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PHRM 864 therapeutics > Lupus Therapeutics > Flashcards

Lupus Therapeutics Flashcards

1
Q

what is lupus

A

-chronic autoimmune disease with diverse clinical presentation
-immune system attacks healthy tissue and organs throughout the body

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2
Q

what are the 3 etiologies of lupus

A

Genetics
Hormonal
Environment

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3
Q

what are the main signs and symptoms of lupus

A

fatigue
depression
photosensitivity
joint pain
n/v
fever
weight loss
Malor “butterfly rash”

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4
Q

What are the mucocutaneous presentations of lupus

A

Malor, photosensitivity, discoid rash, Raynaud’s

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5
Q

Opthalmologic lupus presentation

A

lupus retinopathy

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6
Q

renal presentations in lupus

A

lupus nephritis

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7
Q

when does Drug-induced Lupus Erythematosus occur and how does is resolve

A

occur 3-6 months after drug initiation
resolution occurs within weeks after drug d/c

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8
Q

what is the pneumonic for Drug induced lupus

A

My Pretty Malar Marking Probably Has A Transient Quality

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9
Q

what are the DILE drugs

A

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

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10
Q

What are the diagnostic tools for Lupus

A

SLICC and EULAR

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11
Q

Diagnostic criteria for SLICC

A

Must meet 4 or more total features with 1 from each group or biopsy-proven lupus nephritis w/ systemic lupus

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12
Q

Diagnostic criteria for EULAR

A

Only the highest-weighted criterion score within a single domain.
Patient’s score must be 10 or mor and at least 1 clinical criterion is fulfilled

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13
Q

what is ANA and what is the reference range in lupus

A

Anti-nuclear antibody
positive and negative but not specific

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14
Q

what is Anti-dsDNA and what is the reference range in lupus

A

Anti-Double-Stranded DNA
high specificity
negative
correlates w/ disease activity and marker for nephritis

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15
Q

What is Anti-SM and what is the reference range

A

Anti-Smith Antibody
negative
High specificity

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16
Q

Antiphospholipid reference range

A

negative
positive = inc in clotting factors

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17
Q

what are the 5 main drugs in lupus

A

Hydroxychloroquine
NSAIDs
Glucocorticoids
Immunosuppressants
Biologics

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18
Q

HCQ moa

A

antimalarial (inhibit overactive immune cells)

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19
Q

HCQ place in therapy

A

recommend for all patients

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20
Q

HCQ dosing

A

200-400mg PO daily
max 400mg daily

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21
Q

HCQ side effects

A

Retinal toxicity
neuropsych effects
QT prolongation, cardiomyopathy
myopathy
hypersensitivity reaction
hypoglycemia, anemia
G6PD Deficiency

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22
Q

HCQ monitoring

A

baseline: CBC, LFT, SCr, EKG
periodic: eye exam every 3 months then anually

23
Q

NSAID moa

A

anti-inflammatory and analgesic

24
Q

nsaid dosing

A

ibuprofen: 400-600mg PO q6-8h (max 3200mg)
naproxen: 500mg PO BID

25
Q

Glucocorticoid moa

A

inhibits B and T cell responses
anti-inflammatory

26
Q

what is the place in therapy of glucocorticoids

A

add on to nsaids and HCQ

27
Q

what is the dosing for oral prednisone

A

Mild-moderate: 5-30mg/day
severe: 1mg/kg/day

28
Q

what is the dosing for IV methylprednisolone

A

500-1000mg IV daily x3-6 days, then PO prednisone

29
Q

what is low potency topical steroid

A

fluocinolone valerate & hydrocortisone butyrate

30
Q

where to apply low potency steroids

A

face

31
Q

what is moderate-potency steroids

A

triamcinolone acetonide & betamethasone valerate

32
Q

where to apply moderate-potency steroids

A

trunk and extremities

33
Q

what is the high potency steroids

A

clobetasol

34
Q

where to apply high potency steroids

A

scalp sores and palms

35
Q

what are side effects of topical glucocorticoids

A

skin atrophy
rosacea
telangiectasis

36
Q

immunosuppressant moa

A

suppress immune function

37
Q

immunosuppressant place in therapy

A

adjunct to steroids and help to lower steroid dose
or if insufficient response to HCQ

38
Q

immunosuppressant drugs for lupus

A

MTX
AZA
cyclophosphamide
mycophenolate mofetil

39
Q

methotrexate dosing

A

5-15mg PO once weekly

40
Q

mtx side effects/toxicities

A

BMS, infection, renal, GI, liver, pulmonary, hypersensitivity, derm

41
Q

mycophenolate dosing

A

1-1.5g twice daily

42
Q

mycophenolate side effects

A

BMS, infection, malignancy, AIS, GI

43
Q

cyclophosphamide dosing

A

1-1.5mg/kg once daily PO or IV

44
Q

cyclophosphamide side effects

A

BMS, infection, malignancy

45
Q

Azathioprine dosing

A

50mg PO daily

46
Q

Azathioprine side effects

A

BMS, infection, malignancy
Monitor TPMT deficiency

47
Q

biologics moa

A

block b-cell medicated immunity

48
Q

biologic place in therapy

A

inadequate response to antimalarial and immunosuppressants
severe disease

49
Q

biologics for lupus

A

belimumab
anifrolumab

50
Q

what should not be given with biologics

A

no live vaccines 30 days before starting therapy or during therapy
no more than 1 biologic at a time

51
Q

Belimumab dosing

A

10mg/kg every 2 weeks x 3 doses

52
Q

anifrolumab dosing

A

300mg every 4 weeks

53
Q

what drugs are safe in pregnancy for lupus

A

HCQ, NSAIDs, Glucocorticoids

PHRM 864 therapeutics (26 decks)

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