Therapeutics 3 > Rheumatologic Conditions > Flashcards

Rheumatologic Conditions Flashcards

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1
Q

Lupus

What are the complications associated with lupus?

A
  • cardiovascular
  • renal
  • infections
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2
Q

Lupus

What are the different types of lupus?

A
  • systemic lupus erythematosus
  • drug induced lupus erthematosus

also cutaneous and neonatal

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3
Q

Lupus

What drugs can cause drug induced lupus erthematosus?

A
  • hydralazine
  • procainamide
  • isoniazide
  • minocycline
  • TNF alpha inhibitors
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4
Q

Lupus

What is the clinical presentation of lupus?

A
  • excessive fatigue/overall malaise
  • photosensitivity, joint pain, weight loss
  • fever, nasal ulcers, rash (malar rash, “butterfly” rash)
  • cardiac complications
  • renal complications
  • seizures/psychosis
  • raynaud’s syndrome
  • sjogren’s syndrome
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5
Q

Lupus

What is the first line treatment for lupus?

A

hydroxychloroquine 5 mg/kg ABW (round to nearest 100mg BID)

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6
Q

Lupus

What drug may be given prn for flares in lupus?

A

glucocorticoids

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7
Q

Lupus

What drug is first line for lupus nephritis?

A

belimumab

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8
Q

Lupus

What is the second line treatment for lupus?

organ-threatening and refractory cases

A

cyclophosphamide and rituximab

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9
Q

Lupus

What are the adverse effects of hydroxychloroquine?

A
  • photosensitivity
  • QT prolongation
  • retinopathy
  • thrombocytopenia
  • GI upset
  • emotional lability
  • suicidal ideation
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10
Q

Lupus

What are the monitoring parameters associated with hydroxychloroquine?

A
  • CBC
  • TB, HepB, HepC tests
  • CMP
  • ophthalmologic screening
  • ECG
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11
Q

Lupus

What are the adverse effects of belimumab (Benlysta)?

A
  • GI upset
  • infection
  • infusion related reaction
  • headache
  • insomnia
  • pruritis
  • suicidal ideation
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12
Q

Lupus

What are the monitoring parameters of belimumab (Benlysta)?

A

watch for depression/suicidal ideation and hypersensitivity reactions

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13
Q

Lupus

What are the adverse effects of cyclophosphamide?

A
  • alopecia
  • GI upset
  • renal impairment
  • leukopenia
  • bone marrow suppression
  • cardiotoxicity
  • amenorrhea
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14
Q

Lupus

What are the monitoring parameters of cyclophosphamide?

A
  • CBC w/ diff
  • CMP
  • S/S of cardic toxicity and pulmonary toxicity
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15
Q

Lupus

What are the adverse effects of rituximab?

A
  • GI upset
  • liver impairment
  • cardiac toxicity
  • alopecia
  • back pain
  • cough/dyspnea
  • hepatic impairment
  • hypertension
  • night sweats
  • weight gain
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16
Q

Lupus

What are the monitoring parameters of rituximab?

A
  • CBC w/ diff
  • S/S of tumor lysis syndrome
  • fluid balance
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17
Q

Lupus

What inflammatory markers may be monitored in lupus?

A
  • ESR
  • CRP
  • autoantibodies
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18
Q

Lupus

When should patients with lupus have a follow-up?

A

every 1-3 months in high disease activity, new medication, lab abnormalities

when stable (rare) every 3-4 months

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19
Q

Rheumatoid Arthritis

What is the difference between seropositive and seronegative RA?

A
  • seropositive RA= rheumatoid factor (RF) positive or anti-citrullinated protein antibodies (ACPA) positive, more aggressive disease, higher risk of joint damage
  • seronegative RA= more mild disease, but still experience joint pain and inflammation
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20
Q

Rheumatoid Arthritis

What are the signs and symptoms of RA?

A
  • joint pain, swelling, stiffness, especially in the morning
  • symmetrical joint involvement
  • fatigue, fever, and loss of appetite
  • nodules under the skin near the affected joints
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21
Q

Rheumatoid Arthritis

What are the most common joints involved in RA?

A

hands, wrists, ankles, feet, and knees

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22
Q

Rheumatoid Arthritis

How does RA affect patients quality of life?

A

higher rates of depression and anxiety

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23
Q

Rheumatoid Arthritis

What is the first line treatment for RA?

A

methotrexate

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24
Q

Rheumatoid Arthritis

What may be used to treat more mild cases of RA?

