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PHM 702 pulm, tox & rheumatoid > sle > Flashcards

sle Flashcards

1
Q

risk factors for SLE

A

-Genetics: 1st degree
-Environment: sunlight, smoking, stress, meds
-Hormones (inc risk w/ inc levels)

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2
Q

what happens during pre-clinical

A

Auto-immune proliferation; Over activation of B cell and T cell activation

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3
Q

What happens during clinical phase

A

autoantibody production

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4
Q

Diagnostic Criteria
SOAP BRAIN MD

A
  • Serositis
  • Oral Ulcers
  • Arthritis
  • Photosensitivity
  • Blood disorders
  • Renal Impairment
  • Antinuclear Ab (ANA)
  • Immunotherapy
  • Neurologic Disorders
  • Malar Rash
  • Discoid Rash
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5
Q

Serologic Testing

A
  • ANAs (-) = NOT lupus (+)= maybe lupus
  • Anti-dsDNA Ab
  • Anti-Sm Ab
  • Anti-PL (+)
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6
Q

Anti-phospholipid Syndrome

A

Anti-Pl + with thrombotic event
- hyper coagulable state life threatening, spontaneous abortion

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7
Q

Anti-phospholipid Syndrome Management with aPL (+) with no event

A
  • Not pregnant: Low Dose Aspirin
  • Pregnant: Low Dose Aspirin +/- LMWH
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8
Q

Anti-phospholipid Syndrome Management with APS

A

Pregnant : LDA +/- LMWH
Not pregnant, venous : warfarin INR 2-3
Not pregnant, arterial : warfarin 3-4

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9
Q

Lupus Nephritis clinical presentation

A
  • kidney inflammation
  • protein in urine +/- cast
  • foamy urine, peripheral edema, HTN
  • 6 class, 3-6 require immunosuppression or transplant
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10
Q

Lupus Nephritis Managment (induction vs remission)

A

Induction
- Immunosupressants ( Mycophenolate or CYC) +/- steroids
Remission
- Taper steroid doses + switch immunosuppressant doses as needed

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11
Q

Lupus Nephritis Class III-IV treatment

A
  • G Cortico + MMF
  • response 3-12 months
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12
Q

Lupus Nephritis Class V treatment

A
  • RAAS inh (ACE/ARB)
  • consider GC + MMF, if Urine protein >3gr/24hr
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13
Q

Clinical presentation

A
  • malar rash (cheek bone), fever, arthralagias, alopecia, pain
  • women childbearing age
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14
Q

Biggest risk factor for death in SLE patients

A

Infection

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15
Q

SLE & Pregnancy safe to use and pearls

A
  • Hydroxycholorquine, APAP, low dose/potency Corticos
  • In lupus nepritis HCQ or Azathi
  • consider preterm delivery if LN highly active
  • continue meds throughout pregnancy, best to wait to get pregnant until after remission
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16
Q

SLE monitoring

A
  • s/s q3-6 months
  • q6 months: UA, BMP, CBC, lipid panel, serological disease markers
17
Q

Topical Steroids dosing, clinical pearls, alt

A
  • low potency : facial rash; hydrocortisone 1%
  • high potency: arm, legs, trunk
  • Cyclical applications
  • Alt: tacrolimus
18
Q

NSAIDs clinical pearl, se, monitor

A
  • Separate aspirin at least 1 hr b/f dose
  • SE: Cardiac, AKI, GI
  • Monitor CBC, BMP
19
Q

hydroxychloroquine ae, dose, monitoring

A

1st line
- AE: skin pigment, flu-like symptoms, irreversible rare-ocular toxicity
- dose suppression: 400 mg QD-BID
- dose maintenance: 200-400 mg QD
- eye exam baseline

20
Q

Who gets Corticosteroids

A

Adjunctive therapy for
- mod-severe initial pres
- organ-threatening or life- threatening SLE
- inadequate response to HCQ or NSAIDs
- Poor quality of life
Rapid Symptom Relief

21
Q

Belimumab clinical pearls, AE, who to avoid

A
  • monthly IV inf
  • adj therapy w/ immunosuppressants
  • AE: Depression/Suicidality/ CNS SEs, serious inf if given w/ live vaccines + biologics, avoid in preg
  • avoid in dementia patients
22
Q

Anfrolumab clinical pearls

A
  • Adj w/ standard SLE therapy
  • IV Inf q4 weeks
  • Not indicated in active LE or CNS disease
23
Q

who is inidicated for Immunosuppressants therapy with SLE

A
  • for pts with poor symptom control refractory to HCQ/NSAID/Steroid
  • organ-threatening SLE
  • combo w/ steriods
24
Q

what agent can cause permanent infertility

A

cyclophosphamide

25
Q

Voclosporin clinical pearls, BBW

A
  • adj to immunosuppressants in active LN
  • BBW: infs + malignancy
  • GFR <45 can cause nephrotoxicity
  • CYP3A4 interactions, grapefruit
26
Q

treat to monitor principles

A
  • Shared decisions pts + MD
  • Prolong survival, minimizing organ damage, improve health-related quality of life
  • Multidisciplinary management
    -Monitor, follow-up, to therapy
27
Q

Non-pharm

A

Trigger
- sunscreen, broad coverage, avoid photosensitivity agents, stress, smoking
Prevent/Eradicate Inf
- Treat aggressively, immunosuppressants

28
Q

Which agents treat membranous lupus nephritis 5

A

Mycophenolate
Cyclosporine
Calcineurin inh (Voclosporin)

PHM 702 pulm, tox & rheumatoid (15 decks)

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