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Patient > Complex treatments of dermatology > Flashcards

Complex treatments of dermatology Flashcards

1
Q

features of complex therapies?

A

high toxicity risk
high costs
need monitoring
specialist prescribing not GP

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2
Q

complex therapies ____ first line

A

aren’t

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3
Q

use of isotretinoin? brief

A

retinoid in acne

severe acne unresponsive to topical treatments and oral antibiotics

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4
Q

acitretin use?

A

retinoid in psoriasis- not commonly used

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5
Q

what does photo therapy treat?

A

psoriasis and also seen in eczema

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6
Q

isotretinioin is used in…

A

severe acne unresponsive to topical treatments and oral antibiotics

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7
Q

isotretinioin time frame?

A

16 week course

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8
Q

how many biologically active metabolites in isotretinioin

A

5 at least

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9
Q

what are the 3 mechanisms of action of isotretinioin?

A

reduces skin sebum excretion by 90% after 6 weeks- lowers bacteria concentrations on the skin

decreases hyperheritinisation- reduces down to normal level if hyper. interferes with comedogenesis

anti-inflammatory

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10
Q

how does isotretinoin educe skin sebum excretion?

A

causes apoptosis of sebocytes

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11
Q

how does isotretinoin decrease hyperkeratinisation?

A

blocks the follicles

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12
Q

can you do a repeat course of isotretinoin?

A

yes if relapse

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13
Q

risks of isotretinoin?

A

teratogenic- need contraception for 1 month before and after, tested before during and after.

cant donate blood during or after as it remains in the system
CV risk increased by 30%
depression, suicidal ideation
impaired night vision- DVLA must be informed

dry skin
joint pains
fragile skin- UV protection

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14
Q

what must happen to people with mental health problems when isotretinoin?

A

psychiatric monitoring

stop if mental health deteriorates

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15
Q

why does isotretinoin cause dry skin and mucous membranes and cause joint pain?

A

reduces bodily secretions

dry

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16
Q

if topical treatments dont work for psoriasis treatment, what should you do next?

A

phototherapy

then oral or injectables

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17
Q

when is specialist treatment needed for psoriasis?

A

severe, widespread (10% BSA) and not controlled by topical therapy

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18
Q

when is systemic therapy used?

A 
severe
cant be controlled topically 
AND one off: 
extensive 
function impairment 
phototherapy ineffective
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19
Q

TF: UVA is usually better tolerated in psoriasis phototherapy

A

no, narrowband (ND-UVB) UVB

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20
Q

UVB is ____ ______

A

first line

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21
Q

how often do you have NB-UVB treatment

A

2/3 times a week

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22
Q

how are psoralen and UVA used together?

A

apply psoralen 2 hours before UVA exposure

is activated in UVA presence

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23
Q

how does activated psoralen work?

A

disrupts DNA synthesis, inhibiting basal cell proliferation- prevents thickening which is key in psoriasis

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24
Q

how often is treatment with UVA and psoralen given?

A

3 times weekly

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25
Q

how long till UVA and psoralen is effective?

A

5-6 weeks

26
Q

adverse effects of phototherapy?

A

teratogenic
premature skin ageing
pigmentation
cateract formation

27
Q

side effects of psoralen? solution?

A

nausea
can use MOP-5 in this case
(psoralen is MOP-8)

28
Q

precautions to be taken when on phototherapy?

A

contraceptions
UVA eye protection
regular skin examinations
history of cancer

29
Q

what is acitretin, what does it treat

A

synthetic retinoid

psoriasis

30
Q

how does acitretin work??

A

decreases hyperkeratinisation- normalises skin proliferation, differentiation and cornification

31
Q

acitretin has a _____ half life than isotretinoin but…

A

longer

can convert back into parent molecule so prolonged therapy

32
Q

how long is acitretin therapy?

A

> 16 weeks

33
Q

risks of acitretin?

A 
teratogenic 
blood donation 
hyperlipidaemia 
CV risk assessment needed 
monitor lipid profile 
hepatotoxic- monitor liver function 
keep alcohol intake at t he bare minimum
34
Q

how long must women take contraception after taking acitretin?

A

3 years

35
Q

how often is methotrexate given for the treatment of psoriasis and eczema?

A

once weekly

36
Q

methotrexate mechanism of action?

A

folic acid antagonist- inhibits DHFR

Blocks DNA synthesis- as folate co factors many enzymes

enzyme inhibition leads to increased adenosine which inhibits neutrophil chemotaxis and cytokine secretion- anti-inflammatory action

37
Q

what is the effect of enzyme inhibition of methotrexate

A

increased adenosine which inhibits neutrophil chemotaxis and cytokine secretion
anti-inflammatory

38
Q

at optimal methotrexate dose, how long till effects are seen?

A

1-3 months

39
Q

TF: methotrexate is used for psoriasis and eczema at the same concentrations as in cancer

A

False

40
Q

methotrexate risks

A

liver cirrhosis- LFTs every month then every 3 months if stable
blood disorders
GI symptoms

alopecia, infection risk

41
Q

what blood disorders can methotrexate cause? why

A

thrombocytopenia, anaemia and leucopenia

as all the productions are suppressed

42
Q

what are the gastric side effects of methotrexate?

A

inflammed

nausea

43
Q

how can these gastric side effects be counteracted?

A

5mg folic acid weekly

44
Q

if you give folic acid 5mg with methotrexate what must you do?

A

give on alternate days as they compete for cellular uptake

45
Q

advice on vaccines to patients taking methotrexate

A

increased infection risk
cant have live vaccines while on methotrexate
make sure up to date with vaccines before starting to take

46
Q

interaction between NSAIDs and methotrexate?

A

NSAIDs increase levels of methotrexate

47
Q

how often is ciclosporin given in patients with psoriasis and eczema?

A

twice daily - split 2.5mg/kg

48
Q

mechanism of action cyclosporin

A

blocks calcineurin development factor
IL2 blocked
proliferation of T-lymps and cytokines blocked
proliferation of keratinocytes blocked

49
Q

cyclosporin duration of treatment?

A

2-4 months

50
Q

TF: cyclosporin is more effective than methotrexate

A

false, they’re just as effective as each other

51
Q

risks of ciclosporin

A 
nephrotoxic 
hypertension 
teratogenic 
immunosuppresant 
bruising
52
Q

can you use ciclosporin in pregnancy?

A

only if necessary but try to avoid

53
Q

biologics in psoriasis all target ____

A

TNF

54
Q

2 types of biologics?

A

Etanercept- genetically engineered fusion protein

infliximab etc- monoclonal ABs

55
Q

response to biologics seen within ….

A

6 weeks

56
Q

risks of using biologics?

A

infections- avoid live vaccines
CV risk- severe HF
worsening of neurological disease e.g. MS
cancer risk- varieties not just skin

57
Q

what infections are risks in the use of biologics?

A

reactivation of latent TB
so must screen for TB

listeria and salmonella risk- careful with meats and dairy

58
Q

how does dupilumab work? what does it treat?

A

eczema

monoclonal antibody
inhibits Th cell activation

59
Q

how does dupilumabs ability to inhibit Th cell activation help in eczema?

A

T helper cells disrupt the skin barrier by inhibiting expression of filaggrin- which helps regulate outer skin cells and antimicrobial peptides

60
Q

what can dupilumabs predispose you too?

A

worm infection- must clear before hand

61
Q

dose of dupilumab?

A

injection every 2 weeks

62
Q

when must dupilumab be reviewed?

A

review if no response at 16 weeks

Patient (19 decks)

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