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NAPLEX - JXI > Systemic Steroids & Autoimmune Conditions > Flashcards

Systemic Steroids & Autoimmune Conditions Flashcards

1
Q

how to replace cortisol?

A

steroids

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2
Q

how to replace aldosterone?

A

fludrocortisone

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3
Q

Least potent to most potent steroids acronym?

A

Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies

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4
Q

Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies

A 
cortisone 25mg
hydrocortisone 20mg
prednisone 5mg
prednisolone 5mg
methylprednisolone 4mg
triamcinolone 4mg
dexamethasone 0.75mg
betamethasone 0.6mg
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5
Q

what is the immunosuppressive dose for steroids?

A

≥ 2mg/kg/day or ≥ 20mg/day of prednisone or prednisone equivalent for > 2 weeks

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6
Q

what non-specitive lab tests can be used to detect inflammation?

A

ESR, CRP, RF, ANA

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7
Q

what are the risks of giving immunosupressants to tx autoimmune diseases?

A

↑risk of re-activ TB, Hep B/C, Viruses (live vaccines must be given prior to tx), skin cancers, infections

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8
Q

RA presentation?

A

Bilateral, Symmetrical
▪ Morning stiffness: stiffness and pain worse after rest
Lab tests:
Anti-citrullinated peptide Ab (ACPA), Rheumatoid factor (RF)

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9
Q

what is the initial tx for RA?

A

MTX

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10
Q

for mod-severe RA how should you tx?

A

DMARD or TNFi or non-TNF ± MTX [Never use 2 biologic DMARDS combo]

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11
Q

how should you tx flares?

A

steroids

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12
Q

what is the moa of mtx?

A

Inhibits dihydrofolate reductase, inhibiting folate

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13
Q

what is the mtx dosing for RA?

A

7.5mg - 20mg q week

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14
Q

what is the BBW for mtx?

A

Hepatotoxicity, Myelosupression, Mucositis/stomatitis, Pregnancy (fetal toxicity/death)

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15
Q

moa of leflunomide?

A

inhibitts pyrimidine synthesis

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16
Q

bbw of leflunomide?

A

embryo-fetal tox and hepatotox

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17
Q

accelerated drug elimination option for leflunomide?

A

▪ Cholestyramine 8g TID x11days

▪ Activated charcoal suspension 50g PO Q12H x11days

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18
Q

what are the janus kinase (JAK) enzyme inhibitors?

A

tofacitinib

baricitinib

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19
Q

what are the safety implications with jak inhibitors?

A

BBW: Serious Infections, Malignancy
Note: ↑risk of pulmonary embolism using high dose

20
Q

what are the anti-TNF biologics?

A 
Etanercept (Enbrel)
Adalimumab (Humira)
Infliximab (Remicade)
Cartolizumab pegol (Cimzia)
Golilumab (Simponi)
21
Q

what are the safety parameters for anti-TNF?

A

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
22
Q

should you premedicate rituximab?

A

yes, Steroid + APAP + Antihistamine

23
Q

drugs that can cause DILE

A 
Methimazole 
Propylthiouracil 
Methyldopa 
Minocycline 
Procainamide 
Hydralazine (alone and in BiDil) 
Anti-TNF - enbrel, humira, remicade, cimzia, simponi
Terbinafine
Isoniazid
Quinidine
24
Q

how to tx SLE?

A

FDA: Hydroxychloroquine, belimumab

Others: cyclophosphamide, azathioprine, mycophenolate mofetil, cyclosporine

25
Q

how long should u wait to see tx benefits for SLE?

A

6 months

26
Q

what’s the brand name of belimumba?

A

benlysta

27
Q

how to dx MS?

A

MRI

28
Q

how to tx the symptoms of MS?

A 
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
29
Q

what are the mainstay of tx for pts with relapsing forms of MS?

A

glatiramer acetate and interferon beta formulations

30
Q

brand name of glatiramer acetate?

A

copaxone

31
Q

what is the moa of glatiramer acetate?

A

Immune modulator: Induce and activate T-lymphocyte suppressor cells

32
Q

can you take copaxone when pregnant?

A

yes, it is the preferred agent if tx is necessary

33
Q

brand name for natalizumab?

A

tysabri

34
Q

moa of tysabri?

A

Monoclonal antibody: Binds to the alpha-4 subunit of integrins expressed on the surface of leukocytes

35
Q

which drug requires REMS?

A

alemtuzumab (Lemtrada)

36
Q

how to prevent raynaud’s?

A

nifedipine

37
Q

what drugs can worsen raynauds?

A

Beta-blockers
Bleomycin, cisplatin
Sympathomimetics (vasoconstriction)

38
Q

what is myasthenia gravis?

A

Autoimmune disease that attacks connections between nerves & muscles resulting in weakness in skeletal muscles. Comonly targets Ach receptor

39
Q

sx of myasthenia gravis?

A

changes to eyes/vision, drooping eyelid

40
Q

science word for drooping eyelid

A

ptosis

41
Q

tx for gravis?

A

cholinesterase inhibitors, especially pyridostigmine

42
Q

what is sjogrens syndrome?

A

dry eyes and dry mouth

43
Q

what complications can come from sjogrens?

A

dental caries corneal ulceration and chronic oral infections

44
Q

how to tx dry eyes for sjogrens?

A

popular OTC articial teardrops

cyclosporine eyedrops

45
Q

brand name for cyclosporine eyedrops?

A

restasis

46
Q

how to tx dry mouth for sjogrens?

A

Sugar-free chewing gum w/xylitol
Daily rinses with antimicrobial mouthwash

Oral muscarainic agonists: pilocarpine (Salagen) or cevimeline (Evoxac)

47
Q

what non-drug tx can u use for psoriasis?

A

UV light

UVB phototherapy can improve mild to moderate psoriasis

NAPLEX - JXI (4 decks)

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