PHRM 825: SLE Flashcards
What is systemic lupus erythematosus?
- Chronic autoimmune disease
- Severity varies with periods of relapse and remitting symptoms
- No cure
Pathophysiology of lupus
- Largely unknown
- Sex chromosome X linked theory
- Polymorphisms in gene make up
- Triggers in daily life
What results in the damaged caused by lupus?
Inflammation
What environmental triggers can cause lupus?
- Cigarette smoke
- Petroleum adn solvents
- Psychological stress
- Silica dust, solvents, nail polish
What are the cutaneous manifestations of SLE?
- Butterfly rash
- Red, raised, scaly nonscarring rash on sun-exposed areas
What is the most deadly aspect of SLE and how many patients with SLE are affected by it?
Lupus nephritis (LN) 40-60%
What is the MOA of Lupus nephritis?
Damage and inflammation of the glomerulus
What are the s/sx of lupus nephritis?
- Hematuria
- Proteinuria causing foamy urine
- Increased SCr
- HTN
- Edema
What is the MOA of lupus cerebritis?
- Decreased blood flow to the brain caused by vasculitis
- Clots due to anti-phospholipid syndrome
- Increase in cytokines which can interfere with neuron function
What are s/sx of lupus cerebritis?
- Anxiety
- Depression
- Psychosis
- Seizures
- Cognitive and mood abnormalities
- Migraines
- Neuropathy
- Stroke
What drugs can cause drug induced lupus (DIL)?
- Procainamide
- Hydralazine
- Isoniazid
- Chlorpromazine
- Methyldopa
- Minocycline
- Quinidine
- TNF-alpha inhibitors
What is the mnemonic for the ACR diagnostic criteria and how many of these symptoms have to be present to be able to diagnose SLE?
DOPAMINE RASH
Must include 4 or more symptoms
What are 5 non-pharmacologic treatment options for SLE?
- Sun protection
- Nutrition
- Exercise
- Immunizations (NO LIVE VACCINES)
- Smoking cessation
What 5 medication classes can be used to treat SLE?
- NSAIDs
- Antimalarial agents
- Corticosteroids
- Cytotoxic agents
- Biologics
What is the MOA of antimalarials?
- Not fully understood
- Inhibits movement of neutrophils and eosinophils
- Impairs complement-dependent antigen-antibody reactions
What are the baseline monitoring parameters for NSAIDs?
- SCr
- Urinalysis
- CBC
- LFTs
- BP
What are the baseline monitoring parameters for Antimalarials?
- Ophthalmologic
- SCr
- CBC
- LFTs
What is the MOA of topical corticosteroids?
- Anti-inflammatory
- Suppress immune response
Where are high potency topical corticosteroids used?
- Scalp
- Soles
- Palms
Where are mid-potency topical corticosteroids used?
- Trunk
- Extremitites
Where are low-potency topical corticosteroids used?
Face
What topical corticosteroid delivery systems are used for the body and scalp?
- Body: Creams and ointments
- Scalp: foams and solutions
What is the MOA of systemic corticosteroids?
- Anti-inflammatory
- Suppress immune response
What are the baseline monitoring parameters for systemic corticosteroids?
- BP
- Bone mineral density
- BMP
- FLP
What is the MOA of cytotoxic agents?
Suppression of immune function
What medications are considered cytotoxic agents?
- Cyclophosphamide
- Azathioprine
- Mycophenolate mofetil
What is the MOA of biologic agents?
-B-cell reduction
What 2 agents are biologics?
- Belimumab
- Rituximab
What is the MOA of methotrexate?
Inhibits folic acid reductase (requires folic acid administration to prevent toxicities)
Why should you avoid pregnancy in active SLE?
- Miscarriage
- Preeclampsia
- Pre-term labor
- Fetal growth retardation
- Maternal mortality
- Increased risk of exacerbation
What 3 SLE medications are contraindicated in pregnancy
- Cyclophosphamide
- Mycophenolate mofetil
- Methotrexate
What medication is the drug of choice for SLE in a pregnant patient?
Hydroxychloroquine
What medications are used to treat mild SLE?
NSAID +/- antimalarial
What medications are used to treat moderate SLE?
NSAID + antimalarial +/- maintenance systemic steroids
What medications are used to treat severe SLE? (including lupus nephritis and CNS lupus)
NSAID + antimalarial +/- maintenance systemic steroids +/- cytotoxic agent
What medications are used to treat refractory SLE?
NSAID + antimalarial + maintenance systemic steroids +/- cytotoxic agent +/- biologic agent
