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Rheumatology > Therapeutics > Flashcards

Therapeutics Flashcards

1
Q

What SLE drug requires retinal toxicity?

A

hydroxychloroquine (Plaquenil)

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2
Q

What are the major ADRs and warnings for Benlysta (belimumab)?

A

Infusion reactions (premedicate)
must watch out for depression and suicidal thoughts and PML

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3
Q

Dosing and usage of Benlysta (belimumab)

A

SLE - 200 mg SQ weekly or 10mg/kg IV every 4 weeks

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4
Q

What SLE treatment must you limit sun exposure?

A

Lupkynis (voclosporin)

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5
Q

Major ADR for cyclophosphamide (Cytoxan) in the use of SLE?

A

Hemorrhagic cystitis
Infertility
Teratogenic
Not as effective for African Americans and Hispanics

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6
Q

Dose and usage of cyclophosphamide?

A

500 mg IV once every 2 weeks for 6 doses
Use for SLE flare in Caucasian and Asian patients

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7
Q

ADRs of mycophenolate mofetil (Cellcept)?

A

Myelosuppression
Nausea
Vomiting
Diarrhea
Can take Myfortic to decrease

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8
Q

Contraindications for Cellcept?

A

Pregnancy
Lower doses for asians
Used for AAs and Hispanics

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9
Q

Testing for Imuran (azathiprine) use?

A

TPMT assay to detect deficiency (increased risk of myelosuppression)
Pregnancy use should be less than 2mg/kg per day

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10
Q

Contraindications for MTX?

A

Pregnancy
Breastfeeding
Alcoholism
Chronic liver disease
Blood dyscrasias
Immunodeficiency syndrome
Elderly or CrCl under 30

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11
Q

Testing and risks for MTX use?

A

Hep B and C prior
LFTs
Hepatotoxicity
Pulmonary toxicity
Give with folic acid

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12
Q

ADR of rituximab (Rituxan)?

A

Infusion reactions (premedicate)
PML
Infections (screen TB, Hep B and C prior)

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13
Q

When to use caution with NSAIDs?

A

Patients with renal insufficiency, cardiovascular disease, and gastrointestinal problems
Avoid use in first and 3rd trimester of pregnancy

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14
Q

What medications should be avoided with NSAIDs?

A

Anti platelets, corticosteroids, anticoags
Lithium and methotrexate
Give ASA 1 hour before or 8 hours after IBU

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15
Q

Short term ADRs of Prednisone (Deltasone)?

A

Less than one month of use
increased appetite and weight gain, mood instability, fluid retention, insomnia, elevated blood pressure and blood glucose

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16
Q

Long term side effects with prednisone?

A

Cushings effects (diabetes, bone fractures, hirsutism and menstrual irregularities, angioedema, glaucoma, psychiatric changes, headaches, infections, intracranial hypertension, impaired wound healing

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17
Q

How long can you take corticosteroids until you need to taper medication?

A

No longer than 14 days due to HPA axis suppression

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18
Q

What comorbidities can worsen with prednisone?

A

Heart failure
DM
HTN
OP
Psychiatric conditions

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19
Q

ADRs of sulfasalazine (Azulifidine)?

A

Rash, Nausea, vomiting, diarrhea, oligospermia, folate deficiency

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20
Q

Contraindications of the use of sulfasalazine for RA?

A

Allergy to salicylates or sulfa
GI obstruction
G6PD deficiency (hemolytic anemia)

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21
Q

Counseling on sulfasalazine?

A

May cause yellow orange coloration of skin and urine
Administer with folic acid supplementation
Males may experience oligospermia
Watch out for SJS and TEN and liver failure

22
Q

Monitoring for use of leflunomide (Arava) in RA?

A

TB and pregnancy screening (need cholestyramine washout prior to conception)
Blood pressure and LFTs BUN
CBCs

23
Q

Contraindications for leflunomide for the use of RA treatment?

A

Pregnancy
Severe hepatic impairment
Concomitant use of teriflunomide
Do not start is ALT is over 3 times the normal limit

24
Q

Dosing schedule of etanercept (Enbrel)?

A

SQ once weekly or twice weekly

25
Q

Dosing schedule of Humira (adalimumab)?

A

SQ once every two weeks

26
Q

Dosing schedule of inflixumab (Remicade)?

A

IV once every 4-8 weeks after initial round of once at week 0,2,6 then every 8 weeks

27
Q

Dosing schedule of certolizumab pegol (Cimzia)?

A

SQ once at 1,2,4 weeks then every other week or once monthly

28
Q

Dosing schedyle of Simponi (gloimumab)?

A

SQ once monthly

29
Q

Boxed warnings for Anti TNFs?

A

Serious infections
Lymphomas
Other malignancies

30
Q

Contraindications of Anti TNFs?

A

Active systemic infections

31
Q

Contraindications for inflixumab?

A

Doses over 5mg/kg in moderate to severe heart failure

32
Q

Contraindications for etanercept?

A

Sepsis

33
Q

Warnings for Anti TNF ?

A

Demylinating disease
Hepatitis B reactivation
Heart failure
Hepatotoxicity
Lupus like syndrome
Seizures
Myelosuppression
Severe infections

34
Q

Contraindications for abatacept (Orencia)?

A

COPD patients

35
Q

Warnings for tocilizumab (Actemra) and Kevzara (sarilumab)?

A

Elevated LDL and total cholesterol
ALT or AST over 1.5 times ULN
ANC less than 2000
Platelets less than 100,000

36
Q

Black Boxed Warnings for JAKi?

A

Serious infections
Malignancy
Thrombosis
Increased risk of mortality in patients over 50 years old with one or more CV risk factors treated at higher doses

37
Q

Warning for JAKi?

A

GI perforations, elevated LFTs, Hematologic toxicities
Elevated blood pressures and lipids

38
Q

Patient population to not use JAKis in?

A

Asians
Increased frequency of side effects

39
Q

Who should not use indomethacin for gout?

A

Those with depression

40
Q

ADRs for Colchicine (Colcrys, Mitigare)?

A

Dose dependent GI adverse effects (nausea, vomiting, diarrhea)

41
Q

Dose adjustment qualifications for Colchicine?

A

CYP3A4 and Pglycoprotein inhibitors
Renal impairment

42
Q

When to start colchicine therapy?

A

Within 36 hours of symptoms onset for acute treatment

43
Q

How long after dose treatment of colchicine for acute gout flare should you wait until resuming prophylaxis dosing?

A

12 hours after a treatment dose

44
Q

Adverse effects of allopurinol (Zyloprim)?

A

Fatal hypersensitivity reactions
Elevated LFTs
Rash and kidney toxicity

45
Q

Dosing of allopurinol for ULT treatment if patient has GFR less than 30

A

50mg or less po qd

46
Q

Testing for allopurinol use as ULT?

A

HLA B 5801 - if positive avoid use (usually south east asian patients and african decents)

47
Q

Medication to avoid with allopurinol?

A

Azathioprine (use lower dose of azathioprine by 30 percent to decrease risk of 6MP toxicity)

48
Q

Contraindications of febuxostat (Uloric) use for ULT?

A

CVD patients
Concomitant use of AZA or mercaptopurine
Those who cannot use allopurinol due to hypersensitivity
Severe kidney impairment

49
Q

Contraindications for use of probenecid (Probalan) for ULT?

A

G6PD deficiency (hemolytic anemia)
CrCl less than 50 mL/min
CKD Stage III or greater

50
Q

Contraindication in patients with pegloticase (Krystexxa) use?

A

G6PD deficiency
Only for patients with severe gout refractory to other treatments

51
Q
A

Rheumatology (2 decks)

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