SLE- Immunosuppressants DI

Question 1

Immunosuppressants used in SLE

Answer 1

MTX, AZA, MMF, CYC, CsA

Question 2

Immunosuppressant indications in SLE

Answer 2

Organ-threatening SLE, mainly LN

Question 3

Immunosuppressants are often used in combination with what?

Answer 3

Steroids

Question 4

When to use immunosuppressants?

Answer 4

Poor symptom control after HCQ and steroids

Question 5

CYC and CsA are used when?

Answer 5

Certain types of LN due to toxicity

Question 6

MTX- where else is it used?

Answer 6

Concomitant RA or if arthritis is the main problem/complaint of SLE

Question 7

MTX vs. AZA

Answer 7

MTX is more effective than AZA

Question 8

MTX ADEs

Answer 8

Bone marrow suppression, GI toxicity, hepatotoxicity, nephrotoxicity, etc.

Question 9

When to use AZA

Answer 9

Considered second-line after steroids for more moderate disease course

Question 10

Safest immunosuppressant in pregnancy

Answer 10

AZA

Question 11

AZA ADEs

Answer 11

Bone marrow suppression, N/V

Question 12

MMF: when to use it

Answer 12

Proliferative LN, second-line for membranous LN

non-renal disease

Question 13

When is MMF NOT effective in SLE?

Answer 13

Neuropsychiatric disease

Question 14

MMF ADEs

Answer 14

GI effects (diarrhea, abdominal pain, constipation, anorexia, nausea)

Question 15

MMF CIs

Answer 15

Hematological, CV, and teratogenicity risks- CI’ed in pregnancy!

Question 16

CYC: when to use it

Answer 16

Organ-threatening disease, rescue therapy in non-responders

Question 17

CYC: complications

Answer 17

Organ-threatening cardiopulmonary, renal, or neuropsychiatric disease

Question 18

Warnings with CYC

Answer 18

Hematologic, cardiac, neurologic toxicity; can cause permanent infertility in both men and women

Question 19

Hematologic complications with CYC: what can it do?

Answer 19

Neutropenia

Question 20

Other complications with CYC

Answer 20

Hemorrhagic cystitis, bladder necrosis, cardio toxicity, CNS toxicity, malignancy development

Question 21

CsA: when is it used?

Answer 21

Membranous LN

Question 22

CsA ADE (the one that’s not as severe)

Answer 22

HTN- will make it worse in patients who already have HTN

Question 23

CsA complications/cautions

Answer 23

Hematologic, nephrotoxic, neurotoxic side effects