Lupus Flashcards
Epidemiology
Affects women of child-bearing age. more severe in African americans
Etiology
Four genes required for development of SLE.
5% cases are familial
Environmental triggers such as sunlight, chemicals, diet, hormones, EBV
Pathophysiology
Triggering agents induce a response resulting in overproduction of autoantibodies.
Clinical manifestations
First symptoms appear after 3 years of formation of autoantibodies.
fever, malasise, arthralgia, fatigue, anorexia, weight loss, butterfly rash
Non-pharmacological therapy
Smoking cessation, limit sunlight, balance of rest and exercise for fatigue
What medications can induce lupus?
hydralazine, procainamide
chlorpromazine, isoniazid, methyldopa, minocycline, quinidine
What are the major differences between lupus and drug-induced lupus?
Drug-induced: anti-ssDNA, no prior history, rapid improvement after drug is d/c
most commonly musculoskeletal symptom
Describe the immunological response.
Hyperactivity of B lymphocytes. autoantibodies against nuclear, cytoplasmic, and surface components of various cells.
Loss of immune self-tolerance.
High antigenic load of environmental and self-antigens
What systems are involved with lupus?
Constitutional Musculoskeletal Skin Renal Gastrointestinal Pulmonary Cardiac reticuloendothelial hematologic neuropsychiatric
What are some lab findings?
ANA antinuclear antibodies (dsDNA)
aPL antiphospholipid antibodies
What are the requirements for diagnosis?
involvement of 2 organ systems
4 or more of classification criteria
What are the classification criteria?
malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurological, hematologic, immunologic, ANA titer
What are the goals of therapy?
manage symptoms and induce remission
maintain remission for the longest possible duration
What drugs are appropriate for mild SLE?
non-life threatening organ involvement
NSAIDS, antimalarials, low-dose glucocorticoids
What drugs are appropriate for severe SLE?
Life threatening (renal, cardiopulmonary, hematologic, cns) high-dose glucocorticoids, cytotoxic
Brand, Dose, ADR, monitoring for:
ibuprofen
advil/ motrin
1200-1300mg/day divided in 3-4doses
tarry stools, ab pain, edema, sob, gi bleed, renal dysfunction, hepatic dysfunction, hypertension
scr, urinalysis, ast/alt, cbc, followup yearly
Brand, Dose, ADR, monitoring for:
naproxen
aleve
250-500mg bid
tarry stools, ab pain, edema, sob, gi bleed, renal dysfunction, hepatic dysfunction, hypertension
scr, urinalysis, ast/alt, cbc, followup yearly
Brand, Dose, ADR, monitoring for:
indomethacin
indocin ir 25-50mg 2-3 times daily
tarry stools, ab pain, edema, sob, gi bleed, renal dysfunction, hepatic dysfunction, hypertension
scr, urinalysis, ast/alt, cbc, followup yearly
Brand, Dose, ADR, monitoring for:
hydroxychloroquine
plaquenil 200-400mg daily
CNS, rash, skin/hair pigment change, nausea,. Retinal toxicity
eye exam every 6-12 months
Brand, Dose, ADR, monitoring for:
chloroquine
aralen 250-500mg daily
CNS, rash, skin/hair pigment change, nausea,. Retinal toxicity
eye exam every 3 months
Brand, Dose, ADR, monitoring for:
prednisone
Deltasone 10-20mg/day low-dose
Deltasone 1-2mg/kg/day high-dose
HTN, hypergylcemia, insomnia, osteoporosis, hypokalemia, cararats, weight gain, infections, edema
BP, K, blood glucose(3-6months), cholesterol, bone density(yearly)
Brand, Dose, ADR, monitoring for:
methylprednisolone
Medrol 500-1000mg IV for 3-6 days followed by prednisone 1-1.5mg/kg/day
HTN, hypergylcemia, insomnia, osteoporosis, hypokalemia, cararats, weight gain, infections, edema
BP, K, blood glucose(3-6months), cholesterol, bone density(yearly)
Brand, reason to use for:
Methotrexate
Rheumatrex
dermititis, arthritis if not controlled
Brand, reason to use for
cyclophosphamide
Cytoxan
Severe, add on
nephritis. induce remission
Brand, reason to use for
azathioprine
imuran
to reduce steroid dosing.
maintenance therapy
Brand, reason to use for
mycophenolate mofetil
cellcept
induce remission
