Treatment of SLE Exam 2

Question 1

Pregnancy: Corticosteroids

Answer 1

prednisone preferred – inactivated by placenta; not fluorinated steroid (e.g., dexamethasone or betamethasone)

Question 2

Pregnancy: Hydroxychloroquine

Answer 2

safe in pregnancy & lactation – start preconception, continue throughout

Question 3

Pregnancy: Cytotoxic drugs

Answer 3

AVOID

Question 4

Pregnancy: Azathioprine

Answer 4

Better alternative compared to cytotoxic drugs

Question 5

Pregnancy: mycophenolate

Answer 5

AVOID

Question 6

Pregnancy: cyclophosphamide

Answer 6

AVOID

Question 7

Pregnancy: leflunomide

Answer 7

AVOID

Question 8

Pregnancy: methotrexate

Answer 8

AVOID

Question 9

Pregnancy: cyclosporine

Answer 9

okay to use

Question 10

Pregnancy: tacrolimus

Answer 10

okay to use

Question 11

Identify drugs with most evidence for inducing a lupus-like syndrome.

Answer 11

• Procainamide
• Hydralazine
• Chlorpromazine
• Isoniazid
• Methyldopa
• Quinidine
• Minocycline

Question 12

Toxicity management: Cyclophosphamide IV

Answer 12

• Mesna (Mesnex) may be used to prevent hemorrhagic cystitis
• Adequate hydration and intermittent intravenous cyclophosphamide may minimize bladder toxicity compared to daily oral therapy
• Control nausea & vomiting with po ondansetron & dexamethasone

Question 13

Toxicity management: Azathioprine

Answer 13

Check enzyme TPMT (thiopurine methyltransferase) before starting

Question 14

For focal & diffuse lupus nephritis, which medication(s) do you use if fertility is a concern?

Answer 14

Mycophenolate mofetil + glucocorticoid induction x 6 mo

Question 15

How do you use IV cyclophosphamide + glucocorticoid for induction for a patient that is Caucasian with European background?

Answer 15

use low dose

Question 16

Focal & diffuse lupus nephritis, which medication do you use if patient has hypertension?

Answer 16

ACEI or ARB

Question 17

Focal & diffuse lupus nephritis, which medication do you use if patient has proteinuria?

Answer 17

ACEI or ARB

Question 18

What do you use for Membranous nephritis?

Answer 18

Mycophenolate mofetil + prednisone x 6 mo

Question 19

What do you use for Neuropsychiatric SLE?

Answer 19

Corticosteroids & immunosuppressives

Question 20

What do you use for Cutaneous disease?

Answer 20

• Sun protection
• Topical corticosteroids
• Topical calcineurin inhibitors,

Question 21

What do you use for Resistant cutaneous disease?

Answer 21

• Thalidomide

- rituximab