Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Systemic steroids and autoimmune disorders > notes > Flashcards

notes Flashcards

(147 cards)

Start Studying
1
Q

What endogenous steroid does fludrocortisone mimic?

A

aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what kind of activity does fludrocortisone have?

A

mineralocorticoid that balances water and electrolytes which keeps BP stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

fludrocorticoid is FDA approved for what?

A

Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what activity do other steroids like prednisone have?

A

glucocorticoid that is mostly anti-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is cushing’s syndrome?

A

it is the excess of cortisol production either from the adrenal gland production or high doses of exogenous steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the suppression of the hypothalamus-pituitary-adrenal axis (HPA)?

A

high doses of steroid can cause the adrenal gland to stop producing cortisol by feedback inhibition by suppression of the HPA axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Addison’s disease?

A

when the adrenal gland is not producing enough cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When stopping steroids, they must be tapered off, why?

A

to give time for adrenal glands to start producing cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

list glucocorticoids from least to most potent

A

cute & hot pharmacists & physicians marry together & deliver babies

cortisone 25
hydrocortisone 20
prednisone 5
prednisolone 5
methylprednisolone 4
triamcinolone 4
dexamethasone 0.75
betamethasone 0.6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

dexamethasone brand

A

DexaPak 6, 10, 13 day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

methylprednisolone brand

A 
Medrol
Medrol Therapy Pack
A-Methapred
SOLU-medrol Pack
DEPO-medrol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

prednisone brand

A

Prednisone Intensol

Deltasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

prednisolone brand

A

Millipred
Orapred ODT
Pediapred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Triamcinolone brand

A

Kenalog

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should steroids be taken to mimic the natural diurnal cortisol release?

A

between 7-8am

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

short term SE <1 month of glucocorticoids

A 
mood lability
insomnia
indigestion
bitter taste
hyperglycemia
hypertension
increased appetite/ weight gain
fluid retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

long term SE > 1 month

A

increased intraocular pressure
cushing-like symptoms (moon facies, buffalo hump, muscle wasting, weak bones, striae, acne, GI bleed, esophagitis, hypothyroidism, impaired wound healing, hirsutism, irregular menstruation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what dose of prednisone constitutes as immunosuppressed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How many days taper is the Medrol Therapy Pak?

A

6 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the common symptoms of autoimmune disease?

A

fatigue, weakness, pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

strong immunosuppressants can reactivate what diseases?

A

Tb

hep B & C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are main differences b/w RA and OA?

A

RA is bilateral and symmetrical

OA does not cause “prolonged stiffness”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some symptoms of RA?

A

bone deformity
pain
stiffness
joint swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

