Treatment of SLE Exam 2 Flashcards

1
Q

Pregnancy: Corticosteroids

A

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

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2
Q

Pregnancy: Hydroxychloroquine

A

safe in pregnancy & lactation – start preconception, continue throughout

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3
Q

Pregnancy: Cytotoxic drugs

A

AVOID

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4
Q

Pregnancy: Azathioprine

A

Better alternative compared to cytotoxic drugs

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5
Q

Pregnancy: mycophenolate

A

AVOID

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6
Q

Pregnancy: cyclophosphamide

A

AVOID

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7
Q

Pregnancy: leflunomide

A

AVOID

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8
Q

Pregnancy: methotrexate

A

AVOID

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9
Q

Pregnancy: cyclosporine

A

okay to use

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10
Q

Pregnancy: tacrolimus

A

okay to use

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11
Q

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

A
  • Procainamide
  • Hydralazine
  • Chlorpromazine
  • Isoniazid
  • Methyldopa
  • Quinidine
  • Minocycline
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12
Q

Toxicity management: Cyclophosphamide IV

A
  • 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
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13
Q

Toxicity management: Azathioprine

A

Check enzyme TPMT (thiopurine methyltransferase) before starting

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14
Q

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

A

Mycophenolate mofetil + glucocorticoid induction x 6 mo

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15
Q

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

A

use low dose

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16
Q

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

A

ACEI or ARB

17
Q

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

A

ACEI or ARB

18
Q

What do you use for Membranous nephritis?

A

Mycophenolate mofetil + prednisone x 6 mo

19
Q

What do you use for Neuropsychiatric SLE?

A

Corticosteroids & immunosuppressives

20
Q

What do you use for Cutaneous disease?

A
  • Sun protection
  • Topical corticosteroids
  • Topical calcineurin inhibitors,
21
Q

What do you use for Resistant cutaneous disease?

A
  • Thalidomide

- rituximab