Autoimmune Disease

Question 1

What mineralcorticoid acts like ALDOSTERONE and is approved for Addison’s disease?

Answer 1

Fludrocortisone

Question 2

What are symptoms of Cushing’s Syndrome? What is the cause?

Answer 2

Too much Cortisol!!!
-Acne
-Glaucoma
-Moonface
-Buffalohump
-Psych changes
-Pink-purple stretch marks
-Diabetes
-Infection or impaired wound healing

Question 3

What is Addison’s disease?

Answer 3

Lack of cortisol

Question 4

What are the short-acting systemic steroids?

Answer 4

Hydrocortisone
Cortisone

Question 5

What are the intermediate systemic steroids?

Answer 5

Prednisone
Prednisolone
Methylprednisolone
Triamcinolone

Question 6

What are the Long-Acting systemic steroids?

Answer 6

Betamethasone
Dexamethasone

Question 7

Decadron SE

Answer 7

Dexamethasone
Short term
increased appetite
weight gain
emotional instability
insomnia
increased IOP
fluid retention
increased BP and BG

Long-term
Osteoporosis
Diabetes
Impaired wound healing
Psych disorders
growth retardation

Warning: Adrenal suppression, if taking longer than 14 days, taper SLOWLY

Question 8

Deltasone

Answer 8

Prednisone

Question 9

Millipred

Answer 9

Prednisolone

Question 10

Orapred ODT

Answer 10

Prenisolone

Question 11

Solu-Cortef

Answer 11

Hydrocortisone

Question 12

Kenalog

Answer 12

Triamcinolone

Question 13

What a patient considers immunosuppresed on systemic steroid use?

Answer 13

When using >/= 20 mg/day of prednisone equivalent dose for 2 weeks

Question 14

non-biologic DMARDs

Answer 14

Disease Modifying Anti-rheumatic Drugs
- methotrexate
- hydroxychloroquine
- sulfalazine
- leflunomide

*slow disease progression and prevent further joint damage

JAK inhibitors:
Tofacitinib
Baricitinib
Upadacitinib
**do not use these with bioilogic DMARDs

Question 15

What testing is more specific to rheumatoid arthrisis?

RF
CRP
CPK
ACPA

Answer 15

ACPA

**RF is positive for other immune disorders like SLE

Question 16

What is the preferred initial therapy for rheumatoid arthritis? What situations would you NOT want to use this medication?

Answer 16

Methotrexate (Trexall)

-Pregnancy patient (teratogenic)
-breastfeeding
-Alcoholic
-Chronic liver disease
- Blood Dyscrasias

SE: hepatotoxicity! myleosuppression! mucositis!
**give with FOLATE to help with myleosuppresion and hepatic side effects

Question 17

What can be added on to DMARD therapy when insufficent for a disease flare?

Answer 17

Low-dose systemic steroid

(</= 10 mg/day of prednisone equivalant)

Question 18

What medication is dosed once weekly in RA when it is dosed daily for other conditions?

Answer 18

Methotrexate (Trexall)
**doses daily in cancer!

MOA: irreversibly binds to dihydrofolate reductase to block folate

Question 19

JAK inhibitors

Answer 19

BUT JAK

Baricitinib
Upadacitinib
Tofacitinib

increase risk for infections, malignancy, thrombosis!

Question 20

What is the MAIN side effect with DMARD Plaquenil?

Answer 20

Hydroxychloroquine
Irreverible retinopathy
**get eye exam every 3 months!

Question 21

What non-biologic DMARD can cause yellow-orange coloration?

Answer 21

Sulfasalazine

Question 22

What non-biologic DMARDs are Contraindicated in pregnancy?

Answer 22

Trexall
Lefunomide

Question 22

What non-biologic DMARDs are Contraindicated in pregnancy?

