systemic steriods and autoimmune conditions

Question 1

how to d/c long term steriods

Answer 1

tapper off

Question 2

steroids least potent to most potent

Answer 2

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

Question 3

systemic steroids suppress

Answer 3

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

Question 4

dexamethasone

Answer 4

Dexpak 6, 10, or 13 day
Decadron
- systemic steroids

Question 5

hydrocortisone

Answer 5

solu-cortef
- systemic steroids

Question 6

methylprednisolone

Answer 6

medrol, solu-medrol
- systemic steroids

Question 7

prednisone

Answer 7

Deltasone
- systemic steroids

Question 8

prednisolone

Answer 8

Millipred, Orapred ODT
- systemic steroids

Question 9

triamcinolone

Answer 9

Kenalog
- systemic steroids

Question 10

cortisone is prodrug of

Answer 10

cortisol

Question 11

prednisone is prodrug of

Answer 11

prednisolone

Question 12

medrol pack

Answer 12

day1: 6 tabs
day2: 5 tabs
day 3: 4
3
2 tabs
days 6: 1 tabs

Question 13

immunosuppression from steroids

Answer 13

> =2mg/kg/day or > 20mg/day of prednisone or equivalent potency for >2 weeks

Question 14

symptoms of RA

Answer 14

joint swelling
pain
stiffness
Bone deformity

Question 15

traditional (non-biologic) disease-modifying antirheumatic drugs (DMARDs)

Answer 15

• Methotrexate (trexall, Ortexup, Rasuvo)
• Hydroxychloroquine (plaaquenil) +/- MTX
• Sulfasalazine (Azulifidine) +/- MTX
• leflunomide (Arava) +/- MTX- inhibits pyrimidine synthesis

Question 16

Janus Kinase Inhibitors

Answer 16

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)

Question 17

methotrexate drug inteactions

Answer 17

• liver toxicity!
• renal elimination decreased by aspirin/NSAIDS
• sulfonamides and tacrolimus increase AD avoid using together

Question 18

anti-TNF biologic DMARDS

Answer 18

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

Question 19

Etanercept

Answer 19

Enbrel
weekly
- Anti-TNF Biologic DMARDs

Question 20

Adalimumab

Answer 20

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

Question 21

Infliximab

Answer 21

Remicade
weeks 0, 2, and 6 and then every 8 weeks
stable in NS only
- Anti-TNF Biologic DMARDs

Question 22

Certolizumab pegol

Answer 22

Cimzia
every other week
- Anti-TNF Biologic DMARDs

Question 23

golimumab

Answer 23

Simponi
monthly
- Anti-TNF Biologic DMARDs

Question 24

• Anti-TNF Biologic DMARDs
  Safety/SE/monitoring

Answer 24

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

Question 25

Rituximab

Answer 25

Rituxan - non-TNF inhibitor DMARDs

Question 26

Rasuvo and Otrexup

Answer 26

MTX single use auto-injectors

Question 27

select drugs that can cause drug-induced LUPUS Erythematosus (DILE)

Answer 27

My Pretty Malar Marking Probably Has A TransIent Quality Methimazole Propylthiouracil Methyldopa Minocycline Procainamide Hydralazine (alone or BiDil) Anti-TNF agents Terbinafine Isoniazid Quinidine

Question 28

IgG1-lamba monoclonal antibody:

Answer 28

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

Question 29

Calcineurin inhibitors

Answer 29

suppresses the immune system by inhibiting T-lymphocyte activation Voclosporin (lupkynis)

Question 30

interferon beta formulations and glatiramer acetate

Answer 30

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

Question 31

pegylated interferon

Answer 31

plegridy allows for more convenient SC dosing every 14 days

Question 32

interferon beta 1a

Answer 32

Avonex, Revif

Question 33

interferon beta 1b

Answer 33

Betaseron, extavia stored at room temp

Question 34

peginterferon beta 1a

Answer 34

plegridy

Question 35

drugs induced ryanauds

Answer 35

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

Question 36

myasthenia gravis

Answer 36

cholinesterase inhibitors pyridostigmine (mistinon)