This document provides an overview of lupus, a chronic autoimmune disease that can affect multiple organs and tissues. It discusses the epidemiology of lupus, noting it primarily affects women and is more common in certain ethnic groups. The pathogenesis involves a genetic predisposition interacting with environmental triggers that result in an abnormal immune response attacking the body's own tissues. Symptoms and organ involvement can vary widely between patients. Diagnosis is based on meeting several criteria that may include rashes, arthritis, kidney disease, neurological issues, and positive antibody tests. Treatment depends on disease severity and organ involvement, ranging from lifestyle changes to immunosuppressive drugs and corticosteroids. Lupus nephritis, or kidney involvement,
Lupus is a chronic autoimmune disease that can damage any part of the body. It occurs when the immune system attacks its own tissues and organs. Common symptoms include joint pain, skin rashes, fatigue, and organ inflammation. A diagnosis requires four of eleven specific criteria to be present over time. Approximately 1.5 million Americans have lupus, most of whom are women ages 15-45. Treatment focuses on managing flare-ups and involves corticosteroids, antimalarials, and other medications tailored to individual symptoms. Accommodations for lupus patients in school may include reduced activity, sun protection, and memory aids.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs in the body. It is more common in women, especially of childbearing age, and in African Americans. The disease is characterized by autoantibody production and tissue damage caused by immune complexes. Diagnosis is based on meeting criteria from the SLICC classification system, which improved upon previous criteria. Organ manifestations include renal, neurological, cardiac, pulmonary, hematological and cutaneous involvement. Management aims to suppress symptoms and prevent organ damage through medications like glucocorticoids, antimalarials, immunosuppressants and biologics. The goal is complete remission though sustained remission is rare
Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune disease characterized by excessive autoantibody production leading to tissue damage. It has a wide variety of clinical manifestations that can affect many different organ systems. Some key points:
- SLE predominantly affects women of childbearing age and has a strong genetic component. Certain genetic and environmental factors can increase risk.
- Clinical features include skin rashes, arthritis, kidney involvement ranging from mild proteinuria to severe nephritis, neurological/psychiatric symptoms, hematological abnormalities and involvement of other organs.
- Diagnosis is based on identifying a combination of clinical and laboratory criteria including high titers of antinu
Henoch-Schönlein purpura (HSP) is a systemic vasculitis that commonly affects children. It is characterized by palpable purpura, arthritis or arthralgias, abdominal pain, and renal involvement. HSP is likely an immune-complex mediated disease caused by infections, drugs, or other antigens. It typically resolves on its own within 1-6 weeks but can occasionally lead to long-term kidney damage. Treatment involves symptom management, though steroids have not been proven effective.
Lupus is a chronic autoimmune disease that occurs when a person's immune system attacks their own tissues and organs. Learn about the symptoms of lupus, how it is diagnosed and new treatment options to live well with lupus.
Chronic excessive alcohol consumption can lead to three major forms of alcoholic liver disease: fatty liver, alcoholic hepatitis, and cirrhosis. Fatty liver affects over 90% of heavy drinkers. Some heavy drinkers may progress to alcoholic hepatitis, which is thought to be a precursor to cirrhosis. The risk factors for developing alcoholic liver disease include quantity and duration of alcohol intake, with higher amounts and longer durations increasing risk. Additional risk factors such as gender, hepatitis C infection, and genetics can also influence progression of alcoholic liver disease once fatty liver has developed.
This document discusses multisystem autoimmune disease, also known as systemic lupus erythematosus (SLE). SLE is characterized by the failure to maintain self-tolerance, resulting in an unpredictable and relapsing disease that commonly affects the skin, kidneys, serosal membranes, joints, and heart. Diagnosis requires 4 of several criteria during any observation period, and it is more common in women and black Americans. The pathogenesis involves abnormal self-reactive antibodies against nuclear and cytoplasmic antigens such as Sm/RNP and dsDNA. Complications can include renal disease, skin changes, splenic abnormalities, and Libman-Sacks endocarditis - characterized by nonbacterial vegetations in the heart
Felty's syndrome is a rare condition characterized by rheumatoid arthritis, neutropenia, and splenomegaly. It affects around 1-3% of rheumatoid arthritis patients, predominantly women aged 50-70 years. The cause involves autoantibodies that cause neutrophil destruction and inhibit granulopoiesis. Treatment focuses on controlling the underlying rheumatoid arthritis with medications like methotrexate as well as G-CSF or splenectomy to address the neutropenia and splenomegaly. Complications can include life-threatening infections.
Lupus is a chronic autoimmune disease that can damage any part of the body. It occurs when the immune system attacks its own tissues and organs. Common symptoms include joint pain, skin rashes, fatigue, and organ inflammation. A diagnosis requires four of eleven specific criteria to be present over time. Approximately 1.5 million Americans have lupus, most of whom are women ages 15-45. Treatment focuses on managing flare-ups and involves corticosteroids, antimalarials, and other medications tailored to individual symptoms. Accommodations for lupus patients in school may include reduced activity, sun protection, and memory aids.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs in the body. It is more common in women, especially of childbearing age, and in African Americans. The disease is characterized by autoantibody production and tissue damage caused by immune complexes. Diagnosis is based on meeting criteria from the SLICC classification system, which improved upon previous criteria. Organ manifestations include renal, neurological, cardiac, pulmonary, hematological and cutaneous involvement. Management aims to suppress symptoms and prevent organ damage through medications like glucocorticoids, antimalarials, immunosuppressants and biologics. The goal is complete remission though sustained remission is rare
Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune disease characterized by excessive autoantibody production leading to tissue damage. It has a wide variety of clinical manifestations that can affect many different organ systems. Some key points:
- SLE predominantly affects women of childbearing age and has a strong genetic component. Certain genetic and environmental factors can increase risk.
- Clinical features include skin rashes, arthritis, kidney involvement ranging from mild proteinuria to severe nephritis, neurological/psychiatric symptoms, hematological abnormalities and involvement of other organs.
- Diagnosis is based on identifying a combination of clinical and laboratory criteria including high titers of antinu
Henoch-Schönlein purpura (HSP) is a systemic vasculitis that commonly affects children. It is characterized by palpable purpura, arthritis or arthralgias, abdominal pain, and renal involvement. HSP is likely an immune-complex mediated disease caused by infections, drugs, or other antigens. It typically resolves on its own within 1-6 weeks but can occasionally lead to long-term kidney damage. Treatment involves symptom management, though steroids have not been proven effective.
Lupus is a chronic autoimmune disease that occurs when a person's immune system attacks their own tissues and organs. Learn about the symptoms of lupus, how it is diagnosed and new treatment options to live well with lupus.
Chronic excessive alcohol consumption can lead to three major forms of alcoholic liver disease: fatty liver, alcoholic hepatitis, and cirrhosis. Fatty liver affects over 90% of heavy drinkers. Some heavy drinkers may progress to alcoholic hepatitis, which is thought to be a precursor to cirrhosis. The risk factors for developing alcoholic liver disease include quantity and duration of alcohol intake, with higher amounts and longer durations increasing risk. Additional risk factors such as gender, hepatitis C infection, and genetics can also influence progression of alcoholic liver disease once fatty liver has developed.
This document discusses multisystem autoimmune disease, also known as systemic lupus erythematosus (SLE). SLE is characterized by the failure to maintain self-tolerance, resulting in an unpredictable and relapsing disease that commonly affects the skin, kidneys, serosal membranes, joints, and heart. Diagnosis requires 4 of several criteria during any observation period, and it is more common in women and black Americans. The pathogenesis involves abnormal self-reactive antibodies against nuclear and cytoplasmic antigens such as Sm/RNP and dsDNA. Complications can include renal disease, skin changes, splenic abnormalities, and Libman-Sacks endocarditis - characterized by nonbacterial vegetations in the heart
Felty's syndrome is a rare condition characterized by rheumatoid arthritis, neutropenia, and splenomegaly. It affects around 1-3% of rheumatoid arthritis patients, predominantly women aged 50-70 years. The cause involves autoantibodies that cause neutrophil destruction and inhibit granulopoiesis. Treatment focuses on controlling the underlying rheumatoid arthritis with medications like methotrexate as well as G-CSF or splenectomy to address the neutropenia and splenomegaly. Complications can include life-threatening infections.
1. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of auto-antibodies against components of the cell nucleus.
2. SLE affects multiple organ systems and is more common in females, with a female to male ratio of 9:1 before puberty.
3. Diagnosis of SLE requires meeting 4 out of 11 American College of Rheumatology diagnostic criteria, including at least 1 clinical and 1 immunological criterion. Common clinical manifestations include malar rash, arthritis, renal disease, and hematological abnormalities.
- Systemic Lupus Erythematosus (SLE) is an incurable, multisystemic autoimmune disease that predominantly affects women and has variable rates of median age of onset depending on ethnicity.
- SLE can affect many different body systems and has a variety of potential symptoms and complications, including renal, neurological, and hematological manifestations.
- Treatment involves managing symptoms with medications like hydroxychloroquine, corticosteroids, immunosuppressants, and emerging therapies targeting B cells and cytokines.
This patient has longstanding SLE with quiescent disease activity currently. She has a history of fetal loss and blood clots while pregnant previously. She is seeking contraceptive options other than barrier methods. Given her history of APL antibodies and blood clots, progesterone-only contraceptives like the progesterone IUD or depot medroxyprogesterone would be safest options to avoid estrogen which could increase her risk for further clotting issues.
This document summarizes a study on lupus nephritis. It begins by explaining that lupus nephritis is a disease caused by systemic lupus erythematosus (SLE) that results in kidney inflammation. It then discusses the pathogenesis of lupus nephritis, including genetic factors, immune system activation by nuclear particles, and lymphocyte expansion. Symptoms, diagnosis, and treatment options are also outlined, including corticosteroids, immunosuppressive drugs, managing blood pressure, and dialysis or kidney transplantation in severe cases. The conclusion states that lupus nephritis remains a major SLE complication but improved understanding of its causes and management have led to more effective therapies.
IgA nephropathy is characterized by predominant IgA deposition in the glomerular mesangium. It is the most common cause of glomerulonephritis worldwide. Primary IgA nephropathy occurs most commonly in the second and third decades of life and presents with macroscopic hematuria, asymptomatic hematuria with mild proteinuria, or nephrotic syndrome. Treatment involves controlling blood pressure with ACE inhibitors or ARBs, treating any proteinuria or hematuria, and considering corticosteroids for progressive disease. The pathogenesis involves abnormal IgA immune responses leading to pathogenic IgA deposition in the kidney and subsequent glomerular inflammation and injury.
This document discusses systemic lupus erythematosus (SLE), an autoimmune disease where organs and cells are damaged by autoantibodies and immune complexes. It covers the etiology, pathogenesis, clinical manifestations, diagnosis, and management of SLE. Key points include that SLE affects multiple organ systems and has varied clinical presentations. Diagnosis is based on meeting 4 out of 11 American College of Rheumatology criteria including positive antinuclear antibodies and anti-dsDNA antibodies. Treatment involves managing symptoms across organ systems with medications like steroids, hydroxychloroquine, immunosuppressants, and targeting specific organ involvement. The goal is to control disease activity, prevent organ damage, and improve quality of life.
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. Some key points:
- IBD results from a combination of genetic and immunological factors. Several genes have been identified that increase risk of developing IBD, including NOD2 for Crohn's.
- Ulcerative colitis is limited to the colon and rectum, while Crohn's can affect any part of the GI tract and is typically transmural.
- Histologically, ulcerative colitis shows continuous mucosal inflammation while Crohn's is discontinuous with features like granulomas and cobblestoning.
- The role of the microbiome
This document provides information on membranoproliferative glomerulonephritis (MPGN), including its classification, pathogenesis, clinical presentation, pathology, and treatment. MPGN is classified based on immunofluorescence and electron microscopy findings. It can be immune-mediated via immune complex deposition or complement-mediated via dysregulation of the alternative complement pathway. On pathology, it is characterized by thickened glomerular basement membranes, mesangial hypercellularity, and endocapillary proliferation. Clinical presentation varies from asymptomatic to nephrotic syndrome or renal failure.
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by abnormal autoantibodies and polyclonal B-cell activation. It presents with a variety of clinical manifestations ranging from mild skin and joint involvement to more severe organ damage. Diagnosis is based on meeting 4 out of 17 revised classification criteria by the Systemic Lupus International Collaborating Clinics (SLICC), including both clinical and immunological criteria. Treatment involves hydroxychloroquine, corticosteroids, immunosuppressants, and newer biologics to reduce disease activity and prevent organ damage, the leading cause of mortality in SLE patients. Future therapies are focused on biomarkers and more targeted immunomod
Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. It typically affects young women and is characterized by periods of disease flares and remissions. While the exact cause is unknown, genetic and environmental factors likely contribute to abnormal immune system functioning and production of autoantibodies. Common clinical manifestations include malar rash, arthritis, kidney problems, and hematological abnormalities. Diagnosis involves identifying clinical features and detecting autoantibodies such as antinuclear antibodies and anti-dsDNA antibodies. With proper management, 10-year survival rates are over 90%.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs in the body. Common symptoms include fatigue, joint pain, rashes, and kidney problems. It is caused by genetic and environmental factors that lead to abnormal immune responses against the body's own tissues. Diagnosis involves evaluating clinical features along with blood tests to detect autoantibodies. Treatment depends on the specific organs involved but may include medications to suppress the immune system.
Metabolic Liver Disease definitions by Dr. Ashish BavdekarSanjeev Kumar
This document discusses metabolic liver disease (MLD), including:
1. MLDs can be classified based on their effects, ranging from no harm to the liver to significant liver injury.
2. Data from Indian hospitals shows MLD cases are increasing and now represent a significant portion of liver diseases seen.
3. MLDs can present early in infancy with features like galactosemia, tyrosinemia, or cystic fibrosis or later with glycogen storage disease, Wilson's disease, or lipid storage disorders.
4. Diagnosing MLD can be challenging due to non-specific signs, genetic heterogeneity, and lack of diagnostic facilities in some areas.
Module: Pharmacotherapy III
Module Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value.
Sickle cell anemia is a genetic blood disorder caused by a mutation in the beta-globin gene that results in abnormal hemoglobin. The red blood cells take on a sickle shape, which can cause them to block small blood vessels and obstruct blood flow. This document discusses the inheritance pattern, genetics, mechanism of sickling, signs and symptoms, complications, diagnosis, and treatment of sickle cell anemia. Treatment aims to prevent crises and complications through medications, blood transfusions, and potentially a bone marrow transplant to cure the disease.
download link : https://www.dropbox.com/s/xc0fpdul47g1gu8/IgA%20Nephropathy.ppt?m
Join us on our facebook group: NephroTube...............Follow our blog: www.nephrotube.blogspot.com
The document provides an update on vasculitis, including definitions, classifications of different types based on vessel size, pathogenesis involving inflammation of blood vessels, clinical signs and symptoms depending on type of vasculitis, and treatments focusing on glucocorticoids and immunosuppressants. Specific vasculitic syndromes discussed in more detail include giant cell arteritis, Takayasu arteritis, and Wegener's granulomatosis.
Anemia is common in patients with diabetes mellitus and chronic kidney disease. Erythropoietin production by the kidneys regulates red blood cell production but is deficient in kidney disease, leading to anemia. Three case studies describe patients with diabetes and various degrees of anemia and kidney impairment. The document discusses the pathogenesis, evaluation, and management of anemia in diabetes, including the role of erythropoietin deficiency and treatment targets. It concludes regular anemia screening and early treatment can help prevent complications in diabetes patients.
The document provides an overview of chronic leukemias, focusing on chronic myeloid leukemia (CML). It defines CML and describes its epidemiology, etiology, pathogenesis, clinical presentation, diagnosis, and treatment. CML results from a genetic abnormality that fuses the BCR and ABL genes. It progresses through chronic, accelerated, and blast crisis phases if left untreated. Treatment options include stem cell transplantation, chemotherapy with tyrosine kinase inhibitors like imatinib, and management of symptoms.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can damage any body organ by generating autoantibodies and immune complexes. It predominantly affects women aged 15-65 and has the highest prevalence in African-American and Afro-Caribbean women. While the cause is unknown, genetic, environmental, and hormonal factors likely play a role. Symptoms vary but can include rashes, fatigue, joint pain, and organ involvement. Diagnosis involves clinical criteria and serological markers. Treatment focuses on controlling disease activity and inflammation using medications like NSAIDs, antimalarials, corticosteroids, and immunosuppressants.
Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It is more common in children than adults, with an incidence of 2-3 per 100,000 children per year. The majority of cases are idiopathic, with minimal change disease being the most common cause. Treatment involves corticosteroids as first line therapy, with additional immunosuppressants used for frequent relapses or steroid dependence. Complications can include edema, infections due to loss of immune factors in urine, thrombotic events, and acute renal failure.
Systemic lupus erythematosus (SLE) is an autoimmune disease most common in women of childbearing age. It can affect multiple organ systems. Common manifestations include fatigue, arthritis, rashes, hematologic abnormalities, and kidney involvement. The diagnosis is based on clinical features and autoantibodies. Treatment involves medications to reduce inflammation and suppress the immune system such as antimalarials, corticosteroids, immunosuppressants. Lupus nephritis requires aggressive therapy with corticosteroids and immunosuppressants like cyclophosphamide or mycophenolate mofetil. Research is ongoing into more targeted biologic therapies.
1. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of auto-antibodies against components of the cell nucleus.
2. SLE affects multiple organ systems and is more common in females, with a female to male ratio of 9:1 before puberty.
3. Diagnosis of SLE requires meeting 4 out of 11 American College of Rheumatology diagnostic criteria, including at least 1 clinical and 1 immunological criterion. Common clinical manifestations include malar rash, arthritis, renal disease, and hematological abnormalities.
- Systemic Lupus Erythematosus (SLE) is an incurable, multisystemic autoimmune disease that predominantly affects women and has variable rates of median age of onset depending on ethnicity.
- SLE can affect many different body systems and has a variety of potential symptoms and complications, including renal, neurological, and hematological manifestations.
- Treatment involves managing symptoms with medications like hydroxychloroquine, corticosteroids, immunosuppressants, and emerging therapies targeting B cells and cytokines.
This patient has longstanding SLE with quiescent disease activity currently. She has a history of fetal loss and blood clots while pregnant previously. She is seeking contraceptive options other than barrier methods. Given her history of APL antibodies and blood clots, progesterone-only contraceptives like the progesterone IUD or depot medroxyprogesterone would be safest options to avoid estrogen which could increase her risk for further clotting issues.
This document summarizes a study on lupus nephritis. It begins by explaining that lupus nephritis is a disease caused by systemic lupus erythematosus (SLE) that results in kidney inflammation. It then discusses the pathogenesis of lupus nephritis, including genetic factors, immune system activation by nuclear particles, and lymphocyte expansion. Symptoms, diagnosis, and treatment options are also outlined, including corticosteroids, immunosuppressive drugs, managing blood pressure, and dialysis or kidney transplantation in severe cases. The conclusion states that lupus nephritis remains a major SLE complication but improved understanding of its causes and management have led to more effective therapies.
IgA nephropathy is characterized by predominant IgA deposition in the glomerular mesangium. It is the most common cause of glomerulonephritis worldwide. Primary IgA nephropathy occurs most commonly in the second and third decades of life and presents with macroscopic hematuria, asymptomatic hematuria with mild proteinuria, or nephrotic syndrome. Treatment involves controlling blood pressure with ACE inhibitors or ARBs, treating any proteinuria or hematuria, and considering corticosteroids for progressive disease. The pathogenesis involves abnormal IgA immune responses leading to pathogenic IgA deposition in the kidney and subsequent glomerular inflammation and injury.
This document discusses systemic lupus erythematosus (SLE), an autoimmune disease where organs and cells are damaged by autoantibodies and immune complexes. It covers the etiology, pathogenesis, clinical manifestations, diagnosis, and management of SLE. Key points include that SLE affects multiple organ systems and has varied clinical presentations. Diagnosis is based on meeting 4 out of 11 American College of Rheumatology criteria including positive antinuclear antibodies and anti-dsDNA antibodies. Treatment involves managing symptoms across organ systems with medications like steroids, hydroxychloroquine, immunosuppressants, and targeting specific organ involvement. The goal is to control disease activity, prevent organ damage, and improve quality of life.
This document provides an overview of inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease. Some key points:
- IBD results from a combination of genetic and immunological factors. Several genes have been identified that increase risk of developing IBD, including NOD2 for Crohn's.
- Ulcerative colitis is limited to the colon and rectum, while Crohn's can affect any part of the GI tract and is typically transmural.
- Histologically, ulcerative colitis shows continuous mucosal inflammation while Crohn's is discontinuous with features like granulomas and cobblestoning.
- The role of the microbiome
This document provides information on membranoproliferative glomerulonephritis (MPGN), including its classification, pathogenesis, clinical presentation, pathology, and treatment. MPGN is classified based on immunofluorescence and electron microscopy findings. It can be immune-mediated via immune complex deposition or complement-mediated via dysregulation of the alternative complement pathway. On pathology, it is characterized by thickened glomerular basement membranes, mesangial hypercellularity, and endocapillary proliferation. Clinical presentation varies from asymptomatic to nephrotic syndrome or renal failure.
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by abnormal autoantibodies and polyclonal B-cell activation. It presents with a variety of clinical manifestations ranging from mild skin and joint involvement to more severe organ damage. Diagnosis is based on meeting 4 out of 17 revised classification criteria by the Systemic Lupus International Collaborating Clinics (SLICC), including both clinical and immunological criteria. Treatment involves hydroxychloroquine, corticosteroids, immunosuppressants, and newer biologics to reduce disease activity and prevent organ damage, the leading cause of mortality in SLE patients. Future therapies are focused on biomarkers and more targeted immunomod
Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. It typically affects young women and is characterized by periods of disease flares and remissions. While the exact cause is unknown, genetic and environmental factors likely contribute to abnormal immune system functioning and production of autoantibodies. Common clinical manifestations include malar rash, arthritis, kidney problems, and hematological abnormalities. Diagnosis involves identifying clinical features and detecting autoantibodies such as antinuclear antibodies and anti-dsDNA antibodies. With proper management, 10-year survival rates are over 90%.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs in the body. Common symptoms include fatigue, joint pain, rashes, and kidney problems. It is caused by genetic and environmental factors that lead to abnormal immune responses against the body's own tissues. Diagnosis involves evaluating clinical features along with blood tests to detect autoantibodies. Treatment depends on the specific organs involved but may include medications to suppress the immune system.
Metabolic Liver Disease definitions by Dr. Ashish BavdekarSanjeev Kumar
This document discusses metabolic liver disease (MLD), including:
1. MLDs can be classified based on their effects, ranging from no harm to the liver to significant liver injury.
2. Data from Indian hospitals shows MLD cases are increasing and now represent a significant portion of liver diseases seen.
3. MLDs can present early in infancy with features like galactosemia, tyrosinemia, or cystic fibrosis or later with glycogen storage disease, Wilson's disease, or lipid storage disorders.
4. Diagnosing MLD can be challenging due to non-specific signs, genetic heterogeneity, and lack of diagnostic facilities in some areas.
Module: Pharmacotherapy III
Module Coordinator: Dr. Arwa M. Amin Mostafa
Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy
School: Dubai Pharmacy College
Year of first presented in Class: 2018
This presentation is for Educational purpose. It has no commercial value.
Sickle cell anemia is a genetic blood disorder caused by a mutation in the beta-globin gene that results in abnormal hemoglobin. The red blood cells take on a sickle shape, which can cause them to block small blood vessels and obstruct blood flow. This document discusses the inheritance pattern, genetics, mechanism of sickling, signs and symptoms, complications, diagnosis, and treatment of sickle cell anemia. Treatment aims to prevent crises and complications through medications, blood transfusions, and potentially a bone marrow transplant to cure the disease.
download link : https://www.dropbox.com/s/xc0fpdul47g1gu8/IgA%20Nephropathy.ppt?m
Join us on our facebook group: NephroTube...............Follow our blog: www.nephrotube.blogspot.com
The document provides an update on vasculitis, including definitions, classifications of different types based on vessel size, pathogenesis involving inflammation of blood vessels, clinical signs and symptoms depending on type of vasculitis, and treatments focusing on glucocorticoids and immunosuppressants. Specific vasculitic syndromes discussed in more detail include giant cell arteritis, Takayasu arteritis, and Wegener's granulomatosis.
Anemia is common in patients with diabetes mellitus and chronic kidney disease. Erythropoietin production by the kidneys regulates red blood cell production but is deficient in kidney disease, leading to anemia. Three case studies describe patients with diabetes and various degrees of anemia and kidney impairment. The document discusses the pathogenesis, evaluation, and management of anemia in diabetes, including the role of erythropoietin deficiency and treatment targets. It concludes regular anemia screening and early treatment can help prevent complications in diabetes patients.
