Systemic Steroids & Autoimmune Conditions Flashcards
how to replace cortisol?
steroids
how to replace aldosterone?
fludrocortisone
Least potent to most potent steroids acronym?
Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies
Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies
cortisone 25mg hydrocortisone 20mg prednisone 5mg prednisolone 5mg methylprednisolone 4mg triamcinolone 4mg dexamethasone 0.75mg betamethasone 0.6mg
what is the immunosuppressive dose for steroids?
≥ 2mg/kg/day or ≥ 20mg/day of prednisone or prednisone equivalent for > 2 weeks
what non-specitive lab tests can be used to detect inflammation?
ESR, CRP, RF, ANA
what are the risks of giving immunosupressants to tx autoimmune diseases?
↑risk of re-activ TB, Hep B/C, Viruses (live vaccines must be given prior to tx), skin cancers, infections
RA presentation?
Bilateral, Symmetrical
▪ Morning stiffness: stiffness and pain worse after rest
Lab tests:
Anti-citrullinated peptide Ab (ACPA), Rheumatoid factor (RF)
what is the initial tx for RA?
MTX
for mod-severe RA how should you tx?
DMARD or TNFi or non-TNF ± MTX [Never use 2 biologic DMARDS combo]
how should you tx flares?
steroids
what is the moa of mtx?
Inhibits dihydrofolate reductase, inhibiting folate
what is the mtx dosing for RA?
7.5mg - 20mg q week
what is the BBW for mtx?
Hepatotoxicity, Myelosupression, Mucositis/stomatitis, Pregnancy (fetal toxicity/death)
moa of leflunomide?
inhibitts pyrimidine synthesis
bbw of leflunomide?
embryo-fetal tox and hepatotox
accelerated drug elimination option for leflunomide?
▪ Cholestyramine 8g TID x11days
▪ Activated charcoal suspension 50g PO Q12H x11days
what are the janus kinase (JAK) enzyme inhibitors?
tofacitinib
baricitinib
what are the safety implications with jak inhibitors?
BBW: Serious Infections, Malignancy
Note: ↑risk of pulmonary embolism using high dose
what are the anti-TNF biologics?
Etanercept (Enbrel) Adalimumab (Humira) Infliximab (Remicade) Cartolizumab pegol (Cimzia) Golilumab (Simponi)
what are the safety parameters for anti-TNF?
BBW:
Serious inf,
Malignancies,
screen for latent TB
Warning: Demyelinating disease, Hep B reactivation, HF, hepatotoxicity, lupus-like syndrome ▪ Do NOT use with other biologics or live vaccines Monitor: TB test, signs of infection
should you premedicate rituximab?
yes, Steroid + APAP + Antihistamine
drugs that can cause DILE
Methimazole Propylthiouracil Methyldopa Minocycline Procainamide Hydralazine (alone and in BiDil) Anti-TNF - enbrel, humira, remicade, cimzia, simponi Terbinafine Isoniazid Quinidine
how to tx SLE?
FDA: Hydroxychloroquine, belimumab
Others: cyclophosphamide, azathioprine, mycophenolate mofetil, cyclosporine
how long should u wait to see tx benefits for SLE?
6 months
what’s the brand name of belimumba?
benlysta
how to dx MS?
MRI
how to tx the symptoms of MS?
Incontinence: Anticholinergic Constipation: Laxatives Muscle Spasms: Muscle Relaxant Muscle Pain: Analgesics Localized Pain: botulinum toxin (Botox) Tremor: propranolol Depression: Anti-depressants Fatigue: modafinil, methylphenidate Dizziness/vertigo: meclizine, scopalamine Cognitive function: donepezil Erectile Dysfunction: PDE-5
what are the mainstay of tx for pts with relapsing forms of MS?
glatiramer acetate and interferon beta formulations
brand name of glatiramer acetate?
copaxone
what is the moa of glatiramer acetate?
Immune modulator: Induce and activate T-lymphocyte suppressor cells
can you take copaxone when pregnant?
yes, it is the preferred agent if tx is necessary
brand name for natalizumab?
tysabri
moa of tysabri?
Monoclonal antibody: Binds to the alpha-4 subunit of integrins expressed on the surface of leukocytes
which drug requires REMS?
alemtuzumab (Lemtrada)
how to prevent raynaud’s?
nifedipine
what drugs can worsen raynauds?
Beta-blockers
Bleomycin, cisplatin
Sympathomimetics (vasoconstriction)
what is myasthenia gravis?
Autoimmune disease that attacks connections between nerves & muscles resulting in weakness in skeletal muscles. Comonly targets Ach receptor
sx of myasthenia gravis?
changes to eyes/vision, drooping eyelid
science word for drooping eyelid
ptosis
tx for gravis?
cholinesterase inhibitors, especially pyridostigmine
what is sjogrens syndrome?
dry eyes and dry mouth
what complications can come from sjogrens?
dental caries corneal ulceration and chronic oral infections
how to tx dry eyes for sjogrens?
popular OTC articial teardrops
cyclosporine eyedrops
brand name for cyclosporine eyedrops?
restasis
how to tx dry mouth for sjogrens?
Sugar-free chewing gum w/xylitol
Daily rinses with antimicrobial mouthwash
Oral muscarainic agonists: pilocarpine (Salagen) or cevimeline (Evoxac)
what non-drug tx can u use for psoriasis?
UV light
UVB phototherapy can improve mild to moderate psoriasis
