systematic steroid and autoimmune conditions Flashcards
does long term steroid be suddenly stopped
needs to be tapered slowly
what are the 2 main endogenic steroids
cortisol
aldosterone
how to replace cortisol
any steroids with glucocorticoid effects (antiinflammatory)
how to replace aldosterone
fludrocortisone which has mineralocorticoid activity
hypothalmic pituatory adrenal axis
systemic steroid can cause adrenal glands to stop producing cortisol by creating a negative feedback
what is cushings syndrome
adrenal gland producing too much cortisol or systemic steroids high dose
what are some effects of cushings or high dose steroids
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
what are some ways to reduce steroid high dose risk
alternate day dosing
use localized meds
for gut use- budesonide
for long term use, as low dose and lowest time possible
what is addisons disease
opposite of cushings- not making enough cortisol
steroid least potent to most potent
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
what are short acting steroids
cortisone and hydrocortisone
what are long acting and potent steroids
dexamethasone and betamethasone
what are intermediate acting steroids
prednisone
prednisolone
methylprednisolone
triamcinolone
what are some short term AE with systemic steroids
weight gain
increase in apetite
mood changes
insomnia
** take with food
when is it considered immunosuppression through steroids
> 2mg/kg/day or >20mg/day of predisone or equivalent for >2 weeks
biomarkers for autoimmune conditions
ESR= erythrocyte sedimentation rate
CRP= C-reactive protein
RF= rheumatoid factor
ANA= antinuclear antibody
what are some autoimmune conditions
RA= rheumatoid arthritis
SLE= systemic lupus erythematosus
MS= multiple sclerosis
Celiac disease
SJS= sjogrens syndrome
raynauds
myasthenia gravis
psoriasis
what are some risk of strong immunosuppressants
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
in RA contrast to OA what happens
RA symmetrical worsens after rest
ACPA or anti citrullinated peptide antibody and RF are useful lab test
what are treatment options for RA
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
non biological DMARDS are
MTX or texall-
Hydroxycholorquine -
sulfasalazine
leflunomide
JAK
what are some points for MTX
weekly dose
otrexup and rasuvo are SC auto injectors
7.5mg-20 mg weekly dose
hepatoxic, myelosupression, mucositis, teratogenic
folaate defeciency
what are some points for hydroxychloroquine
plquenil
irreversible retinopathy
eye exam
lower hepatoxic than MTX
sulfazalazine
sulfa allergy
HA SJS TEN
yellow-orange skin or urine
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
what are some JAK or Janus kinase
tofacitinib
baricitinib
updacitinib
what are the BBW for JAK
infections such as TB, viral, bacterial and fungal
increase risk for malignancy, thrombosis
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
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
biological DMARS are
anti TNF
non TNF
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
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
non TNF inhibitors biologic DMARDs
Rituximab IV premedicate with steroid or tylenol and antihistamine
anakinra
abatacept
tocilizumab
sarilumab
what is a BBW for rituximab
HBV reactivation- screening high risk groups
infusion related reaction
depletes CD20 B cell
which non TNF biological DMARD have no BBW
anakinra and abatacept
warnings for anakinra
malignency and serious infections
BBW for tocilizumab
serious infection, screen for TB
what is SLE
erithematosis
female
AA and asian
DILE but resolves after discontinuation
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
what are some charecteristics of SLE
Butterflyrash
photosensitivity
joint pain
stiffness
muscle pain
lupus nephritis
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
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
what are the points for belimumab
benlysta SC and IV once wekly or every other week
BBW= serious infections
what are some points on voclosporin
BBW= serious infections
nephrotoxic
not used with live vaccines
MS
myelin sheath is attacked by self
causes fatigue , tingling, numbness, blurred vision
muscle spasm, pain
how to detect MS
MRI
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
what is raynauds
triggered by cold or stress leading to vasospasm
blue of fingers
tx- nifedipine or CCbs
nitroglycerin, PD5
what drugs cause raynauds
BB
bleomycin
amphetamines
pseudophedrines
celiac disease
immune system reacting to gluten
need gluten free diet
sx- diarrhea, ab pain, bloating, weight loss
myasthenia gravis
autoimmune disease of the nerve and muscles in skeletal muscles causing double vision
droopy eye
problem chewign
what drugs can worsen myasthenia gravis
abx= aminoglycosides and quinolones
MG salts
BB and CCB
muscle relaxants
local anesthesia
tx for myasthenia gravis
cholinesterase inhibitor
pyridostigmine (mestinon)- cholinergic AE
SJS
dry eyes dry mouth
TX- restasis- cyclosporin emulsion
Xiidra
sugar free chewing gum lozenge and antimicrobial mouthwash
