Term
Define lupus:
a) Systemic lupus erythematosus
b) an autoimmune dz
c) a chronic inflammatory dz
d) type of collagen-vascular dz |
|
Definition
all are true.
involved musculoskeletal, integument, and vessels |
|
|
Term
Lupus is a type of collagen-vascular disease. What are others?
a) Systemic sclerosis
b) Scoliosis
c) Polymyositis/dermatomyositis,
d) Polymyalgia rheumatica
e) Drug-induced vasculitis |
|
Definition
| all are except b)scoliosis |
|
|
Term
| true or false, lupus is less prevalent in white people, occurs usually in 15-45yo, and more common in females. |
|
Definition
| true, likely to see it in young females. |
|
|
Term
| triggers of lupus? a) genetics b) environment c) diet d) hormonal |
|
Definition
genetics, environment, and hormonal. (also diet).
Genetics: First degree relatives 20 times more likely to develop SLE than general population At least 4 genes identified that are required for SLE expression
Environmental: Sunlight, drugs, chemicals, diet, environmental estrogens, infections with viruses and bacteria
Hormonal Androgen may inhibit and estrogen may enhance expression of autoimmunity |
|
|
Term
Which of the following are true about lupus pathophysiology?
a) Body produces excessive and abnormal autoantibodies which create immune complexes
b) Autoantibodies can be against many different cell types in the body – reason for multi-system involvement
c) Many autoantibodies attack nuclear constituents of the cell (antinuclear antibodies)
d) also attack the phospholipid moiety of the prothrombin activator complex (antiphospholipid antibodies)
e) The autoantibodies are present many years before SLE is diagnosed |
|
Definition
|
|
Term
Clinical Presentation of Lupus includes:
a) Cutaneous manifestation
b) Multi-system disease
c) Must have 4 out of 11 of the criteria developed by the American College of Rheumatology
d)Characterized by various periods of flare-ups (inflammation) |
|
Definition
|
|
Term
What is: Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds.
a)Malar rash (aka butterfly rash)
b)Discoid rash
c)Raynaud's phenomenon
d)Livedo reticularis
e)Periunguinal erythema
f)Vasculitis |
|
Definition
|
|
Term
What is: Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions.
a)Malar rash (aka butterfly rash)
b)Discoid rash
c)Raynaud's phenomenon
d)Livedo reticularis
e)Periunguinal erythema
f)Vasculitis |
|
Definition
|
|
Term
What is: when blood vessels spasm and block flow; fingers, ears, toes turn white or blue in color. Lots of times are painless, maybe some tingling. Can use four different medications. (What are they?)
a)Malar rash (aka butterfly rash)
b)Discoid rash
c)Raynaud's phenomenon
d)Livedo reticularis
e)Periunguinal erythema
f)Vasculitis |
|
Definition
c)Raynaud's phenomenon
the four diff meds are: Viagra, topical NTG, CCB, or an ACE inhibitor |
|
|
Term
What is: a common cutaneous finding consisting of a mottled reticulated vascular pattern that appears like a lace-like purplish discoloration of the lower extremities.
a)Malar rash (aka butterfly rash)
b)Discoid rash
c)Raynaud's phenomenon
d)Livedo reticularis
e)Periunguinal erythema
f)Vasculitis |
|
Definition
|
|
Term
What is: redness around the fingernails?
a)Malar rash (aka butterfly rash)
b)Discoid rash
c)Raynaud's phenomenon
d)Livedo reticularis
e)Periunguinal erythema
f)Vasculitis |
|
Definition
|
|
Term
To treat Raynaud's phenomenon, what meds can be used?
a)Viagra
b)SL NTG
c)Topical NTG
d)CCB
e)ACE inhibitor |
|
Definition
| all can be used except the SL NTG |
|
|
Term
What is: Pleuritis or pericarditis?
a)Malar rash (aka butterfly rash)
b)Discoid rash
c)Raynaud's phenomenon
d)Livedo reticularis
e)Periunguinal erythema
f)Serositis |
|
Definition
|
|
Term
| true or false: end stage renal dz is a major cause of morbidity and mortality |
|
Definition
true.
so are infection, CAD, and problems with meds |
|
|
Term
When Lupus is suspected, a fluorescent antinuclear antibody test is performed, trying to detect antibodies to dsDNA and Sm antigens. If both of these are found, good indicator (80%) for lupus.
