SLE Treatments Quiz

Question 1

Rank the following corticosteroid medications from least potent to most potent:

Dexamethasone
Hydrocortisone
Methylprednisolone
Prednisone

Answer 1

Hydrocortisone
Prednisone
Methylprednisolone
Dexamethasone

Question 2

Choose the example that best represent a high dose regimen for prednisone.

A) Oral prednisone 5 mg daily
B) Oral prednisone 1-2 mg/kg daily
C) IV prednisone 500-1000 mg daily

Answer 2

B – IV prednisone at 500-1000 mg daily is WAY too much

Question 3

List 7 side effects of long term corticosteroid use

Answer 3

Osteoporosis
Hyperglycemia/uncontrolled diabetes
Increased risk of infection due to immunosuppression
Elevated blood pressure at high doses
Psychosis/other psychological manifestations
Easy bruising/skin thinning
Adrenal insufficiency/adrenal crisis sx
Weight gain
Hyperlipidemia

Question 4

The mechanism of action underlying the antiinflammatory and immunomodulatory effects of hydroxychloroquine is unknown. Several possible mechanisms of action have been proposed. It is unclear if these mechanisms work similarly for rheumatic and for autoimmune diseases.

List at least 4 of the likely explanations for the pharmacologic effect of hydroxychloroquine when used to manage Lupus.

Answer 4

1) Inhibits cytokine production
2) Reduces lysosome activity
3) Protects cell surface against any potential disturbances
4) Competitive binding to nucleic acid ligands
5) Inhibition of endosomal NADPH oxidase
6) Reduction of leakage of lysosomal enzymes

Question 5

Suppose that after reviewing biopsy results for Ms. ML (PBL case patient) her disease is staged at Class III lupus nephritis. What is your treatment plan for Ms. ML?

Answer 5

Patients with either focal (class III) or diffuse (class IV) lupus nephritis are at high risk of progressing to ESRD and require aggressive therapy.

Administer high dose prednisone for at least 4 weeks, depending on clinical response. Then, taper it to a daily maintenance dose for approximately 2 years. In acutely ill patients, intravenous (IV) methylprednisolone may be used to initiate corticosteroid therapy.

Cyclophosphamide and azathioprine and Mycophenolate mofetil are effective in proliferative lupus nephritis. Mycophenolate mofetil has been shown to be at least as effective as IV cyclophosphamide, with less toxicity. MM is also likely more effective than azathioprine.