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Derm Pharm 2020 > 1 - TOPICAL CALCINEURIN INHIBITORS > Flashcards

1 - TOPICAL CALCINEURIN INHIBITORS Flashcards

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Dermatology Board Prep flashcards
1
Q

Topical calcineurin inhibitors are free of the adverse effects of topical corticosteroids I.e. atrophy, striae, potential hypothalamo-pituitary-adrenal axis suppression

A

True

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2
Q

Cyclosporine (a calcineurin inhibitor) lacks topical activity because its large molecular weight results in poor epidermal penetration

A

True

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3
Q

Tacrolimus and pimecrolimus have lower molecular weights (than the oral calcineurin inhibitor cyclosporine) and so can penetrate inflamed skin

A

True

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4
Q

Tacrolimus is a macrolide produced by the soil bacterium Streptomyces tsukubaensis

A

True

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5
Q

Tacrolimus’s structure and mechanism of action are similar to those of cyclosporine

A

True

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6
Q

Tacrolimus and pimecrolimus prevents cytokine production and blocks T cell activation and proliferation

A

True

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7
Q

Topical tacrolimus is FDA approved as second line therapy for the short term and non-continuous chronic treatment of moderate to severe atopic dermatitis in immunocompetent adults

A

True

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8
Q

Topical tacrolimus for atopic dermatitis is as effective as moderately potent topical corticosteroids for the trunk and extremities, and superior in efficacy to mild potency corticosteroids for the face and neck

A

True

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9
Q

Chronic atopic dermatitis lesions of the face and flexures are most justified for treatment with topical calcineurin inhibitors

A

True (topical calcineurin inhibitors have comparatively superior/similar potency to a TCS that would not have been used on the face/flexures due to risk of TCS adverse effects)

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10
Q

Tacrolimus 0.1% ointment is similar in efficacy to topical corticosteroids of class I (superpotent) and class II/III (high) potency

A

True

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11
Q

Once the atopic dermatitis has stabilised, proactive maintenance treatment with Tacrolimus 2 or 3 times weekly can significantly prevent flares in paediatric and adult patients

A

True

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12
Q

Tacrolimus ointment may reduce the number of flares and prolonged the time to first flare in atopic dermatitis

A

True

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13
Q

Topical Tacrolimus is more effective than pimecrolimus in adult atopic dermatitis patients

A

True

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14
Q

Topical tacrolimus and Pimecrolimus have similar safety and tolerability profile

A

True

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15
Q

Use of topical tacrolimus ointment in oral lichen planus can result in systemic absorption, though clinically significant adverse events associated with systemic absorption have not been observed

A

True

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16
Q

The efficacy of topical tacrolimus ointment in oral lichen planus is at least equal to those of topical clobetasol propionate 0.05% ointment (superpotent Class I TCS)

A

True

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17
Q

Although there have been 2 cases of oral SCC in oral lichen planus patients after treatment with tacrolimus ointment, further studies will clarify if there is a causal relationship

A

True

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18
Q

Topical tacrolimus 0.03% ointment is generally for paediatric patients and the 0.1% ointment is generally for adult patients

A

True

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19
Q

Topical tacrolimus 0.1% ointment is almost as efficacious as clobetasol propionate 0.05% ointment (superpotent class I TCS) in vitiligo on the face

A

True

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20
Q

Tacrolimus 0.1% ointment has a defined role in facial, inverse and genital psoriasis

A

True

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21
Q

Topical tacrolimus and pimecrolimus, either as monotherapy or combined with oral hydroxychloroquine is effective in cutaneous lupus erythematosus

A

True (topical tacrolimus and pimecrolimus was equal to clobetasol propionate 0.05% ointment in facial LE)

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22
Q

Topical tacrolimus 0.1% ointment and pimecrolimus 1% cream is useful in seborrheic dermatitis

A

True

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23
Q

Open studies have shown favourable results with topical tacrolimus in the treatment of Rosacea

A

True

24
Q

Tacrolimus 0.1% ointment has shown favourable results in morphea (localised scleroderma)

A

True

25
Q

Topical tacrolimus may result in local application site irritation

A

True

26
Q

The localised application site irritation due to topical tacrolimus is transient and decreases in prevalence over time

A

True

27
Q

Both topical tacrolimus and pimecrolimus are absolutely contraindicated in individuals with hypersensitivity to the active drug or components of the ointment/cream

A

True

28
Q

Both topical tacrolimus and pimecrolimus are relatively contraindicated in children less than 2 years of age

