Lupus Therapeutics Flashcards
what is lupus
-chronic autoimmune disease with diverse clinical presentation
-immune system attacks healthy tissue and organs throughout the body
what are the 3 etiologies of lupus
Genetics
Hormonal
Environment
what are the main signs and symptoms of lupus
fatigue
depression
photosensitivity
joint pain
n/v
fever
weight loss
Malor “butterfly rash”
What are the mucocutaneous presentations of lupus
Malor, photosensitivity, discoid rash, Raynaud’s
Opthalmologic lupus presentation
lupus retinopathy
renal presentations in lupus
lupus nephritis
when does Drug-induced Lupus Erythematosus occur and how does is resolve
occur 3-6 months after drug initiation
resolution occurs within weeks after drug d/c
what is the pneumonic for Drug induced lupus
My Pretty Malar Marking Probably Has A Transient Quality
what are the DILE drugs
Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine
Anti-TNF
Terbinafine
Isoniazid
Quinidine
What are the diagnostic tools for Lupus
SLICC and EULAR
Diagnostic criteria for SLICC
Must meet 4 or more total features with 1 from each group or biopsy-proven lupus nephritis w/ systemic lupus
Diagnostic criteria for EULAR
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
what is ANA and what is the reference range in lupus
Anti-nuclear antibody
positive and negative but not specific
what is Anti-dsDNA and what is the reference range in lupus
Anti-Double-Stranded DNA
high specificity
negative
correlates w/ disease activity and marker for nephritis
What is Anti-SM and what is the reference range
Anti-Smith Antibody
negative
High specificity
Antiphospholipid reference range
negative
positive = inc in clotting factors
what are the 5 main drugs in lupus
Hydroxychloroquine
NSAIDs
Glucocorticoids
Immunosuppressants
Biologics
HCQ moa
antimalarial (inhibit overactive immune cells)
HCQ place in therapy
recommend for all patients
HCQ dosing
200-400mg PO daily
max 400mg daily
HCQ side effects
Retinal toxicity
neuropsych effects
QT prolongation, cardiomyopathy
myopathy
hypersensitivity reaction
hypoglycemia, anemia
G6PD Deficiency
HCQ monitoring
baseline: CBC, LFT, SCr, EKG
periodic: eye exam every 3 months then anually
NSAID moa
anti-inflammatory and analgesic
nsaid dosing
ibuprofen: 400-600mg PO q6-8h (max 3200mg)
naproxen: 500mg PO BID
Glucocorticoid moa
inhibits B and T cell responses
anti-inflammatory
what is the place in therapy of glucocorticoids
add on to nsaids and HCQ
what is the dosing for oral prednisone
Mild-moderate: 5-30mg/day
severe: 1mg/kg/day
what is the dosing for IV methylprednisolone
500-1000mg IV daily x3-6 days, then PO prednisone
what is low potency topical steroid
fluocinolone valerate & hydrocortisone butyrate
where to apply low potency steroids
face
what is moderate-potency steroids
triamcinolone acetonide & betamethasone valerate
where to apply moderate-potency steroids
trunk and extremities
what is the high potency steroids
clobetasol
where to apply high potency steroids
scalp sores and palms
what are side effects of topical glucocorticoids
skin atrophy
rosacea
telangiectasis
immunosuppressant moa
suppress immune function
immunosuppressant place in therapy
adjunct to steroids and help to lower steroid dose
or if insufficient response to HCQ
immunosuppressant drugs for lupus
MTX
AZA
cyclophosphamide
mycophenolate mofetil
methotrexate dosing
5-15mg PO once weekly
mtx side effects/toxicities
BMS, infection, renal, GI, liver, pulmonary, hypersensitivity, derm
mycophenolate dosing
1-1.5g twice daily
mycophenolate side effects
BMS, infection, malignancy, AIS, GI
cyclophosphamide dosing
1-1.5mg/kg once daily PO or IV
cyclophosphamide side effects
BMS, infection, malignancy
Azathioprine dosing
50mg PO daily
Azathioprine side effects
BMS, infection, malignancy
Monitor TPMT deficiency
biologics moa
block b-cell medicated immunity
biologic place in therapy
inadequate response to antimalarial and immunosuppressants
severe disease
biologics for lupus
belimumab
anifrolumab
what should not be given with biologics
no live vaccines 30 days before starting therapy or during therapy
no more than 1 biologic at a time
Belimumab dosing
10mg/kg every 2 weeks x 3 doses
anifrolumab dosing
300mg every 4 weeks
what drugs are safe in pregnancy for lupus
HCQ, NSAIDs, Glucocorticoids
