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Therapeutics IV Final Subjects > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What is psoriasis characterized by?

A

I DAVES - Inflammation, Disease waxes and wanes, altered maturation of skin, vascular changes, epidermal hyperproliferation secondary to activation of immune system, Scaly, erythematous patches, papules and plaques that are itchy

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2
Q

What does psoriatic skin look like compared to regular skin on an epidemal cross sectional slide in a microscope

A

Psoriatic skin has proliferation of epitheliasl cells much deeper

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3
Q

What cell mediates the immue response for psoriasis

A

T-cells

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4
Q

What is the age of onset of psoriasis?

A

15-25 yrs old

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5
Q

What is psoriatic arthritis?

A

skin symptoms of psoriasis that precedes development of the joint symptoms of arthritis

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6
Q

What stimulates the keratinocyte huyperproliferation?

A

Interleukins (1,6,8,12,17,23), TNF

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7
Q

Where are the IL and TNF released from that cause the hyperproflieration of keratinocytes?

A

T-cells and keratinocytes

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8
Q

What kind of vascular changes happens during PsO

A

vasodilation, hyperpermeability, angiogenesis

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9
Q

with joint involvment, what invades the synovium and causes bone resorption and destruction?

A

The ILs(1,6,8,2,17,23) and TNF

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10
Q

Macrophages and T cells release ____ and it acts of 3 sites. What are the three sites and what is the outcome.

A

It releases TNF and IL 1, 6, 8, 12, 17, 23. They act on Endothelial cells, Keratinocytes and T-cells: which cause inc adhesion mol, VEGF; hyperproliferation and release of proinflammatory cytokines; induction of IL-1, il-6 and IL-8

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11
Q

What are some causes of PsO?

A

Genetic, stress, injury to skin, infections, medications, weather

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12
Q

What are the 9 different types of PsO

A

Plaque/Guttate/Pustular/inverse/erythrodermic/nail/palmar/plantar/scalp/psoriatic arthritis

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13
Q

What joints are usually affected in arthritic PsO?

A

DIP

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14
Q

What is affected more, finger or toe nails?

A

finger nails

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15
Q

What are some typical nail changes?

A

onycholysis (separation from the nail bed), pitting, oil-drops, hyperkeratosis (thickening), discoloration

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16
Q

What are some comorbidities with PsO?

A

arthritis, CD and UC, CV, metabolic syndrome

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17
Q

What are some assessment tools?

A

PASI, PGA, BSA, pt assessments of disease and QOL

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18
Q

What do you tx a pt with if they have Psoriasis with psoriatic arthritis?

A

Anti-TNF’s +/- MTX or just try MTX alone

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19
Q

What are some Anti-TNF’s

A

etanercept (Embrel), adailumumab (Humira), Infliximab (Remicade), Golimumab (Simponi but not for PsO)

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20
Q

If you have limited Psoriasis with no psoriatic arthritis what do you use first?

A

Tocials/targeted phototherapy (like Corticosteroid cream and Vit D)

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21
Q

If you dont have psoriatic arthritis but you have extensive disease, or there is no effect from topicals then what do you use?

A

systemic tx or biologics (anti-TNF or non anti-TNF)

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22
Q

What topicals do you use in mild (limited) disease for PsO?

A

Topical Corticosteroids, retinoids (vit A), vit D, anthralin, Tar, keratolytics, lubricants

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23
Q

Why are emollients or moisturizers used?

A

To moisturize, lubricate and soothes dry and flaky skin; retains moisture in the stratum corneum

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24
Q

How often are emollients and mositurizers uesed? contraindications?

A

1 - 3 times a day; no known ones

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25
Q

What is a common Keratolytic? What is the dose and the frequency? What does it do? What are some adverse effects?

A

Salicyclic acid (2-6%), apply 1-3 times a day. helps remove scales and reduce hyperkeratosis; can cause skin irritation and systemic absorption

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26
Q

What is a contraindication with salicylic acid topical for PsO?

A

UVB phototheray

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27
Q

How does Coal Tar work?

A

suppresses DNA, dec epidermal cell proliferation and scale development

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28
Q

What concentration of coal tar is the most effective?

A

5%

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29
Q

What are the 4 problems with coal tar?

A

SSSS: Smell, Sting, Stain, Sensitize

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30
Q

What are some adverse effects of coal tar?

A

Skin irriation, contact dermatitis, folliculitis, photosensitivity, staining

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31
Q

Can coal tar be used for scalp PsO? How?

A

yes, shampoo

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32
Q

What is Goekerman regimen?

A

Coal Tar + UV

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33
Q

What are the 4 properties of Corticosteroids?

A

Anti-inflammatory, dec in vascular permeablility, antiproliferative, immunosuppressive

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34
Q

What are the different levels of potency?

A

1-7 (1 is most potent, 7 is least potent) 1 is up to 92%, 7 is as low as 41%

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35
Q

what potency is hydrocortisone?

A

lowers potency (5,6,7)

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36
Q

What potency is clobetasol propionate?

