Lupus Flashcards
what is SLE
chronic autoimmune dx
attacks healthy organs and tissue
how many people affected by lupus
1.5 mil Americans
5 mil worldwide
risk factors for lupus
female
childbearing age 15-45
non-white
etiology of Lupus
unknown but possibly
- genetic
- hormonal
- environmental
when might drug induced lupus poccur
3-6 months after initaition
drugs causing lupus
methimazole
propylthiouracil
methyldopa
minocycline
procainamide
hydralazine
anti-TNF
terbinafine
isoniazid
quinadine
my pretty malar marking probably has a transient quality
signs and symptoms of lupus
fatigue
depression
photosensitiviy
joint pain
N/V
fever
weight loss
malar butterfly rash
retinopathy
lupus nephritis
there isnt one clear presentation
lupus diagnosis criteria
> 4 symptoms, 1 fromeach group
or
biopsy lupus nephritis with anti dsDNA or ANA lab +
or
score is 10 and 1 clinical criteria filled
what is ANA lab
anti-nuclear antibody
positive in lupus but also non specific
what is anti-dsDNA lab
high specificity for lupus
disease activity
marker in lupus nephritis
what is anti-smith lab
high specificity for lupus
what is antiphospholipid antibody lab
increase in clotting factors
which labs have high specificity for lupus
anit-dsDNA
anti smith antibody
treatment options
hydroxychloroquine
NSAIDs
glucocorticoids
immunosupresants
biologics
first line treatment SLE
hydroxychloroquine
hydroxychloroquine dosing
200-400 mg PO daily
max 400 mg daily
side effects from hydroxychloroquine
retinal tox: bullseye maculopathy
anxiety/depression
QT prolong
myopathy
hypersensitivity reaction
G6PD deficiency
hypoglycemia
hemolytic anemia
what is a G6P deficeincy
x linked disorder that causes RBCs to breakdown
who should we not give hydroxychloroquine to?
G6P deficiency
monitoring for hydroxychloroquine
CBC
LFTs
SCr
EKG
eye exam - 3 months then annually
NSAIDs place in therapy
first line mild symptoms
dosing for NSAIDs
ibuprofen: 400-600 mg PO q6-8h
max: 3200 mg/day
naproxen: 500 mg PO BID
max: 1500 mg/day
side effects NSAIDs
GI bleed
increased BP, worsen HF, CV event
increased renal tox
hepatotox
monitoring for NSAIDs
CBC
LFTs
SCr
BP
s/sx fluid retention/bleeding
steroids place in therapy
if failure on HCQ and NSAIDS
- can add on
oral steroid tx
mild:prednisone 5-30 mg/day
severe: 1 mg/kg/day
IV steroid tx
pulse therapy
methylpred: 500-1000 mg daily x 3-6 days then PO prednisone
topical steroid use
cutaneous lupus
which steroids low potency topical and place to use
fluocinolone and hydrocortisone (face)
which steroids moderate potency topical and use
triamcinolone and betamethasone (trunk and extremitiies)
which steroid to use high potency and locatin
clobetasol
(scalp and palms)
corticosteroid adverse effects
glaucoma
incrased BP
osteoporosis
GI bleed, gastritis
sleep disturb
weight gain
hyperglycemia
Cushing
topical side effects to steroids
rosacea
skin atrophy
telangiectasis
monitoring for glucocorticoids
BP
BMP - every 6 month
FLP - every 6 month
bone mineral density - annual
immunosuppressant meds used
methotrexate
azathioprine
cyclophosphamide
mycophenolate mofetil
methotrexate dosing lupus
5-15mg once PO weekly
methotrexate side effects
bone marrow supression
infection
mycophenolate mofetil dosing
1-1.5 g BID
mycophenolate mofetil adverse effects
bone marrow supression
infection
malignancy
acute inflammatory
cyclophosphamide dose
1-1.5mg/kg once daily PO
0.5 mg/m2 BSA every month x 6 month
cyclophosphamide side effects
BMS
infection
malignancy
azathioprine dosing
50 mg PO daily
azathioprine side effects
BMS
infection
malignancy
azathioprine monitoring
TPMT deficiency
what drug should we not give if TPMT deficiency
azathioprine
biologics place in therapy
3rd line after HCQ and immunosuppressants
biologic medications
belimumab
rituximab
anifrolumab
what to consider with biologics
no live vaccines 30 days before starting therapy or during
belimumab side effects
hypersensitivity
infusion reaction
anifrolumab side effects
hypersensitivity reactions
retuximab side effects
hypersensitivity reaction
infusion reaction
Hep B reactivation
rituxumab consideration
premedicate 30 mins prior to admin
additional therapies to consider
-limus
-sporins
non-pharm treatments
exercise and rest
smoking cessation
limit UV exposure and use sunscreen
cutaneous lupus drug therapy 1st line and refractory
1st line:topical steroid
hydroxychloroquine
if severe: systemic steroid
refractory: high dose steroid
MTX
mycophenolate
lupus nephritis treatment mild to moderate
steroid +/- azathioprine, myco, -limus
lupus nephritis severe
mycophenolate mofetil
or cyclosporine + steroid
(could add belimumab to either)
or myco + limus/sporin
best prognosis for pregnancy is remission for how long before preg
6 months+
pregnancy can cause what
flares
tips for contraception
avoid estrogen products
screen for antiphospholipid since clot risk
drugs of choice in pregnancy
hydroxychloroquine
NSAIDs before 20 weeks
glucocorticoids
which meds contraindicated in pregnancy
methotrexate
cyclophosphamide
mycophenolate
if pregnant person has antiphospholipid antibodies what are they at risk for
miscarriage
blood clot
pregnant person with antiphospholipid antibodies treatment
no fetal loss - ASA
fetal loss - ASA +/- lovenox
hx of thrombo - lovenox