Study These Flashcards
A

hydroxychloroquine or sulfasalazine

25
# Rheumatoid Arthritis What may be used in more severe or refractory cases of RA?
- TNF alpha inhibitors - janus kinase (JAK) inhibitors - abatacept - rituximab - tocilizumab
26
# Rheumatoid Arthritis What are the adverse effects of methotrexate?
- alopecia - GI upset - LFT impairment - spontaneous fetal abortion, *contraindicated in pregnancy* - thrombocytopenia - headache - dizziness
27
# Rheumatoid Arthritis What is the mechanism of action of methotrexate?
dihydrofolate reductase inhibitor, *must be coadministered with folic acid*
28
# Rheumatoid Arthritis What are the monitoring parameters for methotrexate?
- CBC w/ diff - liver function tests - renal function - pulmonary function - S/S of infection
29
What drugs are TNF alpha inhibtors?
- infliximab - certolizumab - adalimumab (Humira) - golimumab - etanercept
30
# Rheumatoid Arthritis What are the adverse effects of TNF alpha inhibitors?
- antibody formation - infection - headache - infection site reaction - rash - GI upset - agranulocytosis - cardiac morbidity - dsypnea - hepatic impairment | *can cause drug induced lupus*
31
# Rheumatoid Arthritis What are the monitoring parameters for TNF alpha inhibitors?
- prior to initiation= TB test, Hep B and C - during therapy= CBC, CMP, S/S of infection
32
# Rheumatoid Arthritis What drugs are JAK inhibitors?
tofacitinib or upadacitinib
33
# Rheumatoid Arthritis What are the adverse effects of JAK inhibitors?
- GI upset - headache - hyperlipidemia - hepatic impairment
34
# Rheumatoid Arthritis What is the monitoring for JAK inhibitors?
- CBC w/ diff - CMP - lipid panel - S/S of infection
35
# Rheumatoid Arthritis How often should xrays be done?
every 1-2 years
36
# Psoriasis What is psoriasis?
chronic autoimmune skin disease, presents with thick red skin patches or rash often found on elbows, knees, scalp, face, palms, lower back, and soles of feet
37
# Psoriasis What is the most common type of Psoriasis?
plaque psoriasis
38
# Psoriasis What are the causes of Psoriasis?
genetics and/or enviromental (skin injury, infection, obesity, stress, drugs, alcohol)
39
# Psoriasis What may indicate a more severe Psoriasis disease?
psoriatic arthritis, only 30% develop
40
# Psoriasis What is the first line treatment for mild-moderate Psoriasis?
topical agents
41
# Psoriasis What topical agents are used in Psoriasis?
- topical corticosteroids - topical calcineurin inhibitors - vitamin D analogues - topical tararotene - emollients - salicyclic acid - topical anthralin - coal tar
42
# Psoriasis What is the second line treatment for mild-moderate Psoriasis? | if inadequate respond/ineffective first line
topical agent + phototherapy
43
# Psoriasis What is the first line treatment for moderate-severe Psoriasis?
systemic agent (methotrexate) +/- topical agent OR phototherapy, consider biologic if comorbid conditions (psoriatic arthritis)
44
# Psoriasis What is the mechanism of vitamin D analogues? | calcipotriene/calcitrol
binds vitamin D receptors= inhibits proliferation of keratinocytes
44
# Psoriasis What emollients may be used as topical treatment for Psoriasis?
petrolatum, shea butter, cocoa butter, mineral oil *used in combo with topical corticorticosteroids for 4-8 weeks= decreased adverse events and prevents relapse of corticosteroids*
45
# Psoriasis How can vitamin D be used in treatment of Psoriasis?
- long term (52 weeks) - short term 4-12 weeks * in combo with topical corticosteroids*
46
# Psoriasis What are the adverse effects of vitamin D analogues?
burning, itching, edema, peeling, dryness, inflammation
47
# Psoriasis What IL 12/23 antagonists may be used for Psoriasis?
ustekinumab (Stelara)
48
# Psoriasis What IL17 inhibitors may be used for Psoriasis?
- secukinumab (Cosentyx) - lexkizumab (Taltz)
49
# Psoriasis What IL23 inhibitors may be used for Psoriasis?
guselkumab (Tremfya)
50
# Dermatitis What is the cause of atopic dermatitis? | aka eczema
gene mutation, filaggrin mutation
51
# Dermatitis What are the signs and symptoms of eczema?
- extremely dry skin - itch/burn - thick skin, cracked skin, scaly skin - raw skin, swollen - small bumps that crust over
52
# Dermatitis What nonpharmacotherapy may be employed for eczema?
- moisturize right after showers - decrease use of nonsoap cleansers - consider wet wrap therapy +/- corticosteroids
53
# Dermatitis When would topical corticosteroids be considered for eczema?
failed emollient use and skin hygiene
54
# Dermatitis What are the adverse effects of topical corticosteroids?
- potentially HPA axis suppression (children) - skin burning/irritation - rash formation - hypopigmentation - pruritis - secondary skin infection - skin atrophy - xeroderma
55
# Dermatitis What drugs are topical calcineurin inhibitors?
- tacrolimus - pimecrolimus
56
# Dermatitis When may topical calcineurin inhibitors be used?
- acute cases of inflammed skin (severe burning and itching) - "steroid sparing adjunct" - may be used as maintenance 2-3x/week to prevent relapse and decrease topical corticosteroid use - sensitive areas: face, anogenital skin folds
57
# Dermatitis What are the adverse effects of calcineurin inhibitors?
- local burning sensation - skin infection - hypersensitivity - pruritis - erythema - headache
Therapeutics 3
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