Answer 22

Trexall
Lefunomide

Question 23

Lefunomide

Answer 23

non-biologic DMARD

***avoid in pregnancy, wait 2 years after treatment to get pregnant OR use the accelerated drug elimination for 11 days
- Cholestyramine
- Activated Charcoal

SE: hepatotoxicity

Question 24

biologic DMARDs

Answer 24

Anti-TNF Biologics: Adalimumab (Humira) Etanercept (Enbrel) Infliximab (Remicade) Certolizumab (Cimzia) Golimumab (Simponi) CD20 Biologic Rituximab (Rituxan)

Question 25

Anti-TNF Biologics

Answer 25

"Go InCert Humira and Enbrel to avoid a Tumor Necrosis Factor" Golimumab (Simponi) Infliximab (Remicade) Certolizumab (Cimzia) Adalimumab (Humira) Etanercept (Enbrel) BW: serious infections **do not use with other biologics or JAK inhibitors, malignances Warning: causes demyelinating, hep B reactivation, HF, Hepatotoxicity, lupus-like syndrome **do not use with LIVE vaccines!!!! ***these are usually add-on therapy to MTX

Question 26

CD20 biologic DMARD

Answer 26

Rituximab (Rituxan) **HBV reactivation **premedicate with steroid, APAP, antihistamine due to serious infusion related reactions

Question 27

Counseling points for Enbrel and Humira

Answer 27

Weekly SC injections Cause: HF, liver damage, infection Store in fridge, can be stored at room temp for a MAX of 14 days Humira - inject into ab or thigh Enbrel - inject into ab, thigh, or upper arm

Question 28

Which drugs are DILE drugs?

Answer 28

My Pretty Malar Mark Probably Has A TransIent Quality Minocycline Proylthiouracil (hyperthroidism) Methimazole (hyperthyroidism) Methyldopa (alpha 2 agonist) Procainamide (Class 1a) Hydralazine Anti-TNF (Humira, Simponi, Enbrel, Remicade) Terbinafine Isoniazid Quinidine

Question 29

What are the common treatments of SLE?

Answer 29

Hydroxychloroquine (Plaquenil) Cyclophosphamide (antimetabolite) Transplant meds: Azathioprine Mycophenolate mofetil Cyclosporine ***may take up to 6 months to see improvement!

Question 30

What are common labratory findings for Lupus?

Answer 30

Antinuclear Antibodies (ANA) anti-ssDNA anti-dsDNA

Question 31

What is a biologic DMARD that is approved for SLE?

Answer 31

Belimumab (Benlysta)

Question 32

What are the signs and symptoms of multiple sclerosis?

Answer 32

fatigue numbness blurred vision deterioration of cogn muscle spasms pain incontinence

Question 33

What are the mainstay treatments for multiple sclerosis?

Answer 33

Glatiramir Acetate (Copaxone) and Interferon beta

Question 34

What multiple sclerosis therapy is preferred in pregnancy?

Answer 34

glatiramir acetate (Copaxone) warning: chest pain

Question 35

Pyrimidine synthesis inhibitors and there uses

Answer 35

lefunomide use in RA teriflunomide use in MS **both have hepatotoxicty and CI in pregnancy!

Question 36

Interfern beta

Answer 36

Warning: psych, hepatotoxicity, thyroid dysfunction **do not expel air bubble due to loss of drug!!!!!

Question 37

What monoclonal antibody is approved for MS that is also approved for IBD?

Answer 37

Natalizumab (Tysabri) **PML ----- need REMS

Question 38

What is the DOC for Reynaud's Phenomenon (cyanosis and cold extremities)?

Answer 38

Nifedipine (Procardia)

Question 39

What is myasthenia gravis?

Answer 39

autoimmune disease affecting nerves and muscles that control the face and eyes -vision loss -ptosis (dropping eyelid) -problems chewing or swallowing Tx: pyridostigmine (anticholinergic)

Question 40

What drugs worsen myasthenia gravis?

Answer 40

AG or Quinolones BB or CCB Magnesium Muscle relaxants

Question 41

Sjogren's Syndrome is?

Answer 41

autoimmune disease marked by DRY eyes and DRY mouth Tx: eye drops -Cyclosporine (Restasis) oral med for dry mouth pilocarpine (cholinergic)