Systemic Steroids and Autoimmune Conditions Flashcards
cushings, RA, SLE, MS, Raynaud's, celiac's, myasthenia gravis, sjogrens, psoriasis
what is the difference between cushings and addisons disease
cushings is an overproduction of cortisol which downregulates ACTH and CRH
addisons is too little cortisol from adrenal gland
what disease does abrupt discontinuation of long term steroids mimic
addisons
adverse effects of long term steroids
glaucoma/cataracts
weight gain
fat deposits (moon face)
pink/purple stretch marks
growth retardation
muscle wasting
easily bruised
infection
insomnia
hyperglycemia
GI bleed
HTN, hypothyroidism
hirsutism and irregular periods in women
poor bone health
steroid equivalents
hydrocortisone 20mg
cortisone 20mg
MEPN 4mg
triamcinolone 4mg
prednisone 5mg
prednisolone 5mg
dexamethasone 0.75mg
betamethasone 0.6mg
what dose of steroids is considered immunosuppressed and requires a taper
> 2mg/kg/day of prednisone
or
20mg prednisone a day x >2 weeks
medrol dosing
2112
1112
1111
111
11
1
ways to decrease systemic steroids risk
every other day dosing
lowest dose for lowest duration
local injection
inhaled > po for lung diseases
if gut disease use low absorption steroid
traditional DMARDs for RA
MTX
HCQ
sulfasalazine
leflunomide
JAK-is (“-nib”)
traditional biologic DMARDs
etanercept
adalimumab
infliximab
certolizumab
golimumab
rituximab
MTX
BBW
CI
Pearls/Counseling
dosed 7.5-20mg PO QWEEK
BBW: myelosuppression, hepatotox, mucositis/stomatitis, teratogenic, acute renal failure, GI tox
MTX is contraindicated in
pregnancy and BF
AUD
CLD
blood dyscrasias
immunodeficiency syndrome
MTX DDI
no alcohol or NSAIDs (dec [MTX])
AVOID sulfa and tacro topicals
loops inc [MTX]
MTX and CYA increase [ ] of each other
what should be given to patients on MTX? Why?
folate to decrease heme, GI, hepatic SE
hydroxychloroquine dosing
200-400mg PO QD initially with food or milk
what should a patient be warned about if taking HCQ
irreversible retinopathy
myopathy, neuropathy, cardiomyopathy, QTp, PSYCH issues
anti-TNF drugs and brand names
adalimumab (Humira)
etanercept (Enbrel)
infliximab (Remicade)
certolizumab (Cimzia)
golimumab (Simponi)
anti-TNF biologics
warnings
DO NOT USE IN HF
hep B reactivation
lupus
seizures
myelosuppression
anti-TNFs are monotherapy T or F
false, always in addition to MTX
what is the non-TNF biologic used for RA
Rituximab (Rituxan)
rituximab pearls
pre treat with AH, steroid, APAP
what drugs cause drug-induced lupus
MMZ and PTU
methyldopa
minocycline
procainamide
hydralazine
quinide
anti-TNFs
terbinafine
isoniazid
tx options for SLE
HCQ
cyclophosphamide
MMF
cyclosporine
can add on Benlysta (belimumab)
which drugs are FDA indicated for SLE
all but HCQ
what drug for SLE inhibits type 1 INFs
anifrolumab (Saphnelo)
patient diagnosed with MS who is pregnant
what is the tx of choice
glatiramer acetate (Copaxone)
besides glatiromer acetate (Copaxone), what are other disease-modifying tx options for MS
Avonex qweek
Plegridy
Betaseron
Natalizumab (also for IBD)
what drugs worsen myasthenia gravis
FQ
macrolides
magnesium salts
anthracyclines
BBs and CCBs
some APs
muscle relaxants
local anesthetics
first line tx for myasthenia gravis
AchE-i to prevent Ach breakdown!
pyridostigmine (Mestinon)
what are hallmark sx of Sjogrens
dry eyes and dry mouth
raynauds treatment
CCBs! Usually nifedipine
raynauds is worsened by
BB
bleomycin
cisplatin
sympathomimetics
cocaine
what strength of steroids are recommended for psoriasis? Which steroids are in this rank?
high potency
halobetasol
clobetasol
fluocinonide 0.1% cream
beclometasone 0.05% ointment
for mild-moderate psoriasis, what are first line tx options?
high potency steroids +/or topical retinoid or vitamin D analog
vitamin d analog used for psoriasis
calcipotriene
topical retinoid for psoriasis
tazarotine or SSA
what are first line tx options for severe psoriasis
MTX
CYA
hydroxyurea
anti-TNFs (adalimumab, infliximab (Remicade), etanercept (Enbrel), certilizumab (Cimzia)
can be in addition to topical high potency steroid, topical Vit D analog, and/or topical retinoid
