NAPLEX _ Systemic Steroids & Autoimmune Conditions

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  1. Systemic Steroids (PO, IV) Dose Equivalence
    • "Cute Hot Pharmacist & Physicians Marry Together & Deliver Babies"
    • Cortisone _ 25 mg
    • Hydrocortisone _ 20 mg
    • Prednisone _ 5 mg
    • Prednisolone _ 5 mg
    • Methylprednisolone _ 4 mg
    • Triamcinolone _ 4 mg
    • Dexamethazone _ 0.75 mg
    • Betamethazone _ 0.6 mg
    • Short Acting Steroids == C || H
    • Moderate-Acting Steroids == P || P || M || T
    • Long-Acting & Highest Potency Steroids == D || B
  2. DexPak 6, 10 or 13 Day **
    • Hydrocortisone
    • Class: Glucocorticoids (Systemic Steroids)
    • CI: Live vaccines || Serious systemic infections
    • Warnings: must Taper slowly
    • SE: 
    • -- Short-term SE (used <1 mo) == increased appetite or weight gain || fluid retention || emotional instability || insomnia || indigestion || bitter taste || higher doses increase BP and BG
    • -- Long-term SE == Glaucoma, Cataracts || Fat deposits || Pink-purple stretch marks || Growth retardation || Psychiatric changes || HA, Intracranial hypertension, Hypothyroidism || Acne || GI bleeding/esophagitis/ulcers || Diabetes || Poor bone health || Hirsutism  OR Irregular menstrual periods (women only)
  3. Solu-CORTEF
    Cortef
    • Hydrocortisone
    • Class: Glucocorticoids (Systemic Steroids)
    • CI: Live vaccines || Serious systemic infections
    • Warnings: must Taper slowly
    • SE: 
    • -- Short-term SE (used <1 mo) == increased appetite or weight gain || fluid retention || emotional instability || insomnia || indigestion || bitter taste || higher doses increase BP and BG
    • -- Long-term SE == Glaucoma, Cataracts || Fat deposits || Pink-purple stretch marks || Growth retardation || Psychiatric changes || HA, Intracranial hypertension, Hypothyroidism || Acne || GI bleeding/esophagitis/ulcers || Diabetes || Poor bone health || Hirsutism  OR Irregular menstrual periods (women only)
  4. Medrol || Medrol Dosepak **
    Solu-MEDROL **
    A-Methapred **
    Depo-Medrol **
    • MethylPRENISolone
    • Class: Glucocorticoids (Systemic Steroids)
    • CI: Live vaccines || Serious systemic infections
    • Warnings: must Taper slowly
    • SE: 
    • -- Short-term SE (used <1 mo) == increased appetite or weight gain || fluid retention || emotional instability || insomnia || indigestion || bitter taste || higher doses increase BP and BG
    • -- Long-term SE == Glaucoma, Cataracts || Fat deposits || Pink-purple stretch marks || Growth retardation || Psychiatric changes || HA, Intracranial hypertension, Hypothyroidism || Acne || GI bleeding/esophagitis/ulcers || Diabetes || Poor bone health || Hirsutism  OR Irregular menstrual periods (women only)
    • ** Also used acutely in SLE to control flares at higher doses (taper) 
  5. Deltasone **
    • PredniSONE
    • Class: Glucocorticoids (Systemic Steroids)
    • CI: Live vaccines || Serious systemic infections
    • Warnings: must Taper slowly
    • SE: 
    • -- Short-term SE (used <1 mo) == increased appetite or weight gain || fluid retention || emotional instability || insomnia || indigestion || bitter taste || higher doses increase BP and BG
    • -- Long-term SE == Glaucoma, Cataracts || Fat deposits || Pink-purple stretch marks || Growth retardation || Psychiatric changes || HA, Intracranial hypertension, Hypothyroidism || Acne || GI bleeding/esophagitis/ulcers || Diabetes || Poor bone health || Hirsutism  OR Irregular menstrual periods (women only)
    • NOTES: prednisone is prodrug of prednisolone
    • -- patient is Immune-Suppressed when using >/= 2 mg/kg/day OR >/= 20 mg/day of prednisone for >/= 2 weeks
