Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

864 > Lupus > Flashcards

Lupus Flashcards

1
Q

Epidemiology

At least 1.5 million Americans and
* 5 million people worldwide have a form of lupus

Gender:
* 9 in 10 people with lupus are women
* More common in ___ of
childbearing age

Age:
* Peak incidence between ages of 15-45
years old

Ethnicity:
* More prevalent in Asian, African, Arab,
Hispanic/Latins and American Indians
background

A

women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Exact etiology of SLE is unknown but many pre-disposing factors

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Drug-induced Lupus Erythematosus (DILE)

  • Overreaction to certain medications
  • Symptoms occur __ - __ months of
    drug initiation
  • Resolution occurs within ___ of drug discontinuation
  • Around 10% of SLE cases are drug-
    induced
  • There are at least 46 medications that
    can cause DILE
A
  • 3-6
  • weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MPMMPHATIQ

A
  • Methimazole
  • Propylthiouracil
  • Methyldopa
  • Minocycline
  • Procainamide
  • Hydralazine (alone, and in BiDil)
  • Anti-TNF agents (ex. Infliximab and
    etanercept)
  • Terbinafine
  • Isoniazid
  • Quinidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A

D) minocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Signs/Symptoms

  • Fatigue
  • Depression
  • Photosensitivity
  • Joint Pain
  • Nausea/Vomiting
  • Fever
  • Weight Loss
  • Malar “_______” rash
A

butterfly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
A
  • butterfly rash, discoid rash, raynaud phenomenon
  • lupus retinopathy
  • lupus nephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
A

a) butterfly
c) sun exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Key labs

all labs positive in lupus
- ANA - not ___
- anti-dsDNA - ___ specificity, correlates with disease activity, important marker of lupus ___
- anti-SM - ___ specificity
- Antiphospholipid Antibody - Increase clotting factors

A
  • specific
  • high, nephritis
  • high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
A
  • rash
  • mouth ulcers
  • ANA +
  • anti-dsDNA +
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pharmacologic Treatments

A
  • HCQ
  • NSAIDs
  • glucocorticoids
  • immunosuppressants
  • biologics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HCQ

MOA: Antimalarial —> Inhibit overactive immune cells
* Place in therapy: Recommended for ALL patients with SLE
* Benefits: Reduce flares and help manage pain
* Dosing: 200-400 mg PO daily
* Max: 400 mg daily

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HCQ SE

Side effects:
- Ophthalmologic: Retinal Toxicity ( ____ )
- CNS: Neuropsychiatric Effects (anxiety,
depression, insomnia, suicidal ideation,
etc)
- CV: QT prolongation, cardiomyopathy
- Neuromuscular: Myopathy
- Dermatologic: Hypersensitivity reaction
- Other: Hypoglycemia, Hemolytic anemia
( ____ )

A
  • bullseye mucopathy
  • G6PD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

G6PD Deficiency

  • ___ disorder that causes RBCs to prematurely break down
A

X-linked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HCQ - monitoring

Baseline:
* CBC
* LFTs
* SCr
* EKG

Periodic:
* ___ exam
* 3 months after starting therapy,
then annually

A
  • eye
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

NSAIDs

Place in therapy: Considered first line for mild symptoms

Dosing:
* Ibuprofen: 400-600 mg PO Q6-8H
* Naproxen: 500 mg PO BID

Side effects
- GI: Bleeding, gastritis, perforation
- CV: Increased BP, worsening HF, cardiovascular events
- Renal: Increased SCr, renal toxicity
- Hepatic: Hepatoxicity

Monitoring Parameters:
* Baseline:
* CBC
* LFTs
* SCr
* BP

S/sx of ___and bleeding

A
  • fluid retention
17
Q

Glucocorticoids

MOA: Inhibit B and T cell responses

Benefits: Anti-inflammatory and helpful
during flares
- Variable dosage forms - PO, topical, IV
- Place in therapy: ___ treatment, if not responsive to NSAIDs/ antimalarial

A
  • adjunctive
18
Q

GC

PO/IV Side Effects
* Ophthalmologic: Glaucoma
* CV: ___ BP
* Bone: Increased risk of ___
* GI: GI bleed, gastritis
* CNS: Psychosis/sleep disturbances
* Other: Weight gain, increased ___ ,
increased risk of infection risk &
___ syndrome

