S LEaving my brain at home Flashcards

(41 cards)

1
Q

SLE triggers

A
  • UV light triggers
  • stress
  • smoking
  • virus/virus ike elements
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2
Q

SLE dx

A

4 out of the following 11 SOAP, BRAIN, MD
1. serotosis
2. oral ulcers
3. arthritis
4. photosensitivity
5. blood disorders
- hemolytic anema w/ reticulocytosis
- leukopenia on 2+ occassions
- lymphopenia on 2+ occasions
- thrombocytopenia in absence of offending drugs
6. renal involvement: persistent proteinuria, cellular casts
7. antinuclear Ab
8. immunology/serologic testing
9. neurologic disorder (with unclear cause)
10. malar rash
11. discoid

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3
Q

SLE serologoic testing

A
  • ANA: if negative, pretty positive it’s NOT SLE, but if positive, eh
    • Good for excluding, not confirming SLE
  • Anti-dsDNA Ab: perform after ANA titer to confirm
  • Anti-Sm Ab: smith proteins
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4
Q

Antiphospholipid syndrome (APS)

A
  • secondary APS: aPL(+) AND thrombotic event
  • associated with DVTs, stroke, and neurologic manifestations
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5
Q

lupus nephritis (LN)

A
  • kidney inflammation d/t either
    • intravascular deposition of immune complexes in glomeruli
    • formation of immune complexes on self-antigens on glomerular basement membrane

presnetation of SLE

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6
Q

LN dx

A
  • persistent proteinuria and/or cellular casts
  • renal biopsy and histology to confirm
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7
Q

LN presentation

A
  • foamy urine
  • peripheral edema
  • concomitant HTN
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8
Q

topical steroids in SLE

A
  • lower potency for face
  • using it around the clock makes it lose its efficacy
  • can use a topical CNI if topical steroid CI
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9
Q

adequte HCQ trial in SLE

A

6 months

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10
Q

HCQ in SLE

A
  • give to everyone
  • reduces flares and reduces risk of major organ involvemnt
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11
Q

gluocortivoid use in SLE

A
  • Adjunctive treatment for
    • Moderate-severe flare
      • Rapid symptom relief: prednisone 20-60mg/day or IV pulse followed by PO taper
        • Taper down by 10-20% Q 5-7 D
    • organ or life threating
    • inadequater response to hydroxychloroquine or NSAIDs
  • Poor QOL without
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12
Q

GLutocorticoid lonog term use AE

A
  • OP
  • HLD
  • Fat redistribution
  • Moon facies
  • Growth faillure
  • Amenorrhea
  • Immunsuppresion
  • HPA suppression
  • Cataracts
  • Obesity
  • Seziures
  • Echymosis
  • Muscle weakness
  • Acne
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13
Q

Belimumab use in SLE

A
  • b lymphocyte stimulat antag
  • adjunctive treatment for
    • non-active-CNS, Ab (+) SLE
    • musculoskeletal cutaneous disease unresponsive to HCQ, NSAID, steroid
    • lupus nephritis III, IV, or V
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14
Q

belimumab AE

A
  • nausea
  • diarrhea
  • allergic reaction
  • ifusion reaction
  • depression/suicidality
  • PML
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15
Q

anifrolumab use in SLE

A
  • interferon antag → reuce imune cell recruitment, improves symptoms, stabilizes organ disease
    • Adjunct med to be used in combo with standard SLE treatment
    • IV inf Q4W
    • NOT indicated in active LN or CNS disease
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16
Q

When to use immunosuppressants in SLE and list them

A
  • for poor symptom control refractory to HCQ/NSAID/steroid
  • indicated for organ threatening LE (lupus nephritis
  • immunosuppressants
    • MTX
    • AZA
    • MMF
    • CYC (cyclophsophamide)
    • Cyclosporine
    • rituximab
    • CNIs (tacrolimus)
    • Voclosporin
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17
Q

MTX use inSLE

A

If pt also has RA or primary presentaiton of arhtritis

18
Q

AZA use in SLE

A
  • Second line after steroids for a more moderate disease coures
  • Safe in preggers
19
Q

