SLE is an ______ disease.

Autoimmune

SLE is characterized by the presence of _______.

Autoantibodies (aAb)

______ are the cause of the pathogenesis of disease in SLE.

Autoantibodies (aAb)

T/F: The treatment approach for SLE is individualized for each patient?

True

What is the main hallmark of SLE?

Positive Anti-nuclear antibodies (ANA)

Which antigens are implicated in SLE?

- dsDNA
- Histone
- Sm antigen
- RPN
- SS-A/Ro
- SS-B/La

Which antigen associated with SLE can be due to drug-induced LE?

Histone

Diagnosis of SLE must contain at least 4 of the following:

- Malar rash
- Discoid rash
- Positive ANA
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis
- Kidney disease
- Neurologic disorder
- Hematologic disorder
- Positive antibodies

What are some GI manifestations of SLE?

- Abdominal pain
- Dyspepsia
- Pancreatitis
- Abnormal liver enzymes

Which drugs have a definite drug association with SLE?

- Hydralazine
- Procainamide
- Minocycline
- Chlorpromazine
- Isoniazid
- Penicillamine
- Methyldopa
- Interferon-alpha

What are the main groups of drugs used in the treatment of SLE?

- NSAIDs
- Corticosteroids
- Antimalarials
- Immunosuppressives
- Immunoglobular antimetabolites
- Biologic agents

Which drug is the first line agent for arthritis, musculoskeletal pain, fever and serositis?

NSAIDs

What is the general MOA of NSAIDs?

COX inhibition

What are some side effects of NSAIDs?

- Hepatotoxicity
- GI bleeding
- Aseptic meningitis
- Complications in detecting lupus
- Nephritis

Relatively low doses of ______ are used to treat arthritis, cutaneous manifestations and serositis?

Cortiocosteroids

Relatively high doses of cortiocosteroids are used to treat ______, _____, _____, and _____ in SLE.

Nephritis
Cerebritis
Hematologic abnormalities
Vasculitis

What is the mainstay in therapy during pregnancy for SLE?

Corticosteroids

What are some side effects of cortiocosteroids?

- Osteonecrosis
- Hyperglycemia
- Hyperlipidemia
- Osteoporosis

Which antimalarial drug is used in the treatment of SLE?

Hydroxychloroquine

Hydroxychlorquine is used to prevent ______ in SLE.

Flares

What is the MOA of hydroxychloroquine?

- Increases the pH of lysosomes from 4 to 6
- Decreases immune cell functioning
- Inhibits MHCII association with self-proteins

What are some side effects of antimalarials in SLE?

- Antithrombotic effects
- Lipid lowering effects
- Macular damage

Immunosuppressive act as anti-________.

Proliferative

Mycophenolate mofetil (MMP) is a ______ to improve oral bioavailability.

Prodrug

Mycophenolate is marketed as ______.

CellCept

Mycophenolate sodium is marketed as _____.

Myfortic

What is the MOA of mycophenolic acid?

Reversibly inhibits inosine monophosphate dehydrogenase

Inosine monophosphate dehydrogenase controls the synthesis of ____ in the de novo pathway of ______ biosynthesis.

GMP
Purine

_____, _____, and _____ are immunosuppressants that inhibits T-cell and B-cell proliferation.

Cyclosporine
Tacrolimus
Rapamycin

Cyclophosphamide is an _______ agent.

Alkylating

_______ interferes with DNA replication by intra-strand DNA cross-links.

Cyclophosphamide

_______ is commonly used to treat severe organ system disease and nephritis in SLE.

Cyclophosphamide

What are some side effects of cyclophosphamide?

- Passes through placenta and into breast milk
- Hemorrhagic cystitis
- Bladder/gonadal toxicity

Which immunosuppressant is preferred in pregnancy?

MMF

Which drug can be used to prevent bladder/gonadal toxicity associated with cyclophosphamide?

Mesna
(2-mercaptoethane sulfonate Na)

What immunomodulator antimetabolies are used in the treatment of SLE?

Azathiopurine
Mercaptopurine

Immunomodulator antimetabolies most strongly affect the proliferation of ____ and ____ cells.

T
B

Azathiopurine is a prodrug that is metabolized into _______.

Mercaptopurine

What are the uses of immunomodulator antimetabolites in SLE?

Steroid sparing
Useful in non-renal manifestations of SLE

What are some side effects of the immunomodulator antimetabolites?

- Bone marrow toxicity
- GI toxicity
- Monitor for signs of infection, sore throat
- Liver/pancreas toxicity

Which biologic agents are used in the treatment of SLE?

Belimumab
Rituximab
Tocilizumab
Infliximab

Belimumab is an anti- _______ agent.

BLyS

Rituximab is an anti- ______ agent.

CD20

Tocilizumab is an anti-______ agent.

IL-6R

Infliximab is an anti-_____ agent.

TNF-a