SYSTEMIC STEROIDS/AUTOIMMUNE CONDITIONS Flashcards
FLUDROCORTISONE MIMICS
ALDOSTERONE
MINERALOCORTICOID ACTIVITY
BALANCE OF WATER AND ELECTROLYTES
STABILIZES BLOOD PRESSURE
GLUCOCORTICOID ACTIVITY
ANTI-INFLAMMATORY
CUSHINGS SYNDROME
ADRENAL GLAND PRODUCES TOO MUCH CORTISOL
ADDISONS DISEASE
ADRENAL GLAND IS NOT MAKING ENOUGH CORTISOL
LONG TERM EFFECTS OF STEROIDS
PSYCHIATRIC CHANGES, HYPOTHYROIDISM
GLAUCOMA, CATARACTS
ACNE
FAT DEPOSITS IN FACE, ABDOMEN, UPPER BACK
GI BLEEDING/ULCERS
STRETCH MARKS AND EASY BRUISING
MUSCLE WASTING
DIABETES
POOR BONE HEALTH
HIRSUTISM
IRREGULAR PERIODS
WAYS TO REDUCE SYSTEMIC STEROID RISKS
ALTERNATE DAY DOSING
USE LOCAL STEROIDS
FOR GUT, USE STEROID WITH LOW SYSTEMIC ABSORPTION
USE LOWEST POSSIBLE DOSE
STEROIDS LEAST POTENT TO MOST
EQUIVALENT DOSES
CUTE HOT PHARMACISTS & OHYSICIANS MARRY TOGETHER & DELIVER BABIES
CORTISONE = 25 MG
HYDROCORTISONE = 20 MG
PREDNISONE = 5 MG
PREDNISOLONE = 5 MG
METHYLPREDNISOLONE = 4 MG
TRIAMCINOLONE = 4 MG
DEXAMETHASONE = 0.75 MG
BETAMETHASONE = 0.6 MG
RATIO OF METHYLPREDISOLONE TO PREDNISONE
4 MG : 5 MG
WHAT STEROID DOSE MAKES ONE IMMUNOSUPPRESSED
≥ 2 MG/KG/DAY OR
≥ 20 MG/DAY OF PREDNISONE FOR ≥ 2 WEEKS
WHAT NON SPECIFIC LAB VALUES CAN BE USED TO DETECT INFLAMMATION
ERYTHROCYTE SEDIMENTATION RATE (ESR)
C REACTIVE PROTEIN (CRP)
RHEUMATOID FACTOR (RF)
ANTI-NUCLEAR ANTIBODY (ANA)
MEDROL THERAPY PACK DOSING
21 COUNT OF 4 MG TABLETS
2/1/1/2
1/1/1/2
1/1/1/1
1/1/1
1/1
1
USE OF STRONG IMMUNOSUPPRESSANTS CAN INCREASE THE RISK OF
REACTIVATION OF TB, HEP B AND HEP C
VIRUSES
LYMPHOMAS OR SKIN CANCERS
INFECTIONS
CLINICAL PRESENTATION OF RHEUMATOID ARTHRITIS
BILATERAL SYMMETRICAL
MORNING STIFFNESS
JOINT SWELLING
PAIN
BONE DEFORMITY
WHAT LAB TESTS CAN BE USED TO IDENTIFY RHEUMATOID ARTHRITIS
ACPA
RF
REGARDLESS OF SEVERITY, SYMPTOMATIC RA SHOULD BE STARTED ON
DMARD TO SLOW DISEASE PROCESS AND PREVENT FURTHER JOINT DAMAGE
WHAT IS THE PREFERRED INITAL THERAPY FOR RA
METHOTREXATE
STEROID USE IN RA
LOWEST DOSE POSSIBLE FOR THE SHORTEST DURATION
MTX DOSING FOR RA
7.5 - 20 MG ONCE WEEKLY
