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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?

23
Q

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

24
Q

What are the alternative therapies for SLE?

A
  1. TNF Inhibitors
  2. Leflunomide
  3. Calcineurin Inhibitors
25
What is the main concern with TNF inhibitors and SLE treatment?
Antibody formation, common with Infliximab
26
What are the calcineurin inhibitors that can be used in SLE?
1. Cyclosporine --> hyperuricemia 2. Tacrolimus
27
How do you spell the brand name of Voclosporin, brand new Calcineurin inhibitor?
Lupkynis
28
How to spell the brand name of Cyclophosphamide?
Cytoxan
29
What is the focal and diffuse lupus nephritis plan for SLE in African Americans and Hispanics?
1. MMF + GC 2. Improved = MMF + AZA 3. Not Improved = CYC + GC 4. Not Improved again = Rituximab OR Calcineurin Inhibitor + GC
30
What is the focal and diffuse lupus nephritis plan for SLE in Caucasians?
1. CYC + GC 2. Improved = MMF + GC 3. Not Improved = High dose MMF + GC 4. Not improved again = Rituximab OR Calcineurin Inhibitors + GC
31
For Focal and Diffuse Nephritis what is the treatment plan for SLE?
1. KEEP HCQ 2. DC GC meds first than immunosuppressive drugs
32
What is the treatment plan for Antiphospholipid Syndrome with no thromboembolism and low risk and no pregnancy? Primary Prophylaxis
Low dose ASA prophylaxis or NOTHING
33
What is the treatment plan for Antiphospholipid Syndrome with increased risk of SLE + lupus anticoagulant + >1aPL antibody? Primary Prophylaxis
HCQ + low dose ASA
34
What is the treatment plan for Antiphospholipid Syndrome with unprovoked venous thromboembolism + APS? Secondary Prophylaxis
Warfarin target INR 2-3
35
What is the treatment plan for Antiphospholipid Syndrome with first arterial thrombosis + APS? Secondary Prophylaxis
Warfarin target INR 3-4 OR Warfarin target INR 2-3 + low dose ASA
36
What is the treatment plan for Antiphospholipid Syndrome with recurrent arterial thrombosis? Secondary Prophylaxis
Warfarin target INR 3-4, low dose ASA or LMWH
37
What is the treatment plan for Antiphospholipid Syndrome with recurrent refractory thrombosis?
Add these meds: 1. Statins 2. HCQ 3. Vitamin D 4. Other platelet inhibitors 5. LMWH
38
What are the effects of Antiphospholipid Syndrome?
1. Venous thrombosis 2. Arterial thrombosis 3. Recurrent fetal loss 4. Thrombocytopenia 5. Livedo reticularis 6. Increased Thromboxane A2
39
What drugs for SLE can be used during pregnancy?
1. UNfluorinated Corticosteroids (prednisone preferred) 2. HCQ 3. NSAIDs, avoid near term 4. AZA
40
What drugs are AVOIDED for SLE during pregnancy?
1. Mycophenolate 2. Cyclophosphamide 3. Leflunomide 4. Methotrexate
41
What is the treatment for APS + early loss without thrombosis in pregnancy?
Low dose ASA +/- Lose dose UH or LMWH Continue ASA postpartum
42
What is the treatment for APS + loss after 10 weeks without thrombosis in pregnancy?
Low dose ASA + MID dose UH or LMWH
43
What is the treatment for aPL with thrombosis in pregnancy?
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
All women with APS should receive anticoagulation with prophylactic doses of what?
1. Heparin/LMWH/or Warfarin 6 wk postpartum
45
What drugs are most likely causing drug-induced lupus?
1. Procainamide 2. Hydralazine 3. Infliximab
46
What is the entry criterion for the 2019 EULAR/ACR SLE Classification Criteria?
ANA Titer >1:80

GI/Rheumatology Module (18 decks)

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