Systemic Steroids and Autoimmune Flashcards
(107 cards)
1
Q
How is aldosterone replaced
A
via fludrocordisone which mimics it and has mineralcorticoid activity to balance waterand electrolytes
2
Q
what disease is fludrocortisone used for for
A
addisons and orthostatic hypotension (off label)
3
Q
glucocorticoid activity does what
A
anti-inflammatory
4
Q
what do systemic steroids cause the adrenal gland to stop producing
A
cortisol, due to feedback inhibiton (HPA axis supression)
5
Q
cushing’s syndrome
A
too much cortisol
6
Q
addison’s disease
A
not enough cortisol
7
Q
Steroid equivalence
A
Cute - cortisone 25 hot - hydrocortisone 20 pharmacists - prednisone 5 and physicians - prednisolone 5 marry - methylprednisolone 4 together - triamcinolone 4 and Deliver - dexamethasone 0.75 Babies - Betamethasone 0.6
8
Q
Dexpak
A
dexamethason
9
Q
decadron
A
dexamethasone
10
Q
solu-cortef
A
hydrocortisone
11
Q
medrol/solu-medrol
A
methylprednisolone
12
Q
deltasone
A
prednisone
13
Q
millipred
A
prednisolone
14
Q
orapred
A
prednisolone
15
Q
kenalog
A
triamcinolone
16
Q
long term effects of steroids
A
1) fat deposits (moon face)
2) glaucoma/cataracts
3) stretch marks, bruising
4) growth retardation
5) infection, impaired wound healing
6) psychiatric changes
7) acne
8) gi bleds
9) diabetes
10) poor bone health
11) women - hairy, irregular periods
17
Q
how to reduce systemic steroid risks
A
alternate day dosing, use steroid with low systemic absorption
18
Q
short term systemic glucocorticoid side effects
A
insominia, weight gain, emotional instability and
can lead to: increased blood glucose (diabetes), increased blood pressure (hypertension), increased intraocular pressure (glaucoma)
19
Q
warnings for systemic steroids
A
must taper slowly due to adrenal supression
20
Q
common symptoms of autoimmune diseases
A
fatugue, weakness, pain
21
Q
Tests that can detect inflammation
A
ESR (erythrocyte sedimintation rate), C-Reactive protein (CRP), rheymatoid factor (RF), anti-nuclear antibody (ANA)
22
Q
steroid administration
A
with food
23
Q
can you give live vaccines with people on steroids?
A
No if dose is high
24
Q
What can the use of strong immunosuppressants increase the risk of
A
1) Reactivation of TB, Hep B/C - test prior to start
2) Viruses - give live vaccine before tx
3) Lymphomas and certain skin cancers
4) Infections
25
Rheumatoid arthritis symptoms
joint swelling, pain, stiffness, bone deformity
26
RA diagnosis
bilateral, symmetrical with joint pain worse after rest
27
lab tests to detect RA
ACPA (anti-citrullinated peptide antibody) and rheumatoid factor (RF)
28
when should RA be treated
if symptomatic should be started on DMARD (disease modifying RA drug) regardless of severity to prevent progression
29
Preferred initial tx for RA
methotrexate
30
what treatment combo should never be used IN RA
two biologic DMARDS due to risk of fatal infections
31
Trexall
Methotrexate
32
Plaquenil
Hydroxychloroquine
33
moa of MTX
irreversibly binds and inhibits dihydrofolate reductase, thus inhibiting folate
34
boxed warnings MTX
hepatotoxic, myelosupression, mucositis/stomatitis, pregnancy
35
monitoring MTX
CBC, LFTs, chest X Ray, hep B/S serology
36
warning for hydroxychloroquine
irreversible retinopathy therefore monitor with eye exam
37
contraindication for sulfasalizine
sulfa allergy
38
MOA for Leflunomide (Arava)
inhibits pyrimidine synthesis
39
boxed warning for Leflunomide (for RA) and its prodrug which is used for ms teriflunomide
do not use in pregnancy (must be on 2 forms of birth controland not plan to be pregnant for 2 years or do accelerated drug eliminatioN), may cause hepatotoxicity
40
Janus kinase inhibitor boxed warnings
serious infections, increased risk for malignancy, increased risk for thrombosis
41
what can you not use Janus kinase inhibitors with?
