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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

MOA of Adalimumab

A

Human mAb (with IgG1) targeted at TNF-alpha

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2
Q

ROA of Adalimumab

A

SC

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3
Q

MOA of Etanercept

A

Receptor-Ab fusion protein (with p75 TNF receptor and Fc IgG1) targeted at TNF-alpha.

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4
Q

ROA of Etanercept

A

SC

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5
Q

MOA of Infliximab

A

Chimeric mAb (with variable region of mouse mAb on human IgG1) targeted at TNF-alpha.

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6
Q

ROA of Infliximab

A

IV

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7
Q

What is the BBW for all monoclonal antibodies (targeted against TNF-alpha) used to treat psoriasis?

A

BBW: Infection, including fungal/mycobacterial/viral, neoplasms, and Tb. NOT with immunosuppressives or concurrent vaccinations

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8
Q

What is a specific contraindication to etanercept?

A

SEPSIS

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9
Q

What is a specific contraindication to infliximab?

A

Contraindicated with heart failure and murine protein hypersensitivity

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10
Q

What is one trait of all monoclonal antibodies used to treat psoriasis?

A

IMMUNOSUPPRESSION

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11
Q

What is the MOA of Ustekinumab?

A

mAb directed at interleukin (binds to p40 subunit integral to IL-12 and IL-23 activation to suppress formation of pro-inflammatory Th1 and Th17)

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12
Q

What are some adverse effects of Ustekinumab?

A

Infections, neoplasa, anaphylaxis. (pre-test for Tb)

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13
Q

Ustekinumab is contraindicated in what people?

A

Contraindicated with live virus vaccines.

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14
Q

List the drugs used to treat psoriasis that target retinoic acid receptors (RAR).

A

Acitretin (oral)

Tazorotene (oral or topical)

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15
Q

List the drugs used to treat acne that target retinoic acid receptors (RAR).

A

Tazorotene
Adapalene
Isotretinoin
Tretinoin (ATRA)

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16
Q

Drugs that target RAR do what? (broad)

A

Alters cellular differentiation and proliferation

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17
Q

Topical drugs that target RAR do what?

A

correct abnormal follicular keratinization, reduce P. acnes counts, and reduce inflammation.

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18
Q

True or false: all drugs that target RAR are teratogenic.

A

FALSE: only oral drugs

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19
Q

What is the most common laboratory abnormality in patients taking RAR drugs?

A

Hyperlipidemia (serum lipids, serum trnasaminases, CBC and pregnancy test before use!)

20
Q

What are the main systemic areas that are influenced by people taking RAR drugs?

A

Mucocutaneous

Musculoskeletal

21
Q

What is the acute toxicity of RAR drugs comparable to? List some symptoms.

A

Vitamin A intoxication

-dry skin, nosebleeds from dry membranes; conjunctivitis; reduced night vision; hair loss.

22
Q

What are some symptoms unique to topical RAR drug use?

A

increase risk of sunburn; erythema; burning

23
Q

What is a unique adverse effect of Isotretinoin?

A

must monitor for depression/ suicidal ideas

24
Q

What is the MOA of calcipotrene?

A

Binds to Vit D receptor; complex associates with RXR-alpha and binds DNA vitamin D response elements to modulate epidermal differentiation and inflammation

25
Q

What is calcipotrene used to treat?

A

psoriasis

26
Q

What are the adverse effects of calcipotrene?

A

Topical irritant (reduced by concurrent corticosteroids)

In EXCESS- hypercalcemia and hypercalcuria

increased susceptibility to UV-induced skin cancer

27
Q

What is the MOA of calcitrol?

A

Hormonally active form of Vitamin D3

28
Q

Why is calcitrol given over calcipotrene?

A

it is way better tolerated in sensitive skin areas

29
Q

What is the MOA of benzoyl peroxide?

A

Topical pro-drug converted to benzid acid that works by free radical liberation that is lethal for P. acnes.

30
Q

What can benzoyl peroxide be combined with?

A

Can be formulated with antimicrobials or adapalene!

31
Q

Why might it be beneficial to combine an antimicrobial with benzoyl peroxide?

A

The benzoyl peroxide may prevent anti-microbial resistance

32
Q

What are the AEs of benzoyl peroxide?

A
  • Drying of skin: peeling, erythema, irritation
  • Bleach hair or colored fabrics;
  • AVOID contact with eyes or mucous membranes
33
Q

What may be a big issue with giving antibiotics to treat acne? How do you prevent this?

A

Resistance may occur. Give drugs for 4-8 weeks until switching due to unresponsiveness. If responsive, use until NO NEW spots appear.

34
Q

What is salicyclic acid?

A

Topical keratolytic that causes desquamation of horny layer of the skin.

35
Q

What can salicyclic acid treat?

A

acne
psoriasis
warts

36
Q

What are the AEs of salicyclic acid?

A

Contact irritation

Neonatal toxicity (via breasmilk)

Prolonged administration over large areas may lead to salicylism (especially in children and patients with renal/ hepatic impairment)

37
Q

What are some symptoms of salicylism?

A
  • Tinitus and dizziness (early)

- Seizures, Renal/liver failure, and organ edema (late)

38
Q

What is the “mild” corticosteroid?

A

Hydrocortisone

39
Q

What is the “moderate” corticosteroid?

A

Betamethasone valerate

40
Q

What is the “potent” corticosteroid?

A

Fluocinonide

41
Q

What is the “very potent” corticosteroid?

A

Clobetasol Proprionate

42
Q

How do corticosteroids work?

A

bind to cytoplasmic steroid receptors and complex migrates to nucleus to produce trans-activating and trans-repressive effects on nuclear transcription. (Increase anti-inflammatory lipocortins and decrease release of endogenous inflammatory mediators)

43
Q

True or false: corticosteroids do not treat the underlying cause of acne.

A

TRUE: Just reduces the symptoms of the inflammation (does not alter underlying cause).

44
Q

What is special about fluorinated corticosteroids?

A

SHOULD NOT BE APPLIED TO FACE )→ leads to perioral dermatitis

45
Q

What are the two major dermatologic adverse effects to topical steroids?

A

Dermal atrophy

Corticoid rosacea

46
Q

What is dermal atrophy?

A

shink, wrinkled “cigarette paper”-appearing skin with prominent telangiectases and tendency for purpura and ecchymosis

47
Q

What is corticoid rosacea?

A

Persistent erythema, telangiectatic vessels, pustules, and papules in central facial distribution

DERM (17 decks)

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