A

highest potency (1)

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37
Q

what potency is Fluocinonide?

A

2 or 3,4

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38
Q

What potency is mometasone furoate?

A

2

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39
Q

What potency is diflorasone diacetate?

A

1

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40
Q

What usage restriction is on class 1 topical corticosteroids?

A

no more than twice daily for up to 2-4 weeks

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41
Q

What are some adverse effects of corticosteroids (topical)

A

burning, itching, skin atrophy, erythema, folliculities, excessive hair growth, acne, rebound PsO if abrubtly stopped

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42
Q

What are some rare systemic side effects?

A

hypothalamic-pituitary-adrenal axis suppression

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43
Q

What is calcipotriene? Brand name?

A

Vit D3 analogue; Dovonex

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44
Q

What is the MoA of Dovonex?

A

inhibits proliferation and inc differentiation of keratinocytes and decreases T-cell infiltration

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45
Q

What is Dovonex used to tx?

A

plaque PsO

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46
Q

What is the dose and dosage forms of calcipotriene?

A

0.005% cream, ointment and scalop solution applied QD or BID; often used in combination with corticosteroids

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47
Q

How long does it take the theraputic response to occur for Calcipotriene (Dovonex)

A

2 wk

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48
Q

Maximal effect of calcipotriene (dovonex) can take up to how long?

A

6-8 wk

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49
Q

Side effects from Dovonex?

A

burning, itching, skin irritation; redness, rash, dermatitits;

50
Q

What are some serious but rare side effects of Calcipotriene (Dovonex)

A

inc Ca and dec parathyroid hormone

51
Q

Can Vit A derivatives be used for PsO?

A

yes (topical Retinoids)

52
Q

What is an example of a topical Retinoid?

A

Tazarotene (Tazorac)

53
Q

How does Tazarotene work?

A

reduces keratinocyte proliferation, reducees inflammation and normalizes abnormal keratinocyte differenetatioan

54
Q

What is Tazarotene indicated for?

A

plaque psoriasis

55
Q

What is the dose and dosage form of Vit A Retinoids like Tazarotene

A

0.05% and 0.1% cream and gel applied QD

56
Q

How long does it take to see the clinical efficacy of Tazarotene?

A

1-2 weeks

57
Q

side effects of Tazarotene?

A

same as Vit D and cortico except for fissuring, inc sensitivity to sunlight

58
Q

What pt population is Tazarotene contraindicated in?

A

Pregnancy (X)

59
Q

Are there oral retinoids?

A

yes

60
Q

What is the name of the two oral retinoids?

A

Etretinate & Acitretin

61
Q

What is the brand name of Acitretin

A

Soriatane

62
Q

What type of psoriasis is Acitretin for? WHy is it reserved for severe forms?

A

pustular and erythrodermic psoriasis; due to side effects

63
Q

Etretinate was withdrawn from US market; but Acitretin is related to it how?

A

It is the active metabolite.

64
Q

What is the MoA of Soriatane?

A

Unknown

65
Q

What is the indication of Soriatane?

A

severe PsO

66
Q

What is the dose of Acitretin?

A

25-50mg QD

67
Q

What is the adverse effect profile of Acitretin (Soriatane)?

A

dryness and inflammation of the lips, alopecia, skin peeling, dry skin, rhinitis, nose bleeds, nail disorders, itching, thickening of the conjunctiva, joint pain, spinal hyperostosis, depression

68
Q

What do I think are the important side effects of Soriatane?

A

depression, joint pain, alopecia, pregnacy X

69
Q

Are the oral retinoids contraindicated in pregnanacy?

A

Yes

70
Q

What are the two BBW to the oral retinoid, Soriatane?

A

Female pts should not injest ethanol during tx w/ or for 2 months after cessation of therapy; male pts should not d onate blood druing and for at least 3 yrs following Soratane therapy

71
Q

What are some precautions associated with Soriatane (acitretin)?

A

teratogenic, BBWs, hepatotoxicity, lipid abnormalities, eye, bone, pancreatitis, benign intracranial hypertension

72
Q

What should you monitor while on Soriatane?

A

glu, lipids, LFTs

73
Q

What drugs should you avoid with Soriatane due to the inc risk of intracranial pressure?

A

Tetracyclines

74
Q

What is the MoA of MTX

A

block folic acid synthesis by inhibiting dihydrofolic acid reductase; inhibits DNA synthesis

75
Q

What is the dosing of MTX?

A

7.5mg QW; 2.5mg at 12hr intervals

76
Q

preg category of MTX?

A

X

77
Q

What are some contraindications of MTX?

A

avoid in oral antibiotcis, pts w/ alcoholism (liver damage), immunodeficient pts, pts with blood dyscrasias

78
Q

Slide 33 Has a list of Warnings for MTX.

A

What are they?

79
Q

What should you monitor when on MTX?

A

CBC and platelet counts; LFTs, RFTs, Chest X-ray (infection), liver biopsies with long term use

80
Q

What are the serious adverse effects of MTX?

