Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What drugs can trigger psoriasis?

A
  1. Antimalarials
  2. Lithium
  3. B blockers
  4. Indomethacin
  5. Mepacrine
  6. ACE inhibitors
  7. Alcohol
  8. Topical drugs
  9. Overuse and sudden withdrawal of some oral corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Kobners phenomenon?

A
  1. Traumatised skin resulting in a psoriatic event at the site of injury
  2. Cytokines released —> activate T cells
  3. T cells —> more cytokines, keratinocytes and inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is plaque psoriasis?

A

Start as small papules that then grow and unite to form a plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does plaque psoriasis look like?

A

Classic silvery white scaly appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the major biological abnormalities of plaque psoriasis?

A
  1. Hyperproliferation of the epidermis
  2. Abnormal differentiation of keratinocytes
  3. Infiltration of the dermis and epidermis with activated T lymphocytes and neutrophils
  4. Stimulation of the cutaneous vasculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does guttate psoriasis like?

A

Initially start of as pink papules that become scaly, arises rapidly and responds well to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When does guttate psoriasis usually occur?

A

After a streptococcal throat infection - possibly superantigen stimulation of the IS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is erythrodermic psoriasis?

A

A severe variant that is widespread with massive protein loss, problems maintaining core body temperature and excessive fluid losses - requires aggressive treatment in hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the complications of erythrodermic psoriasis?

A

Pustulosis, arthropathy, staphylococcal skin infection and growth retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is pustular psoriasis?

A

A severe form that causes superficial pustulation of the lesions often on the palms and soles

May be widespread - associated with fever and malaise, fluid and electrolyte disturbances and infection

High relapse rate - can be fatal - hospitalised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main changes to nails in nail psoriasis?

A
  1. Pitting
  2. Oncholysis - selecting nail from nail bed
  3. Accumulation of subungual debris
  4. Colour changes

More often finger than toe nails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is psoriatic arthritis?

A

In the peripheral interphalangael joints - RF not elevated - difficult to distinguish from rheumatoid arthritis

Associated with cutaneous changes - nail and scalp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is inverse/flexural psoriasis?

A

Smooth inflamed lesions mostly in creases or folds - minimal or absent scaling

Perinanal skin in children and beneath breast in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are emollients?

A

Bath oils, soap substitutes and skin creams that moisturise, lubricate and soothe dry flaky skin by forming an occlusive film

To moisturise - apply liberally all over body tid

Psoriatic plaque - pretreatment

Contact dermatitis and foliculitis - ADR’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where is dithranol from?

A

Brazilian tree - Andira araroba

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does dithranol do?

A
  1. Slows cell proliferation
  2. Decrease inflammation

Very effective with no systemic S/E

17
Q

How do you use dithranol?

A
  1. 0.05 - 0.1% starting concentration applied each night at bedtime
  2. Rinse off each morning - coat skin with emollient
  3. Increase dose after a few days
  4. Little increase efficacy after 5%
18
Q

What are the problems with dithranol?

A
  1. Staining
  2. Inflammation and irritation of non psoriatic skin
  3. Short treatment
    - 0.1% for 5-20 mins
    - 1% over 5 mins
  4. Not as effective as calcipotriol in clearing lesions
19
Q

What is coal tar?

A

White soft or yellow soft paraffin base available in lotions, gels or shampoos

5% most effective

20
Q

What are the problems with coal tar?

A
  1. Smelly, messy and stains clothing
  2. Irritation - can cause contact dermatitis
  3. Phototoxic response
  4. Don’t apply over a large area - use on well separated small lesions
21
Q

How are corticosteroids applied?

A

Applied directly to lesion - goal is to increase time of remission

May make a lesion disappear but may return after discontinuation - taper strength

22
Q

What do you use for plaque psoriasis?

A

High potency topical steroid bd until control

23
Q

What are the S/E’s of corticosteroids?

A
  1. Skin atrophy - thinning of skin after 3-14 days
  2. Increase in fine hair growth
  3. Hypopigmentation
  4. Allergic contact dermatitis
  5. Systemic absorption - adrenal suppression
24
Q

What is an example of a vitamin D analogue?

A

Calcipotriol

  • 50 micrograms/gram ointment
  • 50 micrograms/gram scalp lotion
    Max weekly cumulative dose = 5mg ie. 100g or 100ml
  • use once or twice a day
  • notice effect week 2
  • max effect - weeks 6 to 8
  • flare up if used intermittently
25
Q

What are the adverse reactions of calcipotriol?

A
  1. Skin irritation - don’t use on face or flexural areas
  2. Peripheral ring of scales around treated lesions
  3. Rare - hypercalcameia
26
Q

How do retinoids work?

A

Tazarotene

  1. Topically active retinoid
  2. Normalise keratinocyte differentiation
  3. Anti-proliferative and anti-inflammatory effects
  4. Moderately effective
  5. Limited by skin irritation and increased
    photosensitivity
  6. Adequate contraception required in women of child bearing age
27
Q

How does phototherapy work?

A
  1. Phototherapy = UVB radiation
  2. Photo chemotherapy = light plus drugs
  3. PUVA therapy (psoralen and UVA)
  4. Take 2 hours before therapy
  5. Peak effect - 48 to 72 hours post therapy
  6. Shield eyes and skin from sun for 6 hours
28
Q

What drugs are used for systemic therapy?

A
  1. Retinoids
  2. Cyclosporin
  3. Methotrexate
  4. Tacrolimus
  5. Psoralens
  6. Biologic therapy agents
29
Q

What are the indications for systemic therapy?

A
  1. Failure of adequate topical trials
  2. Repeated hospital admission
  3. > 10% of body affected
  4. Extensive chronic plaque psoriasis in elderly or infirim
  5. Widespread pustular or erythrodermic psoriasis
30
Q

What are retinoids used for systemic therapy?

A
  1. They are vitamin A derivatives
  2. Eg. Acitretin
  3. Most effective for pustular and erythrodermic psoriasis
  4. Limit to severe forms
  5. Initial dose —> maintenance dose
  6. Teratogenic
  7. Avoid in severe liver and kidney disease
31
Q

What is systemic methotrexate used for?

A
  1. Used in patients unresponsive to topical therapy
  2. Can be used in severe pustular or erythroderma, arthritis and plaque involving more than 20%
  3. Folic acid antagonist
  4. Given weekly - caution
  5. Monitor blood, liver and kidney function
32
Q

What is systemic ciclosporin used for?

A
  1. Resistant disease
  2. Immunosuppressant
  3. Use lowest possible dose
  4. Monitor BP and kidney function
  5. Never exceed 5mg/kg/day
  6. 90% remission in 7-10 weeks
  7. Relapse 2-4 months post treatment
  8. Tacrolimus - similar to ciclosporin
33
Q

How do biological therapy agents work?

A
  1. Block T cell activation
  2. Inhibit T cell proliferation
  3. Inhibit T cell destruction
  4. Block effector cytokines
34
Q

What biological agents are used to treat psoriasis?

A
  1. Etanercept - 12 weeks
  2. Infliximab - 10 weeks
  3. Adalimumab - 16 weeks
  4. Ustekinumab - 16 weeks

Consider changing to an alt biological drug in adults if the psoriasis doesn’t respond adequately to a first biological drug ( see above for time for change)

35
Q

What are the risks with biologic agents?

A
  1. Risk of immunosuppressive not known
  2. Increased risk of infection and reactivation of TB
  3. S/E’s include influenza like symptoms, leucocytosis, arthralgia, exacerbation of psoriasis or development of variant forms
  4. 1/3 of patients respond rapidly others slowly or not at all
  5. Control not cure
36
Q

How should topical corticosteroids be used?

A

Sparingly and gradually withdrawn

Pharmacology (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions