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Rheumatology > Therapeutics > Flashcards

Therapeutics Flashcards

(51 cards)

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1
Q

What SLE drug requires retinal toxicity?

A

hydroxychloroquine (Plaquenil)

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2
Q

What are the major ADRs and warnings for Benlysta (belimumab)?

A

Infusion reactions (premedicate)
must watch out for depression and suicidal thoughts and PML

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3
Q

Dosing and usage of Benlysta (belimumab)

A

SLE - 200 mg SQ weekly or 10mg/kg IV every 4 weeks

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4
Q

What SLE treatment must you limit sun exposure?

A

Lupkynis (voclosporin)

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5
Q

Major ADR for cyclophosphamide (Cytoxan) in the use of SLE?

A

Hemorrhagic cystitis
Infertility
Teratogenic
Not as effective for African Americans and Hispanics

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6
Q

Dose and usage of cyclophosphamide?

A

500 mg IV once every 2 weeks for 6 doses
Use for SLE flare in Caucasian and Asian patients

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7
Q

ADRs of mycophenolate mofetil (Cellcept)?

A

Myelosuppression
Nausea
Vomiting
Diarrhea
Can take Myfortic to decrease

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8
Q

Contraindications for Cellcept?

A

Pregnancy
Lower doses for asians
Used for AAs and Hispanics

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9
Q

Testing for Imuran (azathiprine) use?

A

TPMT assay to detect deficiency (increased risk of myelosuppression)
Pregnancy use should be less than 2mg/kg per day

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10
Q

Contraindications for MTX?

A

Pregnancy
Breastfeeding
Alcoholism
Chronic liver disease
Blood dyscrasias
Immunodeficiency syndrome
Elderly or CrCl under 30

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11
Q

Testing and risks for MTX use?

A

Hep B and C prior
LFTs
Hepatotoxicity
Pulmonary toxicity
Give with folic acid

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12
Q

ADR of rituximab (Rituxan)?

A

Infusion reactions (premedicate)
PML
Infections (screen TB, Hep B and C prior)

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13
Q

When to use caution with NSAIDs?

A

Patients with renal insufficiency, cardiovascular disease, and gastrointestinal problems
Avoid use in first and 3rd trimester of pregnancy

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14
Q

What medications should be avoided with NSAIDs?

A

Anti platelets, corticosteroids, anticoags
Lithium and methotrexate
Give ASA 1 hour before or 8 hours after IBU

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15
Q

Short term ADRs of Prednisone (Deltasone)?

A

Less than one month of use
increased appetite and weight gain, mood instability, fluid retention, insomnia, elevated blood pressure and blood glucose

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16
Q

Long term side effects with prednisone?

A

Cushings effects (diabetes, bone fractures, hirsutism and menstrual irregularities, angioedema, glaucoma, psychiatric changes, headaches, infections, intracranial hypertension, impaired wound healing

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17
Q

How long can you take corticosteroids until you need to taper medication?

A

No longer than 14 days due to HPA axis suppression

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18
Q

What comorbidities can worsen with prednisone?

A

Heart failure
DM
HTN
OP
Psychiatric conditions

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19
Q

ADRs of sulfasalazine (Azulifidine)?

A

Rash, Nausea, vomiting, diarrhea, oligospermia, folate deficiency

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20
Q

Contraindications of the use of sulfasalazine for RA?

A

Allergy to salicylates or sulfa
GI obstruction
G6PD deficiency (hemolytic anemia)

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21
Q

Counseling on sulfasalazine?

Study These Flashcards
A

May cause yellow orange coloration of skin and urine
Administer with folic acid supplementation
Males may experience oligospermia
Watch out for SJS and TEN and liver failure

22
Q

Monitoring for use of leflunomide (Arava) in RA?

Study These Flashcards
A

TB and pregnancy screening (need cholestyramine washout prior to conception)
Blood pressure and LFTs BUN
CBCs

23
Q

Contraindications for leflunomide for the use of RA treatment?

Study These Flashcards
A

Pregnancy
Severe hepatic impairment
Concomitant use of teriflunomide
Do not start is ALT is over 3 times the normal limit

24
Q

Dosing schedule of etanercept (Enbrel)?

Study These Flashcards
A

SQ once weekly or twice weekly

25
Dosing schedule of Humira (adalimumab)?
SQ once every two weeks
26
Dosing schedule of inflixumab (Remicade)?
IV once every 4-8 weeks after initial round of once at week 0,2,6 then every 8 weeks
27
Dosing schedule of certolizumab pegol (Cimzia)?
SQ once at 1,2,4 weeks then every other week or once monthly
28
Dosing schedyle of Simponi (gloimumab)?
SQ once monthly
29
Boxed warnings for Anti TNFs?
Serious infections Lymphomas Other malignancies
30
Contraindications of Anti TNFs?
Active systemic infections
31
Contraindications for inflixumab?
Doses over 5mg/kg in moderate to severe heart failure
32
Contraindications for etanercept?
Sepsis
33
Warnings for Anti TNF ?
Demylinating disease Hepatitis B reactivation Heart failure Hepatotoxicity Lupus like syndrome Seizures Myelosuppression Severe infections
34
Contraindications for abatacept (Orencia)?
COPD patients
35
Warnings for tocilizumab (Actemra) and Kevzara (sarilumab)?
Elevated LDL and total cholesterol ALT or AST over 1.5 times ULN ANC less than 2000 Platelets less than 100,000
36
Black Boxed Warnings for JAKi?
Serious infections Malignancy Thrombosis Increased risk of mortality in patients over 50 years old with one or more CV risk factors treated at higher doses
37
Warning for JAKi?
GI perforations, elevated LFTs, Hematologic toxicities Elevated blood pressures and lipids
38
Patient population to not use JAKis in?
Asians Increased frequency of side effects
39
Who should not use indomethacin for gout?
Those with depression
40
ADRs for Colchicine (Colcrys, Mitigare)?
Dose dependent GI adverse effects (nausea, vomiting, diarrhea)
41
Dose adjustment qualifications for Colchicine?
CYP3A4 and Pglycoprotein inhibitors Renal impairment
42
When to start colchicine therapy?
Within 36 hours of symptoms onset for acute treatment
43
How long after dose treatment of colchicine for acute gout flare should you wait until resuming prophylaxis dosing?
12 hours after a treatment dose
44
Adverse effects of allopurinol (Zyloprim)?
Fatal hypersensitivity reactions Elevated LFTs Rash and kidney toxicity
45
Dosing of allopurinol for ULT treatment if patient has GFR less than 30
50mg or less po qd
46
Testing for allopurinol use as ULT?
HLA B 5801 - if positive avoid use (usually south east asian patients and african decents)
47
Medication to avoid with allopurinol?
Azathioprine (use lower dose of azathioprine by 30 percent to decrease risk of 6MP toxicity)
48
Contraindications of febuxostat (Uloric) use for ULT?
CVD patients Concomitant use of AZA or mercaptopurine Those who cannot use allopurinol due to hypersensitivity Severe kidney impairment
49
Contraindications for use of probenecid (Probalan) for ULT?
G6PD deficiency (hemolytic anemia) CrCl less than 50 mL/min CKD Stage III or greater
50
Contraindication in patients with pegloticase (Krystexxa) use?
G6PD deficiency Only for patients with severe gout refractory to other treatments
51

Rheumatology (2 decks)

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