Steroids and Autoimmune Conditions Flashcards
HPI: CY is a 38 y/o female who presents to the hospital on 7/7 with a severe flare of rheumatoid arthritis. She’s taken multiple agents in the past including: gold, MTX, prednisone, infliximab (progressed on med), and etanercept. She’s here for a clinic visit and was found to have an acute episode of hepatitis and unusual bruising.
Allergies: Etanercept (severe rash, swelling)
CY has had an allergic reaction to etanercept. What drug class does etanercept belong to?
a. Anti-CD 20
b. Folate antagonist
c. Interferon inhibitor
d. Interleukin inhibitor
e. Tumor necrosis factor inhibitor
e
HPI: CY is a 38 y/o female who presents to the hospital on 7/7 with a severe flare of rheumatoid arthritis. She’s taken multiple agents in the past including: gold, MTX, prednisone, infliximab (progressed on med), and etanercept. She’s here for a clinic visit and was found to have an acute episode of hepatitis and unusual bruising.
PMH: Allergic rhinitis, GERD, osteopenia, fibromyalgia, breast cancer (R breast lumpectomy)
Meds:
Leflunomide 20 mg QD
MTX 2.5 mg, 10 tabs weekly
Prednisone 2.5 mg QD
Pantoprazole 40 mg QD
Loratadine 10 mg QD PRN
Capsaicin apply 5x daily
Lidocaine 5% ointment PRN
Labs on 5/17:
WBC (4-11) = 5.9
GLU = 135
AST (10-35) = 35
ALT (6-40) = 39
Labs on 7/7:
WBC = 5.6
GLU = 131
AST = 212
ALT = 199
Which of CY’s meds are most likely contributing to the new lab abnormalities on 7/7?
a. Leflunomide
b. Methotrexate
c. Prednisone
d. Pantoprazole
e. Lidocaine
a, b
Both leflunomide and MTX can cause acute hepatitis.
HPI: CY is a 38 y/o female who presents to the hospital on 7/7 with a severe flare of rheumatoid arthritis. She’s taken multiple agents in the past including: gold, MTX, prednisone, infliximab (progressed on med), and etanercept. She’s here for a clinic visit and was found to have an acute episode of hepatitis and unusual bruising.
Meds:
Leflunomide 20 mg QD
MTX 2.5 mg, 10 tabs weekly
Prednisone 2.5 mg QD
Pantoprazole 40 mg QD
Loratadine 10 mg QD PRN
Capsaicin apply 5x daily
Lidocaine 5% ointment PRN
CY tells the medical team that she wants to start trying to get pregnant after her recovery. Which of her meds is contraindicated in pregnancy?
a. Leflunomide
b. Pantoprazole
c. Methotrexate
d. Loratadine
e. Prednisone
a, c
A pt reports that her mouth and gums are sore. Upon inspection, the oral cavity appears inflamed. Which med is most likely responsible for this complaint?
a. Hydroxychloroquine
b. Methotrexate
c. Infliximab
d. Rituximab
e. Interferon beta-1a
b
When used weekly for rheumatoid arthritis, the most common side effects of methotrexate are stomatitis (inflammation and redness of the oral mucosa that can lead to pain and difficulty talking, eating, and sleeping), nausea, and diarrhea.
Which steroid is preferred for managing orthostatic hypotension in a pt with Addison’s disease?
a. Prednisone
b. Dexamethasone
c. Hydrocortisone
d. Fludrocortisone
e. Cortisone
d
-Fludrocortisone has mineralocorticoid activity. It mimics aldosterone and helps maintain fluid and electrolyte balance, which helps stabilize BP.
-Addison’s disease occurs when the body isn’t producing enough cortisol or when exogenous steroids are stopped abruptly (in this case, the pt may experience an Addisonian Crisis).
HPI: OP is a 54 y/o male who presents to the clinic today with increased pain and stiffness. He’s also complaining of GI upset from his Trexall. His provider confirms disease progression of his rheumatoid arthritis.
PMH: T2DM, HTN, rheumatoid arthritis, G6PD deficiency
Meds:
Trexall 20 mg PO weekly
Millipred 10 mg PO daily
Lotensin 40 mg PO daily
Lantus 20 mg SC QHS
What additional med/s would be appropriate to add for improved control of OP’s rheumatoid arthritis?
a. Methotrexate
b. Humira
c. Infliximab
d. Benlysta
e. Rituximab
b, c, e
-Methotrexate is a duplication of therapy (the pt is already taking Trexall)
-Benlysta is not indicated for the tx of rheumatoid arthritis
HPI: OP is a 54 y/o male who presents to the clinic today with increased pain and stiffness. He’s also complaining of GI upset from his Trexall. His provider confirms disease progression of his rheumatoid arthritis.
