolate (Cellcept)
sodium aurothiomalate (Myochrysine)
tacrolimus (Prograf)

Answer 4

Transplant pts: continue

Severe SLE: Weigh risk of disease flare without meds vs risk of infection with meds

can stop these meds x 7 days preop if mild SLE

Question 5

Interferons
interferon beta-1B (Betaseron),
Interferon beta-1a (Avonex, Rebif)
glatiramer acetate (Copaxone)
teriflunomide (Aubagio)

Answer 5

Continue

Question 6

Methotrexate

Answer 6

Continue

Question 7

etanercept (Enbrel)

Answer 7

if dosing q week;

Schedule surgery in the 2nd week after the held dose

Question 8

adalimumab (Humira)

Answer 8

if dosing q 2 weeks;

schedule surgery in the 3rd week after the last dose

Question 9

abatacept (Orencia)

Answer 9

if dosing q 4 weeks,

schedule surgery in the 5th week after last dose

Question 10

tofactinib

kinase inhibitor

Answer 10

increased risk of surgical site infection

UtD suggests stopping 7 days prior to sx