Lupus

Question 1

what is SLE

Answer 1

chronic autoimmune dx
attacks healthy organs and tissue

Question 2

how many people affected by lupus

Answer 2

1.5 mil Americans
5 mil worldwide

Question 3

risk factors for lupus

Answer 3

female
childbearing age 15-45
non-white

Question 4

etiology of Lupus

Answer 4

unknown but possibly
- genetic
- hormonal
- environmental

Question 5

when might drug induced lupus poccur

Answer 5

3-6 months after initaition

Question 6

drugs causing lupus

Answer 6

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

Question 7

signs and symptoms of lupus

Answer 7

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

Question 8

lupus diagnosis criteria

Answer 8

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

Question 9

what is ANA lab

Answer 9

anti-nuclear antibody
positive in lupus but also non specific

Question 10

what is anti-dsDNA lab

Answer 10

high specificity for lupus
disease activity
marker in lupus nephritis

Question 11

what is anti-smith lab

Answer 11

high specificity for lupus

Question 12

what is antiphospholipid antibody lab

Answer 12

increase in clotting factors

Question 13

which labs have high specificity for lupus

Answer 13

anit-dsDNA
anti smith antibody

Question 14

treatment options

Answer 14

hydroxychloroquine
NSAIDs
glucocorticoids
immunosupresants
biologics

Question 15

first line treatment SLE

Answer 15

hydroxychloroquine

Question 16

hydroxychloroquine dosing

Answer 16

200-400 mg PO daily
max 400 mg daily

Question 17

side effects from hydroxychloroquine

Answer 17

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

Question 18

what is a G6P deficeincy

Answer 18

x linked disorder that causes RBCs to breakdown

Question 19

who should we not give hydroxychloroquine to?

Answer 19

G6P deficiency

Question 20

monitoring for hydroxychloroquine

Answer 20

CBC
LFTs
SCr
EKG
eye exam - 3 months then annually

Question 21

NSAIDs place in therapy

Answer 21

first line mild symptoms

Question 22

dosing for NSAIDs

Answer 22

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

Question 23

side effects NSAIDs

Answer 23

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

Question 24

monitoring for NSAIDs

Answer 24

CBC
LFTs
SCr
BP
s/sx fluid retention/bleeding

Question 25

steroids place in therapy

Answer 25

if failure on HCQ and NSAIDS - can add on

Question 26

oral steroid tx

Answer 26

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

Question 27

IV steroid tx

Answer 27

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

Question 28

topical steroid use

Answer 28

cutaneous lupus

Question 29

which steroids low potency topical and place to use

Answer 29

fluocinolone and hydrocortisone (face)

Question 30

which steroids moderate potency topical and use

Answer 30

triamcinolone and betamethasone (trunk and extremitiies)

Question 31

which steroid to use high potency and locatin

Answer 31

clobetasol (scalp and palms)

Question 32

corticosteroid adverse effects

Answer 32

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

Question 33

topical side effects to steroids

Answer 33

rosacea skin atrophy telangiectasis

Question 34

monitoring for glucocorticoids

Answer 34

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

Question 35

immunosuppressant meds used

Answer 35

methotrexate azathioprine cyclophosphamide mycophenolate mofetil

Question 36

methotrexate dosing lupus

Answer 36

5-15mg once PO weekly

Question 37

methotrexate side effects

Answer 37

bone marrow supression infection

Question 38

mycophenolate mofetil dosing

Answer 38

1-1.5 g BID

Question 39

mycophenolate mofetil adverse effects

Answer 39

bone marrow supression infection malignancy acute inflammatory

Question 40

cyclophosphamide dose

Answer 40

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

Question 41

cyclophosphamide side effects

Answer 41

BMS infection malignancy

Question 42

azathioprine dosing

Answer 42

50 mg PO daily

Question 43

azathioprine side effects

Answer 43

BMS infection malignancy

Question 44

azathioprine monitoring

Answer 44

TPMT deficiency

Question 45

what drug should we not give if TPMT deficiency

Answer 45

azathioprine

Question 46

biologics place in therapy

Answer 46

3rd line after HCQ and immunosuppressants

Question 47

biologic medications

Answer 47

belimumab rituximab anifrolumab

Question 48

what to consider with biologics

Answer 48

no live vaccines 30 days before starting therapy or during

Question 49

belimumab side effects

Answer 49

hypersensitivity infusion reaction

Question 50

anifrolumab side effects

Answer 50

hypersensitivity reactions

Question 51

retuximab side effects

Answer 51

hypersensitivity reaction infusion reaction Hep B reactivation

Question 52

rituxumab consideration

Answer 52

premedicate 30 mins prior to admin

Question 53

additional therapies to consider

Answer 53

-limus -sporins

Question 54

non-pharm treatments

Answer 54

exercise and rest smoking cessation limit UV exposure and use sunscreen

Question 55

cutaneous lupus drug therapy 1st line and refractory

Answer 55

1st line:topical steroid hydroxychloroquine if severe: systemic steroid refractory: high dose steroid MTX mycophenolate

Question 56

lupus nephritis treatment mild to moderate

Answer 56

steroid +/- azathioprine, myco, -limus

Question 57

lupus nephritis severe

Answer 57

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

Question 58

best prognosis for pregnancy is remission for how long before preg

Answer 58

6 months+

Question 59

pregnancy can cause what

Answer 59

flares

Question 60

tips for contraception

Answer 60

avoid estrogen products screen for antiphospholipid since clot risk

Question 61

drugs of choice in pregnancy

Answer 61

hydroxychloroquine NSAIDs before 20 weeks glucocorticoids

Question 62

which meds contraindicated in pregnancy

Answer 62

methotrexate cyclophosphamide mycophenolate

Question 63

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

Answer 63

miscarriage blood clot

Question 64

pregnant person with antiphospholipid antibodies treatment

Answer 64

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