TRADITIONAL NON-BIOLOGIC DMARDS IN RA
METHOTREXATE
HYDROQXYCHLOROQUINE
SULFASALAZINE
LEFLUNOMIDE
JAK INHIBITORS
HYDROXYCHLOROQUINE WARNING
IRREVERSIBLE RETINOPATHY
CARDIOMYOPATHY, QT PROLONGATION
SULFASALAZINE CONTRAINDICATION
SULFA OR SALICYLATE ALLERGY
LEFLUNOMIDE BOXED WARNING
DO NOT USE IN PREGNANCY
HEPATOTOXICITY
LEFLUNOMIDE ACCELERATED DRUG ELIMINATION OPTIONS
PURPOSE: TO REMOVE ACTIVE METABOLITE
CHOLESTYRAMINE
ACTIVATED CHARCOAL
LEFLUNOMIDE AND PREGNANCY
MUST HAVE NEGATIVE PREGNANCY TEST
USE 2 FORMS OF BIRTH CONTROL DURING TREATMENT
MUST WAIT 2 YEARS AFTER DC OR USE ACCELERATED DRUG ELIMINATION TO BE PREGNANT
JAK INHIBITOR AGENTS
TOFACTINIB
BARICITINIB
UPADACITINIB
JAK INHIBITORS BOXED WARNING
SERIOUS INFECTIONS
MALIGNANCY
THROMBOSIS
CAN JAK INHIBITORS BE USED WITH BIOLOGIC DMARDS
NO
ANTI-TNF BIOLOGIC DMARDS
ETANERCEPT (ENBREL)
ADALIMUMAB (HUMIRA)
INFLIXIMAB (REMICADE)
CERTOLIZUMAB (CIMZIA)
GOLIMUMAB (SIMPONI)
WHICH ANTI-TNF BIOLOGICS NEED TO BE USED WITH MTX
REMICADE
SIMPONI
ENGREL DOSING FREQUENCY
WEEKLY
HUMIRA DOSING FREQUENCY
EVERY OTHER WEEK
REMICADE ADMINISTRATION
IV
CIMZIA DOSING FREQUENCY
EVERY OTHER WEEK
SIMPONI DOSING FREQUENCY
MONTHLY
REMICADE WARNINGS
INFUSION REACTIONS
DELAYED HYPERSENSITIVITY
ANTI-TNF BOXED WARNINGS
SERIOUS INFECTIONS, SCREEN FOR LATENT TB
MALIGNANCIES
ANTI-TNF WARNINGS
DEMYELINATING DISEASE
HEP B REACTIVATION
HF
HEPATOTOXICITY
LUPUS-LIKE REACTION
RITUXIMAB (RITUXAN) MOA
ANTI-CD 20 B CELLS
RITUXAN ADMINISTRATION
IV
WITH MTX
PREMEDICATION WITH STEROID, APAP, ANTIHISTAMINE
CLINICAL PRESENTATION OF SLE
FATIGUE, DEPRESSION
ANOREXIA, WEIGHT LOSS,
MUSCLE PAIN
BUTTERFLY RASH
PHOTOSENSITIVITY
JOINT PAIN, STIFFNESS
KEY DRUGS THAT CAN INDUCE LUPUS ERYTHEMATOSUS
MY PRETTY MALAR MARKING PROBABLY HAS A TRANSIENT QUALITY
METHIMAZOLE
PTU
METHYLDOPA
MINOCYCLINE
PROCAINAMIDE
HYDRALAZINE
ANTI-TNF
TERBINAFINE
ISONIAZID
QUINIDINE
LAB FINDINGS IN SLE
POSITIV ANA
ANTI-SSDNA
AND-DSDNA
SLE DRUG TREATMENT
HYDROXYCHLOROQUINE
CYCLOPHOSPHAMIDE
AZATHIOPRINE
MYCOPHENOLATE
CYCLOSPORINE
