Psoriasis and Acne Flashcards
What is the most common autoimmune disease in the U.S?
Psoriasis
What happens in psoriasis
T-cells are stimulated by an undefined antigen by an undefined antigen presenting cell. These T cells release pro-inflammatory cytokines such as TNF and IFN that induce keratinocyte and endothelial cell proliferation
These three psoriasis drugs have the same MOA. What are they and what is the mechanism?
Adalimumab, Etanercept, and Infliximab
They are all TNF Alpha blockers
More specifically, what is adalimumab?
It is a monoclonal antibody for TNF-Alpha
What is Etanercept?
It is a receptor antibody fusion protein for TNF- alpha
What is Infliximab?
It is a chimeric monoclonal antibody for TNF-alpha
It is important to note that all of these TNF-alpha blockers can be used against other autoimmune diseases such as arthritis, spendylitis, crohn’s,etc…
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What are the Black Box Warnings for the TNF-alpha blockers
May predispose to infections (fungal, mycobacterial/viral) , neoplasia, and tuberculosis
This reflects their immunosuppresive character.
Infliximab can cause adverse effects like?
Heart Failure, Murine protein hypersensitivity
Inflicts heart failure and murine protein hypersensitivity
Etanercept
Etaner-sepsis…absolutely contraindicated w/ sepsis
What is Ustekinumab
It binds the p40 subunit used for Interleukin 12 and Interleukin 23 stimulation. This helps them suppress Th12 and Th17 which are both pro-inflammatory cells.
What are the potential side-effects of Ustekinumab?
Potential for infection, neoplasms
What are the contraindications for ustekinumab>
Live vaccines, test for latent TB before giving. Some anaphylactic responses have been reported.
Retinoids and Retinoic acid =
Vitamin A
What is Vitamin A usually responsible for?
bone growth, testicular development and function, ovarian function, maintenance of mucosal and epithelial surfaces
What are the two Retinoid drugs?
acetretin and tazarotene
How does Retinoic acid help treat acne
It increases cell turnover and mitosis. Expulsion of active comedones (white heads and black heads) and prevent new comedones from forming through sloughing and expulsion of horny cells from the follicle.
Drugs that target the Retinoid A receptors are?
Tretinoin (ATRA)/ Isotretinoin, Adalpene, Tazarotene
Targeting RAR predominantly affects?
Differentiation and proliferation
Targeting RX
Induces apoptosis
RAR drugs are used to treat acne/psoriasis whereas RXR drugs are used more frequently in the treatment of Kaposi’s Sarcoma and mycosis fungoides
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Systemic toxicity of Retinoids
Pretty much Vitamin A intoxication.
Nosebleed, dry skin, hair loss, poor night vision.
Retinoids are Teratogenes
Retinoids induce hyperlipidemia.
Prior to retinoid therapy, what should be tested
Do a pregnancy test, test lipids, and do a CBC
Monitor Isotretinoin pts for what>
suicidal thoughts
Topical retinoids used for?
acne and photoaging correction
How do topical retinoids work against acne
Correct follicular keratinization, reduce P. acnes counts, and reduce inflammation
How do topical retinoids provid relief of photoaging
inhibit matrix metalloproteinases in response ot UV radiation, Induce epidermal hyperplasia in atrophic skin and reduce keratinocyte atypia,
adverse effects of topical retinoids
erythema, desquamation, burning and stinging
Calcipotriene can induce what>
Hypercalcemia and hypercalciurua
Also greater susceptibility to UV damage
Calcitriol
Hormonally active VitD3. Better tolerated in sensitive skin areas
Look at sheet for benzoyl peroxide , steroids, and salicylic acid
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Topical glucocorticoid potency is measured by>
ability to produce cutaneous blanching.
Classified as mild-moderate-potent-and very potent
