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PT III - DEENT > PCOL of Psoriasis (Maize) > Flashcards

PCOL of Psoriasis (Maize) Flashcards

1
Q

Psoriasis is a disease characterized by keratinocyte ____ and incomplete ____ caused by cytokines (IL-1 & TNFa) released from infiltrating activated T-cells.

Evidence points to an ____-mediated disorder, possibly an organ-specific ____ ____ of skin.

A

hyperproliferation and incomplete differentiation

immune;autoimmune disease

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2
Q

Cytotoxic Agents – Coal tar
MOA:
- Suppresses ____ synthesis which ____ epithelial cell proliferation
- ____ agent

A
  • DNA; decreases

- Photosensitizing

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3
Q 
Cytotoxic Agents - Coal tar 
Side Effects:
- Irritation, stinging, burning (\_\_\_\_ smarts)
- Folliculitis (bumps around hair follicles) particularly of the axilla and groin (tar acne)
- \_\_\_\_ dermatitis 
- Photosensitizing
- Carcinogenic (rare)
- No \_\_\_\_ side effects
- Will stain light skin and hair
- Unpleasant \_\_\_\_
A
  • tar
  • contact
  • systemic
  • odor
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4
Q

Cytotoxic Agents - Shale tar (ichthammol)

  • Cytotoxic but the exact mechanism of action is unknown
  • No clinical studies have demonstrated its ____, but it is ____ and gives ____ relief
  • It is less ____ and has no ____ activity unlike coal tar
  • Also used for treatment of ____, ____, and acute ____ ____
A
  • effectiveness; safe; symptomatic
  • irritating; photosensitizing
  • eczema, rosacea, otitis externa
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5
Q

Cytotoxic Agents - Anthralin
MOA:
____ of the DNA alpha helix by ____ ____

Pharmacological effect
suppresses ____ keratinocyte cell ____

Side effects:

  • Local ____, mainly to normal skin
  • ____ on normal skin around lesions
  • Severe ____ with eye contact
  • No ____ side effects
  • Will stain skin, hair, clothes a dark brown/black color
A

MOA:
Disruption, free radicals

Pharmacological effect
hyperplastic; growth

Side effects

  • irritation
  • erythema
  • conjunctivitis
  • systemic
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6
Q

T-cell and cytokine suppressors - Methotrexate

MOA:

  • Inhibits ____ ____
  • Promotes the ____ of activated _-____

Pharmacological effect

  • ____ keratinocyte hyperproliferation
  • ____ the number of T-cells

Side effects:

  • GI: diarrhea, ulcerative stomatitis
  • Blood ____ (anemia)
  • Cirrhosis (liver scarring)
  • Teratogenic
  • loss of ____
A

MOA:

  • dihydrofolate reductase
  • apoptosis; T-cells

Pharmacological effect

  • Reduces
  • Reduces

Side effects

  • dyscrasias
  • hair
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7
Q 
T-cell and cytokine suppressors - 
Mycophenolate mofetil (Myfortic)

MOA:

  • Inhibits ____ synthesis
  • Inhibits ____ production

Pharmacological effect:

  • reduces the number of _-_____
  • ____ action

Side effects

  • ____ ____ suppression
  • GI upset
  • ____ symptoms (achy, low grade fever)
A

MOA:

  • purine
  • cytokine

Pharm effect:

  • T-cells
  • Anti-inflammatory

Side effects:

  • bone marrow
  • flu-like
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8
Q

T-cell and cytokine suppressors - Cyclosporine

MOA:

  • Arrests keratinocytes in the __ stage of the cell ____
  • Inhibits ____ and ____ of cytokines

Pharmacological effect

  • reduces the number of _-_____
  • ____ action

Side effects

  • ____ after long term use
  • ____tension
  • ____ hyperplasia (gum overgrowth)
  • Multiple drug interactions through ____
A

MOA:

  • G0; cycle
  • production and release

Pharmacological effect

  • T-cells
  • Anti-inflammatory

Side effects:

  • nephrotoxicity
  • hyper
  • gingival
  • CYP3A4
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9
Q

Antibody Therapy - T-cell inhibitors
Which drug (MOA):
____ - binds to the antigen on psoriatic plaques preventing T-cells from binding

____ - binds CD 11a to inhibit T-cell activation and migration

A
  • Alefacept (Amevive)

- Efalizumab (Raptiva)

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10
Q 
Antibody Therapy - TNFα inhibitors
What drugs (3)

bind free TNFα and reduces inflammation

A
  • Etanercept (Enbrel), Adalimumab (Humira), Infliximab (Remicade)
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11
Q

2 Types of Antibody Therapy

A

T-cell inhibitors

TNFα inhibitors

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12
Q

Antibody Therapy:

Pharmacological effect:
- Reduces the ____ and ____ of the plaques

Side Effects

  • ____ reactions: chills, site pain, inflammation
  • Serious infections and malignancies
  • Blood ____
A

Pharm effect:
- number and size

Side effects:

  • injection
  • dyscrasias
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13
Q

Nuclear Receptor Binder - Retinoids

MOA:

  • Binds to either ____ or ____ retinoid receptors
  • A ____ or ____ is formed which alters DNA transcription (direct)
  • A single receptor complex binds ____ ____ to alter DNA transcription (indirect)
A
  • RAR (Retinoic Acid Receptors) or RXR (Retinoid X Receptors)
  • homodimer or heterodimer
  • transcription factors
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14
Q

Nuclear Receptor Binder - Retinoids

Pharmacological effect:

  • ____ proliferation and ____ differentiation of keratinocytes
  • Acitretin does not suppress ____ ____ as effectively as the other retinoids
A
  • Reduces; enhances

- sebum production

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15
Q

Nuclear Receptor Binder - Retinoids
Acitretin (Soriatane)

Kinetics:

  • Half life is __ hours
  • Drug is still ____ in the serum from _ to _ ____ after discontinuation
A
  • 49

- detectable; 1 to 3 years

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16
Q

Nuclear Receptor Binder - Retinoids
Acitretin (Soriatane)

SIDE EFFECTS

  • ____ effects
  • ____ effects
  • Pseudotumor ____
  • Smaller changes in blood lipids than ____
A
  • dermatological
  • opthalmic
  • cerebri
  • isotretinoin
17
Q

Nuclear Receptor Binder - Retinoids
Acitretin (Soriatane)

DERMATOLOGICAL Side Effects

  • lip inflammation
  • alopecia (hair loss)
  • ____ on palms, soles, and fingertips
  • dry ____ and epitaxis
  • dry ____ and stomatitis
A
  • peeling
  • nose
  • mouth
18
Q

Nuclear Receptor Binder - Retinoids
Acitretin (Soriatane)

OPHTHALMIC Side Effects

  • ____ irritation,
  • dryness or thickening of conjunctiva,
  • ____ vision,
  • loss of ____/____
A
  • eye
  • blurred
  • eyelashes/eyebrows
19
Q

Benign intracranial hypertension associated with acitretin

A

Pseudotumor cerebri

20
Q

Nuclear Receptor Binder - Retinoids
Tazarotene (Tazorac)

SIDE EFFECTS

  • Pruritis, burning, stinging, erythema, irritation, rash, ____ and ____ skin
  • ____
  • No known systemic side effects
  • Teratogenic (Do not use in pregnancy)
A
  • peeling; dry

- photosensitivity

21
Q

Nuclear Receptor Binder - Vitamin D derivative
Calcipotriene (Dovonex)

MOA:
- Calcipotriene-VDR complex forms a ____ with ____ ____ to alter DNA function

Pharmacological effect:

  • Inhibits ____ and promotes ____ differentiation
  • Decreases ____ by decreasing ____ ____ release
A

MOA:
- heterodimer; retinoid receptors

Pharm effect:

  • proliferation; epidermal
  • inflammation; inflammatory cytokine
22
Q

Nuclear Receptor Binders - Steroids

Steroids are called ____ because they are formed in the adrenal ____

Corticosteroids have two main effects:

Most corticosteroids have a mixture of these activities

A

corticosteroids; cortex

  1. Na+ retention - mineralocorticoids
  2. Hepatic glycogen storage – glucocorticoid
23
Q

Nuclear Receptor Binders - Steroids

Mineralocorticoids:

  • ____ is the endogenous steroid
  • Acts on the ____ to retain ___ and thus retains water
  • These usually have ____ anti-inflammatory activity
A
  • Aldosterone
  • kidneys; Na+
  • little
24
Q

Nuclear Receptor Binders - Steroids

Glucocorticoids:

  • ____ and ____ are the endogenous steroids
  • Have significant effect on ____ to help the body through ____ times
  • These compounds usually have ____ anti-inflammatory action
A
  • Cortisol and cortisone
  • metabolism; stressful
  • greater
25
Q

Nuclear Receptor Binders - Steroids
MOA:
- modulate inflammation either ____ or ____ by increasing the transcription of anti-inflammatory proteins or decreasing the transcription of inflammatory proteins

