Treatment of SLE Exam 2 Flashcards
Pregnancy: Corticosteroids
prednisone preferred – inactivated by placenta; not fluorinated steroid (e.g., dexamethasone or betamethasone)
Pregnancy: Hydroxychloroquine
safe in pregnancy & lactation – start preconception, continue throughout
Pregnancy: Cytotoxic drugs
AVOID
Pregnancy: Azathioprine
Better alternative compared to cytotoxic drugs
Pregnancy: mycophenolate
AVOID
Pregnancy: cyclophosphamide
AVOID
Pregnancy: leflunomide
AVOID
Pregnancy: methotrexate
AVOID
Pregnancy: cyclosporine
okay to use
Pregnancy: tacrolimus
okay to use
Identify drugs with most evidence for inducing a lupus-like syndrome.
- Procainamide
- Hydralazine
- Chlorpromazine
- Isoniazid
- Methyldopa
- Quinidine
- Minocycline
Toxicity management: Cyclophosphamide IV
- 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
Toxicity management: Azathioprine
Check enzyme TPMT (thiopurine methyltransferase) before starting
For focal & diffuse lupus nephritis, which medication(s) do you use if fertility is a concern?
Mycophenolate mofetil + glucocorticoid induction x 6 mo
How do you use IV cyclophosphamide + glucocorticoid for induction for a patient that is Caucasian with European background?
use low dose
Focal & diffuse lupus nephritis, which medication do you use if patient has hypertension?
ACEI or ARB
Focal & diffuse lupus nephritis, which medication do you use if patient has proteinuria?
ACEI or ARB
What do you use for Membranous nephritis?
Mycophenolate mofetil + prednisone x 6 mo
What do you use for Neuropsychiatric SLE?
Corticosteroids & immunosuppressives
What do you use for Cutaneous disease?
- Sun protection
- Topical corticosteroids
- Topical calcineurin inhibitors,
What do you use for Resistant cutaneous disease?
- Thalidomide
- rituximab
