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Systemic Lupus Erythematosus Furqan Khan RN BSN CWCN NURS 504 Advanced Pharmacology Liberty University.

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Presentation on theme: "Systemic Lupus Erythematosus Furqan Khan RN BSN CWCN NURS 504 Advanced Pharmacology Liberty University."— Presentation transcript:

1 Systemic Lupus Erythematosus Furqan Khan RN BSN CWCN NURS 504 Advanced Pharmacology Liberty University

2 Edmunds, M. W., & Mayhew, M. S. (2009). Pharmacology for the primary care provider. St. Louis, MO: Saunders.

3 Prevalence: Almost 90% of all cases occur in women Overall, SLE affects women eight times more often than it does men At age 30 years, the ratio of women to men is 10:1 The ratio at age 65 years, the ratio appears to be about 3:1 The prevalence rate among women between ages 15 and 64 years is 1 in 700 women Symptoms usually appear between ages 15 and 25 years The prevalence in the general population is about 1 in 1000 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians ’ Information & Education Resource. Retrieved from

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5 Signs & Symptoms: PERCENTAGE (%) Achy joints / arthralgia – 95% Fever of more than 100 degrees F / 38 degrees C - 90% Arthritis / swollen joints – 90% Prolonged or extreme fatigue – 81% Skin Rashes – 74% Anemia – 71% Kidney Involvement - 50% Pain in the chest on deep breathing / pleurisy – 45% Butterfly-shaped rash across the cheeks and nose - 42% Sun or light sensitivity / photosensitivity - 30% Hair loss / Alopecia - 27% Abnormal blood clotting problems – 20% Fingers turning white and/or blue in the cold – 17% Mouth or nose ulcers – 12% Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information & Education Resource. Retrieved from

6 BUTTERFLY RASH PHOTOSENSITIVE ERYTHEMA SUBACUTE CUTANEOUS RASHDISCOID LUPUS ERYTHMATOUS BULLOUS LESIONS Images : dermatlas.org

7 Pathophysiology: The plasma cells are producing antibodies that are specific for self proteins, namely ds-DNA Overactive B-cells. Estrogen is a stimulator of B-cell activity Suppressed regulatory function in T-cells. Lack of T-cells IL-10, also a B-cell stimulator is in high concentration in lupus patient serum. High concentration linked to cell damage caused by inflammation Increased levels of Ca 2+. Leads to spontaneous apoptosis Moser, R. (2001). Primary Care for Physician Assistants: Clinical Practice Guidelines. New York. McGraw- Hill Medical Publishing.

8 Pathophysiology: RBCs lack CR1 receptor. Decreasing the affective removal of complexes IgG is the most “pathogenic” because it forms intermediate sized complexes that can get to the small places and block them. DNA is the main antigen for which antibodies are formed. Extracellular DNA has an affinity for basement membrane where it is bound by auto-antibodies. Classical thickening of the basement membrane Moser, R. (2001). Primary Care for Physician Assistants: Clinical Practice Guidelines. New York. McGraw- Hill Medical Publishing.

9 Laboratory and Other Studies for Systemic Lupus Erythematosus TestNotes Complete blood count The most common anemia in SLE is from chronic disease. Hemolytic anemia will usually have a positive direct Coombs' test, for either IgG or complement, or both. Both Leukopenia and Lymphopenia are found in SLE. Thrombocytopenia can be due to SLE or to Antiphospholipid antibodies Erythrocyte sedimentation rateAlthough the ESR is commonly elevated, it is not specific for SLE Comprehensive metabolic panel An elevated Creatinine may be a clue to renal lupus. Mild elevations in liver function tests occur in 30% Creatine Phosphokinase SLE Myositis presents with proximal muscle weakness. Creatine phosphokinase is usually elevated Urinalysis Glomerulonephritis usually presents with Proteinuria, with or without Hematuria. Erythrocytes or granular casts can be seen Serologies Anti-DNA or anti-Sm are specific for SLE. Low C3 and low C4 are common in SLE, but not specific. A negative ANA argues against SLE. Anti-RNP, anti-Ro/SSA, anti-La/SSB, and Antiphospholipid antibodies may be found, but they are not specific for SLE Renal biopsyIndicated in patients with laboratory findings suggestive of lupus nephritis Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians ’ Information & Education Resource. Retrieved from

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11 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information Education &Resource. Retrieved from

12 PHARMACOLOGY: NSAIDs – Acetaminophen CORTICOSTEROIDS – Prednisone ANTI-MALARIAL - Hydroxychloroquine Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information & Education Resource. Retrieved from

13 PHARMACOLOGY: NSAIDS NON STEROIDAL ANTI-INFLAMMATORY DRUGS Use to control mild to moderate pain, fever, and various inflammatory conditions, such as rheumatoid arthritis and osteoarthritis. NSAIDS have analgesic, antipyretic, and anti- inflammatory properties. Analgesic and anti-inflammatory effects are due to inhibition of prostaglandin synthesis. Antipyretic action is due to vasodilation and inhibition of prostaglandin synthesis in the CNS NON STEROIDAL ANTI-INFLAMMATORY DRUGS Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (2009). Drug information handbook. Hudson, OH: Lexi-Comp.