BELIMUMAB (BENLYSTA) USE
SLE BY REDUCE ACIVITY OF B-CELL MEDIATEDD IMMUNITY AND AUTOIMMUNE RESPONSE
BELIMUMAB (BENLYSTA) WARNINGS
SERIOUS INFECTIONS
DO NOT GIVE WITH OTHER BIOLOGIC DMARDS OR LIVE VACCINES
CALCINEURIN INHIBITOR WARNINGS
INFECTIONS, MALIGNANCIES
NEPHROTOXICITY,
HTN
MULTIPLE SCLEROSIS PRESENTATION
FATIGUE
NUMBNESS
BLURRED VISION
DETERIORATION OF COGNITIVE FUNCTION
MUSCLE SPASMS
PAIN
INCONTINENCE
GAIT INSTABILITY
DMARD FOR MS
INTERFERON BETA FORMULATIONS
GLATIRAMER ACETATE
COPAXONE MOA
GLATIRAMER ACETATE
IMMUNE MODULATOR
COPAXONE DOSING FREQUENCY
SC DAILY OR
SC 3 TIMES/WEEK
COPAXONE WARNINGS
CHEST PAIN
COPAXONE SIDE EFFECTS
INJECTION SITE REACTION
FLUSHING
DIAPHRESIS
DYSPNEA
WHICH AGENT IS PREFERRED FOR MS IN PREGNANCY
COPAXONE
INTERFERON BETA PRODUCTS
AVONEX, REBIF
PLEGRIDY
BETASERON, EXTAVIA
AVONEX DOSING VS REBIF DOSING
IM WEEKLY VS
SC 3X/WEEK
INTERFERON BETA PRODUCT WARNINGS
PSYCHIATRIC DISORDERS
INJECTION SITE NECROSIS
↑LFT
THYROID DYSFUNCTION
SPHINGOSINE 1-PHOPHATE RECEPTOR MODULATORS CONTRAINDICATION
ARRYTHMIAS AND OTHER CV CONDITIONS
OZANIMOD: USE WITH MAOI
SIPONIMOD: CYP2C93/3
SPHINGOSINE 1-PHOPHATE RECEPTOR MODULATORS WARNINGS
SLOW HR
SHOULD MONITOR FOR 6 HOURS AFTER FIRST DOSE
ECG REQUIRED AT BASELINE
MACULAR EDEMA (NEED EYE EXAMS)
NATALIZUMAB (TYSABRI) MOA
MONOCLONAL ANTIBODY BINDS TO INTEGRINS ON LEUKOCYTES
TYSARBI BOXED WARNING
PML
ONLY AVAILABLE THROUGH REMS PROGRAM
WHICH DRUGS CAN WORSEN RAYNAUD’S
BETA BLOCKERS
BLEOMYCIN, CISPLATIN
SYMPATHOMIMETICS, AMPHETAMINES, SUDOFED, ILLICIT DRUGS
RAYNAUD’S PREVENTION AND TREATMENT
CCB NIFEDIPINE
MYASTHENIA GRAVIS SYMPTOMS
CHANGES TO EYES/VISION
DROOPING EYELID (PTOSIS)
WHAT DRUGS CA WORSEN MYASTHENIA GRAVIS
ABX: AMINOGLYCOSIDE AND QUINOLONES
MG SALTS
ANTIARRHYTHMICS
BB AND CCB
ANTIPSYCHOTICS
MUSCLE RELAXANTS
LOCAL ANESTHETICS
MYASTHENIA GRAVIS TREATMENT
CHOLINESTERASE INHIBITORS - BLOCK THE BREAKDOWN OF ACh, IMPROVING TRANSMISSION AND INCREASE MUSCLE STRENGTH
SJOGRENS CHARACTERISTICS
DRY EYES AND DRY MOUTH
SJOGRENS TREATMENT
CYCLSPORINE EYE DROPS (RESTASIS)