A

directly; indirectly

26
Q

Nuclear Receptor Binders - Steroids

MOA:
____ Mechanism – a homodimer binds to the ____ ____ ____ (___) in the DNA

A

Direct

  • Glucocorticoid Response Element (GRE)
27
Q

Nuclear Receptor Binders - Steroids

MOA:
____ Mechanism: a single receptor/steroid complex binds __-_ and __-__ and prevent ____ to the ____

A

Indirect

  • AP-1 and NF-kB;
    binding
    TRE
28
Q

Nuclear Receptor Binders - Topical Glucocorticoids

Relative Potency (Efficacy)

  • A ____ assay is used to measure efficacy
  • 7 degrees of potency
  • Steroids in each class have the same relative ____
A
  • vasoconstrictor

- efficacy

29
Q

Effectiveness of Topical Glucocorticoids
Percutaneous absorption -

  • Proportional to the (3):
  • ____ or ____ skin is more permeable
  • ____ dressing can enhance percutaneous absorption by as much as __ ____
  • The skin acts as a ____ so frequent dosing is not needed
A
  • duration of use
  • area of coverage and
  • thickness of skin
  • Abraded or inflamed
  • Occlusive; 10 fold
  • reservoir
30
Q

Effectiveness of Topical Glucocorticoids

Depends on (5):

A
  • Concentration
  • Efficacy
  • Salt
  • Vehicle
  • Percutaneous absorption (Application)
31
Q

Topical Glucocorticoids Side Effects

Immediate side effects of topical steroids
- Increased risk of ____ ____ and ____ of infection

Long term use of topical steroids (7)

A
  • local infection and masking

Long Term:

  • Atrophy of the dermis and epidermis
  • Striae
  • Purpura
  • Telangiectasia (spider veins on the face)
  • Acne
  • Hypertrichosis
  • Cataracts and glaucoma
32
Q

Topical/Oral Glucocorticoids

Systemic Side Effects:

  • Topical glucocorticoids can be absorbed in sufficient quantities to produce systemic side effects
  • Usually only occurs under ____ ____ like when ____ potency with ____ dressing are used over a large area of the body for a long period of time
  • Adrenal suppression affects the ____
  • Cushing’s Syndrome
  • Addison’s Syndrome
  • Growth suppression in ____
A
  • extreme use
    high
    occlusive
  • HPA (Hypothalamus-Pituitary-Adrenal) axis
  • children
33
Q

Adrenal cortex will begin to ____ if no longer used.

A

atrophy

34
Q

Effectiveness of Topical Glucocorticoids

Permeability of the skin

  • (High/Low) - scalp, axilla, face, eyelids, neck, perineum & genitalia
  • (High/Low) - back, palms, and soles
A comparison of absorption hydrocortisone (1) from the forearm
Sole of foot - 0.14 times
Palm - 0.83
Scalp - 3.5
Forehead - 6
Vulva - 9 
Scrotal skin – 42
A
  • High

- Low

35
Q

Topical/Oral Glucocorticoids

Systemic Side Effects - Cushing’s Syndrome (4)

A
  • Rounding, puffiness, plethora (redness) of the face (“moon face”)
  • Fat redistributes to the face and trunk (“buffalo hump”)
  • Fine hair grows over the thighs, face, trunk
  • Alopecia (hair loss on head)
36
Q

Phototherapy - Methoxsalen

MOA:

  • Belongs to the chemical class ____
  • ____ – a drug that is excited by a specific wavelength of light
  • The drug does not have activity until excited
  • After exposure to ____, methoxsalen combines with the ____ in epidermal cells by forming ____ linkages with ____
A

MOA:

  • psoralens
  • Chromophore
  • UVA, DNA, covalent, pyrimidines
37
Q

Phototherapy - Methoxsalen

Pharmacological effect:

  • Normalizes ____ and ____ of keratinocytes
  • ____ cutaneous blood vessels
  • Cytotoxic to _-____
  • Increases ____ pigmentation

Side Effects (7)

A

Pharmacological effect:

  • number and arrangement
  • Reorganizes
  • T-cells
  • melanin

Side Effects:

  • Pruritus
  • Nausea
  • Erythema & Blistering
  • Hyperpigmentation
  • Increased skin aging
  • Increased risk of skin cancer
  • Cataracts
38
Q

Topical/Oral Glucocorticoids

Systemic Side Effects - Addison’s Syndrome (6)

A
  • Weakness & fatigue
  • Weight loss
  • Hyperpigmentation (tan color)
  • Hypotension
  • Electrolyte imbalance
  • Possible death if discontinued to rapidly

PT III - DEENT (12 decks)

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