PHRM 864 > Lupus > Flashcards

Lupus Flashcards

(50 cards)

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1
Q

What are the 3 categories of pre-disposing factors for lupus?

A
  • genetics
  • hormonal (estrogen)
  • environment
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2
Q

What percentage of lupus cases are drug induced?

A

10%

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3
Q

Which medications cause drug-induced lupus?

A
  • methimazole
  • propylthiouracil
  • methyldopa
  • minocycline
  • procainamide
  • hydralazine
  • Anti-TNF agents
  • terbinafine
  • isoniazid
  • quinidine

AI Has Many Many Many Pretty Peculiar Qualities and Traits

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4
Q

What signs and symptoms are key traits of lupus?

A
  • butterfly rash (malar)
  • discoid rash
  • Raynaud Phenomenon
  • Lupus Nephritis

Other symptoms:
- photosensitivity
- fatigue
- N/V/D
- mouth ulcers

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5
Q

What are the key labs used to diagnose lupus?

A
  • Anti-nuclear antibody (ANA)
  • Anti-double-stranded DNA (Anti-dsDNA)
  • Anti-Smith Antibody (Anti-SM)
  • Antiphospholipid Antibody

All will be positive in a patient with Lupus

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6
Q

Which of the key labs have high specificity for diagnosing Lupus?

A
  • Anti-dsDNA
  • Anti-SM
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7
Q

What are the general treatment options for lupus?

A
  • Hydroxychloroquine
  • NSAIDs
  • glucocorticoids
  • Immunosuppressants
  • Biologics
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8
Q

How is hydroxychloroquine used in Lupus?

A
  • mainstay of treatment
  • recommended for all patients

  • inhibits overactive immune cells
  • reduces flare and helps manage pain

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9
Q

What is the dosing for hydroxychloroquine?

A
  • 200-400 mg PO QD
  • Max of 400 mg QD
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10
Q

What are the side effects from hydroxychloroquine?

A
  • Bulls eye maculopathy
  • QT prolongation
  • Hemolytic anemia
  • G6PD Deficiency
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11
Q

If a patient has G6PD deficiency, can they take HCQ for their lupus?

A

No!

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12
Q

What are the monitoring parameters for HCQ?

A
  • Baseline: CBC, LFTs, Scr, EKG
  • Periodic: eye exam 3 months after starting therapy, then annually
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13
Q

What are the benefits to using NSAIDs for lupus?

A
  • helpful with fevers serositis, myalgias, and arthralgias
  • considered first line for mild symptoms
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14
Q

What is the dosing for the NSAIDs for lupus?

A
  • Ibuprofen: 400-600 mg PO Q6-8H (Max 3.2 g/day)
  • Naproxen: 500 mg PO BID (Max 1-1.5 g/day)
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15
Q

What are the side effects from NSAIDs?

A
  • Bleeding, gastritis, perforation
  • increased BP, worsening HF, CV events
  • increased SCr, rental toxicity
  • hepatotoxicity
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16
Q

What are the monitoring parameters for NSAIDs?

A
  • s/sx of fluid retention and bleeding
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17
Q

What are the benefits to using glucocorticoids in lupus?

A
  • anti-inflammatory and helpful during flares
  • variable dosage forms: PO, topical, IV
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18
Q

What is the place in therapy for glucocorticoids for lupus?

A

Adjunctive treatment if not responsive to NSAIDs and HCQ

Patients can be on HCQ, NSAIDs, and glucocorticoids all at once

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19
Q

What is the oral glucocorticoid drug and dosing options?

A
  • Prednisone
  • Mild-moderate disease: 5-30 mg PO QD
  • severe disease: 1 mg/kg/day
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20
Q

What is the IV glucocorticoid drug and dosing?

A
  • Methylprednisolone
  • 500-1000 mg IV daily for 3-6 days, then PO prednisone
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21
Q

What are the various topical glucocorticoids for each potency?

Where are they indicated for?

Study These Flashcards
A
  • Low: fluocinolone, hydrocortisone (face)
  • Moderate: triamcinolone, betamethasone (trunk & extremities)
  • High: clobetasol (scalp sores & palms)
22
Q

What are the topical side effects from the glucocorticoids?

