Systemic Steroids & Autoimmune Conditions

Folic acid

What should you take with methotrexate to help reduce toxicity

20 mg/day or greater

Patient is imuunocompromised when using what dose of prednisone or prednisone equivalent?

4 mg methylprednisolone/5 mg prednisone

Methylprednisolone to prednisone conversion

Fludrocortisone

Which steroid is preferred for managing orthostatic hypotension in a patient with Addison’s disease?

Emotional instability

Short-term side effect of oral steroids

To reduce the risk of fatal infusion reactions

Why is acetaminophen given prior to rituximab

Restasis

Brand name for cyclosporine opthalmic

Positive rheumatoid factor, swollen, painful joints, morning stiffness

Rheumatoid arthritis diagnosis

Methotrexate

First-line treatment of RA, if no contraindications

Disease-modifying antirheumatic drug

What does DMARD stand for?

Patient will need to begin latent TB treatment prior ro starting anti-TNF treatment

Before starting anti-TNF treatment, what should happen if a patient has latent TB?

Cortisone, hydrocortisone, prednisone, methylprednisolone, dexamethasone

Oral corticosteroids ranked in order from lowet to highest anti-=inflammatory potency

Stomatitis, nausea, diarrhea

Most common side effects of methotrexate

Hydroxychloroquine

Which medications can be used to treat systemic lupus erythematosus?

Every 14 days

How often is peginteferon beta-1a (Plegridy) given?

White, then blue, fingers and toes that become painful upon warming

Ryanud’s clinical presentation

Once weekly

How often is etanercept given?

Visual problems, including irreversible retinopathy, are a concern with the use of hydroxychloroquine. Eye exams should be monitored at baseline and every 3 months

What needs to be monitored routinely with hydroxychloroquine?

Plaquenil

Brand name for hydroxychloroquine

Psoriasis

What are calcipotriene and calcipotriene/betamethasone used to treat?

Calcium channel blockers

First-line treatment for Raynaud’s phenomenon

Wheay, barley, rye

Which drug exipients contain gluten?

TB test & HBV tests

What should be checked prior to initiating TNF-inhibitor therapy?

0.75 mg dexamethasone/5 mg prednisone

Dexamethasone to prednisone covnversion

Anti-CD 20 antibody

Rituximab (Rituxan) drug class

Betamethasone

Which steroid has the greatest anti-inflammatory potency?

A demyelinating disease that attacks the myelin sheath of the brain and spinal cord

What is multiple sclerosis?

Difficulty walking, gait instability, muscle spasms and incontinence

Multiple sclerosis clinical presentation

Tumor necrosis factor inhibitor

Etanercept drug class

Leflunomide and methotrexate

Which drugs can cause acute hepatitis (elevated AST and ALT)?

Leflunomide and methotrexate

Which drugs have a boxed warning for embryo-fetal toxicity?

Bradycardia; an ECG is required at baseline and any time treatment is interrupted. Heart rate should be monitored for 6 hours after the first dose

Main concern for fingolimod?

Macular edema (monitor with eye exams), hepatoxicity (monitor LFTs) and myelosuppression (monitor CBC)

Fingolimod major side effects requiring monitoring

IV infusion that can cause infusion-type reactions (chills, fever, pruritis, hypotension); pre-medication may be necessary. Infliximab is only stable in NS and requires a filter, it can increase the risk of DILE, patients should be screened for latent TB before starting this drug

Infliximab important information

Prednisone

Prodrug of prednisolone

Solu-Medrol

Parenteral form of methylprednisolone

Therapy packs provide a convenient tapering system for the patient; the dose starts high and quickly decreases over a period of a few days. The strength of each tablet is the same; the patient will just take a different number of tablets with each dose according to the schedule

How does Medrol tablet therapy pack decrease the risk for side effects?

Positive ANA (antinuclear antibodies)

Which laboratory value would suggest a diagnosis of systemic lupus erythematosus?

Muscarinic agents are helpful for this condition. Xylitol may be useful in chewing gum for cavity prevention. Always use sugar-free candy or gum. A major complication of dry mouth is tooth decay (dental caries or cavities)

Dry mouth management

Avoid prolonged exposure to the sun to reduce photosensitivity. Smoking and many drugs may induce or exacerbate SLE. The main complications are renal (over 50% of patients develop lupus nephritis), hematologic and neurologic.

SLE important information

Copaxone

Brand name for Glatiramer acetate

It is used for multiple sclerosis and can cause injection site reactions, flushing, sweating, pain, chest pain, dyspnea and rash. It is administered by SC injection daily or three times per week and is the preferred treatment of MS during pregnancy

Glatiramer acetate important information

Diarrhea, weight loss, abdominal pain, bloating

Celiac disease exacerbation symptoms

Hydralazine

Drug that can cause drug-induced lupus erythematosus (DILE)

A salicylate allergy

Contraindication to the use of sulfasalazine

Cushing’s syndrome

Condition which occurs due to long-term corticosteroid use

Impaired wound healing, weight gain, osteoporosis, hyperglycemia, a buffalo hump

Side effects of Cushing’s syndrome

Increased riskm of serious infections and lymphomas and other malignancies (notably, skin cancer)

Anti-TNF biologics boxed warning

Liver damage, exacerbation of heart failure, risk of infection, risk of lymphoma or skin cancer

Enbrel warnings

Weekly

How is methotrexate dosed for patients with rheumatoid arthritis

Oral, SC and IM

What formulations of methotrexate are available?

Humira

Brand name for adalimumab

Administered by subcutaneous injection every other week (in the abdomen or thigh). It can be given alone or in combination with methotrexate, but it is a biologic DMARD so it should not be used in combination with any other biologiv DMARD. Patients receiving biologic immunosuppressant drugs should not receive live vaccines during treatment (they must be given before the start of therapy)

Adalimumab important information

Sulfasalazine

Which medication can cause yellow-orange urine discoloration?