Lupus Flashcards
SLE predisposing factors
- genetics
- hormonal - estrogen
- environment - smoking, drugs, UV, pollution, etc
Drug-induced lupus medications (acronym)
my pretty malar marking probably has a transient quality
methimazole
propylthiouracil
minocycline
methyldopa
procainamide
hydralazine
anti-TNF agents
terbinafine
isoniazid
quinidine
Which laboratory tests have high specificity for lupus?
anti-dsDNA antibody
anti-Smith antibody
SLICC diagnostic requirements
must meet ≥ 4 total features with 1 from each group (clinical and immunological)
What is the backbone treatment of SLE?
Hydroxychloroquine
If someone has G6PD deficiency, which medication should they not take?
hydroxychloroquine
HCQ side effects
- retinal toxicity - bullseye maculopathy
- neuropsychiatric effects
- QTc prolongation
- myopathy
- hypersensitivity rxn
- hypoglycemia
- hemolytic anemia - G6PD deficiency
Glucocorticoids place in therapy
adjunct treatment - if not response to HCQ or NSAIDs
Glucocorticoids side effects
- glaucoma
- increased BP
- increased risk of osteoporosis
- GI bleed, gastritis
- sleep disturbances
- weight gain
- increased BG/hyperglycemia
- topical steroid - skin atrophy, rosacea
Immunosuppressants place in therapy
- adjunct when disease gets more severe or to lower steroid dose
- insufficient response to HCQ
Which immunosuppressants are used for SLE?
- methotrexate
- azathioprine
- cyclophosphamide
- mycophenolate
All of the immunosuppressants have a side effect of increased risk of malignancy, EXCEPT
methotrexate
All of the immunosuppressants have these side effects in common:
bone marrow suppression
infection
Which immunosuppressant has the unique side effect of acute inflammatory syndrome (AIS)?
mycophenolate
Which immunosuppressant should you not use with a TPMT deficiency?
azathioprine
Which biologics are used for SLE?
- Belimumab
- Rituximab
- Anifrolumab
Biologics clinical pearls
- no live vaccines 30 days before starting therapy OR during therapy
- do not use more than 1 biologic at same time
With which biologic should you premedicate 30 mins prior to infusion to avoid infusion reactions?
rituximab
Which biologic may reactivate Hep B?
rituximab
Additional therapies for SLE
Calcineurin inhibitors:
tacrolimus
pimecrolimus
volcosporin
