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NAPLEX Prep > Systemic Steroids and Autoimmune Conditions > Flashcards

Systemic Steroids and Autoimmune Conditions Flashcards

cushings, RA, SLE, MS, Raynaud's, celiac's, myasthenia gravis, sjogrens, psoriasis

1
Q

what is the difference between cushings and addisons disease

A

cushings is an overproduction of cortisol which downregulates ACTH and CRH

addisons is too little cortisol from adrenal gland

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2
Q

what disease does abrupt discontinuation of long term steroids mimic

A

addisons

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3
Q

adverse effects of long term steroids

A

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

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4
Q

steroid equivalents

A

hydrocortisone 20mg
cortisone 20mg
MEPN 4mg
triamcinolone 4mg
prednisone 5mg
prednisolone 5mg
dexamethasone 0.75mg
betamethasone 0.6mg

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5
Q

what dose of steroids is considered immunosuppressed and requires a taper

A

> 2mg/kg/day of prednisone
or
20mg prednisone a day x >2 weeks

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6
Q

medrol dosing

A

2112
1112
1111
111
11
1

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7
Q

ways to decrease systemic steroids risk

A

every other day dosing
lowest dose for lowest duration
local injection
inhaled > po for lung diseases
if gut disease use low absorption steroid

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8
Q

traditional DMARDs for RA

A

MTX
HCQ
sulfasalazine
leflunomide
JAK-is (“-nib”)

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9
Q

traditional biologic DMARDs

A

etanercept
adalimumab
infliximab
certolizumab
golimumab
rituximab

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10
Q

MTX
BBW
CI
Pearls/Counseling

A

dosed 7.5-20mg PO QWEEK
BBW: myelosuppression, hepatotox, mucositis/stomatitis, teratogenic, acute renal failure, GI tox

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11
Q

MTX is contraindicated in

A

pregnancy and BF
AUD
CLD
blood dyscrasias
immunodeficiency syndrome

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12
Q

MTX DDI

A

no alcohol or NSAIDs (dec [MTX])
AVOID sulfa and tacro topicals
loops inc [MTX]
MTX and CYA increase [ ] of each other

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13
Q

what should be given to patients on MTX? Why?

A

folate to decrease heme, GI, hepatic SE

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14
Q

hydroxychloroquine dosing

A

200-400mg PO QD initially with food or milk

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15
Q

what should a patient be warned about if taking HCQ

A

irreversible retinopathy
myopathy, neuropathy, cardiomyopathy, QTp, PSYCH issues

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16
Q

anti-TNF drugs and brand names

A

adalimumab (Humira)
etanercept (Enbrel)
infliximab (Remicade)
certolizumab (Cimzia)
golimumab (Simponi)

17
Q

anti-TNF biologics
warnings

A

DO NOT USE IN HF
hep B reactivation
lupus
seizures
myelosuppression

18
Q

anti-TNFs are monotherapy T or F

A

false, always in addition to MTX

19
Q

what is the non-TNF biologic used for RA

A

Rituximab (Rituxan)

20
Q

rituximab pearls

A

pre treat with AH, steroid, APAP

21
Q

what drugs cause drug-induced lupus

A

MMZ and PTU
methyldopa
minocycline
procainamide
hydralazine
quinide
anti-TNFs
terbinafine
isoniazid

22
Q

tx options for SLE

A

HCQ
cyclophosphamide
MMF
cyclosporine

can add on Benlysta (belimumab)

23
Q

which drugs are FDA indicated for SLE

A

all but HCQ

24
Q

what drug for SLE inhibits type 1 INFs

A

anifrolumab (Saphnelo)

25
Q

patient diagnosed with MS who is pregnant
what is the tx of choice

A

glatiramer acetate (Copaxone)

26
Q

besides glatiromer acetate (Copaxone), what are other disease-modifying tx options for MS

A

Avonex qweek
Plegridy
Betaseron
Natalizumab (also for IBD)

27
Q

what drugs worsen myasthenia gravis

A

FQ
macrolides
magnesium salts
anthracyclines
BBs and CCBs
some APs
muscle relaxants
local anesthetics

28
Q

first line tx for myasthenia gravis

A

AchE-i to prevent Ach breakdown!

pyridostigmine (Mestinon)

29
Q

what are hallmark sx of Sjogrens

A

dry eyes and dry mouth

30
Q

raynauds treatment

A

CCBs! Usually nifedipine

31
Q

raynauds is worsened by

A

BB
bleomycin
cisplatin
sympathomimetics
cocaine

32
Q

what strength of steroids are recommended for psoriasis? Which steroids are in this rank?

A

high potency
halobetasol
clobetasol
fluocinonide 0.1% cream
beclometasone 0.05% ointment

33
Q

for mild-moderate psoriasis, what are first line tx options?

A

high potency steroids +/or topical retinoid or vitamin D analog

34
Q

vitamin d analog used for psoriasis

A

calcipotriene

35
Q

topical retinoid for psoriasis

A

tazarotine or SSA

36
Q

what are first line tx options for severe psoriasis

A

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

NAPLEX Prep (57 decks)

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