Pharm - atopic derm/psoriasis Flashcards
psoriasis is what kind of disorder
immune and inflammatory
name 5 local psoriasis treatment options
topical CS
coal tar
vitamin D analogues
UV light
calcineurin inhibitors
can anti TNF drugs be used in psoriasis?
name them
yes
adalimumab
golimumab
etanercept
infliximab
certolizumab
name 4 calcineurin inhibitors that can be used for psoriasis
tacrolimus
pimecrolimus
cyclosporin
voclosporin
name 2 classes of drugs used in psoriasis
hydrating agents
antipruritics
___ in ___ preparations can be used as hydrating agents in psoriasis
water in oil
what class of antipruritics are preferred in psoriasis patietns
1st generation antihistamines like diphenhydramine and hydroxyzine
are antidepressants used in psoriasis?
what is the concern?
yes – for their sedation and antihistamine effect
concern - falls in the elderly and anticholinergic effects
what does calcipotriene do
is it a steroid?
NOT a steroid
a synthetic vitamin that slows the growth of skin cells
used in psoriasis
explain how calcineurin inhibitors work
prevent the dephosphorylation of NFAT
when NFAT is dephosphorylated, it goes into the nucleus and increases expression of genes encoding for IL-2, which promotes the release and activity of T cells
suppressess mainly T CELL ACTIVITY
true or false
calcineurin inhibitors suppress mainly B cell activity
false - T cell
calcineurin inhibitors cause decreased ____, ____ and _____
decreased NFAT, IL-2, and T cell activation
what is the black box warning of calcineurin inhibitors
increase in malignancies
major issue with calcineurin inhibitors is that they are _____ toxic
nephro
calcineurin inhibitors have highly variable ______
explain*****
highly variable pharmacokinetics
they have highly variable absorption – need to always be administered under same conditions
may have competition for biotransformation and elimination
KINETICS ARE NOT DEPENDABLE
which calcineurin inhibitor is the “best of the bunch” as far as not having highly variable kinetics
pimecrolimus
since calcineurin inhibitors have variable pharmacokinetics, what should be monitored
concentration 2 hours post dose (cyclosporin) and at C0 (tacrolimus)
which calcineurin inhibitor has the most highly variable GI absorption
cyclosporin
since calcineurin inhibitors are known to cause nephrotoxicity, what should be monitored?
labs like creatinine and BUN
pt should always be hydratedq
why is IFNY used in psoriasis pts
because in psoriasis patients the response to IFN is attenuated or absent
name 2 PDE4 inhibitors
apremilast
crisaborole
differentiate between the safety of the 2 PDE4 inhibitors apremilast and crisaborole
apremilast is an older drug. enters the brain and may cause severe side effects like anorexia and depression
crisaborole however does not enter the brain and does not have these severe psych side effects
true or false
crisaborole is not a steroid
TRUE
it is a PDE4 inhibitor
aside from crisaborole and apremilast, name 2 other PDE4 inhibitors and what they’re used for
roflumilast and cilomilast
used in COPD and emphysema for their anti inflammatory effects in smooth muscle
name 3 main medications that can trigger or exacerbate acne
anabolic steroids
sex sterouds
corticosteroids
carbamazepine can do what
trigger or exacerbate acne
lithium can….
trigger acne
what is an important consideration of retinoic acid drugs
highly lipophilic – can enter the body even topically
name some side effects of retinoids**8
teratogenic (oral)
very lipophilic and can enter the body even when given topically
may worsen acne at first, cause dry, cracked skin, skin eruptions, lesions
what are RARS
retinoic acid receptors
retinoids bind to
name some drugs that put you at risk for stephens johnson syndrome
NNRTI (in HIV+ pts)
anticonvulsants
sulfonamides
anti malarials
antibiotics
NSAIDS (oxicams)
antifungals
toxic epidermal necrolysis
“scalded” skin disease – developed from SJS
skin sheets off
females with SJS more likely to develop than men
what is a clear sign of the beginnings of stevens johnson syndrome
a BLISTERING RASH
What population is MOST likely to develop SJS
HIV infected patients
why do drug manufacturer’s not test for the potential risk of SJS
cant be tested for unless its in humans
