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My own Naplex > Systemic Steroids and Autoimmune > Flashcards

Systemic Steroids and Autoimmune Flashcards

1
Q

How is aldosterone replaced

A

via fludrocordisone which mimics it and has mineralcorticoid activity to balance waterand electrolytes

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2
Q

what disease is fludrocortisone used for for

A

addisons and orthostatic hypotension (off label)

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3
Q

glucocorticoid activity does what

A

anti-inflammatory

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4
Q

what do systemic steroids cause the adrenal gland to stop producing

A

cortisol, due to feedback inhibiton (HPA axis supression)

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5
Q

cushing’s syndrome

A

too much cortisol

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6
Q

addison’s disease

A

not enough cortisol

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7
Q

Steroid equivalence

A 
Cute - cortisone 25
hot - hydrocortisone 20
pharmacists - prednisone 5
and
physicians - prednisolone 5
marry - methylprednisolone 4
together - triamcinolone 4
and
Deliver - dexamethasone 0.75
Babies - Betamethasone 0.6
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8
Q

Dexpak

A

dexamethason

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9
Q

decadron

A

dexamethasone

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10
Q

solu-cortef

A

hydrocortisone

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11
Q

medrol/solu-medrol

A

methylprednisolone

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12
Q

deltasone

A

prednisone

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13
Q

millipred

A

prednisolone

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14
Q

orapred

A

prednisolone

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15
Q

kenalog

A

triamcinolone

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16
Q

long term effects of steroids

A

1) fat deposits (moon face)
2) glaucoma/cataracts
3) stretch marks, bruising
4) growth retardation
5) infection, impaired wound healing
6) psychiatric changes
7) acne
8) gi bleds
9) diabetes
10) poor bone health
11) women - hairy, irregular periods

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17
Q

how to reduce systemic steroid risks

A

alternate day dosing, use steroid with low systemic absorption

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18
Q

short term systemic glucocorticoid side effects

A

insominia, weight gain, emotional instability and

can lead to: increased blood glucose (diabetes), increased blood pressure (hypertension), increased intraocular pressure (glaucoma)

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19
Q

warnings for systemic steroids

A

must taper slowly due to adrenal supression

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20
Q

common symptoms of autoimmune diseases

A

fatugue, weakness, pain

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21
Q

Tests that can detect inflammation

A

ESR (erythrocyte sedimintation rate), C-Reactive protein (CRP), rheymatoid factor (RF), anti-nuclear antibody (ANA)

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22
Q

steroid administration

A

with food

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23
Q

can you give live vaccines with people on steroids?

A

No if dose is high

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24
Q

What can the use of strong immunosuppressants increase the risk of

A

1) Reactivation of TB, Hep B/C - test prior to start
2) Viruses - give live vaccine before tx
3) Lymphomas and certain skin cancers
4) Infections

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25
Q

Rheumatoid arthritis symptoms

A

joint swelling, pain, stiffness, bone deformity

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26
Q

RA diagnosis

A

bilateral, symmetrical with joint pain worse after rest

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27
Q

lab tests to detect RA

A

ACPA (anti-citrullinated peptide antibody) and rheumatoid factor (RF)

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28
Q

when should RA be treated

A

if symptomatic should be started on DMARD (disease modifying RA drug) regardless of severity to prevent progression

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29
Q

Preferred initial tx for RA

A

methotrexate

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30
Q

what treatment combo should never be used IN RA

A

two biologic DMARDS due to risk of fatal infections

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31
Q

Trexall

A

Methotrexate

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32
Q

Plaquenil

A

Hydroxychloroquine

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33
Q

moa of MTX

A

irreversibly binds and inhibits dihydrofolate reductase, thus inhibiting folate

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34
Q

boxed warnings MTX

A

hepatotoxic, myelosupression, mucositis/stomatitis, pregnancy

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35
Q

monitoring MTX

A

CBC, LFTs, chest X Ray, hep B/S serology

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36
Q

warning for hydroxychloroquine

A

irreversible retinopathy therefore monitor with eye exam

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37
Q

contraindication for sulfasalizine

A

sulfa allergy

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38
Q

MOA for Leflunomide (Arava)

A

inhibits pyrimidine synthesis

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39
Q

boxed warning for Leflunomide (for RA) and its prodrug which is used for ms teriflunomide

A

do not use in pregnancy (must be on 2 forms of birth controland not plan to be pregnant for 2 years or do accelerated drug eliminatioN), may cause hepatotoxicity

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40
Q

Janus kinase inhibitor boxed warnings

A

serious infections, increased risk for malignancy, increased risk for thrombosis

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41
Q

what can you not use Janus kinase inhibitors with?