A

True

29
Q

Both topical tacrolimus and pimecrolimus are absolutely contraindicated in individuals with an active skin infection at the site to be treated

A

True

30
Q

Exposure to topical tacrolimus or pimecrolimus is not associated with an increase in the overall cancer rate

A

True

31
Q

The use of topical tacrolimus may be associated with an increased risk of T-cell lymphoma

A

True (although this may be inconclusive as another study found no increased risk of lymphoma in patients treated with topical calcineurin inhibitors, and that patients with atopic dermatitis itself was associated with an increased lymphoma risk although this study did not find any cases of lymphoma in topical calcineurin inhibitors users)

32
Q

There is a theoretical risk that topical calcineurin inhibitors may cause lymphoma, although available data on lymphoma following topical calcineurin inhibitor use are inconsistent and insufficient to draw a conclusion about the causal role

A

True

33
Q

Available data have found no evidence indicating that skin cancer is associated with topical calcineurin inhibitor use

A

True

34
Q

Combining UVB and tacrolimus seems to have a limited direct photocarcinogenic potential on keratinocytes compared to UVB alone

A

True

35
Q

Systemic absorption of topical tacrolimus in atopic dermatitis is low and not clinically significant

A

True (although marked systemic absorption has been observed in Netherton’s syndrome)

36
Q

Patients with Netherton’s syndrome treated with topical tacrolimus are at risk for systemic absorption of topical tacrolimus

A

True (serum levels elevated, although no signs or symptoms of toxicity have been observed) - tacrolimus can be switched to pimecrolimus

37
Q

Topical tacrolimus may cause enhanced facial flushing after alcohol ingestion

A

True

38
Q

Topical Tacrolimus may cause Rosacea-like dermatitis

A

True (although ironically topical tacrolimus has shown favourable results in Rosacea)

39
Q

Topical tacrolimus may cause acne

A

True

40
Q

Topical tacrolimus may cause reactivation of HPV infection

A

True

41
Q

Pimecrolimus is a semi synthetic derivative of the macrolide ascomycin, with a similar structure to that of tacrolimus

A

True

42
Q

Pimecrolimus appears to have a role in atopic dermatitis of the head and neck

A

True

43
Q

The need for topical corticosteroids for atopic dermatitis on the head and neck is reduced with pimecrolimus cream

A

True

44
Q

Intervention with Pimecrolimus cream at the first signs and symptoms of a subsequent recurrence of atopic dermatitis reduced the number of flares/prevented progression to flares requiring topical corticosteroids

A

True

45
Q

The efficacy of pimecrolimus 1% cream in oral lichen planus is equal to topical Triamcinolone Acetonide 0.1% paste (moderately potent Class IV/V TCS)

A

True

46
Q

Pimecrolimus 1% cream + NB-UVB is superior to placebo + NB-UVB for facial vitiligo lesions

A

True

47
Q

Pimecrolimus 1% cream is equal in efficacy to mometasone furoate 0.1% cream (High potency Class II/III TCS) and clobetasol propionate 0.05% ointment (Superpotent Class I TCS) for facial vitiligo lesions

A

True

48
Q

The role of pimecrolimus in inverse psoriasis is inconclusive

A

True (unlike tacrolimus, which has shown clear benefit for facial, genital and inverse psoriasis)

49
Q

Pimecrolimus 1% cream has comparable efficacy to ketoconazole for seborrheic dermatitis, but adverse effects appeared more with pimecrolimus

A

True

50
Q

Pimecrolimus 1% cream is effective in corticosteroid-induced Rosacea

A

True

51
Q

Topical Pimecrolimus has successfully treated Netherton’s syndrome

A

True (increased absorption and systemic toxicity from topical tacrolimus)

52
Q

There is no increase of systemic absorption of topical pimecrolimus with increasing body surface area treated

A

True (and no drug related systemic adverse events)

53
Q

The order of decreasing potency for topical calcineurin inhibitors are Tacrolimus 0.1% > Tacrolimus 0.03% > Pimecrolimus 1%

A

True

54
Q

Topical pimecrolimus has not been associated with drug related systemic events

A

True

55
Q

The use of pimecrolimus cream results in minimal systemic absorption

A

True

56
Q

Topical pimecrolimus does not increase the risk of malignancy

A

True (this risk is unclear with topical tacrolimus and lymphoma due to mixed data)

57
Q

Topical pimecrolimus may cause enhancement of molluscum contagiosum

A

True

Derm Pharm 2020 (47 decks)

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