The document provides an overview of chronic leukemias, focusing on chronic myeloid leukemia (CML). It defines CML and describes its epidemiology, etiology, pathogenesis, clinical presentation, diagnosis, and treatment. CML results from a genetic abnormality that fuses the BCR and ABL genes. It progresses through chronic, accelerated, and blast crisis phases if left untreated. Treatment options include stem cell transplantation, chemotherapy with tyrosine kinase inhibitors like imatinib, and management of symptoms.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can damage any body organ by generating autoantibodies and immune complexes. It predominantly affects women aged 15-65 and has the highest prevalence in African-American and Afro-Caribbean women. While the cause is unknown, genetic, environmental, and hormonal factors likely play a role. Symptoms vary but can include rashes, fatigue, joint pain, and organ involvement. Diagnosis involves clinical criteria and serological markers. Treatment focuses on controlling disease activity and inflammation using medications like NSAIDs, antimalarials, corticosteroids, and immunosuppressants.
Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It is more common in children than adults, with an incidence of 2-3 per 100,000 children per year. The majority of cases are idiopathic, with minimal change disease being the most common cause. Treatment involves corticosteroids as first line therapy, with additional immunosuppressants used for frequent relapses or steroid dependence. Complications can include edema, infections due to loss of immune factors in urine, thrombotic events, and acute renal failure.
Systemic lupus erythematosus (SLE) is an autoimmune disease most common in women of childbearing age. It can affect multiple organ systems. Common manifestations include fatigue, arthritis, rashes, hematologic abnormalities, and kidney involvement. The diagnosis is based on clinical features and autoantibodies. Treatment involves medications to reduce inflammation and suppress the immune system such as antimalarials, corticosteroids, immunosuppressants. Lupus nephritis requires aggressive therapy with corticosteroids and immunosuppressants like cyclophosphamide or mycophenolate mofetil. Research is ongoing into more targeted biologic therapies.
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by inflammation in tissues throughout the body. The name comes from a 13th century physician who observed facial lesions resembling a wolf bite. Diagnosis is based on criteria developed by the American College of Rheumatology including malar rash, discoid lesions, arthritis, serositis, renal disease, and immunologic abnormalities. Treatment involves hydroxychloroquine, corticosteroids, immunosuppressants like azathioprine. Lupus nephritis requires aggressive therapy with glucocorticoids, cyclophosphamide or mycophenolate mofetil. Treatment goals are complete or partial renal response through reduction
Lupus is a systemic autoimmune disease characterized by chronic inflammation that can affect multiple organs. It can cause a variety of symptoms affecting the skin, joints, kidneys, and other body systems. While there is no single diagnostic test, a combination of clinical features, lab tests like ANA, and organ involvement can help diagnose lupus. If left untreated, lupus can significantly impair quality of life, but treatment aims to control symptoms and prevent organ damage.
Three key factors determine the fate of clinical trials for lupus: patients, interventions, and endpoints. Early lupus trials faced challenges including patient heterogeneity, active versus inactive disease definitions, and background treatments obscuring treatment effects. Rituximab and abatacept failed phase 3 trials potentially due to easy-to-fail endpoints and aggressive background medications. Using more sensitive endpoints like BILAG A flares versus milder definitions may have shown benefits. Later trials like BLISS incorporated lessons learned to successfully demonstrate drug efficacy using refined trial designs. Ongoing late-stage trials continue evolving approaches.
A brief outlook on Systemic Lupus Erythematosus (SLE)RxVichuZ
A simple detailed view into the disease, its pathogenesis, its causative factors, substantial signs and symptoms, treatment goals and varied therapies, with precise details.....
read..go through..........study well...........
for further details, communicate me in watsapp at 808948729 or in fb @ rxvichu623@gmail.com!!!
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This document summarizes the case of a 7-year-old Filipino girl who presented with fever, cough, periorbital and neck swelling, and weight gain for 2-3 weeks. Her examination found edema, arthritis, a facial rash, hemolytic anemia, thrombocytopenia, proteinuria, and low complement levels. Her hospital course involved worsening edema, ascites, oliguria, and gastrointestinal bleeding. Testing found positive antinuclear antibodies, anti-DNA antibodies, and low complement levels consistent with systemic lupus erythematosus. The document provides background information on SLE including definitions, epidemiology, clinical manifestations, diagnostic criteria, and laboratory findings.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems. It is more common in women and typically presents in the 2nd to 3rd decade of life. SLE results from a loss of self-tolerance by the immune system and is characterized by autoantibody production and immune complex-mediated tissue damage. Diagnosis is based on clinical criteria involving symptoms in organs like the skin, joints, kidneys, and heart. Treatment involves managing symptoms with medications like corticosteroids, antimalarials, and immunosuppressants. Prognosis has improved in recent decades but SLE can still lead to organ damage or failure if not properly treated.
The document summarizes the pathogenesis of systemic lupus erythematosus (SLE). SLE results from a failure of self-tolerance mechanisms, influenced by both genetic and environmental factors. Genetic factors that contribute include genes in the MHC region and those encoding early complement components. Environmental triggers involve ultraviolet light exposure and certain drugs. Immunological factors include defective B cell and T cell tolerance, activation of B cells by nucleic acids engaging toll-like receptors, and elevated type I interferons that stimulate dendritic cells and B cells. Together these genetic, environmental, and immunological abnormalities lead to production of autoantibodies against nuclear antigens.
Collaborative language engineering and language use: demo with MetaEdit+Juha-Pekka Tolvanen
Video part of the demonstration: http://www.metacase.com/webcasts/Multi-user.html.
Almost all software development activities require collaboration and language engineering is no exception. First, there is a need for collaboration among language engineers as it is not realistic to expect one man to master all. Second, there is a natural need for collaboration among language users. Finally, there is a need for collaboration among language engineers and language users: Not only when languages are originally designed but more importantly when they are maintained along with the work already created with them. Unfortunately too often tools ignore collaboration by unnecessarily splitting the work into separate formats, tools and roles. We describe and demonstrate collaborative tool capabilities implemented into MetaEdit+ tool and describe experiences on their use in practice.
This document discusses systemic lupus erythematosus (SLE), a chronic autoimmune disease that affects multiple systems in the body. It causes inflammation and damage to tissues and organs. SLE is more common in women and certain ethnic groups. Symptoms can vary from mild to severe and include skin rashes, joint pain, fatigue, and organ involvement. Nursing care for SLE focuses on managing symptoms, preventing flares, medication adherence, health education, and addressing psychosocial needs.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. It is more prevalent in women and African Americans. Common initial symptoms include fatigue, fever, and weight loss. SLE can cause skin rashes, arthritis, serositis, renal disease, and neurological or hematological abnormalities. Treatment involves managing symptoms with NSAIDs, antimalarials, corticosteroids, and immunosuppressive drugs. Prognosis depends on organ involvement, with renal disease and CNS involvement carrying the worst outcomes.
This document discusses autoimmune disorders, which occur when the immune system attacks the body's own cells and tissues. It provides criteria for classifying autoimmune disorders and discusses some of the potential causes, including genetic, environmental, and hormonal factors. It also summarizes some specific autoimmune diseases like rheumatoid arthritis, systemic lupus erythematosus (lupus), and provides an overview of common treatment approaches which aim to suppress the immune system and reduce inflammation.
This document provides guidelines for screening, treating, and managing lupus nephritis (LN). It defines LN and its classification system. For classes I and II LN, treatment focuses on extrarenal symptoms. Classes III and IV are treated aggressively with glucocorticoids and immunosuppressants. Maintenance therapy includes azathioprine or mycophenolate mofetil with low-dose steroids. Relapse is treated with the initial regimen. The guidelines recommend treatments and monitoring for various LN classes and complications.
SYSTEMIC LUPUS ERYTHEMATOSUS Sle pathophysiology and managementsamirelansary
This document provides an overview and update on systemic lupus erythematosus (SLE). It discusses the definition and classification criteria for SLE, including revisions to the criteria. Genetic factors contributing to SLE susceptibility are described. Increased levels of interferon alpha are implicated in the disease pathogenesis. Clinical manifestations and leading causes of mortality in SLE patients are summarized. Current therapeutic approaches for SLE, including hydroxychloroquine, belimumab, and targeted therapies in development are outlined.
This document discusses systemic lupus erythematosus (SLE) during pregnancy. It notes that SLE occurs more frequently in women, especially during childbearing years. Pregnancy can cause flares in 40-60% of cases, most likely immediately postpartum. Good pregnancy outcomes require quiescent SLE for at least 6 months before conception with no active renal involvement or antiphospholipid antibodies. Management involves preconception counseling and multidisciplinary monitoring of disease activity and fetal wellbeing. Corticosteroids are the treatment of choice for flares.