AZA AE

A
  • Bone marrow suppresion
  • N/V
20
Q

MMF use in SLE

A
  • For proliferative (II-IV) LN and is second line for membranous (V) LN
    • Better than cyclophosphamide

Also used in non-renal disease (non LN)
Not really effective in neuropsychiatric disease

21
Q

MMF AE

A
  • Diarrhea
  • Abdoimal pain
  • Anorexia
  • Nausea
  • Hematologic
  • CV
  • Teratogenicty → no preggers
22
Q

CYC use in SLE

A

Used for organ-threatening cardiopulmonary, renal or neuropsych disease

23
Q

CYC AE

A

TOXIC
- Hematologic tox
- Cardio tox
- neurologic to
- Permanent infertility

24
Q

Cyclosporine use in SLE

A
  • Used for membranous (V) LN
  • Approximately same effectivness as CYC but less tox
25
Cyclosporine AE
- HTN - Hematologic tox - Nephrotox - Neurologic tox
26
Rituximab use in SLE
- really last resort - Off label use in pts with *severe* renal, hematologic or neurpsych SLE *refractory* to other agents - Failure of MMF/CYC in LN or relapsing disease
27
PO tacrolimus use in SLE
For plroferative (V) L alone or in combo with MMF
28
Voclosporin use in SLE
- PO CNI → decreases cytokine production and lymphocyte proliferation - In adjunct to one of the immunosuppresants in active lupus nephritis - Do NOT use with CYC - CYP 3A4 interactions
29
Voclosporin AE
- BBW: infections adn malignances - Nephrotoxic if eGFR <45
30
SLE treat to target principles
- Shared decisions between pt and MD - Prolong survival - Minimize organ damage - Improve QOL - SLE may require multidisciplinary - Monitor, f/u and adjust
31
SLE treat to target recommendations
- Remissio or reduced disease - Flare prevention is a realisitic goal - do NOT have to escalate treatment in asymptomatic pts with stable or increaseing serological activity - Prevent dmaage accrual - Pay attention to QOL - Recognize and treat LN early - Optimize LN outcomew with 3 yrs of immunosuppressive therapy after induction - Lowest posible dose of steroid - Pay attention to APS - Consider antimalarials - Supportive treatments for toehr disease states PRN
32
SLE nonpharm
- Sunscreen - Avoid photosensitizing agents, stress, smoking - Immunizations, vaccines
33
SLE skn disease first line agents
- Topicals: steroids, topical CNIs - HCQ
34
SLE skn disease *refractory* agents
- systemi steroids: preferred agent if first line isn’t enough - methotrexate - MMF - belimumab - anifrolumab - retinoids - dapsone
35
Rfractory/severe SLE agents
- Steroid -sparing immunosuppresnats - methotrexate - MMF - azathioprine: for preggers - cyclophosphamide in organ-threatening idsease - Other - belimumab - anifrlumab
36
Non-SLE/LN speific tratment that neds to be considered in these pts
- IF pt has glomerular disease (persistant proteinuria and/or HTN): ACE or ARB - IF pt has LDL >100: statin
37
Class III-IV (proliferative LN) treatment
- Initial optiosn - glucocorticoid + MMF OR - glucocorticoid + low dose IV CY OR - glucocorticoid + MMF + TAC - If pt responds with 3-12 months, de-escalate to MMF or AZA - IF pt does NOT respond: switch to alternative induction therapy or add TC to MMF *or* rituximab
38
Class V (membranous LN) treatment
- Initial options - UPr <3: RAAS blockade (consider GC + MMF) - UPr > 3: RAAS blockde AND GC + MMF - If pt responds with 3-12 months, de-escalate to MMF or AZA - IF pt does NOT respond: IV CY or CNI - If still no response: - CNI monotherapy or add on to MMF OR - high dose IV CY OR - rituximab
39
If preggers and active LN
- Continue HCQ if already on - non-fluorinated PO GC - AZA (MDD 2mg/kg) if necessary - consider pre-term delivery if LN real bad@28wks
40
APL (+) with no event treatment
- baby asa QD - if preggers: can consider adding LMWH
41
APS treatment | antiphospholipid syndrome
- warfarin - if arterial, goal INR: 3-4 - if venous, goal INR: 2-3