Study These Flashcards
A
  • skin atrophy
  • rosacea
  • telangiectasis
23
Q

What are the monitoring parameters for the glucocorticoids?

Study These Flashcards
A
  • Baseline: BP, BMP, FLP, bone mineral density
  • Q6Months: BMP, FLP
  • Annually: Bone mineral density
24
Q

List the immunosuppressants used for lupus?

Study These Flashcards
A
  • Methotrexate
  • azathioprine
  • cyclophosphamide
  • mycophenolate mofetil
25
What role do immunosuppressants play in lupus treatment?
- adjunct to steroid therapy to lower the dose - if patients have an insufficient response to HCQ ##Footnote Suppression of immune function from attacking healthy cells
26
Which immunosuppressant is NOT associated with increased risk of malignancy?
methotrexate
27
What are the side effects of the immunosuppressants?
- bone marrow suppression - infections - malignancy ##Footnote Mycophenolate --> acute inflammatory syndrome
28
If patients have a TPMT deficiency, which immunosuppressant is contraindicated for them?
Azathioprine
29
What is the dosing for methotrexate?
5-15 mg PO once weekly
30
What is the dosing for mycophenolate mofetil?
1-1.5 g PO BID
31
What is the dosing for cyclophosphamide? | PO and IV
- PO: 1-1.5 mg/kg PO QD - IV: 0.5 mg/m^2 BSA every month for 6 months
32
What is the dosing for azathioprine?
50 mg PO WD
33
What role do biologics play in lupus treatment?
- used if patients have inadequate response to antimalarial and immunosuppressants - used for severe disease
34
What biologics are used for lupus?
- Belimumab (Benlysta)** - Rituximab (Tiruxan) - Anifrolumab (Saphnelo)** | **Specific to lupus
35
What are the pearls to using biologics?
- No live vaccines 30 days before starting therapy nor during therapy - do not use more than 1 biologic at the same time
36
What are the side effects for belimumab and anifroulmab?
- hypersensitivity - infusion reactions
37
What is the dosing for belimumab (BEL)?
10 mg/kg IV every 2 weeks for 3 doses
38
What is the dosing for anifrolumab (Saphnelo)?
300 mg IV every 4 weeks
39
What are the side effects and considerations for rituximab (RTX)?
- infusion reaction - Hep B reactivation - Premedicate 30 minutes prior to admin
40
What is the dosing for rituximab?
- 1 g on days 0 and 15 or - 375 mg/m^2 once weekly for 4 doses
41
What additional therapies could be used in lupus?
- tacrolimus - pimecrolimus - voclosporin (Lupkynis) | Calcineurin Inhibitors
42
What are the nonpharmacologic ways to address lupus?
- rest and exercise - smoking cessation - limit sun exposure/use sunscreen
43
What is the first line option for cutaneous lupus?
- topical steroids - topical calcineurin inhibitors ##Footnote - HCQ or systemic glucocorticoids can be used if they don't want topicals - Refractory options include: high-dose GC, MTX, MMF (BID)
44
How should mild/moderate lupus nephritis (class 1 or 2 LN) be addressed?
- GC +/- another immunosuppressant | AZA, MMF or CNI
45
How should severe lupus nephritis (Class 3 or 4 LN) be addressed?
- MMF (preferred) or CYC +/- GC ##Footnote Triple therapy options: - Belimumab + MMF or CYC +/- GC - CNI + MMF +/- GC
46
Which drug is preferred in lupus nephritis maintenance in class III/IV?
mycophenolate
47
What is the EGFR cut off for CNI agents?
EGFR has to be > 45 mL/min for CNIs
48
What drug class is used to address fluid retention?
diuretics
49
What drug class is used to address pain and inflammation?
NSAIDs
50
What timeline of pregnant patient with lupus would have the best prognosis?
The best prognosis is when the patient achieves remission for > 6 months before pregnancy. ##Footnote - HCQ still drug of choice - D/C NSAIDS after 20 weeks Test for antiphospholipid syndrome
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