Which type of cell shape, if found, will be the highest indicator of lupus?
a) Peripheral (rim)
b) Homogenous
c) Speckled
d) Nucleolar
which indicate SLE?
which types may indicate dsDNA?
which indicate Rheumatoid Arthritis?
which indicates drug-induced lupus? |
|
Definition
true; i think this is what she said..
Highest indicator: Peripheral (rim)
Indicate SLE: Peripheral (rim), Speckled (Ribonucleoprotein), Homogenous (Histones)
Indicate dsDNA: Peripheral (rim) and Homogenous
Indicate Rheumatoid Arthritis: Speckled (acidic nuclear protein), Homogenous (dsDNA, ssDNA)
Indicates drug-induced lupus (DIL): HOMOgenous (HISTONES) |
|
|
Term
Nonpharm tx includes:
a) Exercise
b) Weight loss
c) Not/Quit smoking d)
Sunscreen |
|
Definition
| nonpharmtx: Exercise, Not smoking, Sunscreen (NOT wt loss, this can be an issue in those with lupus) |
|
|
Term
Common drug classes used for lupus include all except:
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics
which are used for mild disease?
for severe disease?
for life-threatening disease? |
|
Definition
all are used for lupus.
for mild disease: NSAIDs, Antimalarials; or CCS prednisone as maintenance for mild dz (<1mg/kg/day)
for severe disease: Cytotoxic meds (esp
for severe lupus nephritis). also CCS prednisone would be used for initial severe dz (1-2mg/kg/day PO) or as maintenance for mild dz (<1mg/kg/day)
for life-threatening disease? methylprednisone IV 500-1000mg QD x 3-6 days |
|
|
Term
What drug do you use for life threatening disease?
a) CCS prednisone (1-2mg/kg/day PO)
b) CCS prednisone (<1mg/kg/day)
c) CCS methylprednisone IV 500-1000mg QD x 3-6 days |
|
Definition
c) CCS methylprednisone IV 500-1000mg QD x 3-6 days
Very serious disease (active nephritis, hemolytic disease): pulse therapy
IV methylprednisolone 500-1000 mg for 3-6 days;
THEN High dose prednisone 1-1.5 mg/kg per day;
THEN Taper down to lowest effective dose |
|
|
Term
What drug do you use for initial control of severe dz?
a) CCS prednisone (1-2mg/kg/day PO)
b) CCS prednisone (<1mg/kg/day)
c) CCS methylprednisone IV 500-1000mg QD x 3-6 days |
|
Definition
| a) CCS prednisone (1-2mg/kg/day PO) |
|
|
Term
What drug do you use for mild disease or as maintenance for mild dz after suppression with higher doses?
a) CCS prednisone (1-2mg/kg/day PO)
b) CCS prednisone (<1mg/kg/day)
c) CCS methylprednisone IV 500-1000mg QD x 3-6 days |
|
Definition
| b) CCS prednisone (<1mg/kg/day) |
|
|
Term
Cyclophosphamide is classified as:
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics |
|
Definition
|
|
Term
Azathioprine is classified as:
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics |
|
Definition
|
|
Term
Mycophenolate mofetil is classified as:
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics |
|
Definition
|
|
Term
which class of meds can cause dark/black stool, dyspepsia, and N/V?
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics |
|
Definition
salicylates, NSAIDs
btw there is NO SET NSAID to use... |
|
|
Term
which class of meds can cause GI bleeding, hepatic and renal toxicity, HTN
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics |
|
Definition
salicylates, NSAIDs
btw there is NO SET NSAID to use... |
|
|
Term
which class of meds can cause visual changes aka retinal toxicity? (specific drug within the class?)
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics
Which specific drug can cause reversible visual changes? which can cause irreversible visual changes?
which is first choice? |
|
Definition
antimalarials-->Hydroxychloroquine, also chloroquine (can cause ocular toxicities like cycloplegia and corneal deposits...)
