Sle body meds.onome


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Sle body meds.onome

  1. 1. Onome Whiteru, MDFellow, Division of RheumatologyAlbert Einstein College of MedicineGet into the Loop!New York City Hospital Tour 2013Annual Lupus Patient Education Series
  2. 2.  You may have wondered: “Why am I taking all of these medications inthe first place.” You may have felt: “I am tired of taking all of these pills” You may been concerned about medicationside effects.
  3. 3.  Because its your body! Lupus can affect your body in so many ways! We will talk about the ways lupus canpossibly affect your body. Then we will go over the medications forlupus and how they can help to protect yourbody.
  4. 4.  Autoimmune disease: Caused by an over-active immune system Your immune system begins to attack your ownbody. Certain genes are more likely to occur in patientswith lupus Many of these genes involve parts of the immunesystem.
  5. 5.  Female:Male ratio of 9:1 during childbearingyears Closer to 2:1 during childhood and aftermenopause, suggesting hormonal influence Disease in males can be more severe 70% of SLE: females between ages 15-45 10% present age >60
  6. 6.  Highest occurrence is in Afro-Caribbeanfemales 1:250 African American to Caucasian ratio 3:1 Child of SLE mother - risk of SLE 7% 10-15% of SLE patients have 1st degreerelative with SLE
  7. 7.  Lupus can be controlled with treatment and insome instances can go into remission. 90% survive 5 years, 80% 10 years Lupus kidney disease worsens prognosis African Americans have more aggressive andtreatment resistant disease 2 different causes of death: Early: disease activity and infections Late: due to long-term disease and treatment
  8. 8.  Skin Brain and Nerves Heart Lungs GI system Kidneys Joints Blood
  9. 9.  MALAR RASH: Fixed red, flat orraised, over the bridge ofthe nose and cheeks Tends to spare thenasolabial folds Discoid lupus: Red or dark patches ofinflammation and scarring Tends to occur on theface, ears, and scalp
  10. 10.  Ulcers in theMouth and Nose: Usually painless Hair Thinning:
  11. 11.  Mood Changes and Psychosis Trouble with memory Severe unending headache Strokes and Seizures Vasculitis-inflammation ofblood vessels of the brain Neuropathy-tingling, burningsensation on body Myelitis- inflammation of thespinal cord causing paralysis
  12. 12.  Heart: Pericarditis- inflammation of thethin lining around the heart Pericardial effusion- fluid build uparound the heart Myocarditis- inflammation of theheart muscleUniversity of Michigan: Lungs: Pleuritis- inflammation of thelining around the lung Pleural effusions- fluid build uparound the lungCleveland Clinic:
  13. 13.  GI System: Belly pain, nausea, vomiting,diarrhea Peritonitis-inflammation of thelining around the abdomen Intestinal vasculitis-inflammation of the bloodvessels with blockage of bloodflow to the intestines Joints: Found in 80% of patients Pain, warmth, swelling andstiffness of the joints. Usually non-erosive Can move deformed fingersback into position
  14. 14.  Kidneys: Inflammation of the kidneys isknown as nephritis A serious complication of lupus A leading cause of death in lupusin the first 10 years of disease Patients can notice foamy/bubblyurine in the commode at home. People will usually have nosymptoms of lupus kidneydisease. Your doctor will run testson your urine. The blood: Anemia Low white blood cells Low
  15. 15.  Malar (Butterfly) Rash Discoid Rash Sensitivity rash to thesun (Photosensitivity) Ulcers in the nose andmouth Arthritis Fluid around theheart, lungs and inthe abdomen Lupus kidney disease Neurologic Disorders: Stroke, inflammation,depression, memorydysfunction, etc… Anemia, low plateletsand low white bloodcell count Abnormal bloodantibody levels ANA blood test
  16. 16.  Affects of lupus are harmful to your body Some complications of lupus are lifethreatening This is why your medications for lupus are soimportant: Your medications protect your body from theharmful and even life threatening affects oflupus.
  17. 17. Active treatment Preventative Treatment Topical Steroids NSAIDs: Advil, Mobic, Naproxen Antimalarials: Plaquenil Steroids: Prednisone, Medrol Cytotoxics/Biologics: Cellcept, Cytoxan, Methotrexate, Imuran, Benlysta Sunscreen At least SPF 30 Calcium, VitaminD, Folate supplements To help prevent SE fromother medications Influenza Vaccine PneumococcalVaccine
  18. 18.  Typically use both oral and IV steroid in lupusdepending on the severity of manifestation Oral: Prednisone Medrol IV: Solu-medrol
  19. 19.  Very potent anti-inflammatory drugs. Not only anti-inflammatory but also suppressthe immune system. Work very quickly by blocking the formationof inflammatory proteins. Also promote action of anti-inflammatoryproteins.
