Question

Nancy is a 23-year-old African American woman who has been coming to your pharmacy every month for her oral contraceptives and during allergy season for her Zyrtec D.

Today, she has a prescription for hydrocortisone cream and has questions for you regarding her new diagnosis of lupus. Her aunt has lupus so she was not surprised, but she’s not sure how to manage it or what it may mean for her future. Up to now, she has felt relatively healthy and just went to the dermatologist for the rash on her face and then was referred to a rheumatologist for testing after she provided her family history. On further questioning at the rheumatologist, she realized that her muscle aches and fatigue may be related to lupus and not so much to her workout regimen.

Past Medical History:

Seasonal allergies

Current Medications:

Ortho Novum 777

Zyrtec D PRN

Social History:

Non smoker, social drinker

Allergies:

NKDA

1.     Identify two key laboratory tests involved in the diagnosis of SLE.

2.     What nonpharmacological measures should you recommend to June as part of your counseling for her today? Give details.

3.     June’s rheumatologist recommended that she take ibuprofen or naproxen for the muscle aches. What dose would you recommend and how would you advise her regarding monitoring her symptoms?

4.     June is engaged and planning to get married after graduation. She is concerned about having a family. What can you tell her about family planning with lupus?

Answer 1

Answer Q 1:

Systemic lupus erythematosus (SLE), also known simply as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary between people and may be mild to severe. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is most commonly on the face.

Diagnosis:

• Blood tests such as antibody test
• Complete blood count
• Urinalysis
• Chest X ray

Answer Q 2:

Non Pharmacological methods

1. Healthy Life styles
2. Minimizing stress
3. Avoidance or minimizing certain types of foods
4. Avoidance of sunlight
5. Avoidance of activities that causes fatigue
6. Occupational exposure to silica, pesticides, and mercury

Answer Q 3:

Since a large percentage of people with SLE have varying amounts of chronic pain, stronger prescription analgesics (painkillers) may be used.

Long term uses of NSAIDs are relatively contraindicated for people with SLE because they increase the risk of kidney failure and heart failure. Pain is typically treated with opioids, varying in potency based on the severity of symptoms. When opioids are used for prolonged periods, drug tolerance, chemical dependency and addiction may occur.

Not to take Over the counter medication it may worsens the symptoms. If the pain is not reducing and the rash increases immediately consult the doctor.

Answer Q 4:

While most infants born to mothers who have SLE are healthy, pregnant mothers with SLE should remain under medical care until delivery. SLE can flare up during pregnancy, and proper treatment can maintain the health of the mother longer. Women pregnant and known to have anti-Ro (SSA) or anti-La antibodies (SSB) often have echocardiograms during the 16th and 30th weeks of pregnancy to monitor the health of the heart and surrounding vasculature.

Contraception and other reliable forms of pregnancy prevention is routinely advised for women with SLE, since getting pregnant during active disease was found to be harmful. Natural contraceptive methods like rhythm method, condoms can be used to avoid pregnancy.