Systemic Steroids & Autoimmune Flashcards
what are the long term efffects of steroids
fat deposits: buffalo hump, moon face
diabetes
women only: hirtuism\
stetch marks
growth retardation
impaired wound healing
poor bone health
GI bleeding
cushings disease
glaucoma, Cataracts
psychiatric changes: hypothyroidism
Glucocorticosteroids
contraindications
warning
short term side effects (<1month)
CI: Live vaccines serious systemic infections
W: adrenal suppression, must Taper slowly
increase appetite
WG
emotional instability
systemic steroid PO-IV dose equivalence
Cortisone 25
Hydrocortisone 20
Prednisone 5
Prednisolone 5
Methylprednisolone 4
Triamcinolone 4
Dexamethasone 0.75
Beclomethasone 0.6
dexmethasone
Dexpak
Decadron
hydrocortisone
Solu-cortef
prednisone
Deltasone
prednisolone
Millipred
OrapredODT
triamcinolone
kenalog
cortisone
no brand
autoimmune disease labs to review & symptoms
weakness, fatigue, and pain
ESR, CRP, RF, ANA
what can occur when taking immunosuppresants
re-activation of TB and Hep B & C must be tested and treated
viruses: must be given prior
Lymphomas
Infections
symptoms of rhematoid arthritis
joint swelling, pain, stiffness, bone deformity, redness, difficulty moving
RA can be found with what labs
RF rheumatoid factor
ACPA anti-citrullinated antibody
drug treatment for RA
non-biologic DMARD (first line)
(P) MTX
or
combo DMARD or TNF biologic or Non TNF biologic
Non-Biologic DMARDs
methotrexate (Trexall)
hydroxychloroquine (Plaquenil)
Sulfasalazine (Azulfidine)
leflunomide (Arava)
Janus Kinase Inhibitor
stimulate immune cell function
Tofacitinib (Xelijanz)
Baricitinib (Olumiant)
Upatacitinib (Rinvoq)
cause thrombosis, Malignancy, serious infection including TB
Cannot be used with other biologic DMARD
Anti-TNF Biologic DMARD
boxed warning
warnings
certolizumab (Cimzia)
adalimumab (Humira)
Golimumab (Simponi)
Etanercept (Enbrel)
Infliximab (Remicade)
serious infection - screen for latent TB & treat
DNU biologic DMARD/live vaccines
cause demyelinating disease, Hep B reactivation,
Heart Failure
Hepatotoxic, Lupus-like syndrome
methotrexate for RA
boxed warning
contraindication
monitoring parameter
7.5 mg- 20mg once weekly (PO,SC,IM)
Hepatoxicity
myelosuppression
mucositits/stomatoitis
CI: pregnancy
CBC, LFTs, chest x-ray, hepB & hepC serologies
hydroxychloroquine
warnings
irrevesible retinopathy
sulfazalazine
contraindicated
sulfa allergy
can cause yellow/orangeskin/ urine
leflunomide
bowed warning
contraindication
Hepatotoxicity
pregnancy
methotrexate drug interactions
should NOT be taken with alcohol
if taken with NSAID/ ASA/ Betalactams/probenecid results in mtx toxicity
avoid with cyclosporine lead to toxic levels
Biologic DMARD Non TNF
(use other MOA other than TNF)
Rituximab (Rituxan)- depletes CD20 B cells
Anakinra (Kineret)
Abatacept (Orencia)
Tocilizumab (Actemra)
Sarilumab (Kevzara)
drugs that cause Drug induce Lupus Erythematosus
PITA PMMHQ M
Propylthiouracil
Isoniazid
Terbinafine
Anti-TNF (5)
Procainamide
Minocycline
Methimazole
Hydralazine
Quinidine
Methyldopa
systemic lupus signs
labs
drug treatment
butterfly rash
fatigue, depression, anorexia, muscle pain
ANA, antissDNA, antidsDNA
hydroxychloroquine
cyclophosphamide
azathioprine
mycophenolate mofetil
cyclosporine
lupus nephritis treatment drug FDA approved
Belimumab (Benlysta)
cannot be given with other biologic DMARD
multiple sclerosis treatment
Glatiramer acetate (Copaxone)
or
Pegylated interferon beta 1a (Pledridy)
Glatiramer acetate (Copaxone) - SC
warning & SE
chest pain
injection site reactions
flushing, diaphoresis, dyspnea
Pegylated interferon beta 1a (Pledridy)
psychiatric disorders (depression/suicide)
injection site necrosis
increases LFTS
thyroid dysfunction
flulikesymtoms
monoclonal antibodies
Natalizumab
Tysarbi
boxed warning:
progressive multifocal leukoencephalopathy
raynauds syndrome drug treatment
CCB nifedipine
drugs that worsen:
BB, bleomycin,cisplatin, amphetamines
