Questions and Answers
What additional medication/s would be appropriate to add for improved control of OP's rheumatoid arthritis? (Select all that apply)
Which steroid is preferred for managing orthostatic hypotension in a patient with Addison's disease?
Fludrocortisone
What other medication should OP be taking because he is on Trexall?
Folic acid
What drug class does etanercept belong to?
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Which of CY's medications is contraindicated in pregnancy? (Select all that apply)
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Which of CY's medications are most likely contributing to the new laboratory abnormalities on 7/7? (Select all that apply)
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Which medication should be started to reduce disease progression in patients diagnosed with RA?
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Which of the following is consistent with a diagnosis of RA in EW? (Select all that apply)
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Calcipotriene is a dermatological drug that is used for this condition:
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Which medication is most likely responsible for a patient reporting sore mouth and inflamed gums?
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Which of the following statements concerning dry mouth are correct? (Select all that apply)
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Which of the following medications can cause yellow-orange urine discoloration?
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Short-term effects that can occur from the use of oral steroids include:
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Which of the following medications is NOT an anti-TNF biologic DMARD?
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What is a first line treatment for Raynaud's phenomenon?
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Which of the following are side effects that can occur from prednisone therapy? (Select all that apply)
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Which statement concerning tapered withdrawal from prednisone is correct?
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How should a patient approach injecting etanercept?
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What is true about Medrol tablet therapy packs?
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Which lab value would suggest a diagnosis of systemic lupus erythematosus?
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What would be considered immunosuppressed in a patient taking methylprednisolone?
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What counseling point should be provided regarding sun exposure and SLE?
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What autoimmune disorder attacks the myelin sheath of the brain and spinal cord?
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What does acetaminophen reduce when given prior to rituximab infusions?
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What is the active ingredient in Restasis?
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Which of the following medications carry warnings related to liver damage and the risk of infection? (Select all that apply)
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Which statements regarding Humira are correct? (Select all that apply)
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Which of the following steroids has the greatest anti-inflammatory potency?
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Rank the following oral corticosteroids in order of their anti-inflammatory potency (Least potent first):
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Exacerbation of celiac disease can include which of the following symptoms? (Select all that apply)
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What should be done for a patient testing positive for latent TB infection before starting adalimumab?
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Which medication can be recommended for a pregnant patient who should not use harmful medications?
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Which statements about infliximab therapy are correct? (Select all that apply)
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What is the equipotent daily dose of prednisone for a patient transitioning from dexamethasone?
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What are common side effects of Copaxone?
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What is a contraindication to the use of sulfasalazine?
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What should be checked prior to initiating TNF-inhibitor therapy? (Select all that apply)
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What can be interchanged for RK's interferon therapy to decrease injection burden?
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What is the most important monitoring parameter with initial use of fingolimod?
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Which medication is used to treat systemic lupus erythematosus?
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What is the classic symptom of Raynaud's?
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Which medication is most likely to cause a rash in HN who is on multiple medications?
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How should methotrexate be taken for RA?
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Which drug requires a filter for infusion and is stable only in normal saline?
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What needs to be monitored regularly for patients starting Plaquenil therapy?
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Which of the following contain gluten? (Select all that apply)
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Study Notes
Systemic Steroids and Autoimmune Conditions
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Rheumatoid Arthritis (RA) Management: Appropriate medications for improved control include Humira, Infliximab, and Rituximab; Methotrexate is a duplicate therapy and Benlysta is not indicated for RA.
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Addison's Disease Treatment: Fludrocortisone is preferred due to its mineralocorticoid activity, mimicking aldosterone, which stabilizes blood pressure in Addison’s disease.
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Folic Acid Use in Methotrexate Therapy: Patients on Trexall (Methotrexate) should take folic acid to prevent folate depletion and reduce adverse effects like GI symptoms and liver toxicity; Leucovorin can be an alternative.
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Etanercept Class: Etanercept belongs to TNF (tumor necrosis factor) inhibitors; allergic reactions can occur in some patients.
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Pregnancy Contraindications: Methotrexate and Leflunomide are contraindicated in pregnancy due to the risk of teratogenic effects; patients on Leflunomide must have a negative pregnancy test and use contraception.
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Lab Abnormalities in RA Patients: Leflunomide and Methotrexate can contribute to elevated AST and ALT levels, indicating potential hepatotoxicity; Prednisone and other listed medications are not implicated.
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First-Line DMARD for RA: Methotrexate is the first-line disease-modifying antirheumatic drug for symptomatic RA.
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Diagnosis of RA: Consistent symptoms include morning stiffness, swollen joints, and positive rheumatoid factor; elevated ESR and ACPA tests may further support diagnosis.
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Calcipotriene Use: This topical medication is used for treating psoriasis, available in various combinations.
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Methotrexate Side Effects: Common side effects include stomatitis, nausea, and diarrhea, especially when administered weekly for RA.
