Psoriasis

Question 1

What are the Treatment for facial areas?

Answer 1

1) Topical calcineurin blockers
2) mild corticosteroids
3) Coal Tar

Question 2

What are the treatment for skin folds?

Answer 2

Corticosteroids and antifungals such as clotrimazole (sweaty areas, increase growth of fungus)
- pimecrolimus fine too

Question 3

What are triggers for psoriasis?

Answer 3

-Cold weather, excessive alcohol, smoking, pregnancy, infection (i.e. after streptococcal infection)

Question 4

What are treatment for body?

Answer 4

1) corticosteroids
2) Tazorotene
3) Coal tar
4) Vit D derivative (calcipotriol)
5) Anthralin

Question 5

Calcineurin and Vit D derivative time of action?

Answer 5

Up to 4-6 wks

Question 6

Systemic treatment

Answer 6

1) biologics
2) MTX
3) Acitretin (like isotretinoin) but should not be pregnant for 2 years after treatment b/c of long half life with metabolite created by alcohol consumption.
4) Cyclosporine.
5) Photo-therapy. Specific kind is called PUVA which suppresses cell division (oral psoralens + UVA light; psoralens is activated by UV to chelate DNA)

Question 7

Nail and psoriatic arthritis treatment

Answer 7

-Usually systemic treatment

Question 8

Drugs that could aggravate psoriasis

Answer 8

1) BB (could also cause an initial episode)
2) Lithium
3) oral steroids
4) Antimalarials
5) Alcohol
6) NSAIDs

Question 9

MTX–> dosing, side effects

Answer 9

• ->Dosing is 7.5-25 mg once weekly divided into 3 doses (i.e. 6 am, 6 pm then 6 am following day)
• -> Major SE:
  1) oral ulcers (take folic acid 1 mg daily)
  2) teratogenic and affects MALE and WOMEN (women should have 2 forms of contraception and shouldn’t be pregnant 1 month after D/C and men 3 months after D/C
  3) Liver hepatitis.
  4) hematological effects: blood dyscrasias.(a general term for various blood disorders, like neutropenia, agranulocytosis, hemolytic anemia, Thrombocytopia, aplastic anemia
  5) Nephrotoxic.

Question 10

blood dyscrasias.

Answer 10

a general term for various blood disorders, like neutropenia, agranulocytosis, hemolytic anemia, Thrombocytopia, aplastic anemia.
–> aplastic anemia includes low RBC, WBC, platelets

Question 11

MTX interactions

Answer 11

1) Ethanol and acitretin increase risk of liver
injury
2) Septra may increase bone marrow suppression.
3) NSAID could increase MTX level. But this is rare at lower RA doses (compete renal secretion)
4) Leflunomide could increase MTX level.

Question 12

MTX CI

Answer 12

1) Liver
2) renal (eliminated renally)
3) lung disease (b/c could cause pulmonary fibrosis)

Question 13

MTX monitoring`

Answer 13

1) Liver
2) SrCr
3) CBC, platelets
4) Albumin