systemic steriods and autoimmune conditions Flashcards
how to d/c long term steriods
tapper off
steroids least potent to most potent
Cute Hote Pharmacists and Physicians Marry Together & Deliver Babies
dose equivalence
short-acting:
Cortisone 25mg
Hydrocortisone 20mg
intermediate-acting:
Prednisone 5mg
Prednisolone 5mg
Methylprednisolone 4mg
triamcinolone 4mg
long-acting &highest potency:
dexamethasone 0.75mg
betamethasone 0.6mg
systemic steroids suppress
adrenal suppression if taking longer than 14 days so tapper off so badly can adjust
SE: Increase IOP, increase BP, increased BG, increase appetite/weight gain
dexamethasone
Dexpak 6, 10, or 13 day
Decadron
- systemic steroids
hydrocortisone
solu-cortef
- systemic steroids
methylprednisolone
medrol, solu-medrol
- systemic steroids
prednisone
Deltasone
- systemic steroids
prednisolone
Millipred, Orapred ODT
- systemic steroids
triamcinolone
Kenalog
- systemic steroids
cortisone is prodrug of
cortisol
prednisone is prodrug of
prednisolone
medrol pack
day1: 6 tabs
day2: 5 tabs
day 3: 4
3
2 tabs
days 6: 1 tabs
immunosuppression from steroids
> =2mg/kg/day or > 20mg/day of prednisone or equivalent potency for >2 weeks
symptoms of RA
joint swelling
pain
stiffness
Bone deformity
traditional (non-biologic) disease-modifying antirheumatic drugs (DMARDs)
- Methotrexate (trexall, Ortexup, Rasuvo)
- Hydroxychloroquine (plaaquenil) +/- MTX
- Sulfasalazine (Azulifidine) +/- MTX
- leflunomide (Arava) +/- MTX- inhibits pyrimidine synthesis
Janus Kinase Inhibitors
inhibits Janus kinase (JAK) enzymes, which stimulates immune cell function
- tofacitinib (Xeljanz)
- baricitinib (Olumiant)
- upadacitinib (Rinvoq)
DO NOT use w/ other biologics DMARDs
keep in mind: risk of infections (TB, viral, bacterial, etc.), malignancy, thrombosis, increased CV risk
monitor CBC, avoid live vax
caution in Asian decent (increased risk)
methotrexate drug inteactions
- liver toxicity!
- renal elimination decreased by aspirin/NSAIDS
- sulfonamides and tacrolimus increase AD avoid using together
anti-TNF biologic DMARDS
used for a variety of diseases… prsoriatic arthritis, plaque psoriasis, etc.
sub Q injections
Etanercept (Enbrel)
Adalimumab (Humira)
Infliximab (Remicade)
Certolizumab pegol (Cimzia)
Golimumab (Simponi)
MTX is first line, this is add-on therapy
however, can bu started w/ or without MTX
Etanercept
Enbrel
weekly
- Anti-TNF Biologic DMARDs
Adalimumab
Humaira
every other week
biosimilars: Cyltezo… and more lol
Cyltezo is the only FDA-approved interchanged biosimilar w/out a separate prescription.
- Anti-TNF Biologic DMARDs
Infliximab
Remicade
weeks 0, 2, and 6 and then every 8 weeks
stable in NS only
- Anti-TNF Biologic DMARDs
Certolizumab pegol
Cimzia
every other week
- Anti-TNF Biologic DMARDs
golimumab
Simponi
monthly
- Anti-TNF Biologic DMARDs
- Anti-TNF Biologic DMARDs
Safety/SE/monitoring
boxed warning: serious infection risk, lymphomas
warning: can cause demyelinating diseases, Hep B reactivation, HF, hepatoxicity, lupus-like syndromes
injection-like reaction!
do not shake or freeze, requires refrigeration
Rituximab
Rituxan
- non-TNF inhibitor DMARDs
Rasuvo and Otrexup
MTX single use auto-injectors
select drugs that can cause drug-induced LUPUS Erythematosus (DILE)
My Pretty Malar Marking Probably Has A TransIent Quality
Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine (alone or BiDil)
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine
IgG1-lamba monoclonal antibody:
prevents the survival of B lymphocytes by blocking the binding of soluble human B lymphocyte stimulator proteins to receptors on B lymphocytes; this reduces the B-cell meditate immunity and autoimmune response
Belimumab (Benlysta)- single dose autoinjector- SC
Calcineurin inhibitors
suppresses the immune system by inhibiting T-lymphocyte activation
Voclosporin (lupkynis)
interferon beta formulations
and
glatiramer acetate
interferon beta: Betaseron, Avonex, Rebif, Extavia, Plegridy- all subQ but avonex IM
can cause flu-like symptoms ontop of all the other stuff
glatiramer acetate: copaxone, glatopa
are parenteral drugs
can cause chest pain, shortness of breath and flushing
all-cause injection site reaction
pegylated interferon
plegridy
allows for more convenient SC dosing every 14 days
interferon beta 1a
Avonex, Revif
interferon beta 1b
Betaseron, extavia
stored at room temp
peginterferon beta 1a
plegridy
drugs induced ryanauds
blue-ish fingers decreased blood flow
can cause or worsen:
beta-blockers
bleomycin, cisplatin
sympathomimetics (from vasoconstrictions): amphetamines, pseudoephedrine, and illicit drugs
tx: Ca channel blocker nifedipine is commonly used
myasthenia gravis
cholinesterase inhibitors
pyridostigmine (mistinon)