A

biologic DMARDS or potent immunosupressants

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42
Q

major mtx ddis

A

alchohol, aspirin/nsaids

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43
Q

entercept, adalimumab, infliximab are what class

A

anti TNF Biologic DMARDS which inhiit tumor necrosis factor alpha

44
Q

Enbrel

A

Etanercept

a biologic

45
Q

Humira

A

Adalimumab

46
Q

Remicade

A

Infliximab

47
Q

Cimzia

A

Cetroloizumab pegol

48
Q

Simponi

A

Golimumab

49
Q

Rituxan

A

Rituximab

50
Q

Rituximab is a what

A

Non -TNF DMARD

51
Q

boxed warning and warning for Anti-TNF DMARDS

A

Boxed: serious infections, malignancies, screen for latent TB and tx

Warning: can cause demyelinating disease, hep B reactivation, heart failure, hepatotoxicity, lupus-like syndrome, do not use with otherbiologic DMARDS or live vaccines

52
Q

Storage of biologics

A

Do not shake or freeze, refrigiration required

53
Q

Pneumonic for drugs that require drugs with filter requirements

A 
That's my 
G - golimzumab (simponi)
A- Amiodarone
L - Lorazepam
P - Phenytoin
L - Lipids (1.2 micron)
A - Amphotercin B (lipid formulations) **5 micron
T - Taxanes (except docetaxel)

whose head is flat

mostly 0.22 microns

54
Q

How often is etanercept (Enbrel) dosed and where

A

SC weekly into the amdomen, thigh, or upper arm

55
Q

how often is adalimumab (humira) dosed and administered

A

SC every other week into the amdomen and thigh (not upper arm)

56
Q

Normal Saline Only Pneumonic

A 
A - Ampicillin
D - Daptomycin, I - Infliximab (remicade), A - Ampicillin.sulbactram (betic)
Can't - Caspofungin
Eat - Ertapenem
Pie - Phenytoin
57
Q

dosing frequency for cetolizumab pegol (Cimzia )

A

every other week

58
Q

biologics dosed every other week

A

certolizumab (cimzia) and adalimumab (HUMIRA)

59
Q

golimumab dosing and location

A

AKA SIMPONI dosed monthly in the abdomen, thigh, or upper arm

60
Q

what does rituximab (rituxan) deplete

A

CDB20 B cells

61
Q

administration of rituximab (rituxan)

A

premedicate with a steroid, acetaminophen, and a antihistamine

62
Q

which biologic can cause hypersensitivity and/or infusion reactions

A

Infliximab (remicade ANTI TNF) - infusion reaction and delayed hypersensitivity

Rituximab (rituxan, NON TNF) - serious and fatal infusion related rxn requiring premedication

63
Q

storage of entercept (enbrel) and adalimumab (himira) atroom temp

A

14 days at room temp

64
Q

Which race is lupas more common in

A

african american and asian

65
Q

DILE drugs pneumonic

A 
My - Methimazole
Pretty - Propylthiouracil
Malar - methyldopa
Marking - minocycline
Probably - procainimide
Has - Hydralazine
A - Anti-TNF
Trans - Terbinafine
Iant - Isoniozid
Quality - Quinidine
66
Q

Clinical Presentation of lupas

A

fatigue, depression, anorexia, weight loss, muscle pain, malar rash (buttefly), photosensiticity, joint pain and stiffness

67
Q

manifistations that contribute to mortality in SLE

A

kidney disease (50% of patients), liver, neurologic

68
Q

tests for lupas

A

antinuclear antibodies, anti SS DNA, anti DS DNA

69
Q

non drug tx for SLE

A

photosensitivity (avoid suscreans and sun protection)

70
Q

tx for SLE

A

hydrxychloroqunalone, cyclophosphamide, azathiprine, mycophenolate mofetil, cyclosporine

71
Q

how long does tx for sle take to show benefit

A

6 months

72
Q

benlysta

A

belimumab (for lupas)

