Pharm Flashcards
what is the mainstay of therapy for many chronic inflammatory and autoimmune diseases
- glucocorticoids
the mechanism of action of glucocorticoids is via regulation of _______
- transcription
what cellular processes do glucocorticoids suppress
- macrophage activation
- cellular immunity
- cytokine production
- WBC trafficking
some side effects of glucocorticoids
- CNS effects
- fluid retention/weight gain/Cushings
- hyperglycemia
- HTN
- infection
things to do before starting patients on glucocorticoids
- PPD test
- check vaccination
- measure bone density to reduce risk for osteoporosis
what anti malarial drug is used for autoimmune disease
- hydroxychloroquine
MOA of hydroxychloroquine
- inhibit TLR signaling
- decrease cytokines, lymphocytes, NK activity
what conditions do we use hydroxychloroquine in
- SLE
- RA
- Sjogren
contraindications of hydroxychloroquine
- retinopathy
- G6PD deficiency
adverse events of hydroxychloroquine
- retinal toxicity
- myopathy/cardiomyopathy
screening for hydroxychloroquine
- ophthalmology screening
MOA of methotrexate
- inhibits DHFR
what conditions do we use methotrexate with
- rheumatic diseases
- inflammatory diseases
what is the drug of choice with rheumatoid arthritis
- methotrexate
what must you give with MTX to avoid oral ulcers and other side effects
- folic acid
side effects of MTX
- mucosal ulceration
- hepatotoxicity
- bone marrow toxicity
- pneumonitis
what is important to monitor in patients taking MTX
- liver function tests
can you use methotrexate in pregnancy
- no
drug interactions with MTX
- sulfamethoxazole
MOA of leflunomide
- inhibits dihydroorate dehyrogenase
- reduces pyrimidine synthesis
- reduces activated T cells
for what conditions do you use leflunomide
- inflam arthritis
- SLE
can you use lefluonimide in pregnancy
- no
side effects of lefluonimide
- rash
- alopecia
- diarrhea
toxicities of lefluonimide
- liver tox
- bone marrow tox
what do you give in case of toxicity or pregnancy on lefluonimide
- chlestyramine
what conditions do you give Azathioprine to treat
- SLE
- systemic vasculitis
- inflammatory myopathy
toxicities of azathioprine
- infection
- bone marrow
- hepatotoxicity
- malignancy
what do you measure to check bone marrow toxicity in patients on azathioprine
- thiopurine methyltransferase
drug interactions with Azathioprine
- allopurinol
- sulfasalazine
- trimethoprim
- ACE-inhibitors
can you use azathioprine in pregnancy
- yes!
you can use mycophenolate in these conditions
- SLE
- scleroderma lung disease
- inflammatory myopathy
- vasculitis
side effects of mycophenolate
- dyspepsia
- diarrhea
- rash
adverse effects of mycophenolate
- CMV infections
- bone marrow suppression
- malignancy
MOA of cyclophosphamide
- alkylating agent
conditions cyclophosphamide treats
- SLE
- vasculitis
- scleroderma
what do you give with cyclophosphamide to protect the bladder from dyspepsia
what is the bad breakdown product
- MESNA
- acrolein
toxicities of cyclophosphamide
- infection risk
- hemorrhagic cystitis
- infertility
- bone marrow suppression
what conditions do we use TNF alpha inhibitors in
- rheumatoid arthritis
- psoriatic arthritis
- juvenile arthritis
do we use TNF alpha inhibitors in lupus
why?
- no
- worsen disease
adverse effects of TNF alpha inhibitors
- reactivation of extrapulmonary TB or Hep B
do we give live vaccines with monoclonal antibodies
- NO
MOA of rituximab
- against CD20
- depletes B cells
what conditions do we use rituximab for?
- rheumatoid arthritis
- ANCA
- SLE
adverse effects of rituximab
- serum sickness
- reactivation of Hep B
- progressive multifocal leukoencephalopathy
MOA of Tocilizumab
- blocks IL-6 signaling
what conditions do we use tocilizumab to treat?
- RA
- juvenile arthritis
- giant cell arthritis
MAO of Belinumab
- blocks activation of Blys/BAFF
- Blys/BAGG binds to autoreactive B cells and helps them to produce autoantibodies.
what do we use Belinumab to treat
- refractive SLE
what do we use IVIg to treat
- Kawasaki dz
- ITP
- SLE
- inflammatory myopathy
