Psoriasis and Acne

Question 1

targeted therapies for psoriasis

Answer 1

adalimumab; etanercept; infliximab

Question 2

targeted therapies for bind to what cytokine?

Answer 2

TNF-a

Question 3

What are the contraindications for infliximab?

Answer 3

heart failure; murine protein hypersensitivity

Question 4

contraindications for etanercept?

Answer 4

sepsis

Question 5

contraindications for adalimumab

Answer 5

none

Question 6

What are the associated black box warnings for infliximab, etanercept, and adalimumab?

Answer 6

infections (all types); neoplasia; tuberculosis

Question 7

What should NOT be used concurrently with infliximab, etanercept, or adalimumab?

Answer 7

immunosuppressives or vaccinate

Question 8

MOA for Ustekinumab?

Answer 8

binds to p40 in IL-12, IL-23 activation disrupting their signal transduction

Question 9

What is the result of the MOA of Ustekinumab

Answer 9

suppresses formation of pro-inflam Th1 and Th17 cells

Question 10

patients taking Ustekinumab are at increased risk for what?

Answer 10

infections and neoplasia => test for latent TB before; no live virus vaccinations

Question 11

What is the first line agent for non-inflam acne?

Answer 11

topical retinoids

Question 12

When topical retinoids are combined with other agents, how is inflam acne managed?

Answer 12

corrects abnormal follicular keratinization; reduces P. acnes counts; reduces inflammation

Question 13

Why are retinoids effective in reducing fine wrinkles and photoaging?

Answer 13

inhibit MMP in UVR response; induce epidermal hyperplasia in atrophic skin and reduce keratinocyte atypia

Question 14

What are ADEs of topical retinoids?

Answer 14

erythema; desquamation; burning; stinging

Question 15

Why do retinoids place patients at increased risk for severe sunburn?

Answer 15

increased reactivity to UV radiation

Question 16

Calcipotriene is a topical drug. What is MOA?

Answer 16

binds to Vit D receptor and complex associates with RXR-a and binds DNA vit D response elements

Question 17

How does calcipotriene improve psoriatic plaques?

Answer 17

modulation of epidermal differentiation and inflammation

Question 18

ADEs with Calcipotriene

Answer 18

topical irritant (clear by corticosteroids);
hypercalcemia, hypercalciuria;
increase susceptibility to UV-induced skin cancer

Question 19

What is the hormonally active form of vit D3?

Answer 19

Calcitriol

Question 20

When is calcitriol better than calcipotriene?

Answer 20

better tolerated in intertriginous and sensitive areas of skin

Question 21

T/F Benzoyl peroxide is a topical pro drug?

Answer 21

true=> converted to benzoic acid in skin

Question 22

What is the MOA for Benzoyl peroxide?

Answer 22

free radical liveration lethal for P. acnes

Question 23

What is the ADEs associated with benzoyl peroxide?

Answer 23

drying of skin with peeling, erythema, irritation

Question 24

How should you treat ADEs associated with benzoyl peroxide?

Answer 24

cool compresses or topical corticosteroids to reduce symptoms and increase healing

Question 25

Often benzoyl peroxide is formulated with antimicrobials, why?

Answer 25

helps to prevent development of resistance

Question 26

Where should Benzoyl peroxide be avoided?

Answer 26

eyes, mucous membranes, bleach hair/fabric

Question 27

Name the mild, moderate, potent and very potent corticosteroids

Answer 27

mild: hydrocortisone
moderate: betamethasone
potent: fluocinonide
very potent: clobetasol propionate

Question 28

What are the 3 ways in which anti-inflammatories have effects?

Answer 28

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

Question 29

Corticosteroid responsiveness varies by what 2 factors?

Answer 29

condition (disease state) and anatomical location

Question 30

What is the main characteristic of the corticosteroid penetration pattern in variable regions of skin?

Answer 30

moist skin with little hair will penetrate faster than those used a lot like plantar foot arches or forearms

Question 31

When given a corticosteroid is given, how is penetration affected in inflamed skin?

Answer 31

increases several fold in inflamed skin of atopic dermatitis and severe exfoliative diseases

Question 32

Importance of intralesional injection of insoluble drugs…

Answer 32

gradually released for 3-4 weeks

Question 33

Where should fluorinated topical steroids NOT be applied? why?

Answer 33

face due to ADEs like perioral dermatitis

Question 34

What are topical corticosteroid ADEs?

Answer 34

Iatrogenic Cushing’s syndrome; Dermal atrophy; corticoid rosacea;

Question 35

When giving children topical corticosteroids, what is a particular concern in the pediatric age group?

Answer 35

growth retardation is one of the adverse systemic effects

Question 36

How will a person with dermal atrophy from corticosteroid use present?

Answer 36

shiny, “cigarette paper” appearin skin with prominent telangiectases and tendency for purpura/ecchymosis

Question 37

How will corticosteroids that cause corticoid rosacea present?

Answer 37

persistent erythema; telangiectatic vessels; pustules; papules in central facial distribution

Question 38

What is the MOA of salicylic acid?

Answer 38

topical keratolytic that causes desquamation of horny layer of skin

Question 39

What type of patients using salicylic acid should be monitored?

Answer 39

children and patients with renal/hepatic impairment increase risk of salicylism due to prolonged administration over large areas

Question 40

Is there any pregnancy involvement with use of salicylic acid?

Answer 40

neonatal toxicity via breast milk and contact toxicity from drug applied to chest area