    • ** Also used acutely in SLE to control flares at higher doses (taper)
  6. Millipred **
    Orapred ODT **
    Pediapred **
    • PrednisoLONE
    • Class: Glucocorticoids (Systemic Steroids)
    • CI: Live vaccines || Serious systemic infections
    • Warnings: must Taper slowly
    • SE: 
    • -- Short-term SE (used <1 mo) == increased appetite or weight gain || fluid retention || emotional instability || insomnia || indigestion || bitter taste || higher doses increase BP and BG
    • -- Long-term SE == Glaucoma, Cataracts || Fat deposits || Pink-purple stretch marks || Growth retardation || Psychiatric changes || HA, Intracranial hypertension, Hypothyroidism || Acne || GI bleeding/esophagitis/ulcers || Diabetes || Poor bone health || Hirsutism  OR Irregular menstrual periods (women only)
    • NOTES: prednisolone is used most commonly in children
  7. Kenalog **
    • Triamcinolone
    • Class: Glucocorticoids (Systemic Steroids)
    • CI: Live vaccines || Serious systemic infections
    • Warnings: must Taper slowly
    • SE: 
    • -- Short-term SE (used <1 mo) == increased appetite or weight gain || fluid retention || emotional instability || insomnia || indigestion || bitter taste || higher doses increase BP and BG
    • -- Long-term SE == Glaucoma, Cataracts || Fat deposits || Pink-purple stretch marks || Growth retardation || Psychiatric changes || HA, Intracranial hypertension, Hypothyroidism || Acne || GI bleeding/esophagitis/ulcers || Diabetes || Poor bone health || Hirsutism  OR Irregular menstrual periods (women only)
  8. Otrexup _ SC **
    Rasuvo _ SC **
    Rheumatrex _ PO **
    Trexall _ PO **
    • Methotrexate (MTX)
    • Class: Traditional (non-biologic) DMARDs
    • Boxed Warnings: Hepatotoxicity || Mucositis/Somatosis
    • CI: pregnancy || breastfeeding || alcoholism
    • SE: varies by route and duration || N/V/B || inc LFTs || Stomatitis || Alopecia || Photosensitivity
    • NOTES: Folate can be given to decrease hematological, GI and hepatic side effects associated with MTX --> give 5 mg PO weekly on the day following MTX administration
    • -- Low WEEKLY doses (never dosed daily for RA)
    • ** FIRST LINE TREATMENT FOR RA **
  9. Plaquenil **
    • Hydroxychloroquine
    • Class: Traditional (non-biologic) DMARDs
    • CI: Retinopathy
    • Warnings: Loss of visual acuity
    • SE: N/V/D || Abd pain || Rash || Pruritus || HA || Vision changes || pigmentation of the skin and hair (rare)
    • Monitoring: Eye exam every 3 months
    • ** Also indicated as Antimalarial agent for SLE -- preferred over chloroquine as it has less side effects ==> takes 6 months to see maximal effect
  10. Azulfidine
    • SulfaSALAzine
    • Class: Traditional (non-biologic DMARDs)
    • CI: sulfa or salicylate allergy
    • Warnings: cause in patients with G6PD deficiency
    • SE: HA || Rash
    • NOTES: can cause Yellow-Orange coloration of skin/urine
    • -- Impairs folate absorption
  11. Arava
    • Leflunomide
    • Class: Traditional (non-biologic) DMARDs
    • NOTES: MUST have negative test prior and use 2 forms of BC -- if pregnancy is desired, must wait 2 years after DC or accelerated drug elimination procedure
    • -- Accelerated Drug Elimination Procedure == 1. Cholestryramine 8 gms PO TID x 11 days (4 gms if 8 gms not tolerated) || 2. Activated Charcoal susp. 50 gm PO Q12H x 11 days
  12. Xeljanz || Xeljanz XR
    • Tofacitinib
    • Class: Traditional (non-biologic) DMARDs
    • NOTES: do NOT use with biologic DMARDs or potent immunosuppressants
    • -- Inhibits Janus Kinase (JAK) enzyme
  13. Traditional (non-biologic) DMARDs (5 drugs)
    • Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
    • Hydroxychloroquine (Plaquenil)
    • SulfaSALAzine (Azulfidine)
