Systemic Steroids & Autoimmune Conditions

Question 1

how to replace cortisol?

Answer 1

steroids

Question 2

how to replace aldosterone?

Answer 2

fludrocortisone

Question 3

Least potent to most potent steroids acronym?

Answer 3

Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies

Question 4

Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies

Answer 4

cortisone 25mg
hydrocortisone 20mg
prednisone 5mg
prednisolone 5mg
methylprednisolone 4mg
triamcinolone 4mg
dexamethasone 0.75mg
betamethasone 0.6mg

Question 5

what is the immunosuppressive dose for steroids?

Answer 5

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

Question 6

what non-specitive lab tests can be used to detect inflammation?

Answer 6

ESR, CRP, RF, ANA

Question 7

what are the risks of giving immunosupressants to tx autoimmune diseases?

Answer 7

↑risk of re-activ TB, Hep B/C, Viruses (live vaccines must be given prior to tx), skin cancers, infections

Question 8

RA presentation?

Answer 8

Bilateral, Symmetrical
▪ Morning stiffness: stiffness and pain worse after rest
Lab tests:
Anti-citrullinated peptide Ab (ACPA), Rheumatoid factor (RF)

Question 9

what is the initial tx for RA?

Answer 9

MTX

Question 10

for mod-severe RA how should you tx?

Answer 10

DMARD or TNFi or non-TNF ± MTX [Never use 2 biologic DMARDS combo]

Question 11

how should you tx flares?

Answer 11

steroids

Question 12

what is the moa of mtx?

Answer 12

Inhibits dihydrofolate reductase, inhibiting folate

Question 13

what is the mtx dosing for RA?

Answer 13

7.5mg - 20mg q week

Question 14

what is the BBW for mtx?

Answer 14

Hepatotoxicity, Myelosupression, Mucositis/stomatitis, Pregnancy (fetal toxicity/death)

Question 15

moa of leflunomide?

Answer 15

inhibitts pyrimidine synthesis

Question 16

bbw of leflunomide?

Answer 16

embryo-fetal tox and hepatotox

Question 17

accelerated drug elimination option for leflunomide?

Answer 17

▪ Cholestyramine 8g TID x11days

▪ Activated charcoal suspension 50g PO Q12H x11days

Question 18

what are the janus kinase (JAK) enzyme inhibitors?

Answer 18

tofacitinib

baricitinib

Question 19

what are the safety implications with jak inhibitors?

Answer 19

BBW: Serious Infections, Malignancy
Note: ↑risk of pulmonary embolism using high dose

Question 20

what are the anti-TNF biologics?

Answer 20

Etanercept (Enbrel)
Adalimumab (Humira)
Infliximab (Remicade)
Cartolizumab pegol (Cimzia)
Golilumab (Simponi)

Question 21

what are the safety parameters for anti-TNF?

Answer 21

BBW:
Serious inf,
Malignancies,
screen for latent TB

Warning: 
Demyelinating disease, 
Hep B reactivation, 
HF, hepatotoxicity, 
lupus-like syndrome
▪ Do NOT use with other biologics or live vaccines Monitor: TB test, signs of infection

Question 22

should you premedicate rituximab?

Answer 22

yes, Steroid + APAP + Antihistamine

Question 23

drugs that can cause DILE

Answer 23

Methimazole 
Propylthiouracil 
Methyldopa 
Minocycline 
Procainamide 
Hydralazine (alone and in BiDil) 
Anti-TNF - enbrel, humira, remicade, cimzia, simponi
Terbinafine
Isoniazid
Quinidine

Question 24

how to tx SLE?

Answer 24

FDA: Hydroxychloroquine, belimumab

Others: cyclophosphamide, azathioprine, mycophenolate mofetil, cyclosporine

Question 25

how long should u wait to see tx benefits for SLE?

Answer 25

6 months

Question 26

what's the brand name of belimumba?

Answer 26

benlysta

Question 27

how to dx MS?

Answer 27

MRI

Question 28

how to tx the symptoms of MS?

Answer 28

``` Incontinence: Anticholinergic Constipation: Laxatives Muscle Spasms: Muscle Relaxant Muscle Pain: Analgesics Localized Pain: botulinum toxin (Botox) Tremor: propranolol Depression: Anti-depressants Fatigue: modafinil, methylphenidate Dizziness/vertigo: meclizine, scopalamine Cognitive function: donepezil Erectile Dysfunction: PDE-5 ```

Question 29

what are the mainstay of tx for pts with relapsing forms of MS?

Answer 29

glatiramer acetate and interferon beta formulations

Question 30

brand name of glatiramer acetate?

Answer 30

copaxone

Question 31

what is the moa of glatiramer acetate?

Answer 31

Immune modulator: Induce and activate T-lymphocyte suppressor cells

Question 32

can you take copaxone when pregnant?

Answer 32

yes, it is the preferred agent if tx is necessary

Question 33

brand name for natalizumab?

Answer 33

tysabri

Question 34

moa of tysabri?

Answer 34

Monoclonal antibody: Binds to the alpha-4 subunit of integrins expressed on the surface of leukocytes

Question 35

which drug requires REMS?

Answer 35

alemtuzumab (Lemtrada)

Question 36

how to prevent raynaud's?

Answer 36

nifedipine

Question 37

what drugs can worsen raynauds?

Answer 37

Beta-blockers Bleomycin, cisplatin Sympathomimetics (vasoconstriction)

Question 38

what is myasthenia gravis?

Answer 38

Autoimmune disease that attacks connections between nerves & muscles resulting in weakness in skeletal muscles. Comonly targets Ach receptor

Question 39

sx of myasthenia gravis?

Answer 39

changes to eyes/vision, drooping eyelid

Question 40

science word for drooping eyelid

Answer 40

ptosis

Question 41

tx for gravis?

Answer 41

cholinesterase inhibitors, especially pyridostigmine

Question 42

what is sjogrens syndrome?

Answer 42

dry eyes and dry mouth

Question 43

what complications can come from sjogrens?

Answer 43

dental caries corneal ulceration and chronic oral infections

Question 44

how to tx dry eyes for sjogrens?

Answer 44

popular OTC articial teardrops | cyclosporine eyedrops

Question 45

brand name for cyclosporine eyedrops?

Answer 45

restasis

Question 46

how to tx dry mouth for sjogrens?

Answer 46

Sugar-free chewing gum w/xylitol Daily rinses with antimicrobial mouthwash Oral muscarainic agonists: pilocarpine (Salagen) or cevimeline (Evoxac)

Question 47

what non-drug tx can u use for psoriasis?

Answer 47

UV light | UVB phototherapy can improve mild to moderate psoriasis