which laboratory tests assist in RA diagnosis

A 
anti-citrulinated peptide Ab (ACPA)
rheumatoid factor (RF) - less specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
when should pts w/ RA be initiated on a DMARD?
when symptomatic regardless of disease severity
26
What is the RA txt goal?
disease remission or low disease activity
27
What is the preferred initial therapy for RA pts?
methotrexate
28
What is the drug treatment regimen for pts with moderate to high disease activity despite MTX (w/ or w/o steroids) ?
a combination of DMARDs, TNF inhibitor biologic or non-TNF biologic, w/ or w/o MTX Do not use two biologic DMARDs in combination b/c of fatal risk of infection
29
What options are there for bridging to wait for DMARDs to take effect in RA?
low dose steroids (<10mg/day) | high dose NSAIDs
30
methotrexate brands
Trexall Otrexup Xatmap Rasuvo
31
BW methotrexate
pregnancy hepatotoxicity mucositis/stomatitis myelosuppression
32
CI methotrexate
pregnancy
33
SE methotrexate
``` alopecia photosensitivity N/V/D increasing LFTs stomatitis ```
34
When can folate be given when on methotrexate?
5mg PO weekly on the day following MTX
35
hydroxychloroquine brand
Plaquenil
36
warning Plaquenil
irreversible retinopathy and loss of vision acuity caution in pts w/ G6PD deficiency
37
SE Plaquenil
N/V/D, abdominal pain, vision changes (dose-related), skin & hair color changes (rare), rash, pruritus, HA
38
What should be monitored in pts on Plaquenil?
eye exams
39
sulfasalazine brand
Azulfidine
40
warning sulfasalazine
caution in pts w/ G6PD deficiency
41
CI sulfasalazine
allergy to sulfa or salicylate
42
SE sulfasalazine
rash, HA, yellow-orange skin/urine
43
What should be given in addition to sulfasalazine and why?
folate 1mg/day decreased folate absorption on sulfasalazine
44
leflunomide brand
Arava
45
warnings leflunomide
fetal-embryo toxicity | hepatotoxicity
46
CI leflunomide
hepatic impairment and pregnancy
47
What needs to be tested and how before using leflunomide?
must have negative pregnancy test and use 2 forms of birth control while on medication
48
how long does a pt have to wait to be pregnant after taking leflunomide?
2 years OR do an accelerated drug elimination procedure of cholestyramine or activated charcoal x 11 days
49
tofacitinib brand
Xeljanz | Xeljanz XR
50
what should Xeljanz not be used with?
do not use in combination w/ other biologic DMARDs
51
MOA tofacitinib
JAK enzymes inhibitor which stimulates immune cells
52
pharmacokinetics Xeljanz
``` avoid 3A4 inhibitors, inducers 2C19 inhibitor (IR only) ```
53
dose adjust Xeljanz
dose adjust IR only in moderate renal ior hepatic impairment
54
which pts should Xeljanz not be initiated?
ANC <1000 lymphocyte count < 500 Hgb < 9
55
DDI methotrexate
alcohol, increased hepatotoxicity
56
what is another name for anti-TNF biologics?
TNF-alpha inhibitors
57
Each anti-tNF inhibitor has its own what type of registry
pregnancy registry b/c of unknown risks to the fetus
58
which anti-tnf biologic DMARDs are available as IV?
infliximab (Remicade) | golimumab (Simponi Aria)
59
Which anti-TNF biologic DMARDs are available SC?
adalimumab (Humira) etanercept (Enbrel) golimumab (Simponi) certolizumab pegol (Cinzia)
60
How often is etanercept administered?
once weekly SC
61
which anti-TNF inhibitor DMARDs require a filter and why?
infliximab (Remicade) | golimumab (Simponi Aria)
62
which anti-TNF inhibitor DMARD causes a infusion reaction?
infliximab (Remicade)
63
which anti-TNF inhibitor DMARD causes delayed hypersensitivity reaction? how far later?
infliximab (Remicade) 3-12 days after infusion
64
infliximab is compatibile with which solvent only?
NS only
65
BW for anti-TNF inhibitors?
serious infections, malignancies
66
CI infliximab
>5mg/kg dose in mod-sev HF
67
CI etanecept
sepsis
68
CI in anti-TNF inhibitors
active systemic infections
69
warning TNF inhibitors
may cause demyelinating disease, HF, hepatotoxicity, serious infections, hep B reactivation, myelosuppression
70
how should TNF inhibitors be stored?
refrigerator | Humira and Enbrel can be stored at room temp x 14 days
71
when can anti-TNF biologics be used as initial therapy?
in severe disease presentation
72
where can Humira be injected?
SC in thigh, abdomen
73
where can Enbrel and Simponi be injected?
SC thigh, abdomen, upper arm
74
how is rituximab administered?
IV
75
MOA of rituximab
depletes CD20 B cells
76
warning rituximab
reactivation of hep B and C | infusion-elated reactions (premedicate w/ steroid, acetaminophen , anti-histamine)
77
anakinra brand
Kinemet
78
warnings anakinra
serious infection, malignancy, Tb reactivation
79
when is anakinra used?
reserved for after one or two DMARD failure
80
abatacept brand
Orencia
81
warning abatacept
serious infection malignancy Tb reactivation COPD worseninig
82
what solvent is abatacept stable in?
NS only
83
tocilizumab brand
Actemra
84
when should Actemra not be used?
ANC < 2000, AST or ALT >1.5x ULN, platelets < 100,000
85
when should Kevzara not be used?
ANC < 2000, AST or ALT >1.5x ULN, platelets < 150,000
86
Kevzara generic
sarilumab
87
classic symptoms of SLE?
depression, fatigue, anorexia, weight loss, malar rash, muscle pain, photosensitivity
88
which manifestations of SLE lead to morbidity/mortality?
hematologic, neurologic, renal manifestations arthritis and cutaneous manifestations are most common
89
what % of pts develop lupus nephritis?
50%
90
which drugs are most associated with drug-induce lupus erythematosus?
``` anti-TNF hydralazine isoniazid methimazole methyldopa minocycline procainamide propylthiouracil quinidine terbinafine ``` Annie Hall Is Merry Merry Mini Pretty Pie & Quite Tubby
91
What agents are used to treat SLE? how long does it take these agents to work? which one is the only ones FDA approved for SLE
NSAIDS (w/ PPIs), azathioprine, MMF, cyclosporine, cyclophosphamide, hydroxychlooquine, belimumab 6 months to work belimumab, hydroxychloroquine