    • Leflunomide (Arava)
    • Tofacitinib (Xeljanz)
  14. Tumor Necrosis Factor (TNF-alpha) Inhibitors
    (Anti TNF-alpha Biologics)
    (5 drugs)
    • Etanercept (Enbrel)
    • Adalimumab (Humira)
    • InFLIXimab (Remicade)
    • Certolizumab (Cimzia)
    • Golimumab (Simponi)
    • -- Testing Before Initiating == TB test || HBV tests || WBC count
    • -- Warnings == Liver damage || exacerbation of HF || risk of Infection || Reactivation of Latent TB
  15. Enbrel **
    • Etanercept
    • Class: TNF-alpha Inhibitors (Anti-TNF-alpha Biologics)
    • Boxed Warnings: Serious infections || other malignancies
    • Warnings: Demyelinating disease || Hep B reactivation || HF || Hepatotoxicity || Myelosuppression and Severe infections || DO NOT use with other biological DMARDs or Live Vaccine
    • SE: Infections || Injection site reactions
    • Monitoring: TB test || signs of infection
    • NOTES: do NOT shake or freeze -- refrigerate
    • -- these agents are used as Add-On therapy (unless initial presentation is severe)
    • -- do NOT use Two Biologics concurrently 
    • -- do NOT use Live Vaccines if using these drugs
  16. Humira **
    • Adalimumab
    • Class: TNF-alpha Inhibitors (Anti-TNF-alpha Biologics)
    • Boxed Warnings: Serious infections || other malignancies
    • Warnings: Demyelinating disease || Hep B reactivation || HF || Hepatotoxicity || Myelosuppression and Severe infections || DO NOT use with other biological DMARDs or Live Vaccine
    • SE: Infections || Injection site reactions
    • Monitoring: TB test || signs of infection
    • NOTES: do NOT shake or freeze -- refrigerate
    • -- these agents are used as Add-On therapy (unless initial presentation is severe)
    • -- do NOT use Two Biologics concurrently 
    • -- do NOT use Live Vaccines if using these drugs
  17. Remicade **
    • InFLIXimab
    • Class: TNF-alpha Inhibitors (Anti-TNF-alpha Biologics)
    • Boxed Warnings: Serious infections || other malignancies
    • Warnings: Demyelinating disease || Hep B reactivation || HF || Hepatotoxicity || Myelosuppression and Severe infections || DO NOT use with other biological DMARDs or Live Vaccine
    • SE: Infections || Injection site reactions
    • Monitoring: TB test || signs of infection
    • NOTES: do NOT shake or freeze -- refrigerate
    • -- these agents are used as Add-On therapy (unless initial presentation is severe)
    • -- do NOT use Two Biologics concurrently 
    • -- do NOT use Live Vaccines if using these drugs
    • ** REQUIRES Filter and stable in NS ONLY
    • ** Infusion reactions
    • ** Delayed hypersensitivity reactions (3-12 days after administration)
  18. Cimzia **
    • Certolizumab pegol
    • Class: TNF-alpha Inhibitors (Anti-TNF-alpha Biologics)
    • Boxed Warnings: Serious infections || other malignancies
    • Warnings: Demyelinating disease || Hep B reactivation || HF || Hepatotoxicity || Myelosuppression and Severe infections || DO NOT use with other biological DMARDs or Live Vaccine
    • SE: Infections || Injection site reactions
    • Monitoring: TB test || signs of infection
    • NOTES: do NOT shake or freeze -- refrigerate
    • -- these agents are used as Add-On therapy (unless initial presentation is severe)
    • -- do NOT use Two Biologics concurrently 
    • -- do NOT use Live Vaccines if using these drugs
  19. Simponi **
    • Golimumab
    • Class: TNF-alpha Inhibitors (Anti-TNF-alpha Biologics)
    • Boxed Warnings: Serious infections || other malignancies
    • Warnings: Demyelinating disease || Hep B reactivation || HF || Hepatotoxicity || Myelosuppression and Severe infections || DO NOT use with other biological DMARDs or Live Vaccine
    • SE: Infections || Injection site reactions
