Other Autoimmune Conditions/Tx Flashcards
1
Q
Systemic Lupus Erythematosus Sxs
A
- Fatigue
- Depression
- Anorexia/weight loss
- Muscle pain
- Malar rash (butterfly rash)
- Photosensitivity - protect from sun
- Joint pain/stiffness
- Renal/hematologic/neurologic manifestations (morbidity/mortality causers)
2
Q
Lupus Labs
A
- Lupus nephritis is common (>50%)*
- ANA +
- Anti-ssDNA +
- Anti-dsDNA +
3
Q
DILE Drugs
A
My Pretty Malar Marking Probably Has A Terrific Quality
- Methimazole
- Propylthiouracil
- Methyldopa
- Minocycline
- Procainamide**
- Hydralazine (alone or BiDil)**
- Anti-TNF agents
- Terbinafine
- Isoniazid**
- Quinidine
4
Q
SLE Tx Options
A
- Hydroxychloroquine (ONLY one with FDA-approved indication)
- Cyclophosphamide
- Azathioprine
- Mycophenolate mofetil
- Cyclosporine
- Belimumab (for lupus or lupus nephritis)
- Voclosporin (for lupus nephritis only)
5
Q
Benlysta
A
- Belimumab
- IgG1-lambda monoclonal antibody
- For lupus or lupus nephritis
- Warning: infection risk
- DO NOT give with other biologic DMARDs or live vaccines
6
Q
Lupkynis
A
- Voclosporin, related to cyclosporine
- Calcineurin inhibitor
- For lupus nephritis only
- Box Warning: infections and malignancies
- Warning: nephrotoxic, HTN
- DO NOT give with live vaccines
- SE: HTN, diarrhea, HA, renal impairment
7
Q
MS Sxs
A
- *Attacks on myelin sheath - what neuronal fxn is lost, can’t be regained**
- Fatigue
- Numbness
- Blurred Vision
- Decreased cog. fxn
- Muscle spasm
- Pain
- Incontinence
- Gait instability
8
Q
MS Tx Options
A
- Interferon beta formulations -peg Q14d
- Glatiramer Acetate - preferred in preggo
- DMARDs specifically for MS
- Monoclonal antibodies
- Chemotherapy drugs
9
Q
Copaxone
A
- Glatiramer acetate**
- Immune modulator to suppress cells in relapsing forms of MS
- Dose SQ daily or 3d/week (larger dose)
- Warning: Chest pain
- SE: Injection site rxn, flushing, diaphoresis, dyspnea
- Preferred agent for MS tx in preggo
10
Q
Avenox
A
- Interferon beta-1a
- Dosed IM weekly
11
Q
Rebif
A
- Interferon beta-1a
- Dosed SQ 3x/week
12
Q
Betaseron
A
- Interferon beta-1b
- Dosed QoD
13
Q
Plegridy
A
- Peginterferon beta-1a
- Dosed SQ Q14d
14
Q
Interferon Information
A
- Warning: Psych disorders, injection site necrosis, increased LFTs, thyroid dysfxn (hyper and hypo)
- SE: Flu-like sxs (premedicate APAP or NSAID)
- Refrigerate for storage, stand at room temp before administration
- Don’t expel air bubble (loss of dose risk)
- Some formulations contain albumin
15
Q
Aubagio
A
- Teriflunomide
- First oral DMARD for MS
- Pyrimidine synthesis inhibitor
- CI in preggo (similar to leflunomide)
16
Q
Gilenya
A
- Fingolimod
- First oral DMARD for MS
- Sphingosine 1-phosphate receptor modulator
- Warning: Bradycardia, monitor for at least 6 hours after first dose (ECG) , infection risk (CBC monitor), macular edema (eye exams), hepatotoxicity (LFTs)
- MS can become MUCH worse when treatment is stopped
17
Q
Zeposia
A
- Ozanimod
- Sphingosine 1-phosphate receptor modulator
- Used for MS
- CI with concomitant MAOI use
18
Q
Mayzent
A
- Siponimod
- Sphingosine 1-phosphate receptor modulator
- Used for MS
- CI CYP2C92/3 genotype (genetic test beforehand)