biologic DMARDS or potent immunosupressants
42
major mtx ddis
alchohol, aspirin/nsaids
43
entercept, adalimumab, infliximab are what class
anti TNF Biologic DMARDS which inhiit tumor necrosis factor alpha
44
Enbrel
Etanercept
| a biologic
45
Humira
Adalimumab
46
Remicade
Infliximab
47
Cimzia
Cetroloizumab pegol
48
Simponi
Golimumab
49
Rituxan
Rituximab
50
Rituximab is a what
Non -TNF DMARD
51
boxed warning and warning for Anti-TNF DMARDS
Boxed: serious infections, malignancies, screen for latent TB and tx
Warning: can cause demyelinating disease, hep B reactivation, heart failure, hepatotoxicity, lupus-like syndrome, do not use with otherbiologic DMARDS or live vaccines
52
Storage of biologics
Do not shake or freeze, refrigiration required
53
Pneumonic for drugs that require drugs with filter requirements
```
That's my
G - golimzumab (simponi)
A- Amiodarone
L - Lorazepam
P - Phenytoin
L - Lipids (1.2 micron)
A - Amphotercin B (lipid formulations) **5 micron
T - Taxanes (except docetaxel)
```
whose head is flat
mostly 0.22 microns
54
How often is etanercept (Enbrel) dosed and where
SC weekly into the amdomen, thigh, or upper arm
55
how often is adalimumab (humira) dosed and administered
SC every other week into the amdomen and thigh (not upper arm)
56
Normal Saline Only Pneumonic
```
A - Ampicillin
D - Daptomycin, I - Infliximab (remicade), A - Ampicillin.sulbactram (betic)
Can't - Caspofungin
Eat - Ertapenem
Pie - Phenytoin
```
57
dosing frequency for cetolizumab pegol (Cimzia )
every other week
58
biologics dosed every other week
certolizumab (cimzia) and adalimumab (HUMIRA)
59
golimumab dosing and location
AKA SIMPONI dosed monthly in the abdomen, thigh, or upper arm
60
what does rituximab (rituxan) deplete
CDB20 B cells
61
administration of rituximab (rituxan)
premedicate with a steroid, acetaminophen, and a antihistamine
62
which biologic can cause hypersensitivity and/or infusion reactions
Infliximab (remicade ANTI TNF) - infusion reaction and delayed hypersensitivity
Rituximab (rituxan, NON TNF) - serious and fatal infusion related rxn requiring premedication
63
storage of entercept (enbrel) and adalimumab (himira) atroom temp
14 days at room temp
64
Which race is lupas more common in
african american and asian
65
DILE drugs pneumonic
```
My - Methimazole
Pretty - Propylthiouracil
Malar - methyldopa
Marking - minocycline
Probably - procainimide
Has - Hydralazine
A - Anti-TNF
Trans - Terbinafine
Iant - Isoniozid
Quality - Quinidine
```
66
Clinical Presentation of lupas
fatigue, depression, anorexia, weight loss, muscle pain, malar rash (buttefly), photosensiticity, joint pain and stiffness
67
manifistations that contribute to mortality in SLE
kidney disease (50% of patients), liver, neurologic
68
tests for lupas
antinuclear antibodies, anti SS DNA, anti DS DNA
69
non drug tx for SLE
photosensitivity (avoid suscreans and sun protection)
70
tx for SLE
hydrxychloroqunalone, cyclophosphamide, azathiprine, mycophenolate mofetil, cyclosporine
71
how long does tx for sle take to show benefit
6 months
72
benlysta
belimumab (for lupas)
73
belimumab (benylysta) MOA
IGG1 lambda monocolonial antibody which prevents the survival of B lymphocytes and reduces B cell mediated immunity and autoimmune response
74
what does MS attack and how does it present
the myelin sheath and causes the deterioration of cognitive function, muscle spasms, pain, incontinence, and difficulty walking with gait instability and visual disturbances
75
