Psoriasis and Acne Flashcards
MOAs; elimination and dose mod in dysfxn; neurologic, teratogenic, immunosuppressive tox
targeted therapies for psoriasis
adalimumab; etanercept; infliximab
targeted therapies for bind to what cytokine?
TNF-a
What are the contraindications for infliximab?
heart failure; murine protein hypersensitivity
contraindications for etanercept?
sepsis
contraindications for adalimumab
none
What are the associated black box warnings for infliximab, etanercept, and adalimumab?
infections (all types); neoplasia; tuberculosis
What should NOT be used concurrently with infliximab, etanercept, or adalimumab?
immunosuppressives or vaccinate
MOA for Ustekinumab?
binds to p40 in IL-12, IL-23 activation disrupting their signal transduction
What is the result of the MOA of Ustekinumab
suppresses formation of pro-inflam Th1 and Th17 cells
patients taking Ustekinumab are at increased risk for what?
infections and neoplasia => test for latent TB before; no live virus vaccinations
What is the first line agent for non-inflam acne?
topical retinoids
When topical retinoids are combined with other agents, how is inflam acne managed?
corrects abnormal follicular keratinization; reduces P. acnes counts; reduces inflammation
Why are retinoids effective in reducing fine wrinkles and photoaging?
inhibit MMP in UVR response; induce epidermal hyperplasia in atrophic skin and reduce keratinocyte atypia
What are ADEs of topical retinoids?
erythema; desquamation; burning; stinging
Why do retinoids place patients at increased risk for severe sunburn?
increased reactivity to UV radiation
Calcipotriene is a topical drug. What is MOA?
binds to Vit D receptor and complex associates with RXR-a and binds DNA vit D response elements
How does calcipotriene improve psoriatic plaques?
modulation of epidermal differentiation and inflammation
ADEs with Calcipotriene
topical irritant (clear by corticosteroids);
hypercalcemia, hypercalciuria;
increase susceptibility to UV-induced skin cancer
What is the hormonally active form of vit D3?
Calcitriol
When is calcitriol better than calcipotriene?
better tolerated in intertriginous and sensitive areas of skin
T/F Benzoyl peroxide is a topical pro drug?
true=> converted to benzoic acid in skin
What is the MOA for Benzoyl peroxide?
free radical liveration lethal for P. acnes
What is the ADEs associated with benzoyl peroxide?
drying of skin with peeling, erythema, irritation
How should you treat ADEs associated with benzoyl peroxide?
cool compresses or topical corticosteroids to reduce symptoms and increase healing
Often benzoyl peroxide is formulated with antimicrobials, why?
helps to prevent development of resistance
Where should Benzoyl peroxide be avoided?
eyes, mucous membranes, bleach hair/fabric
Name the mild, moderate, potent and very potent corticosteroids
mild: hydrocortisone
moderate: betamethasone
potent: fluocinonide
very potent: clobetasol propionate
What are the 3 ways in which anti-inflammatories have effects?
1) induction of inhibitory protein that binds/inactivates NFkB;
2) GR-cortisol complex binding to NFkB
3) GR and NFkB compete for limited availability of coactivators including CREB and steroid receptor coactivator 1
Corticosteroid responsiveness varies by what 2 factors?
condition (disease state) and anatomical location
What is the main characteristic of the corticosteroid penetration pattern in variable regions of skin?
moist skin with little hair will penetrate faster than those used a lot like plantar foot arches or forearms
When given a corticosteroid is given, how is penetration affected in inflamed skin?
increases several fold in inflamed skin of atopic dermatitis and severe exfoliative diseases
Importance of intralesional injection of insoluble drugs…
gradually released for 3-4 weeks
Where should fluorinated topical steroids NOT be applied? why?
face due to ADEs like perioral dermatitis
What are topical corticosteroid ADEs?
Iatrogenic Cushing’s syndrome; Dermal atrophy; corticoid rosacea;
When giving children topical corticosteroids, what is a particular concern in the pediatric age group?
growth retardation is one of the adverse systemic effects
How will a person with dermal atrophy from corticosteroid use present?
shiny, “cigarette paper” appearin skin with prominent telangiectases and tendency for purpura/ecchymosis
How will corticosteroids that cause corticoid rosacea present?
persistent erythema; telangiectatic vessels; pustules; papules in central facial distribution
What is the MOA of salicylic acid?
topical keratolytic that causes desquamation of horny layer of skin
What type of patients using salicylic acid should be monitored?
children and patients with renal/hepatic impairment increase risk of salicylism due to prolonged administration over large areas
Is there any pregnancy involvement with use of salicylic acid?
neonatal toxicity via breast milk and contact toxicity from drug applied to chest area