Hydroxychloroquine: reversible, is first choice antimalarial
Chloroquine: irreversible visual changes
but serious toxicity is uncommon at recommended doses. |
|
|
Term
Hydroxychloroquine is classified as:
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics |
|
Definition
|
|
Term
| true or false: NSAIDs can cause hepatotoxicity |
|
Definition
| true...although mainly can affect renal, can also cause hepatotoxicity in lupus pts and in pts with aseptic meningitis |
|
|
Term
| How do you treat pts with Antiphospholipid syndome? |
|
Definition
low dose ASA
In the presence of antiphospholipid antibodies, 100-325mg of aspirin daily may be used as prophylaxis |
|
|
Term
| Which lupus meds can take months to take maximal effect? which can take 6 months? |
|
Definition
months: antimalarials (hydroxychloroquine and chloroquine)
6 months: cytotoxic, this long for maximal response |
|
|
Term
| Which lupus meds can cause pigmentation changes of hair and skin? |
|
Definition
| antimalarials (hydroxychloroquine and chloroquine) |
|
|
Term
Which of the following is not a time to use CCS for lupus?
a) Lupus nephritis, severe cases of CNS disease
b)Pneumonitis, polyserositis,
c)Vasculitis, thrombocytopenia
d)Mild disease symptoms like fever, arthralgia, pleuritis, skin manifestations |
|
Definition
| Use for all except for d)Mild disease symptoms like fever, arthralgia, pleuritis, skin manifestations |
|
|
Term
which of the following are true about Cytotoxic meds?
a)Useful for immunosuppression
b)Most commonly used in lupus nephritis
c)Benefit: Allow for lower doses of steroids
d)Caution – may take 6 months or more for maximum response
e)Two or more of these agents is not recommended (but is seen sometimes)
which two cytotoxic meds are most commonly used?
what are other cytotoxic meds? |
|
Definition
Drugs most commonly used: cyclophosphamide, azathioprine
Other drugs used: Methotrexate, mycophenolate mofetil, mechlorethamine (nitrogen mustard), chlorambucil, cyclosporine |
|
|
Term
Osteoporosis is a SE of which class of meds used for lupus?
a) NSAID
b) antimalarial
c) corticosteroid
d) cytotoxic
e) biologics |
|
Definition
|
|
Term
When _____ is combined with prednisone, it is the #1, preferred treatment for lupus nephritis.
what is another drug that it is combined with to prevent hemorrhagic cystitis?? |
|
Definition
Cyclophosphamide (CYC)
Can combine with Mesna to prevent hemorrhagic cystitis |
|
|
Term
Which drug does this apply to?
-Pulse therapy is preferred due to decreased side effects
-Major serious side effects: hematopoiesis, infections, bladder complications, sterility, teratogenesis, cancers
-WBC counts must be monitored; dose will need to be altered if count is <1,500/mm3
-Ondansetron + dexamethasone is an appropriate way to control associated N/V
a)Mycophenolate
b)CCS
c)Cyclophosphamide
d)Cyclosporine
e)Azathioprine |
|
Definition
|
|
Term
What two meds may be used as matintenance therapies AFTER patient's lupus nephritis is controlled by cyclophosphamide?
Which of these two meds has these Side effects of concern: Myelosuppression, infections like herpes zoster, cancer, hepatotoxicity, ovarian failure? |
|
Definition
Azathioprine (for long term) and Mycophenolate mofetil (for mild-mod nephritis)
Azathioprine: can be WITH CCS in pts with severe dz, or can be WITHOUT in pts who cannot tolerate CCS
Mycophenolate is often combined with CCS
Azathioprine:Side effects of concern: Myelosuppression, infections like herpes zoster, cancer, hepatotoxicity, ovarian failure |
|
|
Term
Which lupus med has these Side effects of concern: Myelosuppression, infections like herpes zoster, cancer, hepatotoxicity, ovarian failure?
which has this as the Main side effect of concern: Diarrhea? |
|
Definition
Azathioprine: Myelosuppression, infections like herpes zoster, cancer, hepatotoxicity, ovarian failure
Mycophenolate: diarrhea |
|
|
Term
| ____ and ____ are the two newest treatment options for lupus. |
|
Definition
| Newest treatment options: Rituximab and belimumab |
|
|
Term
| Which biologic has this Side effect of major concern: Progressive multifocal leukoencephalopathy (PML)? |
|
Definition
|
|
Term
Which biologic used for lupus do these apply to?