    • Monitoring: TB test || signs of infection
    • NOTES: do NOT shake or freeze -- refrigerate
    • -- these agents are used as Add-On therapy (unless initial presentation is severe)
    • -- do NOT use Two Biologics concurrently 
    • -- do NOT use Live Vaccines if using these drugs
    • ** IV requires Filter
  20. Rituxan **
    • RiTUXimab
    • Class: Non-TNF Biologic
    • MOA: depletes CD20 B cells
    • Boxed Warnings: Infusion-related Reactions || Hep B virus reactivation || Screen for HBV and HCV (high risk groups) || SJS/TEN
    • NOTES: pre-medicate with Steroids, Acetaminophen, and an Antihistamine
    • -- Start infusion at 50 mg/hr
    • ** MUST be used in Combination with Methotrexate
  21. Kineret
    • Anakinra
    • Class: Non-TNF Biologic
    • MOA: IL-1 receptor antagonist
    • Warnings: Malignancies || Serious infections || Screen for TB prior to initiating
    • SE: Injection site reaction
    • NOTES: NOT recommended as first line option per guideline
  22. Orencia || Orencia Clickject
    • Abatacept
    • Class: Non-TNF Biologic
    • MOA: Selective T-cell costimulator
    • Warnings: Malignancies || Serious Infections || screen for latent TB and HBV prior to initiating therapy
  23. Actemra
    • Tocilizumab
    • Class: Non-TNF Biologic
    • MOA: IL-6 receptor antagonist
    • Boxed Warning: Serious Infections || screen for latent TB prior to initiating therapy
  24. CellCept **
    • Mycophenolate mofetil
    • **Select cytotoxic agent -- used in severe disease (flares) of Systemic Lupus Erythematosus**
    • -- Off-Label Use
  25. Azasan
    Imuran
    • AzaTHIOprine
    • **Select cytotoxic agent -- used in severe disease (flares) of Systemic Lupus Erythematosus**
    • Warnings: patients with genetic deficiency of Thiopurine Methyltransferase (TPMT) are at increased risk for myelosuppression and may require lower dose
  26. Gengraf **
    Neoral **
    • CycloSPORINE
    • **Select cytotoxic agent -- used in severe disease (flares) of Systemic Lupus Erythematosus**
  27. Copaxone **
    Giatopa **
    • Glatiramer acetate
    • ** Mainstay Treatment option for patients with relapsing forms of MS **
    • SE: injection site reactions || infection || pain || flushing || diaphoresis || dyspnea
    • NOTES: 20 mg SC daily -OR- 40 mg SC 3 times per week
    • -- preferred agent if treatment is necessary during Pregnancy
    • -- refrigeration preferred || store room temp = one month
    • -- if cold -- let stand to room temp for 20 minutes prior to injecting
  28. Avonex || Avonex Pen
    Rebif || Rebif Rebidose
    • Interferon beta-1a
    • ** Mainstay Treatment option for patients with relapsing forms of MS **
    • Warnings: Psychiatric disorders (depression/suicide) || Injection site reactions || increase LFTs || Thyroid dysfunction (hyper and hypo)
    • SE: Flu-like symptoms following administration || Injection site reactions (mild erythema to severe skin reactions)
    • NOTE: Refrigerate --> let stand to room temp before injection 
    • -- do NOT expel small air bubble in pre-filled syringes due to loss of dose
    • **Avonex _ IM weekly || Rebif _ SC TIW
  29. Betaseron
    Extavia
    Betaconnect
    • Interferon beta-1b
    • ** Mainstay Treatment option for patients with relapsing forms of MS **
    • Warnings: Psychiatric disorders (depression/suicide) || Injection site reactions || increase LFTs || Thyroid dysfunction (hyper and hypo)
    • SE: Flu-like symptoms following administration || Injection site reactions (mild erythema to severe skin reactions)
    • NOTE: do NOT refrigerate
    • -- do NOT expel small air bubble in pre-filled syringes due to loss of dose
    • **SC QOD
  30. Plegridy || Plegridy Starter Pack
