Systemic steroids and rheumatoid arthritis

vitohuxo's version from 2016-03-14 00:42


Question Answer
primary endogenous glucocorticoidcortisol
primary endogenous mineralcorticoidaldosterone
fludrocortisonesynthetic steroid used for mineralcorticoid replacement. highest potency indicated for addisons disease, not inflammation
addison's disease steroids produced too little and will cause need for replacement
tapering recc for patients taking systemic steroids for longer than10-14 days
SE long term steroid usefat deposits in abdomen, face, shouldrs, impaired wound healing, dermal bruising/thinning, hyperglycemia, weight gain, galucoma, amenorrhea, fractures, hirsutism, acne, GI bleeding, psych disturbances, hypokalemia
short term side effects steroids (used under 1 month)weight gain, fluid retention, emotional, insomnia, indigestion, bitter taste, higher doses increase BP and blood glucose
Solu-CORTEFhydrocortisone sytemic
Solu-Medrolmethylprednisolone systemic
Millipred or Orapredprednisolone
anti-inflammatory potency dexamethasone/betamethasone> methylprednisolone/triamcinolone> prednisone/prednisolone> hydrocortisone> cortisone
rheumatoid arthritischronic, symmetrical, systemic disease, usually starts first in hands and feet.
symptoms of rheumatoid arthritisjoint swelling, stiffness, pain, eventually bone deformity. morning stiffness around joints lasting more than 1 hour.
osteoarthritis does not causeprolonged stiffness.
patients with symptomatic rheumatoid arthritis should be started on ______ no matter the severity of diseaseDMARD monotherapy. slow disease process and prevent further joint damage. ideal treatment target is remission or low activity of the disease.
___ is the preferred initial therapy for RAmethotrexate.
moderate or high disease activity RA despite using methotrexate....then can add on or switch toDMARD or TNF or non-TNF biologic. never use two biologics in combo due to infection risk.
otrexup, rasuvo, rheumatrex, trexalmethotrexate. DMARD non-biologic. preg category X
methotrexate dosinglow weekly doses used once weekly for RA (divided oral dosages of 2.5mg Q12h x 3 doses). never use once daily. increase adverse effects mouth sores/intestinal bleeding
methotrexate SEN/V/D, increase liver enzymes, stomatitis, alopecia, photosensitivity
folate and methotrexategive 5mg on the day following metho treatment. decrease GI bleeding and hepatic SE
plaquenilhydrochloroquine. DMARD-non biologic
hydrochloroquine SErash, prurititis, vision changes, pigmentation changes on skin and hair (rare)
monitoring for hydrochloroquineeye exam
sulfasalazineDMARD-non biologic. CI patients sulfa or salicylate allergy
sulfasalazine use caution ptsG6PD deficiency
sulfasalazine SErash, anorexia, dyspepsia, oligospermia,
can cause yellow orange coloration skin/urine sulfasalazine
impairs folate absorption so may give 1mg day folate supplementsulfasalzine
leflunomide DMARD-non biologic pregnancyCI. accelareted drug elimination options are cholestryarmaine and activated charcoal.
Tofacinitinib-xejianzDMARD- non biologic. do not use with biologics. inhibits januse kinase enzymes.
methotrexate and alcoholdo not take! combo increase risk liver toxicity.
enbreletanercept. biologic. TNFalpha inhibitor.
humiraadalimumab. biologic. TNFalpha inhibitor.
humira dose40mg every other weeks unless not taking methotrexate then weekly
remicadeinfliximab. biologic. TNFalpha inhibitor.
remicade dose3mg/kg IV weeks 0,2,6, then every 8 weeks. requires filter and stable in NS only. infusion reactions and delayed hypersensitivity.
simponigolimumab. TNFalpha inhibitor biologic. requires filter.
TNFalpha inhibitors warningcan cause heart failure and hepatoxicity
TNFalpha inhibitors monitoringTB test and signs/symptoms infection, also hep B
store TNFalpha inhibisfridge.
TNF alpha place in therapyadd on therapy to methotrexate unless so severe these can be used first line. do not use live vaccines if using these drugs.
rituxanrituximab. non-tnf biologic. depletes CD20 B cells.
rituxan warningscreen for latent TB and hep B infections
TNF alpha inhibs how to injectSubQ under skin of thigh, abdomen, or upper arm (enbrel and humira). store in fridge except enbrel and humira may be room temp max 14 days.
some foamin gnormal when reconstitute powder from multidose vialenbrel powder