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NAPLEx > systemic steriods and autoimmune conditions > Flashcards

systemic steriods and autoimmune conditions Flashcards

1
Q

how to d/c long term steriods

A

tapper off

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2
Q

steroids least potent to most potent

A

Cute Hote Pharmacists and Physicians Marry Together & Deliver Babies
dose equivalence

short-acting:
Cortisone 25mg
Hydrocortisone 20mg

intermediate-acting:
Prednisone 5mg
Prednisolone 5mg
Methylprednisolone 4mg
triamcinolone 4mg

long-acting &highest potency:
dexamethasone 0.75mg
betamethasone 0.6mg

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3
Q

systemic steroids suppress

A

adrenal suppression if taking longer than 14 days so tapper off so badly can adjust
SE: Increase IOP, increase BP, increased BG, increase appetite/weight gain

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4
Q

dexamethasone

A

Dexpak 6, 10, or 13 day
Decadron
- systemic steroids

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5
Q

hydrocortisone

A

solu-cortef
- systemic steroids

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6
Q

methylprednisolone

A

medrol, solu-medrol
- systemic steroids

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7
Q

prednisone

A

Deltasone
- systemic steroids

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8
Q

prednisolone

A

Millipred, Orapred ODT
- systemic steroids

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9
Q

triamcinolone

A

Kenalog
- systemic steroids

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10
Q

cortisone is prodrug of

A

cortisol

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11
Q

prednisone is prodrug of

A

prednisolone

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12
Q

medrol pack

A

day1: 6 tabs
day2: 5 tabs
day 3: 4
3
2 tabs
days 6: 1 tabs

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13
Q

immunosuppression from steroids

A

> =2mg/kg/day or > 20mg/day of prednisone or equivalent potency for >2 weeks

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14
Q

symptoms of RA

A

joint swelling
pain
stiffness
Bone deformity

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15
Q

traditional (non-biologic) disease-modifying antirheumatic drugs (DMARDs)

A
  • Methotrexate (trexall, Ortexup, Rasuvo)
  • Hydroxychloroquine (plaaquenil) +/- MTX
  • Sulfasalazine (Azulifidine) +/- MTX
  • leflunomide (Arava) +/- MTX- inhibits pyrimidine synthesis
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16
Q

Janus Kinase Inhibitors

A

inhibits Janus kinase (JAK) enzymes, which stimulates immune cell function
- tofacitinib (Xeljanz)
- baricitinib (Olumiant)
- upadacitinib (Rinvoq)
DO NOT use w/ other biologics DMARDs
keep in mind: risk of infections (TB, viral, bacterial, etc.), malignancy, thrombosis, increased CV risk
monitor CBC, avoid live vax
caution in Asian decent (increased risk)

17
Q

methotrexate drug inteactions

A
  • liver toxicity!
  • renal elimination decreased by aspirin/NSAIDS
  • sulfonamides and tacrolimus increase AD avoid using together
18
Q

anti-TNF biologic DMARDS

A

used for a variety of diseases… prsoriatic arthritis, plaque psoriasis, etc.
sub Q injections
Etanercept (Enbrel)
Adalimumab (Humira)
Infliximab (Remicade)
Certolizumab pegol (Cimzia)
Golimumab (Simponi)

MTX is first line, this is add-on therapy
however, can bu started w/ or without MTX

19
Q

Etanercept

A

Enbrel
weekly
- Anti-TNF Biologic DMARDs

20
Q

Adalimumab

A

Humaira
every other week
biosimilars: Cyltezo… and more lol
Cyltezo is the only FDA-approved interchanged biosimilar w/out a separate prescription.
- Anti-TNF Biologic DMARDs

21
Q

Infliximab

A

Remicade
weeks 0, 2, and 6 and then every 8 weeks
stable in NS only
- Anti-TNF Biologic DMARDs

22
Q

Certolizumab pegol

A

Cimzia
every other week
- Anti-TNF Biologic DMARDs

23
Q

golimumab

A

Simponi
monthly
- Anti-TNF Biologic DMARDs

24
Q
  • Anti-TNF Biologic DMARDs
    Safety/SE/monitoring
A

boxed warning: serious infection risk, lymphomas
warning: can cause demyelinating diseases, Hep B reactivation, HF, hepatoxicity, lupus-like syndromes

injection-like reaction!
do not shake or freeze, requires refrigeration

25
Q

Rituximab

A

Rituxan
- non-TNF inhibitor DMARDs

26
Q

Rasuvo and Otrexup

A

MTX single use auto-injectors

27
Q

select drugs that can cause drug-induced LUPUS Erythematosus (DILE)

A

My Pretty Malar Marking Probably Has A TransIent Quality

Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine (alone or BiDil)
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine

28
Q

IgG1-lamba monoclonal antibody:

A

prevents the survival of B lymphocytes by blocking the binding of soluble human B lymphocyte stimulator proteins to receptors on B lymphocytes; this reduces the B-cell meditate immunity and autoimmune response
Belimumab (Benlysta)- single dose autoinjector- SC

29
Q

Calcineurin inhibitors

A

suppresses the immune system by inhibiting T-lymphocyte activation
Voclosporin (lupkynis)

30
Q

interferon beta formulations
and
glatiramer acetate

A

interferon beta: Betaseron, Avonex, Rebif, Extavia, Plegridy- all subQ but avonex IM
can cause flu-like symptoms ontop of all the other stuff

glatiramer acetate: copaxone, glatopa
are parenteral drugs
can cause chest pain, shortness of breath and flushing

all-cause injection site reaction

31
Q

pegylated interferon

A

plegridy
allows for more convenient SC dosing every 14 days

32
Q

interferon beta 1a

A

Avonex, Revif

33
Q

interferon beta 1b

A

Betaseron, extavia
stored at room temp

34
Q

peginterferon beta 1a

A

plegridy

35
Q

drugs induced ryanauds

A

blue-ish fingers decreased blood flow
can cause or worsen:
beta-blockers
bleomycin, cisplatin
sympathomimetics (from vasoconstrictions): amphetamines, pseudoephedrine, and illicit drugs

tx: Ca channel blocker nifedipine is commonly used

36
Q

myasthenia gravis

A

cholinesterase inhibitors
pyridostigmine (mistinon)

NAPLEx (75 decks)

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