Lupus- Heeter

SLE is more common in what gender?

female

SLE is more common in what race?

non-white people

SLE is usually diagnosed between the ages of:

15-45

SLE is characterized by abnormal ____ production.

antibody

True or False: SLE affects many different organ systems.

true

Common symptoms of SLE include:

• fever

• fatigue

• joint pain

• rash

1st line treatment for general/cutaneous lupus

a. Hydroxychloroquine

b. corticosteroids

c. Azathioprine

d. Mycophenolate

a. Hydroxychloroquine (± corticosteroids)

If Hydroxychloroquine is effective at controlling general/ cutaneuous lupus, what would be the next treatment?

Add methotrexate

If methotrexate is contraindicated, what would be the treatment of choice.

(Hydroxychloroquine is ineffective, MTX is contraindicated)

Azathioprine

What agents can be used for initial treatment of mild symptoms?

• NSAIDs

The main ADR of hydroxychloroquine is

retinopathy/ retinal toxicity

Do corticosteroids increase or decrease blood sugar?

INCREASE

For patients with severe life threatening diseases, what therapy utilizes steroids and is effective for inducing lupus remission?

Pulse therapy

If Hydroxychloroquine, MTX, and AZA are all ineffective, what treatment should be added?

Belimumab

Belimumab has an increased risk of _____________.

a. hyperglycemia

b. high bp

c. malignancies

d. depression

d- depression

What type of reactions can occur with the administrated of Belimumab?

Infusion rxns

To reduce hemorrhagic cystitis associated with Cyclophosphamide, pretreat with ___________.

mesna

What General Lupus medication can cause sterility?

a. MTX

b. Hydroxychloroquine

c. Belimumab

d. Cyclophosphamide

d- Cyclophosphamide

Cyclophosphamide and Mycophenolate are both contraindicated in ______________.

pregnancy

For general/ cutaneous lupus, when are Cyclophosphamide and Mycophenolate used?

when all the others aren’t working

Mycophenolate is better for what race?

Non-Caucasians

Cyclophosphamide is better for what race?

white people

What two medications can cause drug induced lupus? (know this)

• hydralazine

• procainamide

Is MTX used for treatment of lupus nephritis?

no

For Antiphospholipid Antibodies:

• what is the main concern?

• main prevention

• secondary prevention

• thrombosis is main concern

• prevent w/ low dose aspirin

• anticoagulant like warfarin

For Raynaud’s Phenomenon, what drugs do we want to avoid?

• pseudoephedrine

• B-blockers

• smoking

(also avoid cold environments)

To treat Raynaud’s Phenomenon what drugs do we use?

• Nifedipine- CCBs

• Losartan- ARBs

• Fluoxetine- SSRIs

• Sildenafil- PDE-5 Inhibitors

(I would for sure at least know the 4 specific drug names)

Medications for Lupus Nephritis Induction

• Pulse-Dosed steroids + MMF or CYC depending on race

Medications for Lupus Nephritis Maintenance

• MMF or AZA ±corticosteroid

• Voclosporin or Belimumab may be added if not well maintained

Nonpharm therapy for lupus management:

• rest

• exercise

• avoid tobacco

• limit sunlight

• establish a support system

Important Cardiac Symptom that may occur because of SLE:

coronary artery disease

Important Hematologic Symptom that may occur because of SLE:

Antiphospholipid Syndrome

What type of skin rash is commonly seen in SLE patients. It is in the shape of a butterfly.

malar rash

What Antinuclear antibodies are seen in 70-80% of SLE patients that are HIGHLY SPECIFIC TO LUPUS.

dsDNA antibodies

In addition to dsDNA antibodies, what others are seen in patients with SLE?

• Anti-Sm

• Antiphospholipid antibodies