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PHRM 864 Exam 4 > Lupus (SLE) > Flashcards

Lupus (SLE) Flashcards

1
Q

SLE

A

Chronic autoimmune disease with a diverse clinical presentation that causes the immune system to attack healthy tissues and organs throughout the body

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2
Q

Epidemiology

A

Sex: Female>male
Onset: 15-45
Ethnicity: more prevalent in Asian, African, Arab, Hispanic, American Indians

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3
Q

Pathophysiology

A

Genetics

Hormonal: estrogen can increase incidence

Environment: smoking, pollution, pesticides, UV exposure, psychological stress, EBV, medications

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4
Q

Drug-induced Lupus Erythematosus (DILE)

A

Overreaction to certain medications

Symptoms occur 3-6 months of drug initiation

Resolution occurs within weeks of drug discontinuation

Around 10% of SLE cases are drug-induced and 46 medications that can cause DILE

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5
Q

DILE examples

A

My Pretty Malar Marking Probably Has A Transient Quality

Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine
Anti-TNF
Terbinafine
Isoniazid
Quinidine

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6
Q

Signs/symptoms

A

Fatigue
Depression
Photosensitivity
Joint pain
N/V
Fever
Weight loss
Butterfly rash

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7
Q

Other signs and symptoms

A

Discoid rash, raynauds, oral/nasal ulcers

Lupus retinopathy

Lupus nephritis

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8
Q

Diagnostic tools

A

SLICC: Must meet > 4 total features with 1 from each group OR biopsy proven lupus with + Anti-dsDNA or + ANA

EULAR: Patients score is > 10 AND at least 1 clinical criterion is fulfilled

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9
Q

Key labs

A

ANA: positive in lupus patients but not specific

Anti-dsDNA: highly specific for diagnosis, important marker in lupus nephritis

Anti-SM: highly specific

Antiphospholipid antibody: increase clotting factors

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10
Q

Hydroxychloroquine

A

Antimalarial–>inhibit overactive immune cells

Recommended for ALL lupus patients

Reduces flares and manages pain

Dose: 200-400 mg PO daily

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11
Q

Hydroxychloroquine side effects

A

Retinal toxicity

Anxiety, depression, insomnia

Hypersensitivity reactions

Hypoglycemia, hemolytic anemia (G6PD)

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12
Q

Monitoring parameters

A

Baseline: CBC, LFT, SCr, ECG

Vision exam 3 months after starting therapy, then annually

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13
Q

NSAIDS

A

Considered 1st line for mild symptoms

Ibuprofen: 400-600 mg PO Q6-8H
Naproxen: 500 mg PO BID

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14
Q

NSAIDS monitoring

A

CBC
SCr
LFTs
BP
S/sx for bleeding and fluid retention

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15
Q

Glucocorticoids

A

Anti-inflammatory and helpful during flares

Adjunctive treatment, if not responsive to NSAIDS/HCQ

Can use all three together

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16
Q

Oral prednisone

A

Mild-moderate disease: 5-30 mg/day
Severe: 1 mg/kg/day

17
Q

IV methylprednisolone

A

500-1000 mg IV daily x 3-6 days, then PO prednisone

18
Q

Topical glucocorticoids

A

cutaneous lupus

Low-potency: Fluocinolone valerate and Hydrocortisone butyrate (Face)

Moderate-potency: Triamcinolone acetonide and Betamethasone valerate (Trunk and extremities)

High potency: Clobetasol (Scalp sores and palms)

19
Q

Glucocorticoids monitoring parameters

A

BP
BMP: baseline then q6 months
FLP: baseline then q6 months
Bone mineral density

20
Q

Immunosuppressants

A

Adjunct to steroid therapy to lower the dose

Insufficient response to HCQ

21
Q

Methotrexate

A

5-15 mg weekly

SE: Bone marrow suppression, infection

22
Q

Mycophenolate mofetil (MMF)

A

1-1.5 g twice daily

SE: Bone marrow suppression, infection, malignancy, AIS

23
Q

Cyclophosphamide

A

1-1.5 mg/kg once daily

SE: Bone marrow suppression, infection malignancy

24
Q

Azathioprine

A

50 mg daily

SE: Bone marrow suppression, infection malignancy

Monitor: TPMT

25
Q

Biologics

A

Inadequate response to antimalarial and immunosuppressants

Severe disease

26
Q

Belimumab

A

10 mg/kg every 2 weeks x 3 doses

SE: hypersensitivity, infusion reactions

27
Q

Anifrolumab

A

300 mg every 4 weeks

SE: hypersensitivity reactions

28
Q

Rituximab

A

1 g on days 0 and 15 or 375 mg/m2 once weekly for 4 doses

SE: infusion reactions, Hep B reactivation

Pre-medicate 30 minutes prior (methylprednisolone)

29
Q

Calcineurin Inhibitors

A

Tacrolimus
Pimecrolimus
Voclosporin

30
Q

Cutaneous lupus treatment

A

First line:
Topical agents:
GC: Clobetasol, betamethasone, triamcinolone, hydrocortisone
CNI: Tacrolimus, pimecrolimus
HCQ
Systemic GC

Refractory: High dose GC, MTX, MMF

31
Q

Lupus nephritis treatment

A

Mild-moderate (Class 1 or 2 LN): GC +/- another immunosuppressant (AZA, MMF, CNI)

Severe nephritis (Class 3 or 4 LN): MMF (preferred) or Cyclophosphamide +/- GC

Triple therapy: Belimumab + MMF or CYC +/- GC
CNI + MMF +/- GC

32
Q

Medications that are safe in pregnancy

A

HCQ
NSAIDS
GC

33
Q

Antiphospholipid antibody

A

An autoimmune disorder characterized by antiphospholipid antibody that can cause blood clots and miscarriages

Prophylaxis:
No prior fetal loss: ASA 81 mg
Prior fetal loss: ASA 81 mg +/- LMWH

PHRM 864 Exam 4 (22 decks)

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