    • Peginterferon
    • ** Mainstay Treatment option for patients with relapsing forms of MS **
    • Warnings: Psychiatric disorders (depression/suicide) || Injection site reactions || increase LFTs || Thyroid dysfunction (hyper and hypo)
    • SE: Flu-like symptoms following administration || Injection site reactions (mild erythema to severe skin reactions)
    • NOTE: Refrigerate --> let stand to room temp before injectition 
    • -- do NOT expel small air bubble in pre-filled syringes due to loss of dose
    • **SC variable dosing (63 mcg day 1, 94 mcg day 15, 125 mcg every 14 days starting day 29)
  31. Aubagio
    • Teriflunomide
    • ** PO immune modulator -- MS **
  32. Gilenya
    • Fingolimod
    • ** PO immune modulator -- MS **
    • Warnings: Bradycardia (must monitor) || Macular edema
    • SE: HA || diarrhea || Flu-like syndrome || back pain || increased LFTs
    • Monitoring: CBC || ECG || eye exam
    • NOTES: Caution when used with drugs that slow HR
    • -- patient MUST be monitored for 6 hours after the first dose
  33. Benlysta
    • Belimumab
    • Class: IgG1-lambda monoclonal antibody
    • MOA: reduces the activity of B-cell mediated immunity and the autoimmune response
    • Warnings: Serious (sometimes fatal) infections
  34. Tysabri **
    • Natalizumab
    • Monoclonal Antibody
    • Boxed Warning: PML (progressive multifocal encephalopathy)
    • SE: infusion-related reactions || HA || fatigue
    • NOTES: stable in NS ONLY
    • -- REMS - only available through the TOUCH prescribing program
  35. Lemtrada
    • Alemtuzumab
    • Class: Recombinant humanized monoclonal antibody
  36. Zinbryta
    • Daclizumab
    • Class: Recombinant humanized monoclonal antibody
    • Monitor: LFTs (prior to initiation, monthly, up to 6 months after last dose)
  37. Celiac Disease
    • Immune response to eating "Gluten" -- found in wheat, barley, and rye
    • Tx: Avoid Gluten stuffs
    • Drugs -- need to look at Package Inserts for excipient components --> look for key word "starch", which will either be corn, potato, tapioca, wheat ==> if just labeled starch, call manufacturer to find out if the starch is wheat
  38. Restasis **
    • CycloSPORINE Emulsion Eye Drops
    • For the treatment of Dry Eyes in patients who do not have satisfactory relief from other measures (OTC)
    • SE: Burning || stinging || redness || pain || blurred vision
    • NOTES: Remove contact lenses prior to administration -- reinsert after 15 minutes
    • -- Separate from artificial tears by 15 minutes
  39. Xiidra
    • Lifitegrast
    • For the treatment of signs and symptoms of Dry Eye Disease
    • SE: unusual taste
    • NOTES: approved in 2016
  40. Salagen
    Isopto Carpine **
    • Pilocarpine _ PO
    • Pilocarpine ophthalmic == used in glaucoma
    • Class: Muscarinic agonist
    • For the treatment of Dry Mouth when OTC treatments do not provide sufficient relief
  41. Evosac
    • Cevimeline
    • Class: Muscarinic agonist
    • for the treatment of Dry mouth when OTC treatments do not provide sufficient relief
  42. Selected Drugs Associated With Drug-Induced Lupus Erythematosus (DILE)
    • Anti-TNF agents (Retuximab, Anakinra, Abatacept, Tocilizumab)
    • Diltiazem
    • Hydralazine (alone and in BiDil)
    • Isoniazid
    • Methyldopa
    • Methimazole
    • Procainamide
    • Propylthiouracil
    • Quinidine
    • Terbinafine

Card Set Information

Author:
HNguyen0287
ID:
334463
Filename:
NAPLEX _ Systemic Steroids & Autoimmune Conditions
Updated:
2017-09-24 01:31:54
Tags:
Naplex RxPREP Steroids
Folders:
RxPREP
Description:
RxPREP _ NAPLEX review - Systemic Steroids & Autoimmune Conditions -- Brand/Generics
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