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naplex > systematic steroid and autoimmune conditions > Flashcards

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
Q

What are some points for leflunomide

A

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
Q

what are some JAK or Janus kinase

A

tofacitinib
baricitinib
updacitinib

27
Q

what are the BBW for JAK

A

infections such as TB, viral, bacterial and fungal
increase risk for malignancy, thrombosis

28
Q

MTX drug interaction

A

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
Q

MTX drug interaction

A

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
Q

biological DMARS are

A

anti TNF
non TNF

31
Q

anti TNF biologic DMARD

A

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
Q

what are some BBW for antiTNF DMARDS

A

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
Q

non TNF inhibitors biologic DMARDs

A

Rituximab IV premedicate with steroid or tylenol and antihistamine
anakinra
abatacept
tocilizumab
sarilumab

34
Q

what is a BBW for rituximab

A

HBV reactivation- screening high risk groups
infusion related reaction
depletes CD20 B cell

35
Q

which non TNF biological DMARD have no BBW

A

anakinra and abatacept

36
Q

warnings for anakinra

A

malignency and serious infections

37
Q

BBW for tocilizumab

A

serious infection, screen for TB

38
Q

what is SLE

A

erithematosis
female
AA and asian
DILE but resolves after discontinuation

39
Q

what drugs can cause DILE

A

methimazole
propylthiouracil
methyldopa
minocycline
procainamide
hydralazine
anti TNF agents
terbinafine
isoniazid

My Pretty malar marking propably has a transIent Quality

40
Q

what are some charecteristics of SLE

A

Butterflyrash
photosensitivity
joint pain
stiffness
muscle pain
lupus nephritis

41
Q

what are some biomarkers of Lupus

A

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
Q

tx for SLE

A

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
Q

what are the points for belimumab

A

benlysta SC and IV once wekly or every other week
BBW= serious infections

44
Q

what are some points on voclosporin

A

BBW= serious infections
nephrotoxic
not used with live vaccines

45
Q

MS

A

myelin sheath is attacked by self
causes fatigue , tingling, numbness, blurred vision
muscle spasm, pain

46
Q

how to detect MS

A

MRI

47
Q

goal and tx

A

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
Q

what is raynauds

A

triggered by cold or stress leading to vasospasm
blue of fingers

tx- nifedipine or CCbs
nitroglycerin, PD5

49
Q

what drugs cause raynauds

A

BB
bleomycin
amphetamines
pseudophedrines

50
Q

celiac disease

A

immune system reacting to gluten
need gluten free diet
sx- diarrhea, ab pain, bloating, weight loss

51
Q

myasthenia gravis

A

autoimmune disease of the nerve and muscles in skeletal muscles causing double vision
droopy eye
problem chewign

52
Q

what drugs can worsen myasthenia gravis

A

abx= aminoglycosides and quinolones
MG salts
BB and CCB
muscle relaxants
local anesthesia

53
Q

tx for myasthenia gravis

A

cholinesterase inhibitor
pyridostigmine (mestinon)- cholinergic AE

54
Q

SJS

A

dry eyes dry mouth
TX- restasis- cyclosporin emulsion
Xiidra

sugar free chewing gum lozenge and antimicrobial mouthwash

naplex (78 decks)

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