Lupus EXAM 4 Flashcards
What is Lupus?
Auto-immune disease
-any organ can be affected
How would a patient with Lupus present?
-Skin lesion (most often), rash
-oral and nasal ulcers
-alopecia
-pleuritis, pericarditis (chest bain)
-kidney damage (proteinuria, RBC cast in the blood)
-neurologic (seizures, psychosis, AMS. neuropathy)
-Cytopenias (hemolytic, neutropenia, leukopenia, lymphopenia, thrombocytopenia)
What labs are used to determine Lupus?
-Antinuclear antibody (ANA)
-Anti-double-strand DNA (dsDNA) – present in 60-70% of patients
-Anti-Sm
-Antiphospholipid antibodies
-Lupus anticoagulant
-Anticardiolipin
-Anti-β2-glycoprotein
-Low complement
-Direct Coomb’s test (w/o hemolytic anemia)
Antibodies of Antiphospholipid are antibodies against what?
Lupus anticoagulant
Anticardiolipin
Anti-ß2-glycoprotein
What is the leading cause of death for Lupus?
What is the LDL goal in these patients?
Cardiovascular
-accelerated arteriosclerosis (inflammation causes plaques), pericarditis, myocarditis
LDL goal: <100 mg/dl
What are the possible triggers of Lupus?
Sun
smoking
Obesity
What is the drug class of choice?
What is the supportive care approach?
Immunosuppressants
supportive care:
-immunizations
-manage co-morbidities (HTN, dyslipidemia, depression)
What is the first-line treatment for unspecific Lupus?
-NSAIDs
-hydroxychloroquine (malaria agent)
-Corticosteroirds
2nd line:
-Belimumab
-Mtx
-Mycophenolate mofetil (immunosuppressant)
-Cyclophosphamide
What is the first-line treatment for Lupus nephritis?
hydroxychloroquine
2nd line:
Mycophenolate mofetil + corticosteroid
then MMF + Azathioprine
What is the first-line treatment for neuropsychiatric lupus?
hydroxychloroquine
2nd line:
-Corticosteroids
-Cyclophosphamide
-Azathioprine
+
Anticonvulsatns (for seizrue
Antidepressants (for depression
Antipsychotics (for psychotic conditions)
What is the first-line treatment for cutaneous lupus?
topical corticosteroids
pimecrolimus
tacrolimus
2nd line:
-hydroxychloroquine
-Methotrexate
-Retinoids
-MMF
-Dapsone
-Thalidomide
Last line treatment for Lupus?
-Rituximab
-tacrolimus/cyclosporine
-IVIG
-plasmapheresis (remove the antibodies, then infusion of new antibodies)
Newer Lupus agents
for lupus nephritis
-Voclosporine (Lupkynis®) - calcineurin inhibitor
for SLE
-Anifrolumab (Saphenlo®) - INF type 1 antagonist
the role in therapy is still unclear
What is the brand name and dose of hydroxychloroquine?
Plaquenil
200-400 mg
What are the side effects of hydroxychloroquine?
Retinal toxicity (yearly eye exam)
Cytopenias
What are the short and long-term side effects of corticosteroids?
short-term
-Hyperglycemia
-immunosuppression
-WBC elevation
-fluid retention, HTN
-GI distress, ulcers
long-term
-Bone mineral density loss
-HPA suppression
What are the brand names of prednisone, prednisolone, and methylprednisolone?
prednisone: Deltasone
prednisolone: Medrol
methylprednisolone: Solu-Medrol
Which of the corticosteroids should be used in patients with liver dysfunction? Why?
Prednisolone or methylprednisolone
bc prednisone must be converted in its active form by the liver
Side effects of NSAIDs
-Afferent (glomerulus) vasoconstriction
-GI distress/ulcers
What is the dose of Methotrexate for Lupus?
10 to 25 mg PO weekly
ADE:
-Myelosuppression
-hepatoxicity (w/ chronic use)
-drug interactions (NSAIDs, sulfonamides, etc.)
What is the brand name of azathioprine?
Imuran
Azathioprine is the prodrug of 6-MP
What is the brand name of rituximab?
Rituxan
HBV reactivation and hypersensitivity reactions
How do NSAIDs and Corticosteroids increase the risk for GI ulcers?
decrease in prostaglandin production
prostaglandin provides protection via carbonate and mucus layer
What are the complications of Antiphospholipid Antibody Syndrome?
Venous, arterial microvascular thrombosis (clots)
-fetal loss after 10 weeks, multiple early misscarriage, intrauterine growth restriction, severe eclampsia
-> can be caused by clotting in the placenta
