Psoriasis Flashcards
1
Q
Psoriasis co-morbidities
A
Psoriatic arthritis Psych CV IBS MS Lymphoma
2
Q
Psoriasis precipitating factors
A
genetics skin trauma cold stress infection beta-blockers
3
Q
Psoriasis exacerbating factors
A
lithium NSAIDs beta-blockers corticosteroid withdrawal stress sunburn
4
Q
treatment for psoriasis caused by keritinocyte turnover
A
vitamin D analogs
retinoids
5
Q
treatment for psoriasis caused by abnormal immune response
A
BRMs and corticosteroids
6
Q
treatment for psoriasis caused by dendritic cells
A
phototherapy
7
Q
What is auspitz’s sign
A
small pinpoints of bleeding
8
Q
Mild or limited psoriasis
A
< or = 5% BSA
9
Q
Moderate psoriasis
A
PASI > or = 8
10
Q
Severe psoriasis
A
PASI > or = 10
DLQI > or = 10
BSA > or = 10%
11
Q
5 non-pharm treatments for psoriasis
A
stress reduction aviod irritants oatmeal baths skin protection moisturizers
12
Q
1st line for mild-moderate psoriasis
A
topical agents
13
Q
2nd line for mild-moderate psoriasis
A
topical agents + phototherapy
14
Q
3rd line for mild-moderate psoriasis
A
topical agents + systemic agent
15
Q
1st line for moderate-severe psoriasis
A
systemic agent (BRM if comorbidities exist) + / - topical agents or phototherapy
16
Q
2nd line for moderate-severe psoriasis
A
More potent systemic or BRM + / - topical agent or phototherapy
17
Q
3rd line for moderate-severe psoriasis
A
BRM (or a different BRM) +/- other agents
18
Q
corticosteroids MOA
A
anti-inflammatory, antiproliferative, immunosuppressive and vasoconstrictive
19
Q
corticosteroid dosing in psoriasis
A
thin layer once or twice daily
20
Q
low potentcy corticosteroid
A
hydrocortisone 1% (Hytone)
21
Q
mid potency corticosteroid
A
betamethasone valerate 1% (betnovate)
22
Q
first line corticosteroid
A
mid potentcy
23
Q
high potency corticosteroid
A
halobetasol 0.05% (ultravate)
betamethasone dipropionate 0.05% (Diprolene)
24
Q
use for hydrocortisone 1%
A
face or flexures
25
use for halobetasol 0.05%
short term only
26
use for betamethasone dipropionate
first line in thicker plaque areas (palms and soles)
27
systemic ADRs of corticosteroids
HPA suppression
osteonecrosis
cataracts
glaucoma
28
local ADRs of corticosteroids
```
striae
skin atrophy
acne
contact dermatitis
fungal skin infections
rosacea
```
29
Corticosteroids preg Cat
C
30
Vitamin D analogs MOA
bind to Vit D receptors inhibit keratinocyte proliferation and enhance keratinocyte differentiation
31
vitamin D analogs dosing
5 mg/week
32
calcipotriene 0.005% brand name
dovonex cream, ointment, or solution
33
calipotriene dosing
AA BID up to 8 weeks
34
calcipotriene and betamethasone dipropionate brand name
taclonex cream, ointment or suspension
35
taclonex dosing
AA daily up to 4 weeks
36
AEs of vitamin D analogs
```
skin irritation
erythema
dryness
stinging/burning
hypercalcemia (high dose or CKD)
```
37
Vitamin D analogs Preg CAt
C
38
Time to response for vitamin D analogs
4-8 weeks
39
retinoids MOA
normalizes keratinocyte differentiation and has antiproliferative and antiinflammatory effects
40
tazarotene brand name
tazorac
41
tazarotene dosing
0.05% or 1% gel or cream daily
42
tazarotene AEs
skin irritation (erythema, pruritis, burning)
43
tazarotene preg Cat
X
44
Topical calcineurin inhibitors MOA
local immune modulating effects (blockage of cytokines) that normalizes hyperproliferation
45
topical calcineurin inhibitors dosing
twice daily
46
tacrolimus 0.03% and 0.1% brand name
protopic ointment
47
pimecrolumus 1% brand name
elidel cream
48
AEs of topical calcineurin inhibitors
```
HA
fever
skin burning
pruritis
erythema
```
49
topical calcineurin inhibitors BBW
malignancy
50
topical calcineurin inhibitors Preg Cat
C
51
type of light for phototherapy
UVA or UVB
52
type of light combined with psoralens
UVA
53
AEs of phototherapy
```
photosensitivity
skin irritation
cataracts
photo aging
lesional blistering
```
54
Acitretin brand name
Soriatane
55
acitretin dosing
10-50 mg once daily
56
What drug is synergistic with phototherapy
acitretin (reduce UV by 30-50%)
57
acitretin AEs
mucocutaneous dryness
hypervitaminosis A
hyperlipidemia
diffuse idiopathic skeletal hyperostosis
58
Acitretin BBW
blood donation x 3 years
| alcohol use x 2 months
59
Acretin Preg Cat
X for 3 years after d/c
60
Acitretin drug interactions
Vitamin A
| Cyp metabolism
61
Acitretin monitoring
Lipids/LFTs, preg test