how is MI diagnosed
MRI
76
Copaxone
Glatiramir acetate
tx for ms (non interferon alpha)
77
glatiramer acetate (copaxone)warnings and side effects
warning: Chest pain
Side effects: injection site reactons, flushing, diaphoresis, dyspnea
78
What is the preferred MS treatment in pregnancy
Copaxone (glatiramer acetate)
79
Copaxone/Glatiramir Acetatedosing
SC daily or 3x per week
80
interferon beta products have what warnngs and side effects
psychiatric disorders, injection site necrosis, thyroid disfunction, increased LFTs
side effects: flu like
81
some interferon beta products contain what (besides PEG)
albumin
82
dosing frequency for pegilated interferon beta
every 14 days
83
Tysabri
Natalizumab
a monocolonial antibody for MS
84
Tysabri (natalizumab) has a boxed warning for what
Progressive multifocal leukoencephalopathy (PML) and is only availale through REMS
*see IBS
85
Simponimod (mayzent) *oral immunomodulator for MS* is contraindicated in what and has what significant adverse events and requires what monitoring
Macular edema, monitor eye exams, LFTs, CBC (same for fingolimod/Gilenyeya)
Contraindicated with CYP2C92/3 genotype
86
Fingolimod (gilyena) has to be monitored for what for how long
bradycardia, 6 hours
87
Teriflumide (aubagio) is contraindicated in what *a MS drug*
pregnancy
88
what are the sympotms of myesthenia gravis
eyes/vision, drooping eyelid (ptosis)
89
what can unmask or worsen myesthenia gravis and what cantreat
drugs, tx with cholinesterase inhibitorsto block the breakdown of each and thus cause cholinergic effects (SLUDGE)
90
sx of sjOgren's syndrome and complications
dry eyes, dry mouth --> complications include dental caries, corneal ulderation, chronic oral infections
91
dry eyes treatment
OTC teardrops or may do cyclosporine tear drops (restasis)
92
restasis
cyclosporine
93
eye drop preservative that can cause irritation
Benzalkonium chloride
94
restasis/cyclosporine side effects
ocular burning
95
liftegrast (Xiidra) eye drop side effect
unusual taste
96
dry mouth tx OTC
OTC: sugar free gum with xylitol or lozenges and daily rinses with antimicrobial mouthwash
97
pilocarpine and cevimeline are what and are contraindicated in whom
muscarinic agents for dry mouth (RX) and are contraindicated in patients with uncontrolled asthma and narrow-angle glaucoma
98
what is psoriasis
a chronic, autoimmune disease that appears on the skin appearing as raised white patches with silvery white buildup
99
non drug tx for psoriasis
UVB phototherapy because it can cause activated T cells in the skin to die
100
Drug tx topical if facial or if other topical tx fails
calcinerurin inhibitors (tacrolimus) which are associated with skin cancer and lymphoma
101
coal tar products are used for what
dandruff, dermatitis, psoriasis
102
systemic retinoids are used in what cases for psoriasis
severe only
103
interleukin receptor antagonists for psoriasis are administered how and can cause what
SC, like every other monocololial antibody infection and diarrhea
104
at what dose would someone be considered immunosuppressed from steroid?
> 2 mg/kg/day or >20mg/day of prednisone or prednisone equivilent
105
when is hydroxychloroquine used as an alternative to lupas
when worried about liver disease
106
Raynaud's is what and caused by what drugs
decreased blood flow to finders which makes it blue and is caused by sympathomimetic, beta blockers, and some chemo drugs (bleomycin, cisplatin)
107
how to treat reynaud's
a DHP CCB (i.e. nifedipine)