Shown to reduce frequency of SLE flares
May cause infusion reactions |
|
Definition
|
|
Term
true or false: alternative and experimental treatments for lupus include: Biologic therapies that interfere with immune response, ablative chemotherapy with hematopoietic stem cell transplantation, combination chemotherapy, and
Experimental agents:
Abatacept
Cyclosporine
DHEA
Eculizumab
Efalizumab
Epratuzumab
Infliximab
Rituximab
Sirolimus
Tacrolimus
Cytokines
Androgens |
|
Definition
|
|
Term
____ and ____ are immunosuppresive agents that are alternative/experimentsl treatments for lupus.
Which can cause Causes dose-related neurological and metabolic adverse effects? Which has the Major adverse effect of hypercholesterolemia ? |
|
Definition
Tacrolimus: Causes dose-related neurological and metabolic adverse effects
Sirolimus: Major adverse effect is hypercholesterolemia |
|
|
Term
| true or false: after the baby is born, the mother's lupuz will no loner be exacerbated, since pregnancy causes disease exacerbation |
|
Definition
false, lupus can still be exacerbated.
Causes disease exacerbation during pregnancy and early postpartum |
|
|
Term
| true or false: after the baby is born, the mother's lupus will no longer be exacerbated, since pregnancy causes disease exacerbation |
|
Definition
| false, lupus can still be exacerbated. Causes disease exacerbation during pregnancy and early postpartum |
|
|
Term
| What three drug classes may be used to treat exacerbations in pregnancy?! |
|
Definition
1)Steroids – considered safe even at higher doses
2)Hydroxychloroquine – safe during pregnancy
3)Cytotoxic drugs – DANGEROUS (If one needs to be used, try azathioprine. Only if severe dz, benefit will outweigh risk) |
|
|
Term
true or false: Antiphospholipid antibodies increase risk of spontaneous abortion.
if it is true, what drugs are used to treat it? |
|
Definition
true.
Treat with corticosteroids, IV immunoglobulin, ASA, and HEPARIN
No standard therapy recommended
Low-dose daily ASA in women with antiphospholipid antibodies and no prior spontaneous abortions
Women at high risk with past spontaneous abortions, treat with low-dose subcutaneous heparin with or without ASA |
|
|
Term
| For women who have lupus with antiphospholipid antibodies and do not want to become pregnant, can they use estrogen containing contraceptives? |
|
Definition
probably not..In general, avoid if antiphospholipid antibodies are present.
It will increase dz flare-ups. increase the risk for thrombosis even more than it already is. |
|
|
Term
| In patient with thrombosis and lupus, how to treat? |
|
Definition
standard heparin; Follow up treatment with warfarin (Goal INR in these patients is ≥3)
Typically treated indefinitely; however, no specific guidelines exist |
|
|
Term
| What 7 drugs did we learn about that can cause drug-induced lupus? (DIL) |
|
Definition
| Most important to recognize: Chlorpromazine, hydralazine, isoniazid, methyldopa, minocycline, procainamide, quinidine |
|
|
Term
Which of these indictes that the lupus pt has DIL?
Exposure to suspected drug
No history of SLE prior to drug
Development of ANAs
One clinical SLE feature
Rapid improvement of symptoms and decline of ANAs after drug is D/C’d
Patients that are____ ______ are more likely to develop DIL, especially if they use which two meds?
which of these two meds is dose related?
which of these two meds may cause DIL even years after pt has been on it? |
|
Definition
all do!
Patients who are slow acetylators are more likely to develop DIL, especially with procainamide and hydralazine
Dose related: hydralazine
Max dose:
Men: 100mg/day
Women: 50mg/day
1 month to years later: Procainamide |
|
|
Term
| What are the most common symptoms in pts with DIL? |
|
Definition
Mulculoskeletal (NOT cutaneous like with regular lupus. Rarely see cutaneous, CNS, or renal involvement!)
Discontinue drug causing DIL
Should return back to normal in days to weeks, but may take up to a year for some symptoms and serologic abnormalities
NSAIDs can be used to treat musculoskeletal manifestations
Stronger treatments should not be indicated |
|
|