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Management of Dry Mouth: Muscarinic agents can be helpful for patients with Sjogren's syndrome; sugar-free gum and candy are recommended to prevent dental caries.
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Urine Discoloration: Sulfasalazine can cause yellow-orange discoloration of urine.
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Short-Term Prednisone Effects: Irritability may occur with short-term use; long-term use typically leads to Cushingoid symptoms such as weight gain and muscle wasting.
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Non-TNF Biologics: Rituximab (Rituxan) is an anti-CD20 monoclonal antibody, not classified as an anti-TNF biologic DMARD.
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Raynaud's Phenomenon Treatment: Calcium channel blockers, such as nifedipine, are first-line treatments.
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Prednisone's Side Effects: Associated with Cushing's syndrome, potential side effects include impaired wound healing, weight gain, osteoporosis, and hyperglycemia.
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Prednisone Tapering Necessity: A slow taper is required when discontinuing long-term prednisone to avoid adrenal crisis from HPA axis suppression.
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Etanercept Administration: This medication is injected subcutaneously once weekly; areas for injection include the abdomen, thigh, or upper arm.
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Medrol Pack Advantages: Therapy packs facilitate a tapering system to minimize steroids' side effects by providing a structured dosing schedule.
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SLE Diagnostic Lab Value: A positive ANA (Antinuclear Antibodies) test is indicative of systemic lupus erythematosus.
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Immunosuppression Threshold: Methylprednisolone at 12 mg per oral TID represents an immunosuppressive regimen equivalent to prednisone 20 mg/day or higher.
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SLE Counseling Points: Advise patients to avoid prolonged sun exposure and wear sunscreen to manage photosensitivity associated with SLE.
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Multiple Sclerosis (MS): This autoimmune disorder primarily affects myelin, with treatment focused on slowing progression; irreversible neuronal damage occurs once function is lost.
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Rituximab Infusion Precautions: Acetaminophen premedication mitigates the risk of fatal infusion reactions; other drugs may also be used for premedication.
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Restasis Active Ingredient: Cyclosporine is the active ingredient aimed at treating severe dry eyes due to Sjogren’s syndrome.
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Enbrel Warnings: This medication carries warnings for liver damage, infection risk, heart failure exacerbation, and increased risk of lymphoma and skin cancer.
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Humira Information: It can be combined with methotrexate, administered bi-weekly, and users should not receive live vaccines during treatment.
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Steroid Potency Ranking: Rank from least to most potent: Cortisone, Hydrocortisone, Prednisone, Methylprednisolone, Dexamethasone, Betamethasone.
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Celiac Disease Symptoms: Symptoms include diarrhea, bloating, abdominal pain, and weight loss; exercise caution with ingredients containing gluten like wheat, barley, and rye.
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Latent TB Management: Patients diagnosed with latent TB must begin treatment prior to starting anti-TNF therapies like adalimumab.
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Pregnancy Considerations for RA: Adalimumab is recommended for patients who are pregnant, avoiding potentially harmful medications.
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Crohn's Disease Infusion Preparation: Patients must be screened for latent TB before starting Infliximab, which can also increase the risk of drug-induced lupus erythematosus (DILE).
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Dexamethasone to Prednisone Conversion: An equipotent dose to 3 mg of dexamethasone BID is 40 mg of prednisone.
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Copaxone Side Effects: Commonly experienced side effects include sweating and dyspnea; administered via subcutaneous injection.
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Sulfasalazine Contraindications: Contraindicated in patients with a salicylate allergy.
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Monitoring Prior to TNF-Inhibitors: Screen for TB and HBV prior to therapy to prevent serious infections.
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Interferon Injectable Options: Peginterferon beta-1a (Plegridy) is administered biweekly and helps decrease injection frequency.
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Fingolimod Monitoring: Heart rate is critical to monitor upon initial administration due to the risk of bradycardia.
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Hydroxychloroquine for SLE: This medication is used for treatment of mild systemic lupus erythematosus.
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Classic Raynaud's Phenomenon Symptoms: Characterized by cold, blue fingers and toes in response to stress or cold exposure.
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Hydralazine and Drug-Induced Lupus: Hydralazine is a common medication associated with drug-induced lupus erythematosus (DILE).
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Methotrexate Dosing Schedule: Methotrexate for RA should always be taken weekly to avoid serious side effects associated with daily dosing.
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Infliximab Stability Conditions: Requires normal saline for stability and administration via IV infusion; a filter is necessary.
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Hydroxychloroquine Monitoring: Patients should undergo routine eye exams to detect potential retinopathy with hydroxychloroquine use.
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Gluten Content in Foods: Foods containing wheat, barley, and rye should be avoided in celiac disease; oats and rice are generally safe.
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Test your knowledge on systemic steroids and their application in autoimmune conditions with this interactive quiz. Explore specific medications like Humira and Infliximab, and understand their roles in managing rheumatoid arthritis and other conditions. Perfect for medical students and healthcare professionals looking to enhance their understanding of treatment options.