A

hepato and renal toxicity, bone marrow suppression, immunosuppression, malignant lympomas, D/N, abdominal distress, Ulcerative stomatitis, lung disease, skin reactions, alopecia, photosensitivity (burning of skin leasions)

81
Q

How does Cyclosporine work?

A

It as an immunosuppressant that stops T-lymphocyte prolieration at the G0 or G1 phase of the cell cycle

82
Q

What is cyclosporine used for?

A

recalcitrant, plaque psoriasis (non-immunocompramised) who have failed to other systemic therapy

83
Q

Is there an oral for? what is the brand name?

A

Yes, Neoral

84
Q

What is the dose for cyclosporine?

A

2.5mg/kg/day PO for 4 wks; if no improvment in 4 wks; inc by 0.5mg/kg/day q 2 wks to a max of 4mg/kg/day or until you see clinical benefit

85
Q

What is the other brand name of cyclosporine?

A

Sandimmune

86
Q

What brand has increased %F?

A

Neoral, so its not bioequivalent

87
Q

What are the 5 black box warnings with cyclosporin (Sandimmune, Neoral)?

A

inc risk of infection, neoplasia, HTN, nephrotoxicity, previous tx with MTX, PUVA, immunosuppressive agents, coal tar, radiation therapy are at an inc risk of skin malignancies while taking cyclosporine

88
Q

What are three things to monitor with cyclosporine?

A

RFTs, HTN, CBC

89
Q

What are some adverse effects of Cyclosporine (HHHHIPMNR)

A

HA, HTN, hypertriglyceridemia, Hirsutism, influenza-like synmptoms, paresthesia, musculoskeletal or joint pain, N/V/D, renal dysfunction

90
Q

What does PUVA stand for and how does it work?

A

Psoralen + UVA (320-400nm); psoralen binds to DNA and breaks it once light is shown on it

91
Q

What nm range is the best for psoriasis?

A

313

92
Q

What is narrowband? Which is more effective? how many txs?

A

311nm, narrowband, 2-5 tx

93
Q

When is Psoralen given?

A

2 hr before UVA exposure 2-4/wk - 25 tx are required for clearance

94
Q

What are some adverse effects of PUVA?

A

N/Pruritus/Erythema, skin burning, Carcinogenicity

95
Q

What are some warnings with PUVA?

A

skin cancer, premature aging, skin burning,

96
Q

What tx should you avoid for PsO in pts taking PUVA?

A

photosensitizing agents (coat tar, anthralin), cyclosporin, MTX and hepatic and cardiac disease

97
Q

What are the three anti-TNFs for PsO?

A

Etanercept (Enbrel), Adalimumab(Humaira), Infliximab (Remicade)

98
Q

What is the T-cell inhibitor for PsO?

A

Alefacept

99
Q

What is the IL-12/23 inhibitor for PsO?

A

Ustekinumab

100
Q

How does Enbrel work?

A

soluble Fc of human and IgG1 and binds TNF

101
Q

What is the dose for psoriasis? psoriatic arthritis?

A

50mg BiWk for 3 months then 50mg QW; 50mg SQ QW

102
Q

Boxed warnings for Enbrel?

A

serious infections (TB, sepsis, fungal infections); malignancies

103
Q

Can Enbrel be used in pts with alcoholic hepatitis?

A

no

104
Q

What is the MoA of remicade?

A

binds and blocks TNF receptor

105
Q

BBW for remicade?

A

Infections (TB, Sepsis, fungal infections), cancer

106
Q

What are some common side effects of remicade?

A

infections, HA, abdominal pain

107
Q

MoA of Humira?

A

binds and blocks TNFalpha receptor

108
Q

BBW for Humira?

A

serious infections (TB, fungal, sepsis), cancer

109
Q

Can the three anti-TNF have hypersensitivity reactions?

A

yes

110
Q

Can you used the Anti-TNF with anakinra or abatacept?

A

No

111
Q

Can the three anti-TNF be used with heart failure?

A

No

112
Q

What are some common side effects of Humira?

A

HA, rash, infection

113
Q

common side effects of enbrel?

A

infection, infusion site reactions

114
Q

brand name of alefacept? What is the MoA?

A

Amevive, stops T-cell lymphocyte activation

115
Q

What are some warnings for Amevive?

A

lymphopenia, malignancies, infections, liver damage

116
Q

What are some common side effects of Amevive?

A

pharyngitis, Dz, N, inc cough, pruritus, myalgia, chills, injection site pain

117
Q

What is the brand name of ustekinumab?

A

Stelara

118
Q

What is the MoA of Stelara?

A

antibody against IL-12 and IL-23 cytokines

119
Q

What is the only disease that amevive (alefacept) and Stelara (ustekinumab) indicated for?

A

PsO

120
Q

What are some warnings for Stelara?

A

infection, malignancies, hypersensitivity, RPLS, immunizations, use with immunosuppressive agents

121
Q

Common adverse events of Stelara?

A

infections, HA, fatigue

122
Q

What other pt population should u avoid stelara in?

A

CV pts

Therapeutics IV Final Subjects (10 decks)

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