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RxPrep
Steroids + Autoimmune conditions (CH 46)
| Question | Answer |
|---|---|
| What is cushing syndrome? | A condition when adrenal glands produce excess cortisol or from chronic high-dose steroid use |
| Most dangerous issue after long-term steroid use? | HPA-axis suppression/adrenal crisis if stopped abruptly |
| How long of steroid therapy increases adrenal suppression risk? | 2 weeks |
| General counseling points on daily steroids? | Take in the morning with food |
| Major steroid contraindications? | Live vaccines, serious systemic infections |
| Common short-term steroid ADRs? | Insomnia, mood changes, increased appetite, fluid retention, GI upset |
| Common long-term steroid ADRs? | Osteoporosis, hyperglycemia, hypertension, cataracts, weight gain, infections, Cushing syndrome |
| What should be monitored during long-term steroid therapy? | BP, glucose, lipids, weight, mood, bone density, eye pressure |
| Which systemic steroid has the lowest potency? | cortisone, 25mg = 5mg prednisone |
| Convert 5mg prednisone to Medrol | 4mg |
| Convert 5mg prednisone to triamcinolone? | 4mg |
| Convert 5mg prednisone to dexamethasone | 0.75mg |
| Convert 5mg prednisone to hydrocortisone | 20mg |
| Convert 5mg prednisone to prednisolone | 5mg (same potency) |
| Convert 5mg prednisone to betamethasone | 0.6mg |
| Brand name of dexamethasone? | Decadron |
| Prednisone DR brand name? | Rayos |
| Prednisolone brand name? | Orapred/pediapred |
| Triamcinolone brand? | Kenalog |
| Hydrocortisone systemic brand name? | Cortef |
| Betamethasone brand name? | Celestone soluspan |
| Preferred initial DMARD for most RA patients? | MTX |
| Methotraxate brand name(s)? | Trexall is the oral Otrexup and Rasuvo are the SC injectors |
| Methotrexate boxed warnings? | Hepatotoxicity, myelosuppression, pregnancy, pulmonary toxicity, serious infections |
| Methotrexate contraindications? | Pregnancy, chronic liver disease, alcohol use disorder, blood dyscrasias, breastfeeding |
| Methotrexate common ADRs? | N/V/D, stomatitis, increased LFTs, alopecia |
| MTX patient should take _____ to help lower toxicity? | Folic acid |
| Methotrexate monitoring? | CBC, LFTs, SCr, pregnancy testing |
| Role of steroids in RA? | Bridge therapy or flare treatment |
| Role of NSAIDs in RA? | Only for symptom relief |
| HCQ major toxicity? | Retinopathy, requires eye exams |
| Sulfasalazine brands? | Azulfidine |
| Sulfasalazine major warnings? | SJS/TEN |
| Unique counseling point of sulfasalazine? | May turn skin yellow or orange |
| Which drugs fall into the nonbiologic-DMARD category? | MTX, HCQ, Sulfasalazine, Leflunomide |
| Leflunomide brand name? | Arava |
| Leflunomide boxed warnings? | Teratogenicity and hepatotoxicity |
| Can non-biologic DMARDs be taken in combination? | Yes, but any combo must include MTX |
| Which drug requires rapid removal when d/c? | Leflunomide, use cholestyramine to rapidly washout the active metabolite |
| Which drugs are JAK inhibitors? | Xeljanz, Olumiant, Rinvoq (drugs than end in -tinib) |
| JAK inhibitor boxed warnings? | *MACE (cardiac events/death), *thrombosis, malignancy, serious infection |
| TNF alpha examples? | Enbrel, Humira, Remicade, Cimzia, Simponi) |
| TNF inhibitor boxed warnings? | TB, serious infections, *lymphoma |
| Required screening before TNF inhibitors? | TB and HBV |
| Live vaccines should be avoided with? | Any biologics |
| Rituximab boxed warnings? | PML, HBV reactivation, infusion reactions |
| Which drugs are IL-6 inhibitors? | Tocilizumab (Actemra) and Sarilumab (Kevzara) |
| Which condition has the unique "butterfly rash"? | SLE |