14 PHARMACOLOGY: NSAIDS NON STEROIDAL ANTI-INFLAMMATORY DRUGS Use cautiously in patients with a history of bleeding disorders, GI bleeding, and severe hepatic, renal, or cardiovascular disease. Safe use in pregnancy is not established and, in general, should be avoided during the second half of pregnancy. NSAIDs prolong bleeding time and potentiate the effect of warfarin, thrombolytic agents, some cephalosporins, and anti-platelet agents. NSAIDs may also decrease response to diuretics or antihypertensive therapy. NON STEROIDAL ANTI-INFLAMMATORY DRUGS Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (2009). Drug information handbook. Hudson, OH: Lexi-Comp.

15 Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (2009). Drug information handbook. Hudson, OH: Lexi-Comp.

16 Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (2009). Drug information handbook. Hudson, OH: Lexi-Comp.

17 Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (2009). Drug information handbook. Hudson, OH: Lexi-Comp.

18 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information & Education Resource. Retrieved from

19 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus :Physicians’ Information & Education Resource. Retrieved from

20 PHARMACOLOGY: ANTI-MALARIALS Hydroxychloroquine is used as an adjunct to corticosteroid therapy in the treatment of discoid lupus erythematosus & systemic lupus erythematosus. Hydroxychloroquine therapy may lead to the regression of skin lesions of discoid or systemic lupus erythematosus and may also have a beneficial effect in patients with systemic lupus erythematosus in whom arthritis is a prominent feature ANTI-MALARIALS DRUGS Moser, R. (2001). Primary Care for Physician Assistants: Clinical Practice Guidelines. New York. McGraw- Hill Medical Publishing.

21 PHARMACOLOGY: ANTI-MALARIALS The usual initial adult dosage of hydroxychloroquine for the treatment of lupus erythematosus is 400 mg once or twice daily for several weeks or months depending on the response of the patient. For prolonged maintenance therapy, mg of daily may be adequate. The exact mechanism of anti-malarial action of the drug in the treatment of rheumatoid arthritis and lupus erythematosus have not been determined. ANTI-MALARIALS DRUGS Moser, R. (2001). Primary Care for Physician Assistants: Clinical Practice Guidelines. New York. McGraw- Hill Medical Publishing.

22 PHARMACOLOGY: ANTI-MALARIALS Ophthalmologic examinations should be performed prior to initiation of hydroxychloroquine therapy and periodically (every 3 months) during therapy whenever long- term use of the drug is contemplated. Hydroxychloroquine should be discontinued immediately, if there is any indication of abnormalities in visual acuity or visual field May exacerbate psoriasis and precipitate a severe attack in patients with the disease. Use in psoriasis patients only if potential benefits outweigh risks. ANTI-MALARIALS DRUGS Moser, R. (2001). Primary Care for Physician Assistants: Clinical Practice Guidelines. New York. McGraw- Hill Medical Publishing.

23 PHARMACOLOGY: ANTI-MALARIALS May concentrate in the liver; use with caution in patients with hepatic disease or alcoholism and in patients receiving other hepatotoxic drugs. Hydroxychloroquine and its metabolites are slowly excreted by the kidneys. Hydroxychloroquine may exacerbate porphyria in patients with the condition, drug should not be used in patients with porphyria unless potential benefits outweigh risks. ANTI-MALARIALS DRUGS Moser, R. (2001). Primary Care for Physician Assistants: Clinical Practice Guidelines. New York. McGraw- Hill Medical Publishing.

24 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information Education Resource. Retrieved from

25 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information Education Resource. Retrieved from

26 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information Education Resource. Retrieved from

27 Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information Education Resource. Retrieved from

28 References Edmunds, M. W., & Mayhew, M. S. (2009). Pharmacology for the primary care provider. St. Louis, MO: Saunders. Moser, R. (2001). Primary Care for Physician Assistants: Clinical Practice Guidelines. Newyork. McGraw- Hill Medical Publishing. Petri, M., Lazaro, D. (2009). Systemic Lupus Erythematosus: Physicians’ Information & Education Resource. Retrieved from Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (2009). Drug information handbook. Hudson, OH: Lexi-Comp.


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