PMH: T2DM, HTN, rheumatoid arthritis, G6PD deficiency
Meds:
Trexall 20 mg PO weekly
Millipred 10 mg PO daily
Lotensin 40 mg PO daily
Lantus 20 mg SC QHS
What other med should OP be taking because he’s on Trexall?
a. Vitamin B12
b. Vitamin B6
c. Glucarpidase
d. Aspirin
e. Folic acid
e
-MTX inhibits dihydrofolate reductase, interfering with folate metabolism. Folate depletion contributes to several AEs of MTX, including GI symptoms and liver toxicity.
-Leucovorin may be used as an alternative folic acid to decrease MTX-induced AEs.
A pt is about to receive an intravenous infusion of a drug for tx of rheumatoid arthritis. The drug is only stable in normal saline and requires a filter. Which drug is described?
a. Infliximab
b. Adalimumab
c. Certolizumab
d. Rituximab
e. Sarilumab
a
-Both infliximab and rituximab are IV infusions that can cause infusion-type reactions (chills, fever, pruritus, hypotension); pre-medication may be necessary.
-Another product that’s available IV and requires a filter is golimumab.
Which of the following should be checked prior to initiating TNF-inhibitor therapy?
a. Sodium
b. TB test
c. Pulmonary function tests
d. 24-hour urine collection
e. HBV tests
b, e
The pharmacist is dispensing etanercept injection to a pt who hasn’t used this med previously. How should the pt be counseled to inject this med?
a. SC once daily
b. IM once weekly
c. IM once daily
d. SC once weekly
e. SC once monthly
d
What is a 1st line tx for Raynaud’s phenomenon?
a. Angiotensin receptor blockers
b. Phosphodiesterase inhibitors
c. Calcium channel blockers
d. ACE inhibitors
e. Statins
c
CCBs, such as ER nifedipine, are often used 1st line to manage Raynaud’s phenomenon.
CM is a 35 y/o female presenting with fatigue, arthralgia, and a butterfly rash over the bridge of her nose. She has been diagnosed with SLE. Which counseling point should the pharmacist provide to CM?
a. Avoid exercise, which may exacerbate arthralgias.
b. Smoking is protective for this disease; wear a nicotine patch to prevent flares.
c. Liver damage is the primary complication of SLE.
d. Avoid prolonged exposure to the sun to reduce photosensitivity.
e. Avoid citrus foods as they have been shown to trigger the disease.
d
-The main complications are renal (> 50% of pts develop lupus nephritis), hematologic, and neurologic.
-Photosensitivity is common d/t the condition.
Which of the following meds can cause yellow-orange urine discoloration?
a. Methotrexate
b. Teriflunomide
c. Tofacitinib
d. Sulfasalazine
e. Dimethyl fumarate
d
Sulfasalazine can cause yellow-orange discoloration of the urine or skin.
HPI: EW is a 51 y/o male who comes to the clinic with complaints of severe pain and swelling in his fingers, toes, and wrists. He states his other joints are “achy,” and he has stiffness in the morning that makes it difficult for him to get going. He had joint pain for the past 3 months, but the intensity has become much worse.
PMH: COPD, HTN, depression, erectile disfunction
Social hx: Denies EtOH use, stopped smoking 2 years ago
Rheumatoid factor (< 40 IU/mL) = 90
Which of the following is consistent with a diagnosis of rheumatoid arthritis in EW?
a. Positive rheumatoid factor
b. Swollen, painful joints
c. Depression
d. Morning stiffness
e. Smoking history
a, b, d
HPI: EW is a 51 y/o male who comes to the clinic with complaints of severe pain and swelling in his fingers, toes, and wrists. He states his other joints are “achy,” and he has stiffness in the morning that makes it difficult for him to get going. He had joint pain for the past 3 months, but the intensity has become much worse.
Allergies: Sulfa (rash)
Rheumatoid factor (< 40 IU/mL) = 90
EW is diagnosed with rheumatoid arthritis. Which of the following meds should be started to reduce disease progression?
a. Prednisone
b. Methotrexate
c. Cimzia
d. Sulfasalazine
e. Simponi
b
-Pts with symptomatic RA should be started on a disease-modifying antirheumatic drug (DMARD).
-MTX should be used 1st line, if there are no contraindications, for treating RA.
-Sulfasalazine should be avoided in pts with a sulfa allergy.
