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systematic steroid and autoimmune conditions Flashcards

1
Q

does long term steroid be suddenly stopped

A

needs to be tapered slowly

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2
Q

what are the 2 main endogenic steroids

A

cortisol
aldosterone

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3
Q

how to replace cortisol

A

any steroids with glucocorticoid effects (antiinflammatory)

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4
Q

how to replace aldosterone

A

fludrocortisone which has mineralocorticoid activity

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5
Q

hypothalmic pituatory adrenal axis

A

systemic steroid can cause adrenal glands to stop producing cortisol by creating a negative feedback

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6
Q

what is cushings syndrome

A

adrenal gland producing too much cortisol or systemic steroids high dose

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7
Q

what are some effects of cushings or high dose steroids

A

glaucoma
fat deposit in face
acne
GI bleed/ ulcer
diabetes
muscle wasting - thin arms and legs compared to body
pink purple stretches in body
irregular period
hair growth in face
poor bone health

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8
Q

what are some ways to reduce steroid high dose risk

A

alternate day dosing
use localized meds
for gut use- budesonide
for long term use, as low dose and lowest time possible

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9
Q

what is addisons disease

A

opposite of cushings- not making enough cortisol

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10
Q

steroid least potent to most potent

A

cute hot pharmacists and physicians marry together and deliver babies
cortisone 25
hydrocortisone 20
prednisone 5
prednisolone 5
methylprednisolone 4
triamcinolone 4
dexamethasone 0.75
betamethasone 0.6

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11
Q

what are short acting steroids

A

cortisone and hydrocortisone

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12
Q

what are long acting and potent steroids

A

dexamethasone and betamethasone

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13
Q

what are intermediate acting steroids

A

prednisone
prednisolone
methylprednisolone
triamcinolone

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14
Q

what are some short term AE with systemic steroids

A

weight gain
increase in apetite
mood changes
insomnia

** take with food

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15
Q

when is it considered immunosuppression through steroids

A

> 2mg/kg/day or >20mg/day of predisone or equivalent for >2 weeks

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16
Q

biomarkers for autoimmune conditions

A

ESR= erythrocyte sedimentation rate
CRP= C-reactive protein
RF= rheumatoid factor
ANA= antinuclear antibody

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17
Q

what are some autoimmune conditions

A

RA= rheumatoid arthritis
SLE= systemic lupus erythematosus
MS= multiple sclerosis
Celiac disease
SJS= sjogrens syndrome
raynauds
myasthenia gravis
psoriasis

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18
Q

what are some risk of strong immunosuppressants

A

reactivation of TB and Hep B and C = testing must be done
live vaccines should be given prior to therapy
lymphomas and certain skin cancers
infections

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19
Q

in RA contrast to OA what happens

A

RA symmetrical worsens after rest
ACPA or anti citrullinated peptide antibody and RF are useful lab test

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20
Q

what are treatment options for RA

A

DMARD = disease modifying antirheumatic drug
DMARD combination is preffered but not more than 1 biologic DMARDS
TNF inhibitor
non TNF inhibitor
Steroids at low dose and low frequency

rest, PA, diet and weight control
surgical intervention

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21
Q

non biological DMARDS are

A

MTX or texall-
Hydroxycholorquine -
sulfasalazine
leflunomide
JAK

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22
Q

what are some points for MTX

A

weekly dose
otrexup and rasuvo are SC auto injectors
7.5mg-20 mg weekly dose
hepatoxic, myelosupression, mucositis, teratogenic
folaate defeciency