62
Methotrexate MOA
anti-inflammatory effecs due to T-cell gene expression and cytostatic effects
63
Methotrexate dosing
2.5-5 mg /week up to 7.5-25 mg/week
64
Common AEs of methotrexate
N/V
mucosal ulceration
HA
anemia
65
Serious AEs of methotrexate
hepatotoxicity
pulmonary fibrosis
bone marrow suppression
66
CIs to methotrexate
pregnancy, unreliable birth control, renal impairment, hepatitis, cirrhosis, alcoholics, leukemia, thrombocytopenia
67
methotrexate pregnancy cat
X
68
methotrexate protein binding interactions
```
salicylates
sulfonamides
phenytoin
thiazides
cipro
```
69
methotrexate renal excretion interactions
salicylates
probenacid
ascorbic acid
70
Monitoring for methotrexate for no hepatic risk factors
liver biopsy with cumulative doses of 1.5 g
| LFTs q 3 months
71
hepatic risk factors for methotrexate
```
history of EtOH> moderate
persistant abnormal LFTs
history of liver disease
family history of liver disease
obesity
renal insufficiency
advanced age
hypoalbuminuria
hepatotoxic meds
```
72
monitoring for methotrexate with hepatic risk factors
liver biopsy at baseline or 2-6 months
every time cumulative dose is 1-1.5 g
LFTs more frequently
73
monitoring for all methotrexate
```
CBC 7-14 days
q2-4 weeks for first few months
q1-3 months
Renal function q 2-3 months
pulmonary toxicity testing
pregnancy test
```
74
cyclosporine MOA
inhibition of the production and release of IL2 and inhibits IL2 activation of resting T cells
75
cyclosporine dosing
2-2.5 mg/kg/day PO in 2 doses
max 5 mg/kg/day
short term 12 weeks to 1 year
76
AEs of cyclosporine
```
impaired renal function
HTN
hypertriglyceridemia
hypomagnesemia
hyperuricemia
hypertrichosis
```
77
CIs to cyclosporine
```
abnormal renal function
uncontrolled HTN
malignancy
prior PUVA
uncontrolled infection
immunodeficiency - not autoimmune
```
78
cyclosporine preg cat
C
79
monitoring for cyclosporine
BP + SCr baseline, biweekly for 12 weeks, qmonth
| increase of 25%+ on 2 occassions decrease dose 25-50% -> still above 10% in a month d/c
80
Cyclosporine drug interactions
3A4 (grapefruit juice)
81
alefacept brand name
amevive
82
alefacept MOA
inhibits t-cell activation by targeting CD2 and inducing apoptosis of memory cells
83
alefacept preg cat
B
84
alefacept dose
15 mg IM QW x 12
85
alefacept BBW
malignancy
86
alefacept AEs
```
lymphopenia
myalgias
chills
pharyngitis
cough
nausea
injection site reaction
```
87
alefacept monitoring
CD4 T cell count biweekly
< 250 hold dose
<250 x 4 weeks d/c
88
TNF alpha inhibitors used for psoriasis
etanercept
infliximab
adalimumab
89
TNF alpha inhibitor MOA
binds and inactivates TNF alpha preventing interaction with its cell surface receptors
90
BBW of TNF alpha inhibitors
serious infections
| malignancies
91
TNF inhibitors monitoring
PPD yearly, periodic CBC + LFTs
92
Etanercept brand name
enbrel
93
infliximab brand name
remicade
94
adalimumab brand name
humira
95
etanercept dosing
50 mg SQ twice weekly x 12 weeks
| 50 mg SQ qweek
96
etanercept AEs
```
injection site reaction
HA
URI
GI upset
Hep B reactivation
worsening/new onset CHF
```
97
infliximab dosing
5 mg/kg IV over 2-3 hours at 0,2,6 weeks then q 8 weeks
98
infliximab AEs
```
hemolytic abnormalities
hepatotoxicity
hypersensitivity
ocular toxicity
worsening/new onset CHF
```
99
adalimumab dosing
80 mg SQ week 1
| 40 mg SQ week 2, q 2weeks
100
adalimumab AEs
Hemolytic abnormalities
| injection site reaction - pruritic urticarial rash
101
ustekinumab brand name
stelara
102
ustekinumab MOA
binds to and interferes with IL12 and IL13 preventing activation of t cells
103
ustekinumab dosing
< or = 100 kg 45 mg SQ at weeks 0,4,q12 weeks
| >100 kg 90 mg SQ at weeks 0,4 q 12 weeks
104
AEs of ustekinumab
```
URI
HA
tiredness
serious infections
malignancies
reversible posterior leukoencephalopathy syndrome
```
105
secukinumab brand name
cosentyx
106
secukinumab MOA
binds to and interferes with IL-17a preventing activation of t-cells
107
secukinumab dosing
300 mg SQ weeks 0,1,2,3,4
| 300 mg SQ q 4 weeks
108
secukinumab AEs
infection
| URI
109
apremilast brand name
Otezla
110
apremilast MOA
inhibits PDE4 which results in increased cAMP and decreased inflammatory feeling (NO, TNFa, IL23, IL10)
111
apremilast dosing
10 mg AM day 1 titrating to 30 mg BID by day 6
112
apremilast AEs
```
HA
fatigue
weight loss
diarrhea
nausea
```