92
belimumab brand
BeLysta
93
belimumab MOA
IgG1 monoclonal antibody - prevent B lymphocyte survival
94
interferon beta agents in MS
``` Avonex Plegridy Betaseron Rebif Extavia Glatiramer acetate (Copaxone, Glatopa) ```
95
which interferon beta used in MS is pegylated? What is the difference of pegylation?
Plegridy pegylated interferon allows for SC dosing q14 days other agents are parenteral
96
what MS agents are oral?
teriflunomide (Aubagio) dimethyl fumarate (Tecfidera) fingolimod (Gilenya)
97
what is the dose of glatiramer acetate?
20mg daily SC OR 40mg TIW SC (spaced q48 hours)
98
SE glatiramer acetate
injection site reactions, pain, flushing, dyspnea, infection, diaphoresis
99
What is the preferred agent in MS patients who are pregnant?
glatiramer acetate (Copaxone, Glatopa)
100
MOA glatiramer acetate
immune modulator that suppresses T-lymphocytes
101
Which agents for MS are interferon beta-1a? | ROA and frequency?
Avonex IM weekly | Rebif SC TIW
102
which agents for MS are interferon beta-1b? | ROA and frequency?
Extavia SC every other day | Betaseron SC every other day
103
which agent for MS is peginterferon beta-1a? | ROA and frequency?
Plegridy SC q14 days
104
MOA of interferon beta products
enhances immune function by altering surface antigens
105
warnings interferon beta priducts
psychiatric disorders, increasing LFTs, injection site necrosis, thyroid disorders (hypo, hyper)
106
SE interferon beta products
flu-like symptoms (may premedicate)
107
which interferon beta products can be left at room temperature?
Betaseron | Extavia
108
which interferon beta products should not be shaken?
Avonex, Betaseron, Extavia
109
If refrigerated, what should you do with interferon beta products before injection?
bring to room temperature and DO NOT take out air bubbles b/c will lead to loss of medication
110
which oral immune modulator is contraindicated in pregnancy and severe hepatic impairment?
teriflunomide (Gilenya)
111
which oral immune modulator causes bradycardia? | How should the pt be monitored?
fingolimod (Aubagio) monitor for 6 hours after initial administration ECG baseline and after monitoring period
112
which immune modulator is contraindicated in pts w/ hx of CVD or stroke?
fingolimod (Aubagio)
113
which immune modulator should not be crushed, chewed, etc?
dimethyl fumarate (Tecfidera)
114
SE Aubagio
macular edema, hepatotoxicity, myelosuppression
115
which immune modulator should be cautious of in pts on HR lowering meds?
fingolimod (Aubagio)
116
which agent is a potassium channel blocker used in MS? What is it for?
dalfampiridine (Ampyra) | increase nerve conduction for walking
117
Ampyra contrauindication
hx of seizures
118
How long does it take for Ampyra to work?
6 weeks, most pts do not respond
119
What is the mAb that binds to the alpha-4 subunit of integrins on surface of leukocytes used in MS?
natalizumab (Tysabri)
120
which agent is a CD52 directed cytolytic mAb?
alemtuzumab (Letrada)
121
which agent targets CD20+ B cells?
ocrelizumab (Ocrevus)
122
which agent is an IL-2 antagonist?
daclizumab (Zinbryta)
123
which recombinant humanized mAb used in MS are IV?
Ocrevus and Letrada
124
CI Lemtrada
HIV pts because prolonged decrease in CD4 count
125
CI Zinbryta
hepatic disease
126
CI Ocrevus
active HepB disease
127
which recombinant humanized mAb used in MS require a REMs program? why?
Lemtrada, Zinbryta serious, fatal autoimmune conditions, infections, malignancies Zinbryta can cause autoimmune hepatitis
128
how do you monitor patients on daclizumab
LFTs at baseline, monthly for 6 months after last dose
129
When are recombinant humanized mAb indicated in MS?
after failure with 2 or more MS agents
130
what is the presentation of Raynaud's phenomenon?
the fingertips turn white ten blue. Once it warms, it becomes red and swollen
131
What is the preferred agent used in Raynaud's?
CCB - nifedipine
132
What is celiac disease?
It is an immune response to gluten found in wheat, barley and rye
133
What are the common symptoms of celiac disease?
abdominal pain, diarrhea, bloating, weight loss constipation more in children
134
how can pharmacists check to see if excipients are gluten-free?
package insert to see if it says it contains starch and if it specified whether or not if its corn, wheat, tapioca or potato. May need to call manufacturer.
135
What can be used to treat dry eye in Sjogren's syndrome?
OTC artificial tears. If they dont work then | cyclosporine (Restasis) or lifitegrast (Xiidra).
136
What is the SE of Restasis
burning
137
what is the SE of Xiidra
unusual taste
138
dry mouth treatment agents
OTC salivary stimulation (xylitol, sugar free gum), antimicrobial mouthwashes, salivary substitutes. If these dont work then muscarinic agonistslike pilocarpine (Salagen) or cevimeline (Evoxac).
139
CI Salagen and Evoxac and why?
contraindicated in pts w/ uncontrolled asthma or narrow angle glaucoma b/c of cholinergic effects
140
what kind of agent is glycopyrrolate
anticholinergic agent used for excess salivation - check to see if there is inappropriate use causing dry mouth
141
What are the topical agents used to treat psoriasis?
tazarotene, anthralin, coal tar, steroids, calcipotriene
142
what is the biggest con of coal tar products?
very messy and stains clothes, bedding, etc
143
what are the systemic agents for psoriasis txt?
acitetin (Soriatane) | apremilast (Otezla)
144
when is acitretin (Soriatane) used?
in severe cases of psoriasis
145
SE of apremilast (Otezla)
diarrhea, weight loss
146
what are the IL-RA used in psoriasis txt?
ustekinumab (Stelara) guselkumab (Tremfya) brodalumab (Siliq)
147
which agents that are used to treat RA, must be given with methotrexate?
infliximab (Remicade) golimumab (Simponi, Simponi Aria) rituximab (Rituxan)

Systemic steroids and autoimmune disorders (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions