Lupus

Question 1

SLE is more common in women of what age range?

Answer 1

teens to early 50s

Question 2

__ is a measurable increase in disease activity (>=1 organ system) involving new or worsening of clinical signs, symptoms or labs

Answer 2

SLE flare

Question 3

Lupus nephritis:

What class is focal with < 50% glomeruli involvement?

Answer 3

class III

Question 4

Lupus nephritis:

What class is diffuse with >= 50% glomeruli involvement?

Answer 4

class IV

Question 5

Increased risk of VTE, arterial thrombosis, and fetal loss with what syndrome?

Answer 5

antiphospholipid syndrome

Question 6

Antiphospholipid antibodies can cause thrombus formation by interfering with __ and endothelial cell fxn

Answer 6

protein c

Question 7

Leukopenia with < __/mm3 is clinical criteria for lupus

Answer 7

4000

Question 8

Lymphopenia with < __/mm3 is clinical criteria for lupus

Answer 8

1000

Question 9

Thrombocytopenia with platelets < __/mm3 is clinical criteria for lupus

Answer 9

100,000

Question 10

At least __ criteria, including at least __ clinical and __ immunologic criterion or biopsy proven lupus nephritis with positive ANA or anti-dsDNA is required for lupus diagnosis

Answer 10

4, 1, 1

Question 11

Two autoantibody tests for lupus?

Answer 11

ANA

APA

Question 12

4 main lab tests for lupus:

Answer 12

autoantibody: ANA and APA
CBC with differential
SCr
urinalysis with microscopy

Question 13

Which is false?

a. it is chronic autoimmune disease that affects multiple organs
b. it affects more women than men
c. increased incidence in older pts
d. can be triggered by environmental factors like smoking and UV light

Answer 13

c. increased incidence in older pts

Question 14

Reducing ___ use is a treatment goal for SLE

Answer 14

corticosteroid

Question 15

Do not give live vaccines to pts receiving immunotherapy.

a. true
b. false

Answer 15

a. true

Question 16

What drug is used for salvage therapy?

Answer 16

rituximab

Question 17

Low dose aspirin is used in __

Answer 17

antiphospholipid syndrome (APS)

Question 18

Steroids are given low potency for what areas?

Answer 18

sensitive areas like the face

given locally for skin manifestations

Question 19

Do not exceed __mg/kg/day or __mg of hydroxychloroquine, whichever is lower

Answer 19

5, 400

Question 20

Which med may reduce clotting, and may be used in all pts with lupus if tolerated?

Answer 20

hydroxychloroquine

Question 21

What is the major AE of hydroxychloroquine?

Answer 21

retinal toxicity (cornea)

Question 22

Methotrexate is given how often?

Answer 22

ONCE weekly

Question 23

Methotrexate has dose adjustments for renal and hepatic impairment.

a. true
b. false

Answer 23

a. true

Question 24

Which med is used for maintenance therapy for nephritis?

Answer 24

azathioprine

Question 25

Lower azathioprine dose needed if pt is __ deficient

Answer 25

TPMT

Question 26

Azathioprine has DDIs with __ and __

Answer 26

allopurinol, febuxostat avoid or decrease dose by 1/3 to 1/4 usual dose

Question 27

Which med is used for induction and maintenance therapy for nephritis?

Answer 27

mycophenolate

Question 28

With mycophenolate wait __ weeks after therapy d/c before attempting pregnancy

Answer 28

6

Question 29

Wait 6 weeks after therapy d/c before attempting pregnancy with what immunosuppressant?

Answer 29

mycophenolate

Question 30

Mycophenolate has low protein binding a. true b. false

Answer 30

b. false HIGH protein binding

Question 31

Which immunosuppressant is used only as induction therapy for nephritis?

Answer 31

cyclophosphamide NOT used for maintenance

Question 32

2 main aEs of cyclophosphamide?

Answer 32

hemorrhagic cystitis | bladder cancer

Question 33

Cyclophosphamide should be avoided in pregnancy a. true b. false

Answer 33

a. true

Question 34

Which immunosuppressant has teratogenicity concern

Answer 34

cyclophosphamide

Question 35

Which immunosuppressant can cause infertility in women and men?

Answer 35

cyclophosphamide

Question 36

__ is a recombinant antibody that promotes B cell apoptosis by binding to BLyS

Answer 36

belimumab prevents B cell maturation

Question 37

Which drug is used in pts with autoantibody positive SLE as an adjunct therapy?

Answer 37

belimumab

Question 38

Do not give vaccines within __ days of belimumab therapy

Answer 38

30

Question 39

Do not give belimumab with other biologics or __

Answer 39

cyclophosphamide

Question 40

Which med is used for salvage therapy for SLE and lupus nephritis?

Answer 40

rituximab

Question 41

main AE of rituximab?

Answer 41

infusion rxns premedicate to prevent infusion and hypersensitivity rxns

Question 42

ACE/ARBs are adjunctive therapies and should be avoided din pregnancy. a. true b. false

Answer 42

a. true

Question 43

Which two adjunctive therapies should not be used in pregnancy?

Answer 43

warfarin (contraindicated) | statins (avoid use)

Question 44

Warfarin is contraindicated in pregnancy. a. true b. false

Answer 44

a. true

Question 45

2 drugs for induction therapy?

Answer 45

mycophenolate | cyclophosphamide

Question 46

2 drugs for maintenance therapy ?

Answer 46

mycophenolate | azathioprine

Question 47

Topical agents are drugs of choice for cutaneous pts w/o systemic Sx a. true b. false

Answer 47

a. true topical steroids topical calcineurin inhibitors

Question 48

What is steroid of choice in pregnancy/

Answer 48

prednisolone

Question 49

Which can be used in pregnancy? a. hydroxychloroquine b. azathioprine c. LMWH d. UFH select all that apply

Answer 49

all of them

Question 50

What must a pt be positive for to use belimumab?

Answer 50

autoantibodies

Question 51

SLEDAI score of <=__ is low disease activity

Answer 51

4

Question 52

Remission is SLEDAI score of what?

Answer 52

0

Question 53

cyclophosphamide lupus nephritis low dose induction dose?

Answer 53

every 2 weeks for 6 doses

Question 54

cyclophosphamide lupus nephritis high dose induction dose?

Answer 54

once a month for 6 months

Question 55

Use a higher or lower dose of azathioprine in Asian pts?

Answer 55

lower 2g

Question 56

What is primary prophylaxis for antiphospholipid syndrome?

Answer 56

hydroxychloroquine + low dose aspirin in pts with positive lupus anticoagulants or persistent anticardiolipin antibody