Topical SE
- skin atrophy
- rosacea
- telangiectasis

A
  • increased
  • osteoporosis
  • BG
  • Cushing
19
Q

Glucocorticoids (GC)

Monitoring parameters:

Baseline:
* BP
* BMP
* FLP
* Bone mineral density

Routine:
* ___ - Every 6 months
* ___- Every 6 months
* ___ - Annually

A
  • BMP
  • FLP
  • Bone mineral density
20
Q

Immunosuppressants (IS)

MOA: Suppression of immune function
from attacking healthy cells

Place in therapy:
- Adjunct to ___ therapy to lower
the dose
- Insufficient response to ___

Medications:
* Methotrexate (MTX)
* Azathioprine (AZA)
* Cyclophosphamide (CYC)
* Mycophenolate mofetil (MMF)

A
  • steroid
  • HCQ
21
Q

Dosages and Side Effects

A
  • weekly
  • BID
22
Q

Dosages and Side Effects

cyclophosphamide (CYC)
IV: ___ mg/m2 BSA q month x 6 months

A
  • 0.5
23
Q

AZA: monitor ___

A

TPMT

24
Q

Biologics

MOA: Monoclonal antibodies that block __ -cell mediated immunity

Place in therapy:
* Inadequate response to ___
and ___
* Severe disease

Medications:
* ___ (Benlysta®)
* ___ (Tiruxan ®)
* ___ (Saphnelo®)

A
  • B-cell
  • HCQ, immunosuppressants
  • belimumab
  • rituximab
  • anifrolumab
25
Q

biologics

Pearls:
- No live vaccines ___ days before starting therapy OR ___
therapy
- Do not use more than 1 biologic at the same time

A
  • 30
  • during
26
Q

biologic

BEL
SE
- ___
- infusion reactions

anifrolumab
- ___

rituximab
SE
- Infusion reactions
- ___ reactivation
- premedication ~ 30 min prior

A
27
Q

Additional therapies

___ Inhibitors (CNI)

A

Calcineurin

28
Q

Cutaneous Lupus

  • 10% of lupus cases and rarely life-threatening
  • Presents on the skin with rash and lesions

First Line:
Topical agents:
- GC: Clobetasol, betamethasone, triamcinolone, hydrocortisone
- CNI: Tacrolimus, pimecrolimus

not topical
- ___
- Systemic GC

Refractory:
* High-dose GC
* ___ or ___

A
  • HCQ
  • MTX, MMF
29
Q

Lupus Nephritis

LN is a serious complication of SLE which can affect 60% of patients within
10 years of diagnosis

Therapy:
Mild/moderate nephritis (Class 1 or 2 LN):
- GC+/- another immunosuppressant ( ___ , ___ , or ___ )

Severe nephritis (Class 3 or 4 LN):
- ___ (preferred) or CYC +/- GC

Triple therapy:
* ___ + ___ or CYC +/- ___
* ___ + ___ +/- GC (triple therapy)

A
  • AZA, MMF, or CNI
  • MF
  • MF
  • belimumab, MMF, GC
  • CNI, MMF
30
Q

LN flow chart

A
31
Q

MSC

A
  • diuretics
  • NSAIDs (unless nephritis)
32
Q

Pregnancy & SLE

Higher maternal and fetal risk compared with healthy women
* Miscarriage
* Fetal growth retardation
* Maternal mortality
* Preeclampsia

The best prognosis is when the patient
achieves remission for ≥ ___ months
before pregnancy
* Pregnancy can cause flares

Contraception
* Avoid ___ -containing
contraception
* Screen for ___ syndrome

A
  • 6
  • estrogen
  • antiphospholipid
33
Q

Antiphospholipid antibody

An autoimmune disorder characterized by ___ that can cause blood clots and miscarriages

A
  • antiphospholipid syndrome
34
Q

summary

  • SLE primarily occurs in women of childbearing age
  • SLE is a multi-system autoimmune disease that can involve any
    organ and present in many ways
  • Many drugs can induce lupus-like symptoms
  • Backbone of lupus therapy: ___ +/- ___ +/- ___ for pain and
    inflammation
  • Monitor for drug side effects/toxicities
A
  • HCQ, GC, NSAIDs

864 (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions