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DERM > PHARM psoriasis and acne > Flashcards

PHARM psoriasis and acne Flashcards

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Dermatology Board Prep flashcards
1
Q

adalimumab MOA

A

human monoclonal antibody that binds to the TNF-alpha binding site

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2
Q

etanercept MOA

A

receptor-antibody fusion protein for the TNF-alpha binding site

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3
Q

infliximab MOA

A

chimeric monoclonal antibody that binds to the TNF-alpha binding site (also has variable region of mouse monoclonal antibody on human IgG1

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4
Q

how is infliximab administered?

A

IV

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5
Q

how are adalimumab and etanercept administered?

A

SC

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6
Q

what are the contraindications of infliximab?

A

heart failure

murine protein hypersensitivity

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7
Q

what is the main contraindication of etanercept?

A

SEPSIS

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8
Q

what are the common black box warnings of infliximab, etanercept, and adalimumab?

A

infection including: fungal/mycobacterial/viral
Neoplasia
TB

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9
Q

MOA of ustekinumab?

A

disrupts IL-12 & IL-23 signal transduction (supreses formation of pro-inflamm. Th1 & Th17 cells

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10
Q

what are the notable adverse effects for ustekinumab?

A 
infections
neoplasia
Test for latent TB before starting treatment
Live virus vaccination contraindicated
Anaphylaxis
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11
Q

what are the functions of vitamin A?

A 
embryonic growth
morphogenesis
Differentiation & maintenance of epithelial tissues
Reproduction
Visual function
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12
Q

what are the effects of retinoids?

A
  • modulation of prolif. & differentiation
  • inhib. of keratinization
  • alterations of cellular cohesiveness
  • decreased sebum secretion & Seb. gland size (isotretinoin)
  • immunologic & anti-inflamm. effects
  • tumor prevention & therapy
  • induction of apoptosis
  • effect on ECM components
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13
Q

MOA of the retinoids?

A
  • activate retinoic acid receptor/retinoid X receptor in suprabasal keratinocytes, causing activation of TFs
  • these activate the synth. of heparin binding epidermal growth factor (HB-EGF) and amphiregulin (AR)
  • these 2 caues proliferation of basal keratinocytes, thereby inducing thickened epidermis and peeling of the stratum corneum
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14
Q

Targeting RARs predominantly affects what?

A

cellular differentiation and proliferation (tretinoin, adapalene & tazarotene used in acne, psoriasis & photoaging)

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15
Q

Targeting RXRs predominantly has what effect?

A

induces apoptosis (used in mycosis fungoides & Kaposi sarcoma)

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16
Q

what are the acute toxicities of the retinoids?

A

similar to Vitamin A intoxication:

  • dry skin, nosebleeds from dry mucous membranes
  • conjunctivitis
  • reduced night vision
  • hair loss
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17
Q

what tests should you do before prescribing retinoids?

A 
Pregnancy test (POTENT TERATOGEN-oral)
baseline: lipids, serum transaminases, CBC
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18
Q

RAR-selective retinoids have what kind of adverse effects?

A

mucocutaneous & musculoskeletal

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19
Q

RXR-selective retinoids have what kind of adverse effects?

A

physiochemical changes

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20
Q

rapidly evolving leukocytosis develops in 20% of pts getting oral __________________-

A

tretinoin

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21
Q

what are the 1st line agents for non-inflammatory acne often combined w/ other agents in the management of inflammatory acne?

A

topical retinoids

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22
Q

how do the topical retinoids reduce fine wrinkles and dyspimentation associated with photoaging?

A

inhibition of MMPs in response to UV radiation

induce epidermal hyperplasia in atrophic skin and reduce keratinocyte atypia

23
Q

what are the adverse effects of the topical retinoids?

A

erythema, desquamation, burning, stinging

increase reactivity to UV radiation–>increased risk for severe sunburn

24
Q

what are the indications for topical retinoids?

A

correct abnormal follicular keratinization
reduce P. acnes counts
reduce inflamm.

25
Q

what is the main indication for calcipotriene?

A

psoriasis

26
Q

how is calcipotriene administered?

A

topical

27
Q

calcipotriene MOA

A

binds to vitamin D receptor, complex associates w/ RXR-alpha & binds DNA vitamin D response elements
(modulation of epidermal differentiation & inflamm.–>improvement in psoriatic plaques)

28
Q

calcipotriene can be a topical irritant and this can be reduced by what?

A

concurrent corticosteroids

29
Q

what 2 classic adverse effects happen when calcipotriene is given as an extra large dose?

A

hypercalcemia

hypercalciuria

30
Q

which topical drug used to treat psoriasis increases a pt’s susceptibility to UV-induced skin ccancer?

A

calcipotriene

31
Q

which is more potent regarding calcium metabolism, calcipotriene or calcitriol when given systemically?

A

calcitriol is 100-200xs more potent than calcitriene

32
Q

what is ustekinumab indicated for?

A

psoriasis

33
Q

what is benzoyl peroxide used for?

A

acne (effective topical pro-drug converted in skin to benzoic acid)

34
Q

benzoyl peroxide MOA

A

free radical liberation kills nearby P. acnes

35
Q

why is benzoyl peroxide often formulated w/ antimicrobials like clindamycin/erythromycin/adapalene?

A

helps to prevent the development of antimicrobial resistance

36
Q

what are the adverse effects of benzoyl peroxide?

A

drying of skin: marked peeling, erythema, & irritation

  • contact dermatitis including rash, pruritis, blistering, crusting or swelling of skin
  • cool compresses or topical steroids to reduce symptoms and increase healing
37
Q

what areas of body should you avoid when using benzoyl peroxide?

A

eyes and mucous membranes

38
Q

what is teh goal with acne treatment in general?

A

simplify the regiment as much as possible

  • increases compliance and decreases skin irritation
  • drier skin-creams; oilier skin-gels or solutions
39
Q

Name a mild corticosteroid

A

hydrocortisone

40
Q

name a moderate corticosteroid

A

betamethasone valerate

41
Q

name a potent corticosteroid

A

fluocinonide

42
Q

name a very potent corticosteroid

A

clobetasol propionate

43
Q

Drug responsiveness varies by what 2 variables?

A

condition (disease)

anatomic location

44
Q

low potent preparations of steroids are supposed to be used on what areas of the body?

A

face & intertriginous areas

45
Q

when are very potent corticosteroids used?

A

usually required on hypereratotic or lichenified dermatoses and for disease of the palms and soles

46
Q

what happens to the absorption of steroids with inflamed skin of atopic dermatitis and in severe exfoliative diseases like erythrodermic psoriasis?

A

absorption is increased several fold

47
Q

where is the wrong place to use fluorinated steroids?

A

the face (may give rise to adverse rxns like perioral dermatitis)

48
Q

what are 2 main adverse effects of topical corticosteroids?

A
  1. dermal atrophy (cigarette paper appearing skin w/ telangiectasias & tendency for purpura & ecchymosis)
  2. Corticoid rosacea (persistent erythema, telangiectatic vessels, pustules, and papules in central facial distribution
49
Q

these adverse effects are found with which drug?
perioral dermatitis, steroid acne, alterations of cutaneous infections, hypopigmentation, hypertrichosis; intcreased intraocular pressure; and allergic contact dermatitis

A

topical steroids

50
Q

which acne treatment is metabolic product of aspirin?

A

salicylic acid

51
Q

salicyclic acid MOA

A

causes desquamation of horny layer of skin

52
Q

what will happen if you use prolonged administration of salicylic acid over large areas especially in children or hepatic imparment?

A

increase the risk of salicylism

53
Q

what are the 2 must known EARLY indicators of salicylate intoxication?

A

dizziness

tinnitus

DERM (11 decks)

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