Systemic lupus erythematosus (SLE) is an autoimmune disease where the immune system attacks its own tissues, causing inflammation and damage. It is characterized by periods of disease flares and remission. Common symptoms include joint pain, rashes, and fatigue. SLE can affect many organs like the skin, lungs, heart, and kidneys. Diagnosis involves evaluating symptoms, lab tests like antinuclear antibodies, and sometimes biopsies. Treatment aims to reduce symptoms during flares and prevent organ damage using medications like corticosteroids, antimalarials, and immunosuppressants. SLE affects mostly women of childbearing age and has no known cure.
1) Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that predominantly affects younger women. SLE can affect almost every system in the body.
2) Management of SLE is individualized depending on symptoms but may include medications like NSAIDs, antimalarials, steroids, immunosuppressants, and cytotoxic drugs. Nursing care focuses on monitoring for organ involvement, managing pain and fatigue, health promotion, and supporting the patient.
3) Key aspects of the nursing care plan include assessing for symptoms, monitoring organ systems affected, educating the patient
This patient has a history of recurrent deep vein thrombosis and pregnancy losses. She presents with right calf swelling and tenderness and is found to have thrombocytopenia and a prolonged PTT. Testing reveals a positive lupus anticoagulant on two occasions more than 12 weeks apart, meeting criteria for antiphospholipid syndrome which can present as recurrent thrombosis.
A 22-year-old college student presents with symptoms including a malar rash, photosensitivity, arthritis, fatigue, and hair loss. Laboratory tests show a positive ANA, positive anti-Smith antibody, and low white blood cell and platelet counts. This constellation of clinical features and laboratory results makes systemic lupus erythematosus the most likely diagnosis for the patient.
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This document provides information about systemic lupus erythematosus (SLE). It defines SLE as a multi-system autoimmune disease affecting various organs mediated by autoantibodies and immune complexes. The causes are unknown but may involve genetic, hormonal, and environmental factors. SLE can affect many organ systems like the kidneys, lungs, heart, and nervous system, causing a variety of clinical manifestations. Diagnosis involves evaluating symptoms, medical history, physical exam, and laboratory tests. Treatment depends on disease severity and organ involvement, and may include medications like NSAIDs, antimalarials, corticosteroids, and cytotoxic drugs. Special considerations are given to SLE in pregnancy and neonates.
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Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect many parts of the body. It is more common in women and certain ethnic groups. Genetic and environmental factors contribute to its development by causing the immune system to attack the body's own tissues and organs. Symptoms can include joint pain, rashes, fatigue, and organ involvement. Diagnosis is based on clinical criteria and the presence of autoantibodies. Treatment involves managing symptoms with medications such as corticosteroids, antimalarials, and immunosuppressants. Lifestyle changes can also help control the disease.
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Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by the formation of autoantibodies and inflammation that can affect multiple organ systems. Common symptoms include rashes, joint pain, fatigue, and organ involvement such as lung, heart, kidney, and brain issues. Diagnosis is based on meeting 4 out of 11 American College of Rheumatology criteria which may include malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disease, and blood abnormalities. Treatment focuses on controlling symptoms, inflammation, and autoantibody formation using medications like hydroxychloroquine and corticosteroids. Prognosis has
This document provides an overview of systemic lupus erythematosus (SLE). It discusses the definition, epidemiology, pathogenesis, diagnosis, clinical manifestations, management, and complications of SLE. The pathogenesis involves genetic susceptibility and environmental triggers leading to abnormal immune responses and autoantibody production. Diagnosis is based on the SLICC classification criteria. Management involves controlling symptoms, preventing organ damage, and treating flares and complications using medications like glucocorticoids, antimalarials, immunosuppressants, and biologics. Life-threatening complications can include renal disease, neurological involvement, hematological abnormalities and vasculitis.
Clinical Research In Lupus by Dr. Meggan MackayLupusNY
This document discusses ways to get involved in lupus research through participation in clinical trials and observational studies. It describes lupus as an autoimmune disease that affects many parts of the body. Research aims to better understand lupus causes, differences in disease severity, and develop new treatments. Observational studies look for disease patterns without medical interventions while clinical trials test new drugs through controlled experiments with volunteers. Participation provides valuable data to advance knowledge of lupus pathogenesis and management.
Lupus is an autoimmune disease where the immune system mistakenly attacks the body's own tissues. It most commonly affects women, especially of certain ethnicities. Symptoms can vary significantly between individuals but include fatigue, rashes, and joint/muscle pain. The exact causes are unknown but genetics and environmental factors like smoking may play a role. Treatment involves a team of specialists aiming to prevent flares and organ damage through medications, lifestyle changes, and managing symptoms. While there is no cure currently, research continues to explore new treatment options like targeted drug delivery systems.
Lupus is an autoimmune disease that can damage any part of the body, including joints, skin, kidneys, blood cells, heart and lungs. It affects women more than men and is characterized by periods of illness (flares) and wellness (remission). While the cause is unknown, genetics and environmental triggers likely play a role. Diagnosis involves reviewing a patient's medical history and symptoms and testing for autoantibodies and organ inflammation. Treatment aims to reduce symptoms and organ damage through medications like corticosteroids and hydroxychloroquine. Prognosis varies depending on organ involvement but early detection and treatment can lead to near normal life expectancy.
Systemic Lupus Erythematosus (SLE) is an autoimmune disease caused by autoantibodies and immune complex deposition. It can affect multiple organ systems. Common manifestations include skin rashes, arthritis, kidney disease, and serositis. SLE predominantly affects women of childbearing age and has a variable course depending on organ involvement. Treatment involves immunosuppression.
The document discusses lupus, an autoimmune disease that commonly affects the kidneys and can lead to end-stage renal disease requiring dialysis or transplantation. Kidney involvement from lupus nephritis is a major cause of illness and death, and the document outlines risk factors for progression to end-stage renal disease as well as treatment options and outcomes for lupus patients with kidney failure.
This document discusses systemic lupus erythematosus (SLE), also known as lupus. It is an autoimmune disorder where antibodies attack the body's own tissues, causing inflammation. It predominantly affects women aged 12-45. The exact cause is unknown but genetic and environmental factors are involved. Symptoms can include joint and skin issues. Complications can impact the kidneys, brain, blood, lungs and heart. Diagnosis involves blood tests, urine tests, and imaging. Treatment includes medications to reduce inflammation and suppress the immune system like NSAIDs, antimalarials, corticosteroids, and immunosuppressants. Management also involves lifestyle measures and developing a support system.
- Systemic lupus erythematosus (SLE) is an autoimmune disorder where the immune system attacks the body's own tissues, causing inflammation in many organs. It predominantly affects women of childbearing age.
- SLE has a female to male ratio of 9:1. Common symptoms include arthritis, rashes, oral ulcers, and fatigue. Long-term complications can include kidney failure, heart disease, and neurological issues.
- Diagnosis involves blood tests to detect autoantibodies and complement levels. Treatment seeks to reduce inflammation and suppress the immune system using medications like NSAIDs, antimalarials, corticosteroids, and immunosuppressants. Managing SLE requires a healthy
The term ‘lupus’ (Latin for ‘wolf’) was first used during the Middle Ages to describe erosive skin lesions evocative of a ‘wolf’s bite’.
Lupus is an autoimmune disease, which means that the body's natural defense system (immune system) attacks its own tissues instead of attacking foreign substances like bacteria and viruses. This causes inflammation which can causes swelling, pain, and tissue damage throughout the body.
This document summarizes the convergent stereoselective synthesis of (-)-deoxypukalide, the enantiomer of a degradation product of the natural product pukalide. Key steps include a novel intraannular furan synthesis using a 4-oxopropargylic β-keto ester and silica gel to form a 3-carboxy 2,5-bridged furan in 96% yield. The synthesis features a "furan-last" strategy employing molecular mechanics calculations to direct stereodefining steps. Installation of the embedded butenolide moiety is achieved to complete the total synthesis of (-)-deoxypukalide, which is confirmed by X-
This document describes a study evaluating the impact of a pharmacist-managed culture review process in an emergency department (ED). The study found that of 819 ED patients discharged with positive cultures in 2013, 21.2% required follow-up due to inappropriate antibiotic coverage. An ED pharmacist intervened in all of these cases, resulting in antibiotic changes for 56% of patients. The pharmacist-managed culture review process improved antimicrobial therapy and care escalation for 69.5% of ED patients with positive cultures. The study illustrates the value of pharmacists in providing antimicrobial recommendations to optimize therapy for ED patients.
