Systemic Steroids and Autoimmune Conditions

Question 1

what is the difference between cushings and addisons disease

Answer 1

cushings is an overproduction of cortisol which downregulates ACTH and CRH

addisons is too little cortisol from adrenal gland

Question 2

what disease does abrupt discontinuation of long term steroids mimic

Answer 2

addisons

Question 3

adverse effects of long term steroids

Answer 3

glaucoma/cataracts
weight gain
fat deposits (moon face)
pink/purple stretch marks
growth retardation
muscle wasting
easily bruised
infection
insomnia
hyperglycemia
GI bleed
HTN, hypothyroidism
hirsutism and irregular periods in women
poor bone health

Question 4

steroid equivalents

Answer 4

hydrocortisone 20mg
cortisone 20mg
MEPN 4mg
triamcinolone 4mg
prednisone 5mg
prednisolone 5mg
dexamethasone 0.75mg
betamethasone 0.6mg

Question 5

what dose of steroids is considered immunosuppressed and requires a taper

Answer 5

> 2mg/kg/day of prednisone
or
20mg prednisone a day x >2 weeks

Question 6

medrol dosing

Answer 6

2112
1112
1111
111
11
1

Question 7

ways to decrease systemic steroids risk

Answer 7

every other day dosing
lowest dose for lowest duration
local injection
inhaled > po for lung diseases
if gut disease use low absorption steroid

Question 8

traditional DMARDs for RA

Answer 8

MTX
HCQ
sulfasalazine
leflunomide
JAK-is (“-nib”)

Question 9

traditional biologic DMARDs

Answer 9

etanercept
adalimumab
infliximab
certolizumab
golimumab
rituximab

Question 10

MTX
BBW
CI
Pearls/Counseling

Answer 10

dosed 7.5-20mg PO QWEEK
BBW: myelosuppression, hepatotox, mucositis/stomatitis, teratogenic, acute renal failure, GI tox

Question 11

MTX is contraindicated in

Answer 11

pregnancy and BF
AUD
CLD
blood dyscrasias
immunodeficiency syndrome

Question 12

MTX DDI

Answer 12

no alcohol or NSAIDs (dec [MTX])
AVOID sulfa and tacro topicals
loops inc [MTX]
MTX and CYA increase [ ] of each other

Question 13

what should be given to patients on MTX? Why?

Answer 13

folate to decrease heme, GI, hepatic SE

Question 14

hydroxychloroquine dosing

Answer 14

200-400mg PO QD initially with food or milk

Question 15

what should a patient be warned about if taking HCQ

Answer 15

irreversible retinopathy
myopathy, neuropathy, cardiomyopathy, QTp, PSYCH issues

Question 16

anti-TNF drugs and brand names

Answer 16

adalimumab (Humira)
etanercept (Enbrel)
infliximab (Remicade)
certolizumab (Cimzia)
golimumab (Simponi)

Question 17

anti-TNF biologics
warnings

Answer 17

DO NOT USE IN HF
hep B reactivation
lupus
seizures
myelosuppression

Question 18

anti-TNFs are monotherapy T or F

Answer 18

false, always in addition to MTX

Question 19

what is the non-TNF biologic used for RA

Answer 19

Rituximab (Rituxan)

Question 20

rituximab pearls

Answer 20

pre treat with AH, steroid, APAP

Question 21

what drugs cause drug-induced lupus

Answer 21

MMZ and PTU
methyldopa
minocycline
procainamide
hydralazine
quinide
anti-TNFs
terbinafine
isoniazid

Question 22

tx options for SLE

Answer 22

HCQ
cyclophosphamide
MMF
cyclosporine

can add on Benlysta (belimumab)

Question 23

which drugs are FDA indicated for SLE

Answer 23

all but HCQ

Question 24

what drug for SLE inhibits type 1 INFs

Answer 24

anifrolumab (Saphnelo)

Question 25

patient diagnosed with MS who is pregnant what is the tx of choice

Answer 25

glatiramer acetate (Copaxone)

Question 26

besides glatiromer acetate (Copaxone), what are other disease-modifying tx options for MS

Answer 26

Avonex qweek Plegridy Betaseron Natalizumab (also for IBD)

Question 27

what drugs worsen myasthenia gravis

Answer 27

FQ macrolides magnesium salts anthracyclines BBs and CCBs some APs muscle relaxants local anesthetics

Question 28

first line tx for myasthenia gravis

Answer 28

AchE-i to prevent Ach breakdown! pyridostigmine (Mestinon)

Question 29

what are hallmark sx of Sjogrens

Answer 29

dry eyes and dry mouth

Question 30

raynauds treatment

Answer 30

CCBs! Usually nifedipine

Question 31

raynauds is worsened by

Answer 31

BB bleomycin cisplatin sympathomimetics cocaine

Question 32

what strength of steroids are recommended for psoriasis? Which steroids are in this rank?

Answer 32

high potency halobetasol clobetasol fluocinonide 0.1% cream beclometasone 0.05% ointment

Question 33

for mild-moderate psoriasis, what are first line tx options?

Answer 33

high potency steroids +/or topical retinoid or vitamin D analog

Question 34

vitamin d analog used for psoriasis

Answer 34

calcipotriene

Question 35

topical retinoid for psoriasis

Answer 35

tazarotine or SSA

Question 36

what are first line tx options for severe psoriasis

Answer 36

MTX CYA hydroxyurea anti-TNFs (adalimumab, infliximab (Remicade), etanercept (Enbrel), certilizumab (Cimzia) can be in addition to topical high potency steroid, topical Vit D analog, and/or topical retinoid