Pharmacology of MOS

Question 1

What are the doses of low, medium and high dose Glucocorticoids

Answer 1

Low: 5-10 mg/d
Medium: 20-40 mg/d
High: 60 mg/d

Question 2

MOA for Glucocorticoids

Answer 2

Regulation of transcription of certain genes; suppress macrophage activation, WBC trafficking and cytokine production

Question 3

Side Effects of Glucocorticoids

Answer 3

Insomnia/Psychosis/Irritability
Weight gain
Hyperglycemia
Cushing's Syndrome
HTN
Infection
Osteoporosis
Cataracts

Question 4

What MUST you consider before placing a patient on Glucocorticoids

Answer 4

PPD testing
Review/Update immunizations
Calcium/Vitamin D supplementation

Question 5

Antimalarial agent that can also be used as an anti-inflammatory; Inhibits TLR signaling, and thus cytokine production and WBC activity; used for SLE, RA and Sjogren syndrome; CONTRAINDICATED with retinopathy and G6PD deficiency

Answer 5

Hydroxychloroquine

Question 6

Indications for Hydroxychloroquine

Answer 6

Malaria prophylaxis
SLE
RA
Sjogren Syndrome

Question 7

Contraindications for Hydroxychloroquine

Answer 7

G6PD deficiency

Retinopathy

Question 8

How does Hydroxychloroquine have anti-inflammatory effects?

Answer 8

Inhibit TLR signaling–> dec. cytokines and WBC activity

Question 9

Dihydrofolate Reductase inhibitor used for inflammatory and autoimmune diseases; CONTRAINDICATED in Pregnancy or with Sulfamethoxazole

Answer 9

Methotrexate

Question 10

MOA of Methotrexate

Answer 10

Dihydrofolate Reductase inhibitor -> interferes with DNA synthesis

Question 11

Contraindications for Methotrexate

Answer 11

PREGNANCY

Sulfamethoxazole

Question 12

____________ ___________ is administered prophylactically along with Methotrexate to prevent megaloblastic anemia and glossitis

Answer 12

Folic Acid

Question 13

Side Effects of Methotrexate

Answer 13

Fatigue/Nausea
Mucosal ulcerations
Hepatotoxicity
Bone Marrow toxicity
Pneumonitis

*note that most involve rapidly dividing cells

Question 14

Dihydroorate Dehydrogenase Inhibitor (no Orotate–> no de novo pyrimidine synthesis); used for arthritis and SLE; TERATOGEN

Answer 14

Leflunomide

Question 15

MOA of Leflunomide

Answer 15

Dihydroorate Dehydrogenase inhibitor (no Orotate–> no de novo pyrimidine synthesis)

Question 16

Side Effects of Leflunomide

Answer 16

Rash
Alopecia
Diarrhea
Liver toxicity
Bone marrow toxicity

*note most have rapidly dividing cells

Question 17

Contraindications for Leflunomide

Answer 17

PREGNANCY

Question 18

Immunosuppressant precursor of 6-mercaptopurine (inhibits Purine synthesis); used for SLE, Systemic Vasculitis and Inflammatory Myopathy; SAFE in pregnancy

Answer 18

Azathioprine

Question 19

MOA of Azathioprine

Answer 19

Precursor to 6-mercaptopurine, which prevents conversion of PRPP to IMP/AMP/GMP

Question 20

Side Effects of Azathioprine

Answer 20

Fever
Rash
Anaphylaxis
Infection
Bone marrow toxicity
Hepatotoxicity
Malignancy

Question 21

Azathioprine is (safe/dangerous) in pregnancy

Answer 21

Pregnancy

Question 22

Immunosuppressant that inhibits the conversion of IMP to GMP (Purine synthesis); indicated for SLE, Scleroderma, Vasculitis and Inflammatory Myopathy

Answer 22

Mycophenolate

Question 23

MOA of Mycophenolate

Answer 23

Inhibit conversion of IMP to GMP (Purine synthesis)

Question 24

Side Effects of Mycophenolate

Answer 24

Dyspepsia
Diarrhea
Abdominal pain
Rash
Infection
Bone Marrow suppression
Malignancy

Question 25

Alkylating agent used for immunosuppression; used for Organ THREATENING complications, like SLE, Vasculitis, Lung Sclerosis, etc; can cause infection, bone marrow toxicity, infertility, hemorrhagic cystitis and bladder malignancy

Answer 25

Cyclophosphamide

Question 26

Indications for Cyclophosphamide

Answer 26

ORGAN THREATENING complications (SLE, Vasculitis, Lung Sclerosis, etc.)

Question 27

Side Effects of Cyclophosphamide

Answer 27

``` Infection Bone marrow toxicity Infertility Hemorrhagic cystitis Bladder malignancy ```

Question 28

Examples of TNF-a inhibitors (5 total)

Answer 28

``` Etanercept Infliximab Adalimumab Certolizumab Golimumab ```

Question 29

Indications for TNF-a inhibitors (Etanercept, Adalimumab, Infliximab, etc.)

Answer 29

RA Psoriasis IBD

Question 30

TNF-a inhibitors can be used for SLE (True or False)

Answer 30

False; associated with worsening disease

Question 31

Side Effects of TNF-a inhibitors (Etanercept, Adalimumab, Infliximab, etc.)

Answer 31

TB and Hepatitis B reactivation | NO LIVE VACCINES

Question 32

_______ is involved with the inflammatory response and granuloma formation around Tuberculosis

Answer 32

TNF-a

Question 33

Monoclonal antibody against B-cell CD20; causes B-cell depletion; indicated for RA, ANCA vasculitis (GPA and MPA) and other autoimmune diseases

Answer 33

Rituximab

Question 34

MOA of Rituximab

Answer 34

Antibody against CD20--> depletes B cells

Question 35

Side Effects of Rituximab

Answer 35

``` Infusion reactions HTN Arthralgias Serum Sickness PML Hepatitis B reactivation ```

Question 36

Anti-IL-6 receptor antibody; indicated for Giant Cell (Temporal) Arteritis and RA

Answer 36

Tocilizumab

Question 37

MOA for Tocilizumab

Answer 37

IL-6 receptor antibody

Question 38

Side Effects of Tocilizumab

Answer 38

Infusion reaction Cytopenias Dyslipidemia

Question 39

Antibody that blocks the activation of B cells (via B Lymphocyte Stimulator); used for SLE refractory to treatment

Answer 39

Belimumab

Question 40

Purpose of Intravenous Ig for treating autoimmune diseases

Answer 40

Occupies and blocks Fc receptors, preventing immune-mediated phagocytosis and production of cytokines

Question 41

Indications for IVIg

Answer 41

Kawasaki's disease ITP SLE