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PHRM 864: Therapeutics IV > Lupus > Flashcards

Lupus Flashcards

1
Q

What is Systemic LUPUS Erythematosus?

A
  • Autoimmune Disease: Body attacks self
  • Causes widespread inflammation and tissue damage that affects almost any organ
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2
Q

What is the Epidemiology of Lupus?

A
  • 16,000 new cases/year
  • Females >males
  • Age 15-45
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3
Q

What is the Pathophysiology of Lupus?

A
  • Genes & Environment
  • Leading to Abnormal Immune Response
  • Making Autoantibodies Immune Complexes
  • Resulting Inflammation & Damage
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4
Q

what are some of the Risk Factors for Lupus?

A
  • Environmental: Infections, UV, Dust, Soil, Allergens, Smoking
  • Genetic: 3+ on X-Chromosome –> why its female
  • Hormonal
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5
Q

What is the way that Drug-INduced Lupus Erythematosus [DILE] happens?

A
  • Its the overreaction to meds
  • Symptoms within 3-6 months
  • Resolution within weeks
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6
Q

What are some of the Medications that cause DILE in Lupus?

Need to know!!

A
  • Metimazole, Propylthiouracil
  • Methyldopa
  • Minocycline
  • Procainamide
  • Hydralazine
  • Anti-TNF Agents
  • Terbinafine
  • Isoniazid
  • Quinidine
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7
Q

What are some of the symptoms of Lupus?

A
  • Fatigue, Depression, Weight loss of gain, Muscle pain, “Butterfly” Rash, Photosensitivity, Joint Pain
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8
Q

What are some of the areas that Lupus could affect?

A
  • Brain: Psychosis, Seizures
  • Lungs: Pneumonitis
  • Vessels: Vasulitis
  • Kidneys: LUPUS NEPHRITIS
  • Skin: Erythema, Butterfly Rash
  • Heart
  • Spleen
  • Joints
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9
Q

What are some other important information about Lupus?

Mortality? QoL? Cost?

A
  • Mortality: 10-15% will die early
  • QoL: Limited functioning; 89% cant work
  • Cost: Very expensive $33,223
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10
Q

What is Lupus known as?

A
  • “Great Imitator”
  • Mimics other diseases
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11
Q

Based on the 2012 SLICC Criteria, what is important to know about Diagonsis of Lupus?

Dont need to know everything just breif info

A
  • Clinical & Immunologic Criteria
  • Must meet 4 of 17 criteria [>1 clinical & >1 immunologic]; OR biopsy
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12
Q

What is the most common Immunologic Criteria that we look at for Lupus Diagnosis?

A
  • ANA: 98% prevalence
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13
Q

What are the goals of therapy for Lupus?

A
  • Induction: Control Disease
  • Maintenacne: Maintain Remission; Prevent Flares
  • Adjunctive: Reduce drugs adverse effects

Decreased Flares; Increase Remission

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14
Q

What are some of the Pharmacologic Treatments for Lupus?

A
  • Hydroxycholorquine
  • Glucocorticoids
  • Immunsuppressants
  • Biologics
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15
Q

What is important to know about Hydrocholoquine in Lupus?

MOA? Place?

A
  • MOA: Antimalarial –> Reduces Autoantibodies
  • Place: ALL patients with Lupus
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16
Q

What are some of the Side Effects of Hydrocholoquine in Lupus?

A
  • Cardiomyopathy, Hemolytic Anemia [G6PD Deficiency], Hypoglycemia, QTc Prolongation, Rentinal Toxicity

Eye Exam ANNAULLY

17
Q

Breif describe what happens within G6PD Deficiency in Lupus?

A
  • G6PD makes glutathione that fights free radicals
  • SO; Decreased G6PD = Increased Free Radicals = Lysed RBC
18
Q

What is the importance of Steroids in Lupus?

MOA? Place?

A
  • MOA: Decreased WBC Activity
  • Place: Mild-Mod = PO Steroids; Severe = IV Steroids
19
Q

What are some of the steriods that are used in Lupus?

A
  • IV Methyprednisolone
  • PO Prednisone
20
Q

What is the Maintenacne goal for steriods in Lupus?

KNOW FOR EXAM

A
  • < 7.5 mg/day [prednisone equivalent] and stop ASAP
21
Q

What are some of the Side Effects of Steroids in Lupus?

Important to know

A
  • Cardio, Insomina, Cushing Syndrome, N/V/D, Ulcers, Hyperglycemia, Infections, Osteoporosis, Glaucoma
22
Q

What is the MOA of Immunosuppressants in Lupus?

A
  • MOA: Stops immune system from attacking healthy tissues
23
Q

What is the Place of Therapy for Immunosuppresants in Lupus?

A
  • Insufficient response in HCQ & are Steroid Sparing [helps decreased steroid use]
  • Mild Disease = MTX
  • Mod Disease = AZA, CNI, MMF
  • Severe Disease = CYC [a lot of side effects]
24
Q

What are some of the Side Effects for the Immunosuppresants in Lupus?

For MTX, MMF, AZA, CYC

A
  • Bone Marrow Suppression, Infections, Malignancy
25
Q

What are two important things to understand about Methotrexate & Azathioprine in Lupus?

A
  • MTX: dosed WEEKLY
  • AZA: Genetic Test –> TPMT/NUDT15 Deficiency
26
Q

Breif describe the TPMT deficiency in Lupus?

A
  • AZA –> 6-MP and TPMT makes it INACTIVE
  • SO; Decreased TPMT will Increase 6-MP [AZA] toxicities = Bone Marrow Suppression
27
Q

What is the MOA for the Biologics in Lupus

A
  • MOA: Monoclonal Antibodies blocks B-cells
28
Q

What is the Place of Therapy for the Biologics in Lupus?

A
  • Inadeqate response to HCQ + S
  • Mod Disease = belimumab
  • Severe Disease = rituximab
29
Q

What are some of the Side Effects for the Biologics in Lupus?

A
  • Hypersensitivity and/or Infusion Reactions
  • Premedicate

Rituximab has Hep B reactivation and PML

30
Q

What are some of the medications that are used for Premedication in Bioloigcs in Lupus?

A
  • Acetaminophen [NSIADs], Histamines, Methylprednislone
31
Q

What are some of the treatments for Cutaneuos Lupus?

A
  • First Line: Topical [clobetasol, betamethasone, triamcinolone, hydrocortisone], HCQ, Steriods
32
Q

What are some of the treatments for Lupus Nephritis?

A
  • Induction: MMF or CYC + Steriods
  • Maintenance: MMF or AZA [not in TPMT deficiency]
  • Severe: RTX
33
Q

What is Anti-Phospholipid Syndrome in Lupus?

MOA?

A
  • Autoimmune disorder with antiphospholipid antibodies that causes blood clots and miscarrage
34
Q

What are some of the Prophylactic Treatments that are used in Anti-phospholipid syndrome in Lupus?

A
  • Primary Prophylaxis: Aspirin 81mg
  • Secondary Prophylaxis: Warfarin +/- Aspirin 81mg
  • During Pregnancy: Enoxaparin
35
Q

What is important to know about Pregnancy in Lupus?

A
  • Higher maternal and fetal risk [increased Miscarrage & flares]
  • Should start to try to get pregnant 6 months after remission
  • Avoid: Cyclophosphamide, Mycophenolate, Methotrexate –> wati 3-6 months before trying

PHRM 864: Therapeutics IV (28 decks)

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