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A - NAPLEX > Chapter 46: Systemic Steroids & Autoimmune Conditions > Flashcards

Chapter 46: Systemic Steroids & Autoimmune Conditions Flashcards

1
Q

Which steroid drug mimics aldosterone

A

fludrocortisone

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2
Q

Fludrocortisone is FDA approved for ____ & used off-label for ____

A

Addison’s disease

Orthostatic hypotension

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3
Q

Steroids such as prednisone and hydrocortisone have more ____ activity, which has more ____ effects

A

glucocorticoid; anti-inflammatory

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4
Q

Systemic steroids can cause the adrenal gland to stop producing ____, which is called ____

A

cortisol; suppression of the HPA axis

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5
Q

Cushing’s Syndrome develops when the adrenal gland produces too much ____, or when exogenous (i.e., taken as a drug) steroids are taken in high doses

A

cortisol

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6
Q

In Addison’s disease:

A

the adrenal gland is not making enough cortisol

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7
Q

If exogenous steroids are stopped suddenly, it can cause

A

Addisonian Crisis, which can be fatal

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8
Q

What are ways to reduce systemic steroid risks

A
  • use alternate day dosing
  • for a condition in the gut, use a steroid with low systemic absorption, such as Budesonide
  • For joint inflammation, inject into the joint so the drug stays local
  • For treatment of asthma, use inhaled steroids that mostly stay in the lungs
  • For conditions that require long-term steroids, use the lowest possible dose for the shortest possible time
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9
Q

Rank steroids from least to most potent

A 
Remember: Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies
Cortisone
Hydrocortisone
Prednisone 
Prednisolone 
Methylprednisolone 
Triamcinolone 
Dexamethasone
Betamethasone
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10
Q

What is the brand name for dexamethasone

A

DexPak 6, 10 or 13 day, Decadron

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11
Q

What is the brand name for hydrocortisone

A

Solu-Cortef

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12
Q

What is the brand name for methylprednisolone

A

Medrol, Solu-Medrol

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13
Q

What is the brand name for prednisone

A

Deltasone

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14
Q

What is the brand name for prednisolone

A

Millipred, Orapred ODT

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15
Q

What is the brand name for Triamcinolone

A

Kenalog

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16
Q

If taking steroids once daily, take between ____ to mimic the natural diurnal cortisol release

A

7-8 AM

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17
Q

Should steroids be taken with or without food?

A

With food

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18
Q

Steroid-induced medical conditions include:

A
  • diabetes
  • hypertension
  • glaucoma
  • psychiatric conditions
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19
Q

Must taper steroids if taking longer than ___ days

A

14

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20
Q

Short-term side effects of steroids can lead to:

A

increased appetite/weight gain, emotional instability, insomnia

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21
Q

Cortisone is a prodrug of

A

cortisol

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22
Q

prednisone is a prodrug of

A

prednisolone

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23
Q

A patient is immunosuppressed when using >/= __ mg/kg/day or >/= __ mg/day of prednisone or prednisone equivalent

A

2; 20

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24
Q

Common way to taper steroids

A

Reduce the dose by 10-20% every few days. Tapers can last 7-14 days

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25
Q

Nonspecific lab blood tests that can be useful in detecting inflammation include:

A

ESR, C reactive protein, rheumatoid factor, and antinuclear antibody

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26
Q

The use of strong immunosuppressants can increase the risk of certain conditions including:

A
  • Reactivation of TB and Hep B and C
  • Viruses
  • Lymphomas and certain skin cancers
  • Infections
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27
Q

_____ is consistent with a rheumatoid arthritis diagnosis

A

Bilateral, symmetrical disease

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28
Q

What are common symptoms of RA

A

Joint swelling, pain, stiffness, bone deformity

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29
Q

Which lab tests are useful to help diagnose RA

A

rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA)

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30
Q

Patients with symptomatic RA should be started on ____, regardless of the severity

A

DMARD

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31
Q

What is the preferred initial DMARD for most patients with RA

A

Methotrexate

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32
Q

Which class of medication are used for RA flares

A

steroids (low-dose)

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33
Q

What is the brand name for MTX oral tab

A

Trexall

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34
Q

What is the brand name for MTX SC auto-injectors

A

Otrexup and Rasuvo

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35
Q

What is the MOA of MTX

A

Irreversibly binds and inhibits dihydrofolate reducatse, inhibiting folate

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36
Q

What is the dosing for MTX for RA

A

7.5-20 mg once weekly (PO, SC, IM)

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37
Q

Why should MTX not be dosed daily in RA

A

Numerous incidences of ADE (e.g, mouth sores, intestinal bleeding, liver damage) have occurred in patients taking daily