23
Q

what are some points for hydroxychloroquine

A

plquenil
irreversible retinopathy
eye exam
lower hepatoxic than MTX

24
Q

sulfazalazine

A

sulfa allergy
HA SJS TEN
yellow-orange skin or urine

25
What are some points for leflunomide
teratogenic hepatoxic HA, SJS, TEN must wait 2 years if pregnancy is desired must have negative pregnancy test and use of 2 forms of birth control
26
what are some JAK or Janus kinase
tofacitinib baricitinib updacitinib
27
what are the BBW for JAK
infections such as TB, viral, bacterial and fungal increase risk for malignancy, thrombosis
28
MTX drug interaction
alcohol= increase liver toxic NSAID and aspirin lowers renal elimination sulfonamide and topical tacrolimus= suppresion and AE loop= increase MTX concentation cyclosporine= both increases when used together
29
MTX drug interaction
alcohol= increase liver toxic NSAID and aspirin lowers renal elimination sulfonamide and topical tacrolimus= suppresion and AE loop= increase MTX concentation cyclosporine= both increases when used together
30
biological DMARS are
anti TNF non TNF
31
anti TNF biologic DMARD
etanercept SC weekly adalimumab SC every other week infliximab IV week 0, 2 and 6 then q8weeks stable on NS only certolizumab SC 0,2,4 then every other week golimumab SC/IV ** pregnancy exposure registry
32
what are some BBW for antiTNF DMARDS
seroius infections including TB, viral, fungi, bacterial HEpB reactivating hepatoxic lupus like syndrome TB test prior to do not shake or freeze but refrigerate MTX 1st line but can be initial if severe
33
non TNF inhibitors biologic DMARDs
Rituximab IV premedicate with steroid or tylenol and antihistamine anakinra abatacept tocilizumab sarilumab
34
what is a BBW for rituximab
HBV reactivation- screening high risk groups infusion related reaction depletes CD20 B cell
35
which non TNF biological DMARD have no BBW
anakinra and abatacept
36
warnings for anakinra
malignency and serious infections
37
BBW for tocilizumab
serious infection, screen for TB
38
what is SLE
erithematosis female AA and asian DILE but resolves after discontinuation
39
what drugs can cause DILE
methimazole propylthiouracil methyldopa minocycline procainamide hydralazine anti TNF agents terbinafine isoniazid My Pretty malar marking propably has a transIent Quality
40
what are some charecteristics of SLE
Butterflyrash photosensitivity joint pain stiffness muscle pain lupus nephritis
41
what are some biomarkers of Lupus
positive antinuclear antibodies= ANA positive anti-single stranded DNA positive anti-double stranded DNA positive anti-SM positive antiphospholipid antibodies low complement elevated ESR CRP
42
tx for SLE
NSAID PPI with NSAID hydroxycholoroquine, cyclophosphamide, azathioprine, mycophenolate mofetil, cyclosporine 6 months not FDA approved FDA approved= Belimumab for lupus and lupus nephritis also FDA approved Voclosporin only for lupus nephritis
43
what are the points for belimumab
benlysta SC and IV once wekly or every other week BBW= serious infections
44
what are some points on voclosporin
BBW= serious infections nephrotoxic not used with live vaccines
45
MS
myelin sheath is attacked by self causes fatigue , tingling, numbness, blurred vision muscle spasm, pain
46
how to detect MS
MRI
47
goal and tx
goal is to prevent disease progression physical therapy glatiramer acetate interferons pyrimidine synthesis inhibitor sphingosine 1 phosphate receptor modulator nuclear factor activator potassium channel blocker monoclonal antibodies oral antineoplastic
48
what is raynauds
triggered by cold or stress leading to vasospasm blue of fingers tx- nifedipine or CCbs nitroglycerin, PD5
49
what drugs cause raynauds
BB bleomycin amphetamines pseudophedrines
50
celiac disease
immune system reacting to gluten need gluten free diet sx- diarrhea, ab pain, bloating, weight loss
51
myasthenia gravis
autoimmune disease of the nerve and muscles in skeletal muscles causing double vision droopy eye problem chewign
52
what drugs can worsen myasthenia gravis
abx= aminoglycosides and quinolones MG salts BB and CCB muscle relaxants local anesthesia
53
tx for myasthenia gravis
cholinesterase inhibitor pyridostigmine (mestinon)- cholinergic AE
54
SJS
dry eyes dry mouth TX- restasis- cyclosporin emulsion Xiidra sugar free chewing gum lozenge and antimicrobial mouthwash

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