Pharm - Lupus Treatment
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Questions and Answers

What is not an environmental trigger for Lupus?

  • Sunlight
  • Certain Drugs
  • Purine diet (correct)
  • Environmental estrogens
  • Up to 10% of lupus cases may be drug-induced, which of the following drugs can lead to drug-induced lupus? These drugs should also be avoided in patients with lupus.

  • Acetaminophen, Ibuprofen, Amoxicillin
  • Tranquilox, Meditralin, Hypotheticor
  • Lisinopril, Metformin, SGLT2i
  • Hydralazine, Procainamide, Quinidine, and/or Isoniazid (correct)
  • Drug-induced lupus usually (DIL) presents with more musculoskeletal symptoms than non-drug induced.

    True

    Most patients with lupus will likely progress to having renal involvement as a part of the disease.

    <p>True</p> Signup and view all the answers

    What is key to the treatment of Renal Lupus?

    <p>All of the above</p> Signup and view all the answers

    A goal of treatment for Lupus is to limit the use of corticosteroids to less than 15 mg per day.

    <p>False</p> Signup and view all the answers

    What patient education is NOT correct for a patient with Lupus?

    <p>Stay up to date on immunizations with on immunosupressant therapy</p> Signup and view all the answers

    What medication is recommended for all SLE patients, regardless of severity?

    <p>Plaquenil (Hydroxychloroquine)</p> Signup and view all the answers

    What is the maximum dose for Hydroxychloroquine?

    <p>5 mg/kg</p> Signup and view all the answers

    What can occur for patients that are using Hydroxychloroquine for SLE?

    <p>Macular damage and visual changes</p> Signup and view all the answers

    A patient with SLE that is already taking Hydroxychloroquine is experiencing a mild flare of symptoms. What should you recommend for this patient?

    <p>A or B</p> Signup and view all the answers

    What can patient with SLE use for more serious or unresponsive clinical manifestations of lupus such as Lupus nephritis, CNS disease, Pneumonitis, Vasculitis, and/or Thrombocytopenia?

    <p>Corticosteroids</p> Signup and view all the answers

    Corticosteroids for SLE

    <p>prednisone 10-20mg/day = Can be used for MILD disease prednisone 1-2mg/kg/day = Can be used for more SEVERE disease IV methylprednisolone 250-1000mg per day for 1-3 days = Pulse dose for immediate improvement 5mg/day corticosteroid = Ideal dose for for chronic maintenance</p> Signup and view all the answers

    Why is Imuran (Azathioprine) used more commonly than Methotrexate in achieving symptom control for patient's on Hydroxychloroquine?

    <p>Compatible with pregnancy</p> Signup and view all the answers

    What medication suppresses cell- mediated immune responses and antibody formation and is effective in renal and non-renal SLE as alternative for induction of remission in both SLE and renal SLE?

    <p>Cellcept® Mycophenolate mofetil</p> Signup and view all the answers

    What pharmaceutical therapy is appropriate for treatment of lupus dermatitis?

    <p>Topical corticosteroids</p> Signup and view all the answers

    Intralesional administration of corticosteriods can be used for q4-6 weeks for discoid lupus

    <p>True</p> Signup and view all the answers

    What SLE Nephritis drug is the standard of care for focal and diffuse lupus nephritis, but can cause hemorrhagic cystitis?

    <p>Cytoxan® Cyclophosphamide</p> Signup and view all the answers

    What Lupus nephritis drug is the standard of care for focal and diffuse lupus nephritis and can be also used for severe organ threatening or life threatening SLE as well as for “rescue” therapy in patients not responding to other agents?

    <p>Cytoxan® Cyclophosphamide</p> Signup and view all the answers

    What drug regime is recommended for Lupus nephritis Class I and II?

    <p>do not require immunosupressants</p> Signup and view all the answers

    Class III (focal) and IV (diffuse) SLE respond to which agents?

    <p>steroids and immunosuppressants</p> Signup and view all the answers

    What is the Class V SLE induction treatment?

    <p>Mycophenolate or cyclophosphamide x 6 months</p> Signup and view all the answers

    What therapies can be used as maintenance therapy for SLE nephritis?

    <p>A or B</p> Signup and view all the answers

    What additional therapy can be used for patients experiencing either musculoskeletal or cutaneous disease that is not being controlled by their Hydroxychloroquine and steroids?

    <p>Benlysta (belimumab)</p> Signup and view all the answers

    Patients with lupus should avoid Alfalfa sprouts, garlic supplements and echinacea.

    <p>True</p> Signup and view all the answers

    What is the maintenance dose for Hydroxychloroquine?

    <p>200-400mg/day</p> Signup and view all the answers

    80% of SLE patients will require low dose steroids as maintenance therapy

    <p>True</p> Signup and view all the answers

    A patient is on Hydroxychloroquine and steroids for SLE. What medication can be added to this combination to help lower the daily dose for steroids (steroid sparing)? This option is safe in pregnancy.

    <p>Imuran® Azathioprine</p> Signup and view all the answers

    A patient is on Hydroxychloroquine and steroids for SLE. What medication can be added to this combination to help with symptoms control? This option is NOT safe in pregnancy.

    <p>Cellcept® Mycophenolate mofetil</p> Signup and view all the answers

    What medication do patients with Lupus nephritis need to decrease proteinuria?

    <p>ACEI/ARB</p> Signup and view all the answers

    What medication is used in Lupus nephritis to achieve LDL goal of <100? This medication is indicated is LDL go above 100.

    <p>Statin</p> Signup and view all the answers

    What medication is an alternative for patients refractory to other treatments for Lupus nephritis? This medication may also be more effective in African Americans.

    <p>Rituxan® rituximab</p> Signup and view all the answers

    ASA 81mg daily for patients with antiphospholipid antibodies (APLA) and needs to be considered for patients with multiple fetal loss.

    <p>True</p> Signup and view all the answers

    Oral contraceptives have not been shown to increase SLE flares

    <p>True</p> Signup and view all the answers

    What medication was recently approved and used in treating active autoantibody-positive SLE in patients on standard therapy?

    <p>Benlysta® (belimumab)</p> Signup and view all the answers

    What medication can be used for acute exacerbations as an add on therapy and works by increasing cortisol levels?

    <p>Acthar Gel</p> Signup and view all the answers

    What medication can cause hemorrhagic cystitis when used as the induction agent for lupus nephritis?

    <p>Cyclophosphamide</p> Signup and view all the answers

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