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38
Q

Boxed warnings for MTX

A

hepatotoxicity, myelosuppression, mucositis/stomatitis, pregnancy

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39
Q

What should be monitored when using MTX

A

CBC, LFTs, CXR, hepatitis B and C serologies

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40
Q

Why is folate given with MTX

A

To decrease hematological, GI and hepatic SE

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41
Q

Brand name for hydroxychloroquine

A

Plaquenil

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42
Q

Warning for hydroxychloroquine

A

irreversible retinopathy

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43
Q

When would you use hydroxychloroquine over MTX

A

If there is a concern for liver disease

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44
Q

What is a CI for sulfasalazine

A

sulfa or salicylate allergy

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45
Q

What color can sulfasalazine turn the skin/urine

A

yellow-orange

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46
Q

What is the MOA for leflunomide

A

Inhibits pyrimidine synthesis resulting in anti-proliferative and anti-inflammatory effects

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47
Q

Boxed warnings for leflunomide

A

Do not use in pregnancy (teratogenic); hepatotoxicity

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48
Q

What are the accelerated drug elimination options for leflunomide

A
  1. Cholestyramine 8 grams PO TID x 11 days

2. activated charcoal suspension 50 grams po Q12H x 11 days

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49
Q

If pregnancy is desired when using leflunomide, you must wait ___ after discontinuation or use accelerated drug elimination procedures

A

2 years

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50
Q

Boxed warnings for Janus Kinase Inhibitors

A

Serious infections including TB, fungal, viral, bacterial and others; malignancies; thrombosis

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51
Q

What medication classes cannot be used with janus kinase inhibitors

A

biologic DMARDs or potent immunosuppressants

52
Q

Renal elimination of MTX is decreased by

A

aspirin and NSAIDs

53
Q

T/F: needles need to be purchased separately with anti-TNF biologic DMARDs

A

F. They are included

54
Q

Etanercept brand name

A

Enbrel

55
Q

Adalimumab brand name

A

Humira

56
Q

Infliximab brand name

A

Remicade

57
Q

Certolizumab pegol brand name

A

Cimza

58
Q

Golimumab brand name

A

Simponi

Goli is a simp

59
Q

What medication can anti-TNF biologic DMARDS be given with

A

MTX. DO NOT USE WITH OTHER BIOLOGIC DMARDs OR LIVE VACCINES

60
Q

Enbrel dosing frequency

A

SC weekly

61
Q

Humira dosing frequency

A

SC every other week

62
Q

Infliximab is given via which route

A

IV

63
Q

Cimzia dosing frequency

A

SC every other week

64
Q

Simponi dosing frequency

A

SC monthly; can also be given IV

65
Q

Boxed warning for anti-TNF biologic DMARDS

A

serious infections; screen for latent TB & treat if needed; lymphomas and other malignancies

66
Q

Warnings for anti-TNF biologic DMARDS

A

Can cause demyelinating disease, hepatitis B reactivation, HF, hepatotoxicity, and lupus-like syndrome

67
Q

Infliximab (Remicade) requires a filter and is only table in ____

A

normal saline

68
Q

Which anti-TNF biologic DMARD causes infusion reactions

A

Infliximab (Remicade)

69
Q

Which anti-TNF biologic DMARD causes delayed hypersensitivity reactions

A

Infliximab (Remicade)

70
Q

Rituximab brand name

A

Rituxan

71
Q

MOA of retuximab

A

Depletes CD20 B cells

72
Q

How is Rituxan given

A

IV

73
Q

What premedications should be given with Rituxan

A

steroid, APAP and antihistamine

74
Q

Boxed warning for Rituxan

A

infustion-related reactions usually with first infusion, HBV reactivation

75
Q

T/F: Rituximab can be given with other biologic DMARDs or live vaccines

A

False

76
Q

Otrexup & Rasuvo (methotrexate single-use auto-injectors) should be administered in what parts of the body

A

abdomen or upper thigh only

77
Q

etanercept (Enbrel) and adalimumab (Humira) can be stored at room temperature for a max of ___ days

A

14

78
Q

Where can adalimumab (Humira) be injected

A

abdomen or thigh

79
Q

Where can etanercept (Enbrel) be injected

A

abdomen, thigh or upper arm

80
Q

Where can golimumab (Simponi) be injected

A

abdomen, thigh or upper arm

81
Q

SLE is most common in which gender/ethnicities

A

women of AA and Asian descent

82
Q

Most common symptoms of SLE

A

fatigue, depression, anorexia, weight loss, muscle pain, malar rash (butterfly rash), photosensitivity, and joint pain and stiffness

83
Q

What condition develops in over 50% of patients with SLE

A

lupus nephritis

84
Q

Which common lab findings are associated with a SLE diagnosis

A

positive ANA and positive anti-ssDNA and anti-dsDNA

85
Q

Treatment for SLE can take up to ____ to see max benefit

A

6 months

86
Q

What drugs are used for chronic SLE

A

hydroxychloroquine, cyclophosphamide, azathioprine, mycophenolate mofetil and cyclosporine

87
Q

Belimumab (Benlysta) used for SLE has what warnings

A

serious infections; do not give with other biologic DMARDs or live vaccines

88
Q

Belimumab (Benlysta) used for SLE has a lower response rate for which population

A

AA

89
Q

Early symptoms of multiple sclerosis includes

A

fatigue, numbness, and blurred vision

90
Q

Glatiramer acetate brand name

A

Copaxone

91
Q

Glatiramer acetate warning

A

chest pain

92
Q

Glatiramer acetate side effects

A

injection site reactions, flushing, diaphoresis, dyspnea

93
Q

What is the preferred agent if treatment of MS is required during pregnancy

A

Glatiramer acetate

94
Q

How is Glatiramer acetate dosed

A

20 mg SC daily or 40 mg SC 3 times per week

95
Q

How is interferon beta-1a (Avonex, Rebif) dosed

A

Avonex: IM weekly
Rebif: SC 3 times per week

96
Q

How is interferon beta-1b (Betaseron, Extavia) dosed

A

SC every other day

97
Q

How is peginterferon beta-1a (Plegridy) dosed

A

SC every 14 days

98
Q

What are warnings for interferon beta products used in MS

A

psych disorders (depression/suicide), injection site necrosis, increased LFTs, thyroid dysfunction (hyper and hypo)

99
Q

What is a SE for interferon beta products used in MS

A

Flu-like symptoms

100
Q

T/F: Make sure to expel the small air bubble in prefilled syringes of interferon beta products

A

False; you will lose the dose

101
Q

Some formulations of interferon beta products used in MS contain ____

A

albumin

102
Q

T/F: All interferon beta products used in MS (except Betaseron and Extavia [interferon beta-1b]) must be refrigerated. If taken out of the refrigerator, you do not need to let it stand at RT prior to injection

A

False; you should let it sit out at RT

103
Q

What is a CI of teriflunomide (Aubagio), an oral immunomodulator

A

pregnancy

104
Q

Fingolimod, an oral immunomodulator, can cause ____ and the patient must be monitored for at least ___ after the first dose

A

bradycardia; 6 hours

105
Q

Fingolimod, an oral immunomodulator, is CI in most patients with history of

A

CVD or stroke

106
Q

Fingolimod, an oral immunomodulator, requires ___ at baseline and at end of initial observation

A

ECG

107
Q

Fingolimod and Siponimod, oral immunomodulators used in MS, have significant ADE for

A

macular edema, hepatotoxicity, and myelosuppression

108
Q

T/F: Diemthyl fumarate and Diroximel fumarate, oral immunomodulators used in MS, CANNOT be crushed, chewed or sprinkled onto food

A

True

109
Q

Siponimod, an oral immunomodulator, is CI with

A

CYP2C93/3 genotype

110
Q

Natalizumab brand name

A

Tysabri

111
Q

Natalizumab boxed warning

A

PML; only available through the REMS TOUCH Prescribing Program

112
Q

Drugs commonly used for symptom control in MS include:

A

anticholinergics for incontinence, laxatives for constipation, muscle relaxants for muscle spasms, analgesics for muscle spams and pain, and propranolol for tremor

113
Q

Which medication class (and specific medication) is used commonly to prevent Raynaud’s Phenomenon

A

CCBs; commonly nifedipine

114
Q

Which drugs can cause or worsen Raynaud’s

A

BB, Bleomycin, cisplatin, sympathomimetics (from vasoconstriction) like amphetamines, PSE and illicit drugs

115
Q

Patients with celiac disease have gluten intolerance. Pharmacists should look at package inserts of medications to look for the excipient components. What words should the pharmacist look for?

A

starch (corn, potato, tapioca, or wheat). Wheat, barley and rye are the gluten proteins

116
Q

Which drugs can worsen or unmask myasthenia gravis

A 
Antibiotics: AMG and quinolones
Mg salts
select antiarrhythmics
BB & CCB
Select antipsychotics
Muscle relaxants
Local anesthetics
117
Q

MOA of pyridostigmine

A

block the breakdown of ACh

118
Q

Sjogren’s syndrome is characterized by

A

severe dry eyes and dry mouth

119
Q

What OTC products can be used for dry eyes in Sjogren’s syndrome

A

artificial teardrops (Systane, Refresh, Clear Eyes, and Liquifem)

120
Q

Cyclosporine emulsion brand name

A

Restasis

121
Q

Side effect of Restasis

A

burning of eyes

122
Q

Lifitegrast Brand name

A

Xiidra

123
Q

Side effect of Xiidra

A

unusual taste

remember xii has unusual taste

124
Q

What rx drugs can provide treatment for dry mouth in Sjogren’s syndrome

A

muscarinic agonists such as pilocarpine or cevimeline. These are CI in pts with uncontrolled asthma and narrow-angle glaucoma

125
Q

What non-drug treatment can help mild-moderate psoriasis symptoms?

A

UVB phototherapy

126
Q

If steroids, vitamin D analogues, anthralin, retinoids, salicylic acid, coal tar and moisturizers fail for treatment of psoriasis, what can be used

A

topical calcineurin inhibitors

A - NAPLEX (83 decks)

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