Systemic Steroids and Autoimmune Conditions Flashcards
What is cushings syndrome and addisons disease?
How to reduce systemic steroid risks?
What are the most to least potent steroids?
adrenal gland makes too much cortisol, adrenal gland doesn’t make enough in addisons. Exogenous steroids taken in high doses can also cause cushings syndrome. Addisonian crisis can be fatal.
Alternate day dosing, high dose initially, taper or use dose packs. Low systemic absorption if gut condition.
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What to know about glucocorticoids names?
What to know about glucocorticoids?
Dexamethasone(Dexpak 6,10, or 13). Hydrocortisone(Solu-cortef), Methylprednisolone(Medrol, Solumedrol, Depo medrol), Prednisone(deltasone), Prednisolone(Millipred, Orapred ODT), Triamcinolone(Kenalog).
Side effects can lead to diabetes, hypertension, glaucoma, psychiatric conditions. Adrenal suppression. must taper slowly, short term side effects are appetite, weight gain, emotional instability, insomnia. Cortisone is prodrug of cortisol, Prednisone is a prodrug of prednisolone.
What to know about Methotrexate names and dosing and MOA?
What are Methotrexates safety warnings?
What to know about Hydroxychloroquine?
Otrexup, Rasuvo, Trexall, Xatmep. inhibits dihydrofolate reductase, inhibiting folate. 7.5-20 mg once weekly, low weekly doses, single dose. Never dose daily for RA, liver damage can happen due to this.
Hepatotoxicity, myelosuppression, mucositis/stomatitis, pregnancy, CBC, LFT’s, chest x ray, hep b and c serologies, folate given to decrease hematological, GI, and hepatic side effects.
Plaquenil, irreversible retinopathy, eye exam.
What to know about sulfasalazine?
What to know about leflunomide?
What to know about Tofacitinib and baricitinib?
Sulfa or salicylate allergy CI’d. Yellow-orange coloration of skin/urine.
Inhibits pyrimidine synthesis. Embryo fetal toxicity, hepatotoxicity BBW. Pregnancy, must have negative pregnancy and two forms of birth control, must wait 2 years or use accelerated drug elimination procedure. This is cholestyramine or activated charcoal suspension.
Do not use with biologic DMARDS or potent immunosuppresants, inhibits Janus Kinase enzymes.
What to know the TNF alpha inhibitors?
What to know about etanercept(Enbrel)?
What to know about adalimumab?
Pregnancy registry, needles are included, serious infections,watch for latent tb, malignancies, demyelinating disease, hep b reactivation, heart failure, hepatotoxicity, lupus like syndrome, do not use with biologic dmards and live vaccines, TB test, signs of infection, MTX is used 1st line and theses are add on but they can be initial.
+/- MTX, SC weekly
Humira, SC every other week, +/- MTX.
What to know about infliximab?
What to know about certolizumab pegol?
What to know about Golimumab?
Remicade. IV, + MTX, filter in NS only, Watch for infusion reactions and delayed hypersensitivity reactions.
Cimzia, SC every other week. +/- MTX
Simponi Aria, + MTX, SC is monthly, requires a filter.
What to know about rituximab?
What to know about anakinra?
What to know about abatacept?
Rituxan, + MTX, Depletes CD20 B cells, pre medicate with a steroid, acetaminophen, and an antihistamine, infusion related reactions, Hep B, screen Hep b and c vaccines, do not give with other biologic dmards or live vaccines.
Malignancies and serious infections.
Orencia
What to know about tocilizumab?
What drugs cause DILE?
How do you treat SLE?
Actemra, serious infections, screen for tb, do not give with other biologic DMARDS or live vaccines.
Methimazole, Procainamide, Propylthiouracil, Methyldopa, Quinidine, Isoniazid, Anti-TNF agents, Terbinafine, Hydralazine. My pretty pony miss muffin the queen is a terrific horse.
Hydroxychloroquine, cyclophosphamide, azathioprine, mycophenolate mofetil, and cyclosporine. Up to 6 months
How does belimumab work?
How does glatiramer acetate work?
What to know about interferon?
Benlysta. !gg1 lamba mab, prevents survival of b lymphocytes, serious infections, do not give with other biologic DMARDS or live vaccines.
Copaxone, Immune modulator that activates t lymphocyte suppressor cells. SC daily or 3 times per week. Injection site reactions, diaphoresis, dyspnea, pregnancy.
Interferon beta 1a, Avonex is IM weekly and Rebif is SC three times per week, Beta 1b is every other day, peginterferon beta 1 a is 125 mcg every 14 days.
What are interferons side effects?
What to know about your oral immunomodulators?
How does dalfampridine work?
Psychiatric disorders, injection site necrosis, increased lefts, thyroid dysfunction(hyper and hypo), flu like symptoms, if refrigerated let stand at room temp, do not expel air bubble due to loss of dose.
Teriflunomide is CI’d in pregnancy. Fingolimod can cause bradycardia, monitored for at least 6 hours, ECG, CI’d in patients with stroke. Slow HR drugs caution, Macular edema(eye exams), monitor LFT’s and monitor CBC. Dimethyl Fumarate do not crush, chew, or sprinkle capsule contents on food.
Potassium channel blocker that may increase nerve signal conduction and indicated to improve walking.
What to know about Alemtuzumab (Lemtrada) and Ocrelizumab (Ocrevus)?
What is Raynauds phenomenon?
How do you treat Sjogrens syndrome?
REMS program.
Beta blockers, bleomycin and cisplatin, sympathomimetics, amphetamines, pseudoephedrine and illicit drugs can cause it. Fingers become white, then blue, then red. Nifedipine is commonly used for prevention.
Cyclosporine(Restasis), watch for burning eyes. Lifitegrasy has unusual taste.
what to know about coal tar products?
What to know about Acitretin(Soriatane)?
What is your PD4 inhibitor for psoriasis?
Can also be used for dandruff and dermatitis, coal tar products are messy.
only in severe cases.
Apremilast (Otezla), weight loss and diarrhea.
What are your Interleukin receptor antagonists?
antibodies that bind to and interfere with proinflammatory cytokines. Ustekinumab is stelara. Can cause serious infections, latent TB screen, diarrhea, sub q injection.