  20. 20.  Acute Lupus flare Active Lupus kidney disease Acute active Lupus of the nervous system Acute anemias Resistent fluid around the heart, lungs or inthe abdomen Inflammation of the blood vessels Severe fever, fatigue, weight loss, arthritis,etc.
  21. 21.  Increased appetite Fluid retention Weight gain High Blood Pressure High cholesterol Diabetes Stomach ulcers Cataracts Osteoporosis Anxiety/Psychosis
  22. 22.  Monitoring: Important to follow blood pressure andcholesterol Check bone density for bone loss Calcium and vitamin D May need alendronate Healthy diet to help weight gain and diabetes Medicines like omeprazole to help preventstomach ulcers Frequent eye exams
  23. 23.  Also known as Plaquenil Old medication used to treat malaria Accumulates in the cell interfering with therecognition of self proteins Used as a preventative agent Decreases the risk of flare Lowers risk of permanent damage Also used for joint and skin manifestations
  24. 24.  Typically a well tolerated medication Safe to use during pregnancy; probably helpswith disease activity Side effects include: Anemias Visual changes Retinal problems Certain rashes and skin discoloration
  25. 25.  Monitoring: Most side effects are quite rare Recommend frequent eye exams
  26. 26.  Other common names: Imuran and Azasan Decreases immune cells from proliferating bystop DNA production in the cells Typically used to treat moderate to severemanifestations of lupus: Maintenance of lupus kidney disease Anemias including low platelets and blood cellcounts Arthritis
  27. 27.  Small studies show that the risk for fetalabnormalities is low when used in pregnancy Side effects: Anemias Infection Liver inflammation Pancreatitis Lymphoma
  28. 28.  Monitoring: Before starting medication should check forinfections like hepatitis B/C and HIV, Requires frequent blood tests to monitor foranemias, and liver inflammation Vaccination to prevent common infections Typically do not screen for lymphoma unlessthere are concerning symptoms
  29. 29.  Other common names: Rheumatrex, Trexall Used as a chemotherapy in much higher doses Inhibits folic acid metabolism in cells as well ascauses release of adenosine which is anti-inflammatory Typically used to treat the arthritis componentof lupus especially if presenting like rheumatoidarthritis Must take with folic acid to prevent side effects
  30. 30.  Methotrexate cannot be taken duringpregnancy and can cause fetal abnormalitiesand miscarriage Must stop methotrexate and allow for washout before getting pregnant Side effects: Mouth ulcers Anemias Infections Liver inflammation Lung fibrosis Hair loss
  31. 31.  Monitoring: Before starting medication should check forhepatitis, HIV, PPD Check baseline chest x-ray Frequent blood tests for anemia and liverinflammation
  32. 32.  Other common name: Cellcept Mycophenolate mofetil: inhibits a moleculecalled inosine monophosphatedehydrogenase, inhibiting DNA and cellmultiplication Typically used for lupus kidney disease as well asrefractory cytopenias, vasculitis
  33. 33.  Side effects: Nausea/vomiting Upset stomach Diarrhea Anemias Infections Lymphomas Mycophenolate is not safe during pregnancyand has been proven to cause birth defects Patients should be off of this medicationbefore getting pregnant
  34. 34.  Monitoring: Frequent blood test to look anemias and any liveror kidney problems Work up any signs of infection Aggressive vaccinations to avoid commoninfections
  35. 35.  Other common name: Cytoxan Cyclophosphamide works by causing changesto DNA so that inflammatory cells cannotmultiply Typically used for the most severemanifestations of Lupus: Lupus kidney disease Lupus of the nervous system Severe vasculitis Severe refractory anemias
  36. 36.  Cyclophosphamide can be given either IV ororally but is a chemotherapeutic agent Side effects: Nausea/Vomiting Hair loss Anemias Infections Inflammation of the bladder Infertility Cyclophosphamide is not safe during pregnancy.Can cause birth defects and fetal loss. Must be off medication before getting pregnant
  37. 37.  Monitoring: Aggressive hydration and the medication MESNAto help prevent bladder issues Anti-nausea medication Frequent blood tests especially to monitor foranemias Lupron monthly to help limit infertility Immunizations
  38. 38.  Other common name: Benlysta Is given as monthly IV infusions In an antibody that inhibits the moleculeBAFF BAFF stimulates B cell production: the cells thatchurn out auto-antibodies in lupus that can causedamage Used to: Help get patients off of their steroids Particularly effective for the skin and arthritismanifestations of lupus
  39. 39.  Side effects: Infection Allergy Infusion reaction It is unknown what the risk to the fetus isduring pregnancy Monitoring: Frequent labs Vaccines and avoidance of infection
  40. 40.  Irene Blanco, MD Yasmin Santiago Our Audience!