This study aimed to characterize medication and device therapy recommendations from a Chart-Based Collaborative Medication Review (CMR) team to improve care for 641 veterans with congestive heart failure (CHF) managed by primary care providers. The CMR team, comprising a cardiologist, hospitalist and pharmacist, reviewed charts of patients with ejection fractions ≤40% and provided 98 recommendations for 70 patients, with 59% regarding guideline therapies and 13% regarding device therapies. So far, primary care providers accepted 66% of the recommendations, with a median time of 15 days to acceptance. The study aims to evaluate the impact of these recommendations on patient outcomes.
1) Oregon State University pharmacy students have participated annually in a statewide rural health outreach event during spring break since 2008, performing health screenings and patient education.
2) In 2010, 42 students provided services like health screenings, medication counseling, and vaccinations to underserved communities in 12 rural Oregon sites.
3) The program aims to promote wellness, educate patients, serve rural areas with limited access, demonstrate pharmacists' patient care roles, and provide experience for student pharmacists.
This newsletter summarizes events from the American Pharmacists Association Annual Meeting, including awards received by OSU College of Pharmacy students and faculty. It also announces the winning of a national Project CHANCE award by OSU students to start a medication reconciliation project with local health centers. Finally, it provides announcements of upcoming events and scholarship opportunities.
This document summarizes a medication reconciliation project between a college of pharmacy and local community health centers. It acknowledges those who contributed to the project, including a programmer who designed their database. The project aimed to identify medication errors and improve patient care by having pharmacy students reconcile medications for patients. Students identified duplications and unclear directions. They provided medication lists and schedules to help increase adherence. The project faced some challenges but provided learning opportunities for students and helped expand pharmacists' roles in healthcare. It will continue as a permanent patient outreach program.
Becky Pape, CEO of SLCH, was named a finalist for the prestigious Shirley Ann Munroe Leadership Award from the American Hospital Association for her leadership in building the first Oregon medical school in over a century and developing a health career training center. Pape was also recognized for supporting the hospital's participation in a community health improvement partnership. The award recognizes outstanding leadership from hospital administrators of small or rural hospitals.
An intern at SAGH pharmacy named Elva Van Devender has received two national awards for her achievements in pharmacy. She was named a John Gans Scholar by the American Pharmacist Association for her quality, leadership and vision as a student pharmacist. She has also been chosen as a 2009-2010 recipient of the American Society of Health-System Pharmacy Student Leadership Award. Van Devender has a bachelor's degree in chemistry, a doctorate in chemistry, and has organized several community health fairs focused on underserved populations. She remains humble about her accomplishments and credits her colleagues for their support.
Truvada and raltegravir are the preferred regimen for occupational post-exposure prophylaxis (PEP) for HIV exposure. PEP should be started immediately after exposure and continued for 28 days to reduce the risk of HIV infection. Important follow up includes monitoring for side effects, adherence support, and HIV testing at baseline and over several months to evaluate infection status. Pharmacists play a key role in ensuring appropriate PEP regimens can be obtained and supporting patient adherence for full treatment duration.
A 26-year-old female presented with rapidly progressive memory deficits, psychiatric symptoms, and language disintegration. Standard tests were unremarkable but EEG showed encephalopathy. Serum tested positive for anti-NMDA receptor antibodies on two occasions. Imaging found bilateral ovarian tumors, and pathology confirmed teratomas. First-line treatment with tumor resection, IVIG, and steroids led to rapid improvement. Anti-NMDA receptor encephalitis should be considered in similar presentations, especially in young females, as prompt diagnosis and treatment including tumor removal can lead to good outcomes.
- The study analyzed patient data including various weight measures, renal clearance equations, and pharmacokinetic values for 239 patients receiving vancomycin.
- Total body weight showed a trend toward being the most accurate predictor of vancomycin volume of distribution, while ideal body weight was the least accurate.
- The Cockcroft-Gault equation using adjusted body weight was the method most closely correlated with vancomycin clearance compared to the MDRD and CKD-EPI equations.
Cystic fibrosis is caused by a defective CFTR gene that codes for a chloride channel protein. This leads to thick, sticky mucus production throughout the body. The mucus clogs lungs and pancreas, causing chronic infection, inflammation, and organ damage. While treatments aim to clear mucus, fight infection, and improve nutrition, lung disease remains the main cause of mortality. New drugs called CFTR modulators target the defective protein and may transform treatment by improving symptoms and slowing disease progression.
The document lists recipients of awards from the American Society of Health-System Pharmacists for the classes of 2010, 2011, and 2012. It provides brief summaries of each recipient's involvement with their school's student society of health-system pharmacy, leadership positions, internships, volunteer work, research presentations, and awards.
This summary provides the key details from the student e-newsletter:
- Eleven OSU students and four faculty members attended the annual APhA meeting in Washington DC. Nearly 7,000 pharmacists and students attended workshops, exhibitions, and events.
- OSU student Elva Van Devender received an APhA Foundation scholarship at the APhA-ASP awards ceremony, where she was one of only nine students nationally to receive this honor.
- Elva Van Devender also received the 2009-2010 ASHP Student Leadership Award, one of only twelve students in the country to receive this prestigious honor.
The document discusses a presentation given to pharmacists about marijuana. It aims to provide information on the clinical pharmacology, evidence for medical use, adverse effects and drug interactions of marijuana so that pharmacists can educate patients and colleagues. The presentation covers the background of marijuana regulation, cannabinoid pharmacology, types of marijuana drugs available, indications for use, evidence of effectiveness for conditions like pain and nausea, side effects, risks of long-term use and interactions with other drugs.
Kcentra is a 4-factor prothrombin complex concentrate approved for reversing vitamin K antagonist-related major bleeding. It contains factors II, VII, IX, X as well as proteins C and S. Kcentra is more effective than fresh frozen plasma for rapidly reversing warfarin-associated coagulopathies and bleeding within 30 minutes of administration. While there is no antidote for newer oral anticoagulants like dabigatran and rivaroxaban, Kcentra may help manage life-threatening bleeding by generating thrombin. Kcentra administration requires monitoring of coagulation parameters and concomitant vitamin K to prevent rebound coagulopathy.
More from Elva Van Devender, Ph.D., Pharm.D., BCPS (20)
1. Lupus: More than Just Skin Deep
Elva Angelique Van Devender, Ph.D., Pharm.D.
PGY1 Pharmacy Practice Resident
Providence Health and Services
Portland, Oregon
January 2012
4. Quick Quiz:
Which statement about lupus is TRUE?
A.Lupus is an infectious disease.
B.Lupus is curable with treatment.
C.Lupus is primarily a disease of the skin.
D.Lupus is more common in women.
E.Lupus is often a disease of the elderly.
4
5. Quick Quiz:
Which statement about lupus is TRUE?
A.Lupus is an infectious disease.
B.Lupus is curable with treatment.
C.Lupus is primarily a disease of the skin.
D.Lupus is more common in women.
E.Lupus is often a disease of the elderly.
5
6. Lupus: More than Just Skin Deep
Elva Angelique Van Devender, Ph.D., Pharm.D.
PGY1 Pharmacy Practice Resident
Providence Health and Services
Portland, Oregon
January 2012
8. Learning Objectives
By the end of this lecture and learning activity, you should be able to….
- Identify the epidemiology and pathogenesis of lupus
- Identify the clinical and diagnostic presentation of lupus
- Recognize drugs that may induce or exacerbate lupus
- Identify the potential impact of lupus to the various parts of the body
- Understand the importance of lupus nephritis as a complication of lupus
- Describe current drug therapy and disease management of the lupus
patient
- List the common side effects of the drugs used to treat lupus
8
9. Precipitating Factors
• The number of cases of lupus in the United States is unknown.
– The CDC estimates 1.5 million people may be affected with the disease.
– The Lupus Foundation of America reports about 16,000 new cases are
diagnosed in the United States each year.
• Lupus primarily affects women (90% of lupus patients are female!).
– Younger women (usually 15-45 years old) are affected more frequently.
– More common in African American, Latina, Asian, and Native American women
than white women
• The etiology of lupus is unknown.
• Theory:
9
genetic disposition
toward lupus
environmental
“trigger” or
infection
“confused”
immune
system that
attacks the
body’s own
tissues
• Possible Triggers of Lupus
• Stress
• Sun Exposure
• Infection
• Hormones
• Smoking
• Surgery
• Pregnancy
• Drugs!!!
10. Drugs than Can Cause Lupus
• Symptoms can include joint pain, muscle pain, and fever, and are mild for most
people.
• It is estimated that up to 10% of lupus may be drug induced. The following are drugs
with the most evidence associated with drug-induced lupus.
– Procainamide (most common)
– Hydralazine
– Phenytoin
– Chlorpromazine
– Quinidine
– Methydopa
– Isoniazid
– Minocycline
• Symptoms usually cease when the medicine is stopped.
10
11. Lupus: A Disease of Autoimmunity
• B-cells run amok and produce antibodies that attack the body’s own tissues!!!
• T-cells probably play a role in activating the errant B-cell response.
• Question: Why don’t we just slam the hammer down on the immune system to
smack this disease into remission?
11
12. Quick Quiz
What is the leading cause of death in lupus patients?
A. liver failure
B. heart disease
C. renal causes
D. malignancy
E. infection
12
13. Quick Quiz
What is the leading cause of death in lupus patients?
A. liver failure
B. heart disease
C. renal causes
D. malignancy
E. infection
13
14. Clinical and Diagnostic Presentation of SLE
SLE accounts for 70% of all
lupus cases.
SLE Characteristics
• Chronic
• Inflammatory
• Multisystem
• Autoimmune
• Fluctuating
• Female: male ratio is
~9:1
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Although we typically think of lupus as a skin disease, it can also affect many organs (i.e.
heart, lungs, kidneys, joints, bone) of the body, resulting in a variety of symptoms.
15. How Will Your Patients Present?
• The clinical presentation in lupus patients is variable:
– Most common symptoms are fatigue and arthralgias (particularly of the hands)
– Depression and headache are the most common of the neuropsychiatric
symptoms. Generalized seizures and psychoses are rare.
• By the numbers:
– 50% of patients have cutaneous features, such as butterfly rash and discoid
lupus as well as photosensitivity.
– 50% of patients have nephropathy, which varies from mild proteinuria and
microscopic hematuria to end-stage renal failure.
– 30% of patients have oral ulcerations.
– 20-30% of patients have pleurisy.
– <20% of patients have pericarditis.
– 10% of patients experience thromboembolic or hemorrhagic complications
(antiphospholipid antibodies associated with hypercoaguable state)
– 10% of patients experience peripheral neuropathy.
•
15
16. How is Lupus Diagnosed?
The American College of Rheumatology established 11 criteria to help
identify the disorder. A person with lupus usually has four or more of the
following symptoms: “SOAP BRAIN MD”
1. Serositis—heart, lung, peritoneum
2. Oral ulcers—painless, usually on roof or back of mouth
3. Arthritis with prolonged morning stiffness, usually up to an hour,
improving as the day goes on
4. Photosensitivity
5. Blood disorders (low RBC, plt, WBC counts)
6. Renal Involvement (proteinuria/ with or without casts)
7. ANA titer> 1:160 (positive test; 93% of people with lupus have this
antibody)
8. Immunologic phenomena- anti-dsDNA antibodies, anti-Smith antibodies,
antiphospholipid antibodies, all of which are specific for diagnosing lupus
9. Neurological disorders – seizures, psychosis
10. Malar “butterfly” rash on the cheeks and nasal bridge
11. Discoid skin lesions (often lead to scarring)
.
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17. What Tests Might be Ordered?
• The tests ordered upfront:
– CBC to screen for leukopenia, anemia, and thrombocytopenia
– Urinalysis and creatinine studies to screen for kidney disease
– ANA - Screening test; sensitivity 95%; not diagnostic without clinical features; caution 5-15%
of normal people have positive test!
• The following are additional autoantibody tests used in the diagnosis of SLE :
– Anti-dsDNA - High specificity; sensitivity only 70%; (marker of disease activity)
– Anti-Sm - Most specific antibody for SLE; only 30-40% sensitivity
– Anti-SSA (Ro) or Anti-SSB (La) - Present in 15% of patients with SLE (not disease specific)
– Anti-RNP – often included with anti-Sm, SSA, and SSB; may indicate mixed connective-
tissue disease with overlap SLE, scleroderma, and myositis (not disease specific)
– Anti-ribosomal P - Uncommon antibodies that may correlate with risk for CNS disease
– Anticardiolipin - used to screen for antiphospholipid antibody syndrome
– Lupus anticoagulant - Multiple tests (eg, direct Russell viper venom test) to screen for
inhibitors in the clotting cascade in antiphospholipid antibody syndrome
– Direct Coombs test - Coombs test–positive anemia to denote antibodies on RBCs
– Anti-histone - Drug-induced lupus ANA antibodies are often of this type
• Biopsies of skin and kidneys (if suspected involvement)
17
18. How is Lupus Treated?
• Desired Treatment Outcomes:
– Reduce flares
– Decreasing swelling and pain
– Reduce/prevent damage to joints
– Reduce/prevent organ damage
– Maintenance of remission
• There is no one size fits all treatment for lupus!!!
• Joint pain: NSAIDS, hydroxychloroquine, or corticosteroids.
• Skin complications:
• Nonpharm: avoid sunbathing, use sunscreens
• Pharm: hydroxychloroquine or corticosteroids
• Organ involvement: corticosteroids and/or immunosuppressive drugs (i.e.
cyclophosphamide, mycophenolate, methotrexate, azathioprine)
18
20. Overall approach to therapy
• Starting at the base and moving up the pyramid with disease severity…
20
Immuno-
modulators
Exercise
Immuno-
suppressants
NSAIDS
Hydroxy-
chloroquine
Low dose
Corticosteroids
High dose
Corticosteroids
Diet Sunscreen No smoking
21. Mild to Moderate Disease
• In a patient presenting without life or organ-threatening symptoms,
conservative measures can be used.
21
Exercise
NSAIDS
Hydroxy-
chloroquine
Low dose
Corticosteroids
Diet Sunscreen No smoking
22. Treatments at a Glance
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
– Examples: ibuprofen, naproxen, diclofenac
– MOA: Decrease inflammation through prostaglandin inhibition
– Use: Provide symptomatic relief for arthralgias, fever, and mild serositis
– AE: GI bleeding (concomitant administration with prednisone may increase risk
of GI ulceration), acute kidney injury, hepatotoxicity
• Antimalarials
– Example: hydroxychloroquine (Plaquenil)
– MOA: Thought to inhibit chemotaxis of eosinophils and locomotion of neutrophils
and impairs complement-dependent antigen-antibody reactions without causing
overt immunosuppression.
– Use:
• Treating lupus skin rashes, constitutional symptoms, arthralgias, and arthritis
• Prevention of lupus flares (associated with reduced morbidity and mortality
in SLE patients)
• Renally protective
– AE: retinopathy
22
23. Treatments at a Glance
• Corticosteroids
– Examples: methylprednisolone, prednisone
– MOA: decrease inflammation by suppressing migration of polymorphonuclear
leukocytes and reversing increased capillary permeability
– Use/place in therapy: in mild, moderate, and severe lupus whenever
immunosuppression is required
– AE: Cushing’s syndrome, osteoporosis, edema, peptic ulcer disease, HPA axis
suppression, hypokalemia and hypomagnesemia, hyperglycemia, decreased
wound healing, pancreatitis, psychosis, glaucoma, insomnia, increased appetite,
HTN, and DM
23
24. Moderate to Severe Disease
• When SLE can’t be controlled by conservative measures alone, more
extreme treatment is needed. This involves the use of high dose
corticosteroids and immunosuppressive agents (i.e. azathioprine,
cyclophosphamide, and mycophenolate mofetil).
24
Immuno-
modulators
Exercise
Immuno-
suppressants
NSAIDS
Hydroxy-
chloroquine
Low dose
Corticosteroids
High dose
Corticosteroids
Diet Sunscreen No smoking
25. • Immunosuppressive (cytotoxic) Agents
– Examples: cyclophosphamide, mycophenolate, azathioprine, methotrexate
– MOA: interfere with DNA synthesis or replication (cytotoxic)
– Use: Immunosuppression in cases of serious SLE organ involvement (especially
severe CNS involvement, vasculitis, and lupus nephritis); cyclophosphamide is
reserved for severe organ-threatening disease. At the other end of the spectrum,
methotrexate or azathioprine may be helpful for milder arthritis or skin disease.
– Place in therapy: in moderate/severe disease when antimalarials and
corticosteroids have failed
– AE: infection, myelosuppression, heptatotoxicity, malignancy
• Immunomodulators
– Examples: rituximab (Rituxan), belimumab (Benlysta)
– MOA: B-cell depletion (rituximab) and B-cell inhibition (belimumab)
– Use/place in therapy: Immunomodulation in patients who have failed
antimalarials, corticosteriods, and immunosuppresion with cytotoxic agents
– AE: infection!!! (also nausea, diarrhea, fever, infusion-site reactions, pharyngitis,
bronchitis, insomnia, extremity pain, depression, and migraine)
25
Treatments at a Glance
26. Belimumab (Benlysta): the first new lupus treatment in 50 years
• The monoclonal antibody belimumab (Benlysta) is a B-lymphocyte stimulator protein
inhibitor (BLyS) thought to decrease the amount of abnormal B cells contributing to
lupus.