19
Q
Nrf2 Activators
A
- DMARD used for MS
- Do not crush/chew/sprinkle capsules on food
20
Q
Tysabri
A
- Natalizumab
- Monoclonal antibody that binds to integrins on leukocytes
- Used for MS
- Boxed warning: progressive focal leukoencephalopathy (PML)
- Only available via REMS
21
Q
Lemtrada
A
- Alemtuzumab
- Recombinant humanized monoclonal antibodies
- Used for MS
- REMS program required
22
Q
MS Sxs Control Options
A
- Anticholinergics for incontinence
- Laxatives for constipation
- Muscle relaxants for muscle spasms
- Analgesics for muscle spasms or pain
- Botox for localized pain/spasms
- Propranolol for tremor
- Antidepressants for depression (SNRI could help with neuropathic pain too)
- Stimulants for fatigue
- Meclizine or scopolamine for dizziness/vertigo
- Donepezil (Acetylcholinesterase-i) for cog. fxn
- PDE5i for ED
23
Q
Raynaud’s Phenomenon
A
- Triggered by cold/stress => vasospasms in extremities that causes fingers/toes to turn white, then blue
- Prevention: vasodilation
- Tx Options: CCB, usually nifedipine
- Alt Tx Options: iloprost, topical nitroglycerin, and PDE5i
24
Q
Key Ingredients to Check for Celiac Disease
A
- “Starch”
- Corn
- Potato
- Tapioca
- Wheat
25
Q
Myasthenia Gravis
A
- Autoimmune disease that attacks connections between nerves/muscles especially in face/neck/eyes
- Sxs: changes to eye/vision (drooping eyelids), problems chewing/swallowing, weak jaw
26
Q
Drugs that Worsen/Mask Myasthenia Gravis
A
- Antibiotics: aminoglycosides, quinolones
- Magnesium salts
- Select antiarrhythmics
- B-blockers and CCB
- Select antipsychotics
- Muscle relaxants
- Local anesthetics
27
Q
Mestinon
A
- Pyridostigmine
- Cholinesterase inhibitor - blocks the breakdown of ACh
- Used for myasthenia gravis
- Warning: cholinergic SE (salivation, lacrimation, urination, diarrhea)
28
Q
Restasis
A
- Cyclosporine eyedrop
- Used for those who haven’t had dry eye relief (Sjogren’s syndrome) from other OTC options (artificial eyedrops)
- SE: ocular burning
29
Q
Xiidra
A
- Lifitegrast
- Can be used for dry eye relief (Sjogren’s syndrome)
- SE: unusual taste)
30
Q
Dry Mouth Treatment Options
A
Usually for Sjogren’s syndrome pts:
- Sugar-free chewing gum/lozenges (with xylitol)
- Daily rinses with antimicrobial mouthwash
- Salivary substitutes (Aquoral, Biotene)
- Muscarinic agonists: pilocarpine (Salagen) or cevimeline (Evoxac) (CI in those with uncontrolled asthma or narrow-angle glaucoma)
31
Q
Retinoids
A
- Option for severe, systemic cases of psoriasis ONLY
- Ex: Acitretin (Soriatane)
32
Q
Otezia
A
- PDE4i, used for systemic psoriasis
- Warning: weight loss
- SE: diarrhea
33
Q
Interleukin Receptor Antagonists
A
- SQ injection option for systemic psoriasis
- Monocloncal antibodies
- Warning: serious infections and latent TB screen
- SE: diarrhea
34
Q
Topical Options for Psoriasis
A
- UV light
- Steroids**
- Vitamin D analog (calcipotriene)**
- Anthralin
- Retinoids** (tazoterene)
- Salicylic acid**
- Coal tar products (used for dandruff/dermatitis too, messy products)
- Protopic/Elidel (calcineurin inhibitors) - use if other treatment options fail, preferred for applying to face
