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GI/Rheumatology Module > SLE Treatment > Flashcards

SLE Treatment Flashcards

1
Q

What is Non-Drug Treatment for SLE?

A
  1. Limit sun exposure and use sunscreen
  2. Balanced rest and exercise
  3. Avoid smoking
  4. Avoid alfalfa sprouts and echinacea
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2
Q

What are the FDA approved drugs for SLE Treatment?

A
  1. Aspirin
  2. Hydroxychloroquine
  3. Prednisone
  4. Belimumab
  5. Voclosporin
  6. Anifrolumab
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3
Q

What drugs are effective for SLE?

A
  1. Hydroxychloroquine
  2. Methotrexate
  3. Azathioprine
  4. Mycophenolate Mofetil
  5. Cyclophosphamide
  6. Belimumab
  7. Voclosporin
  8. Anifrolumab
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4
Q

What is the MOA for NSAIDs in SLE?

A

Antiinflammatory dose

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5
Q

What is are the Antimalarials for SLE?

A

Chloroquine or Hydroxychloroquine

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6
Q

How do you spell the brand name of Hydroxychloroquine?

A

Plaquenil

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7
Q

What are the side effects of antimalarials?

A
  1. Arthritis
  2. Skin Rash
  3. Alopecia
  4. Oral or Genital Ulcers
  5. Serositis
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8
Q

What are the corticosteroids for SLE?

A

Cyclophosphamide, Azathioprine, Mycophenolate Mofetil, Methotrexate, Belimumab, Rituximab, Anifrolumab, and Voclosporin

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9
Q

What is more effective than prednisone alone for Severe SLE?

A

Cytotoxic drugs with oral prednisone

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10
Q

What are the Cyclophosphamide toxicities?

A
  1. Mesna
  2. Hematopoietic Suppression
  3. Bladder Cancer
  4. Sterility
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11
Q

What should you recommend for a patient on cyclophosphamide?

A

Hydration

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12
Q

What should you monitor for Cyclophosphamide?

A
  1. CBC
  2. Urinalysis
  3. Urinary Cytology
  4. Pap Test Yearly
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13
Q

African Americans and Hispanics may respond less well than Caucasians and Asians in what?

A

Cyclophosphamide?

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14
Q

How do you spell the brand name of Azathioprine?

A

Imuran

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15
Q

How do you spell the brand name of Mycophenolate Mofetil?

A

Cellcept
Myfortic, prodrug

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16
Q

What are the side effects of Cellcept?

A

Diarrhea can be severe
Teratogenic

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17
Q

What effect does Cellcept offer?

A

Steroid-Sparing effect

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18
Q

How do you spell the brand name of Belimumab?

A

Benlysta

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19
Q

What is the MOA of Belimumab?

A

Inhibits soluble human B-lymphocyte stimulator (BLyS or BAFE)
FULLY HUMAN

20
Q

What is the admin for Belimumab and how does it help SLE?

A

Inject
Increased BLyS in SLE prolongs B-Cell survival

21
Q

What can decrease the efficacy of Belimumab?

A

Smoking may decrease efficacy

22
Q

How do you spell the brand name of Rituximab?

A

Rituxan

23
Q

How do you spell the brand name of Anifrolumab-fnla?

A

Saphnelo

24
Q

What are the alternative therapies for SLE?

A
  1. TNF Inhibitors
  2. Leflunomide
  3. Calcineurin Inhibitors
25
Q

What is the main concern with TNF inhibitors and SLE treatment?

A

Antibody formation, common with Infliximab

26
Q

What are the calcineurin inhibitors that can be used in SLE?

A
  1. Cyclosporine –> hyperuricemia
  2. Tacrolimus
27
Q

How do you spell the brand name of Voclosporin, brand new Calcineurin inhibitor?

A

Lupkynis

28
Q

How to spell the brand name of Cyclophosphamide?

A

Cytoxan

29
Q

What is the focal and diffuse lupus nephritis plan for SLE in African Americans and Hispanics?

A
  1. MMF + GC
  2. Improved = MMF + AZA
  3. Not Improved = CYC + GC
  4. Not Improved again = Rituximab OR Calcineurin Inhibitor + GC
30
Q

What is the focal and diffuse lupus nephritis plan for SLE in Caucasians?

A
  1. CYC + GC
  2. Improved = MMF + GC
  3. Not Improved = High dose MMF + GC
  4. Not improved again = Rituximab OR Calcineurin Inhibitors + GC
31
Q

For Focal and Diffuse Nephritis what is the treatment plan for SLE?

A
  1. KEEP HCQ
  2. DC GC meds first than immunosuppressive drugs
32
Q

What is the treatment plan for Antiphospholipid Syndrome with no thromboembolism and low risk and no pregnancy? Primary Prophylaxis

A

Low dose ASA prophylaxis or NOTHING

33
Q

What is the treatment plan for Antiphospholipid Syndrome with increased risk of SLE + lupus anticoagulant + >1aPL antibody? Primary Prophylaxis

A

HCQ + low dose ASA

34
Q

What is the treatment plan for Antiphospholipid Syndrome with unprovoked venous thromboembolism + APS? Secondary Prophylaxis

A

Warfarin target INR 2-3

35
Q

What is the treatment plan for Antiphospholipid Syndrome with first arterial thrombosis + APS? Secondary Prophylaxis

A

Warfarin target INR 3-4 OR
Warfarin target INR 2-3 + low dose ASA

36
Q

What is the treatment plan for Antiphospholipid Syndrome with recurrent arterial thrombosis? Secondary Prophylaxis

A

Warfarin target INR 3-4, low dose ASA or LMWH

37
Q

What is the treatment plan for Antiphospholipid Syndrome with recurrent refractory thrombosis?

A

Add these meds:
1. Statins
2. HCQ
3. Vitamin D
4. Other platelet inhibitors
5. LMWH

38
Q

What are the effects of Antiphospholipid Syndrome?

A
  1. Venous thrombosis
  2. Arterial thrombosis
  3. Recurrent fetal loss
  4. Thrombocytopenia
  5. Livedo reticularis
  6. Increased Thromboxane A2
39
Q

What drugs for SLE can be used during pregnancy?

A
  1. UNfluorinated Corticosteroids (prednisone preferred)
  2. HCQ
  3. NSAIDs, avoid near term
  4. AZA
40
Q

What drugs are AVOIDED for SLE during pregnancy?

A
  1. Mycophenolate
  2. Cyclophosphamide
  3. Leflunomide
  4. Methotrexate
41
Q

What is the treatment for APS + early loss without thrombosis in pregnancy?

A

Low dose ASA +/- Lose dose UH or LMWH
Continue ASA postpartum

42
Q

What is the treatment for APS + loss after 10 weeks without thrombosis in pregnancy?

A

Low dose ASA + MID dose UH or LMWH

43
Q

What is the treatment for aPL with thrombosis in pregnancy?

A

Low dose ASA + High UH or LMWH
4 wks before birth switch LMWH to UH
Stop UH at onset of labor
12hr after deliver restart LMWH + Warfarin

44
Q

All women with APS should receive anticoagulation with prophylactic doses of what?

A
  1. Heparin/LMWH/or Warfarin 6 wk postpartum
45
Q

What drugs are most likely causing drug-induced lupus?

A
  1. Procainamide
  2. Hydralazine
  3. Infliximab
46
Q

What is the entry criterion for the 2019 EULAR/ACR SLE Classification Criteria?

A

ANA Titer >1:80

GI/Rheumatology Module (18 decks)

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