73
Q

belimumab (benylysta) MOA

A

IGG1 lambda monocolonial antibody which prevents the survival of B lymphocytes and reduces B cell mediated immunity and autoimmune response

74
Q

what does MS attack and how does it present

A

the myelin sheath and causes the deterioration of cognitive function, muscle spasms, pain, incontinence, and difficulty walking with gait instability and visual disturbances

75
Q

how is MI diagnosed

A

MRI

76
Q

Copaxone

A

Glatiramir acetate

tx for ms (non interferon alpha)

77
Q

glatiramer acetate (copaxone)warnings and side effects

A

warning: Chest pain

Side effects: injection site reactons, flushing, diaphoresis, dyspnea

78
Q

What is the preferred MS treatment in pregnancy

A

Copaxone (glatiramer acetate)

79
Q

Copaxone/Glatiramir Acetatedosing

A

SC daily or 3x per week

80
Q

interferon beta products have what warnngs and side effects

A

psychiatric disorders, injection site necrosis, thyroid disfunction, increased LFTs

side effects: flu like

81
Q

some interferon beta products contain what (besides PEG)

A

albumin

82
Q

dosing frequency for pegilated interferon beta

A

every 14 days

83
Q

Tysabri

A

Natalizumab

a monocolonial antibody for MS

84
Q

Tysabri (natalizumab) has a boxed warning for what

A

Progressive multifocal leukoencephalopathy (PML) and is only availale through REMS

*see IBS

85
Q

Simponimod (mayzent) oral immunomodulator for MS is contraindicated in what and has what significant adverse events and requires what monitoring

A

Macular edema, monitor eye exams, LFTs, CBC (same for fingolimod/Gilenyeya)

Contraindicated with CYP2C92/3 genotype

86
Q

Fingolimod (gilyena) has to be monitored for what for how long

A

bradycardia, 6 hours

87
Q

Teriflumide (aubagio) is contraindicated in what a MS drug

A

pregnancy

88
Q

what are the sympotms of myesthenia gravis

A

eyes/vision, drooping eyelid (ptosis)

89
Q

what can unmask or worsen myesthenia gravis and what cantreat

A

drugs, tx with cholinesterase inhibitorsto block the breakdown of each and thus cause cholinergic effects (SLUDGE)

90
Q

sx of sjOgren’s syndrome and complications

A

dry eyes, dry mouth –> complications include dental caries, corneal ulderation, chronic oral infections

91
Q

dry eyes treatment

A

OTC teardrops or may do cyclosporine tear drops (restasis)

92
Q

restasis

A

cyclosporine

93
Q

eye drop preservative that can cause irritation

A

Benzalkonium chloride

94
Q

restasis/cyclosporine side effects

A

ocular burning

95
Q

liftegrast (Xiidra) eye drop side effect

A

unusual taste

96
Q

dry mouth tx OTC

A

OTC: sugar free gum with xylitol or lozenges and daily rinses with antimicrobial mouthwash

97
Q

pilocarpine and cevimeline are what and are contraindicated in whom

A

muscarinic agents for dry mouth (RX) and are contraindicated in patients with uncontrolled asthma and narrow-angle glaucoma

98
Q

what is psoriasis

A

a chronic, autoimmune disease that appears on the skin appearing as raised white patches with silvery white buildup

99
Q

non drug tx for psoriasis

A

UVB phototherapy because it can cause activated T cells in the skin to die

100
Q

Drug tx topical if facial or if other topical tx fails

A

calcinerurin inhibitors (tacrolimus) which are associated with skin cancer and lymphoma

101
Q

coal tar products are used for what

A

dandruff, dermatitis, psoriasis

102
Q

systemic retinoids are used in what cases for psoriasis

A

severe only

103
Q

interleukin receptor antagonists for psoriasis are administered how and can cause what

A

SC, like every other monocololial antibody infection and diarrhea

104
Q

at what dose would someone be considered immunosuppressed from steroid?

A

> 2 mg/kg/day or >20mg/day of prednisone or prednisone equivilent

105
Q

when is hydroxychloroquine used as an alternative to lupas

A

when worried about liver disease

106
Q

Raynaud’s is what and caused by what drugs

A

decreased blood flow to finders which makes it blue and is caused by sympathomimetic, beta blockers, and some chemo drugs (bleomycin, cisplatin)

107
Q

how to treat reynaud’s

A

a DHP CCB (i.e. nifedipine)

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