| Most common antibodies in SLE? | ANA, anti-dsDNA, anti-Smith |
| IL-6 inhibitor lab abnormalities? | ↑ LFTs, ↑ cholesterol, neutropenia |
| Lab abnormalities commonly seen in SLE? | Low complement (C3/C4), elevated ESR/CRP |
| Which drugs can cause DILE (drug induced lupus-like syndrome)? | Methimimazole, Propyluracil, Methyldopa, Minocycline, Procainamide, Hydralazine, Anti-TNF drugs, terbinafine, isoniazid, Quinidine. |
| Which biologic MUST be used with MTX? | Rituximab |
| First-line therapy for mild SLE? | NSAIDs + hydroxychloroquine |
| Role of steroids in SLE? | Acute flares and severe disease |
| What are the IG-1 drugs used for SLE? | Belimumab (Benlysta) and Anifrolumab (Saphnelo) |
| What drug is commonly used for, and is only approved for lupus nephritis? | Voclosporin (Lupkynis) |
| Anifrolumab indication? | SLE, cannot be used in lupus nephritis |
| Anifrolumab brand name? | Saphnelo |
| Belimumab major warnings? | Serious infections, depression, suicidality |
| Which IG-1 drug can be used in lupus nephritis? | Belimumab (Benlysta) |
| How are JAK inhibitors usually dosed? | PO, daily (or BID for Xeljanz) |
| Which TNF-a drugs are given IV? What is the dosing schedule? | Infliximab 3mg/kg IV, given at weeks 0, 2, 6 and then q8 weeks MUST have filter and can only mix in NS |
| Which biologic is known to have a delayed hypersensitivity reaction? | Infliximab, can occur 3-12 days after admin |
| Major concerns with TNF-a inhibitors? | demyelating disease, Hep B reactivation, HF, lupus, hepatotoxicity |
| Which biologic drug class requires refrigeration and cannot be heated/frozen/shaken? | TNF-a inhibitors |
| Which drugs are TNF-a inhibitors | Think “Every Angry Inflammatory Cell Grumbles”, Etanercept, adalimumab, infliximab, certolizumab, Golimumab. |
| Voclosporin boxed warnings? | Serious infection, malignency (just like the other biologics) |
| Unique voclosporin (Lupkynis) ADRs? | Hyperkalemia, HTN, nephrotoxicity, QT prolongation |
| First-line treatment for mild psoriasis? | Topical therapy +/- UVB phototherapy |
| Role of topical steroids in psoriasis? | Short term treatment |
| What are some common agents used for topical tx of mild-moderate psoriasis? | Topical steroids*, Coal tar, Tazarotene (Tazorac), Anthralin (Zithranol), Calcipotriene, Calcipotriene, tapinarof (VTAMA) |
| Calcipotriene brands? | Doevonex, sorilux |
| Calcipotriene CI? | Hypercalcemia (it is a vitamin D analog) |
| Drug options for systemic tx of psoriasis? | Acitretin (retinoid), Apremilast (Otzela, PDE-4 inhibitor), IL antagonists (-mabs), and tyrosine kinase inhibitors |
| Acitretin indication? | Severe psoriasis refractory to other therapy |
| Acitretin boxed warnings? | Pregnancy and hepatotoxicity, females must sign informed consent before dispensing) |
| Apremilast brand? Class? | Otezla, PDE-4 inhibitor |
| Apremilast major warnings? | Weight loss, depression, suicidality |
| Common Apremilast ADRs? | Diarrhea, nausea, headache |
| What are the first-line options for MS for prevention of future relapses (main part of MS therapy)? | Glatiramer (Copaxone) Interferon beta products (Avonex, Betaseron, Plegridy) |
| Which MS drug therapy requires 2C9 genotypcing and ECG monitoring? | Sponimod (Mayzent) |
| Which MS drug can cause PML, and requires REMS? | Natalizumab (Tysabri) and Ocrelizumab (Ocrevus) |
| Which MS drug can cause first-dose bradycardia? | Gilenva (aka fingolimod) |
| Unique glatiramer reaction? | Immediate post-injection chest pain, flushing, palpitations |
| Which autoimmune medication has a boxed warning for anaphylaxis? | Glatiramer (Copaxone, Glatopa) |
| Which MS drugs fall into the CD20 mAb category? | Ocrevus and Kesimpta |
Created by:
cdaughtry