• Approved by the FDA in March 2011 for use in combination with standard therapies
to treat active autoantibody-positive SLE.
– Reduced disease
– Decreased the number of severe flares
– Decreased steroid use
• Should NOT be used in patients
– With mild disease (20%-30% of lupus patients) who respond to NSAIDs, short
courses of steroids, and antimalarial drugs.
– With severe, life-threatening disease (not tested in trials)
– Of African American or African descent (lack of response in trials)
• Place in therapy
– Patients with moderately severe disease who have failed stronger medications
including high dose/long courses of steroids and immunosuppressive agents (like
cyclophosphamide and mycophenylate)
26
28. Quick Quiz:
Patients with lupus are at risk for all of the following complications from
drug therapy EXCEPT
A.myelosuppression
B.hepatotoxicity
C.malignancy
D.osteoporosis
E.hypotension
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29. Quick Quiz:
Patients with lupus are at risk for all of the following complications from
drug therapy EXCEPT
A.myelosuppression
B.hepatotoxicity
C.malignancy
D.osteoporosis
E.hypotension
29
30. Lupus Nephritis
• Kidney disease
– One of the most serious complications of SLE
– Mortality reduced with medical interventions in recent
years but morbidity on the rise
– Commonly seen within first four years of diagnosis of SLE
– NOT drug induced
• Biopsy required to diagnose
– Assesses the severity of disease
– Predicts short term and long term therapeutic outcomes
– Dictates treatment
• Presentation can range from minimal hematuria and
proteinuria to severe diffuse glomerulonephritis.
– Hypertension in 25-45% of patients
– Elevated SCr
– Anemia
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31. First-Time Guidelines for Lupus Nephritis
(ETA Spring 2012)
• Biopsy all patients to classify and manage the disease
International Society of Nephrology 2003 Revised Classification of SLE Nephritis
• Maintenance therapy
– All patients should receive hydroxychloroquine, given the data
demonstrating its ability to reduce long-term kidney damage.
– Patients with proteinuria of at least 0.5 g/day should also receive ACEI or ARB
– Azathioprine alone is no longer recommended for maintenance therapy.
• Additional recommendations:
– Maintenance of blood pressure <130/80 mm Hg
– statin therapy for patients with LDL > 100 mg/dL (CKD is coronary equivalent!)
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32. First-Time Guidelines for Lupus Nephritis
(ETA Spring 2012)
• Induction therapy for class III/IV lupus nephritis:
– Choice between mycophenolate mofetil (MMF) or cyclophosphamide for
induction therapy in patients with class III/IV lupus nephritis.
• Note: MMF (2 to 3 g/day for 6 months) is preferred over cyclophosphamide
in black and Hispanic patients.
• In those of Caucasian or European background), cyclophosphamide
can be used in either
– the low-dose Euro-Lupus regimen (500 mg IV every 2 weeks for 6
weeks)
– or the high-dose National Institutes of Health regimen (500 to 1000
mg/m² body surface area monthly for 6 months is recommended
– All patients should also receive an intravenous (IV) glucocorticoid pulse for
3 days, followed by prednisone at 0.5 to 1.0 mg/kg per day and then tapered after
a few weeks to the lowest effective dose.
– Patients who fail the first induction should be switched to the other option.
– Patients who fail both MMF and cyclophosphamide should be started on
rituximab or calcineurin inhibitors.
– Patients who improve can be maintained on either MMF (1 to 2 g/day) or
azathioprine (2 mg/kg per day).
32
33. First-Time Guidelines for Lupus Nephritis
(ETA Spring 2012)
• Induction therapy for class V membranous lupus nephritis:
– MMF (2 to 3 g/day for 6 months) plus prednisone (0.5 mg/kg per day for 6
months).
– If improvement, patients should receive maintenance therapy with MMF or
azathioprine.
– If no improvement, patients should be started on cyclophosphamide (500 to
1000 mg/m² monthly for 6 months) plus a glucocorticoid pulse, followed by
daily prednisone (0.5 to 1.0 mg/kg per day).
• The guidelines also address management in pregnant women.
– Pregnancy counseling
– Women with a history of class III or higher disease do not require treatment if
there is no evidence of disease activity.
• Those with mild disease activity should receive hydroxychloroquine (200 to
400 mg/day)
• Those with clinically active disease should receive prednisone at doses
required to suppress activity and, if necessary, azathioprine (not to exceed 2
mg/kg per day).
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34. SLE and Pregnancy
• Women with lupus can safely become pregnant.
– Lupus should be under control or in remission for six
months before getting pregnant.
• Antiphospholipid antibodies may be associated
with increased likelihood of spontaneous abortion
• Pregnancy in women with lupus can result in
– Disease flares
– Greater incidence of miscarriage
– Greater chance of developing preeclampsia
• Discuss risks versus benefits with patients
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Ok in pregnancy
prednisone, hydroxychloroquine, and low-dose aspirin
Ok, but use carefully in pregnancy
azathioprine (not to exceed 2 mg/kg per day).
Not ok in pregnancy
mycophenolate mofetil, cyclophosphamide, and methotrexate (all cytotoxic)
36. References
• Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. 2008;358(9):929-39.
• Bartels CM. Systemic Lupus Erythematosus (SLE). Medscape News [serial online]. November 15, 2011; Accessed December 16, 2011. Available at
http://emedicine.medscape.com/article/332244-overview
• Bernatsky S, Boivin JF, Joseph L, et. al. Mortality in systemic lupus erythematosus. Arthritis & Rheumatism 2006; 54: 2550–2557.
• Alarcón GS, McGwin G Jr, Bastian HM, Roseman J, Lisse J, Fessler BJ, et al. Systemic lupus erythematosus in three ethnic groups. VII [correction of
VIII]. Predictors of early mortality in the LUMINA cohort. LUMINA Study Group. Arthritis Rheum. 2001;45(2):191-202.
• Lupus Foundation of America. Lupus Fact Sheet. http://www.lupus.org/webmodules/webarticlesnet/templates/new_newsroomnews.aspx?articleid=351
&zoneid=59. Accessed December 16, 2011.
• Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis
Rheum.1997;40(9):1725.
• Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol.
2004;15(2):241-50.
• Yazdany J, Panopalis P, Gillis JZ, Schmajuk G, MacLean CH, Wofsy D, et al. A quality indicator set for systemic lupus erythematosus. Arthritis Rheum.
2009;61(3):370-7.
• Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, et al. Efficacy and safety of belimumab in patients with active systemic lupus
erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9767):721-31.
• Hill E. Belimumab Earns FDA Approval for Lupus. Medscape News [serial online]. March 15, 2011;Accessed December 16, 2011. Available at
http://www.medscape.com/viewarticle/738729.
• Appel GB, Contreras G, Dooley MA, et al. Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc
Nephrol. 2009;20(5):1103-12.
• Isenberg D, Appel GB, Contreras G, et al. Influence of race/ethnicity on response to lupus nephritis treatment: the ALMS study. Rheumatology (Oxford).
2010;49(1):128-40.
• Delafuente JC, Cappuzzo KA. Systemic Lupus Erythematosus and Other Collagen-Vascular Diseases. In: Dipro JT, Talbert RL, Yee GC, Matzke GR,
Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York: McGraw-Hill Companies, Inc., 2008: 1431-1445.
• Lau AH. Glomerulonephritis. In: Dipro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach.
7th ed. New York: McGraw-Hill Companies, Inc., 2008: 811-831
• (Chapter). Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey: Pharmacotherapy: A
Pathophysiologic Approach, 7e: http://www.accesspharmacy.com/content.aspx?aID=3187202.
• Walsh N. Predictors of renal failure in systemic lupus erythematosus. MedPageToday [serial online]. November 14, 2011; Accessed December 16,
2011. Available at http://www.medpagetoday.com/MeetingCoverage/ACR/29660.
• Gordan D. First-Time Guidelines for Lupus Nephritis. Medscape News [serial online]. November 8, 2011; Accessed December 16, 2011. Available at
http://www.medscape.com/viewarticle/753134.
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37. Time for a Case!
• We will break into your 14 assigned groups to work on a case.
• Please work through the entire case. You will present on the specific
question your group is given, but you are expected to contribute to the
discussion of the other points as well.
• There will be no answer key distributed for this case.
• You will have about 30 minutes to work up the case. We will then discuss
the case together as a class.
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