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PHRM 845 > Lupus > Flashcards

Lupus Flashcards

1
Q

what is SLE

A

chronic autoimmune dx
attacks healthy organs and tissue

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2
Q

how many people affected by lupus

A

1.5 mil Americans
5 mil worldwide

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3
Q

risk factors for lupus

A

female
childbearing age 15-45
non-white

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4
Q

etiology of Lupus

A

unknown but possibly
- genetic
- hormonal
- environmental

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5
Q

when might drug induced lupus poccur

A

3-6 months after initaition

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6
Q

drugs causing lupus

A

methimazole
propylthiouracil
methyldopa
minocycline
procainamide
hydralazine
anti-TNF
terbinafine
isoniazid
quinadine
my pretty malar marking probably has a transient quality

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7
Q

signs and symptoms of lupus

A

fatigue
depression
photosensitiviy
joint pain
N/V
fever
weight loss
malar butterfly rash
retinopathy
lupus nephritis
there isnt one clear presentation

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8
Q

lupus diagnosis criteria

A

> 4 symptoms, 1 fromeach group
or
biopsy lupus nephritis with anti dsDNA or ANA lab +
or
score is 10 and 1 clinical criteria filled

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9
Q

what is ANA lab

A

anti-nuclear antibody
positive in lupus but also non specific

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10
Q

what is anti-dsDNA lab

A

high specificity for lupus
disease activity
marker in lupus nephritis

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11
Q

what is anti-smith lab

A

high specificity for lupus

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12
Q

what is antiphospholipid antibody lab

A

increase in clotting factors

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13
Q

which labs have high specificity for lupus

A

anit-dsDNA
anti smith antibody

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14
Q

treatment options

A

hydroxychloroquine
NSAIDs
glucocorticoids
immunosupresants
biologics

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15
Q

first line treatment SLE

A

hydroxychloroquine

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16
Q

hydroxychloroquine dosing

A

200-400 mg PO daily
max 400 mg daily

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17
Q

side effects from hydroxychloroquine

A

retinal tox: bullseye maculopathy
anxiety/depression
QT prolong
myopathy
hypersensitivity reaction
G6PD deficiency
hypoglycemia
hemolytic anemia

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18
Q

what is a G6P deficeincy

A

x linked disorder that causes RBCs to breakdown

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19
Q

who should we not give hydroxychloroquine to?

A

G6P deficiency

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20
Q

monitoring for hydroxychloroquine

A

CBC
LFTs
SCr
EKG
eye exam - 3 months then annually

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21
Q

NSAIDs place in therapy

A

first line mild symptoms

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22
Q

dosing for NSAIDs

A

ibuprofen: 400-600 mg PO q6-8h
max: 3200 mg/day
naproxen: 500 mg PO BID
max: 1500 mg/day

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23
Q

side effects NSAIDs

A

GI bleed
increased BP, worsen HF, CV event
increased renal tox
hepatotox

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24
Q

monitoring for NSAIDs

A

CBC
LFTs
SCr
BP
s/sx fluid retention/bleeding

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25
Q

steroids place in therapy

A

if failure on HCQ and NSAIDS
- can add on

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26
Q

oral steroid tx

A

mild:prednisone 5-30 mg/day
severe: 1 mg/kg/day

27
Q

IV steroid tx

A

pulse therapy
methylpred: 500-1000 mg daily x 3-6 days then PO prednisone

28
Q

topical steroid use

A

cutaneous lupus

29
Q

which steroids low potency topical and place to use

A

fluocinolone and hydrocortisone (face)

30
Q

which steroids moderate potency topical and use

A

triamcinolone and betamethasone (trunk and extremitiies)

31
Q

which steroid to use high potency and locatin

A

clobetasol
(scalp and palms)

32
Q

corticosteroid adverse effects

A

glaucoma
incrased BP
osteoporosis
GI bleed, gastritis
sleep disturb
weight gain
hyperglycemia
Cushing

33
Q

topical side effects to steroids

A

rosacea
skin atrophy
telangiectasis

34
Q

monitoring for glucocorticoids

A

BP
BMP - every 6 month
FLP - every 6 month
bone mineral density - annual

35
Q

immunosuppressant meds used

A

methotrexate
azathioprine
cyclophosphamide
mycophenolate mofetil

36
Q

methotrexate dosing lupus

A

5-15mg once PO weekly

37
Q

methotrexate side effects

A

bone marrow supression
infection

38
Q

mycophenolate mofetil dosing

A

1-1.5 g BID

39
Q

mycophenolate mofetil adverse effects

A

bone marrow supression
infection
malignancy
acute inflammatory

40
Q

cyclophosphamide dose

A

1-1.5mg/kg once daily PO
0.5 mg/m2 BSA every month x 6 month

41
Q

cyclophosphamide side effects

A

BMS
infection
malignancy

42
Q

azathioprine dosing

A

50 mg PO daily

43
Q

azathioprine side effects

A

BMS
infection
malignancy

44
Q

azathioprine monitoring

A

TPMT deficiency

45
Q

what drug should we not give if TPMT deficiency

A

azathioprine

46
Q

biologics place in therapy

A

3rd line after HCQ and immunosuppressants

47
Q

biologic medications

A

belimumab
rituximab
anifrolumab

48
Q

what to consider with biologics

A

no live vaccines 30 days before starting therapy or during

49
Q

belimumab side effects

A

hypersensitivity
infusion reaction

50
Q

anifrolumab side effects

A

hypersensitivity reactions

51
Q

retuximab side effects

A

hypersensitivity reaction
infusion reaction
Hep B reactivation

52
Q

rituxumab consideration

A

premedicate 30 mins prior to admin

53
Q

additional therapies to consider

A

-limus
-sporins

54
Q

non-pharm treatments

A

exercise and rest
smoking cessation
limit UV exposure and use sunscreen

55
Q

cutaneous lupus drug therapy 1st line and refractory

A

1st line:topical steroid
hydroxychloroquine
if severe: systemic steroid

refractory: high dose steroid
MTX
mycophenolate

56
Q

lupus nephritis treatment mild to moderate

A

steroid +/- azathioprine, myco, -limus

57
Q

lupus nephritis severe

A

mycophenolate mofetil
or cyclosporine + steroid
(could add belimumab to either)
or myco + limus/sporin

58
Q

best prognosis for pregnancy is remission for how long before preg

A

6 months+

59
Q

pregnancy can cause what

A

flares

60
Q

tips for contraception

A

avoid estrogen products
screen for antiphospholipid since clot risk

61
Q

drugs of choice in pregnancy

A

hydroxychloroquine
NSAIDs before 20 weeks
glucocorticoids

62
Q

which meds contraindicated in pregnancy

A

methotrexate
cyclophosphamide
mycophenolate

63
Q

if pregnant person has antiphospholipid antibodies what are they at risk for

A

miscarriage
blood clot

64
Q

pregnant person with antiphospholipid antibodies treatment

A

no fetal loss - ASA
fetal loss - ASA +/- lovenox
hx of thrombo - lovenox

PHRM 845 (38 decks)

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