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Pharmacotherapeutics > Psoriasis (exam 1) > Flashcards

Psoriasis (exam 1) Flashcards

1
Q

Psoriasis presentation

A

sharp demacrated, erythematous papule and plaques with silver white fine scales

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2
Q

where is psoriasis typically found?

A

on the elbows, knees and scalp
can sometimes affect the nails

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3
Q

which is the most common type of psoriasis

A

chronic plaque psoriasis

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4
Q

what can cause psoriasis?

A

cell mediated immune mechanisms
autoimmune disease
genetics
polymorphisms of vitamin D receptor

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5
Q

medications that can exacerbate psoriasis

A

lithium carbonate
beta blockers
antimalarials
tetracyclines

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6
Q

what can exacerbate psoriasis?

A

smoking, alcohol, stress, infection
injury, trauma
medications

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7
Q

goals of therapy of psoriasis

A

decrease the size/thickness of plaques
improve quality of life
remission

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8
Q

chronic plaque psoriasis diagnosing criteria

A

mild - less than 5% BSA
moderate - 5-10% BSA
severe - more than 10% BSA

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9
Q

consideration for addition of agents in psoriasis is based on

A

disease severity
cost
convenience

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10
Q

mild to moderate psoriasis first line

A

topical agents

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11
Q

mild to moderate psoriasis second line

A

topical agents and phototherapy (if feasible)

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12
Q

mild to moderate psoriasis third line

A

topical agents and systemic therapy

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13
Q

what topical agents are typically given as first line for mild-moderate psoriasis

A

moisturizers (emollients)

intermittent topical corticosteroids

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14
Q

once mild-moderate psoriasis is controlled

A

step down to lower doses/potencies that maintain control of disease

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15
Q

for psoriasis, topical corticosteroids are generally continued

A

as long as the patient has thick active lesions

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16
Q

once clinical improvement of mild-moderate psoriasis occurs, application of topical corticosteroids should be

A

reduced as intermittent maintenance

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17
Q

what can be used to avoid long term intermittent topical corticosteroids?

A

topical immunosuppressives
salicylic acid
tazarotene
calciptriene (Dovonex)
calcitrol (Vectical)

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18
Q

synthetic vitamin D analogs reduce _______________ by binding to receptors in ______________________

A

cell proliferation

epidermal keratinocytes

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19
Q

coal tar (T gel) and anthralin (Zithranol or Dritho-creame) are used only in

A

adults

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20
Q

coal tar and anthralin MOA

A

inhibition of keratinocyte proliferation and anti-inflammatory

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21
Q

when coal tar or anthralin are used in combination with ultraviolet B light,

A

they inhibit epidermal DNA synthesis reducing plaque elevation

22
Q

side effects of coal tar and anthralin

A

increases sensitivity to UV light and the sun
local irritation
unpleasant odor
stains skin and clothing

23
Q

new alternative topical treatments for mild-moderate psoriasis

A

Vtama (tapinarof) cream
Zoryve (roflumilast) cream

24
Q

chronic plaque psoriasis plaques typically ______________________ of treatment

A

recur after cessation

25
Q

maintenance regimen for mild-moderate plaque psoriasis

A

intermittent treatment with previous topical corticosteroid
add a vitamin D analog
can do just vitamin D analog alone

26
Q

severe psoriasis first line therapy

A

biologics

27
Q

treatment for moderate to severe psoriasis

A

phototherapy
systemic non biologics
biologic agents

28
Q

moderate to severe psoriasis first line therapy

A

systemic oral agent with topical agent or phototherapy
or
consider BRM if comorbidities

29
Q

moderate to severe psoriasis second line therapy

A

more potent systemic oral agent
or
2 or more systemic agents in rotation with topical agent

30
Q

moderate to severe psoriasis third line therapy

A

biologic response modifier with other agents

31
Q

ultraviolet A vs B

A

A - penetrates deeper in the skin, takes 20 minutes per session

B - exposure times first few sessions 30-60 seconds

32
Q

how many times is light therapy used per week?

what to do when there is a satisfactory response?

A

2-3 times per week

taper to lowest required to maintain improvement

33
Q

PUVA

A

psoralens and ultra violet A

34
Q

Uvadex (oral methoxsalen)

A

shorter photosensitization onset
produces a triplet electronic state
taken 1.5-2 hours before UVA light exposure

35
Q

three common combination therapies of photochemotherapy

A

psoralen and UVA
Anthralin and UVB
coal tar products and UVB

36
Q

acitretin

A

systemic retinoid
normalizes epidermal differentiation diminishes hyper proliferation and inflammation

37
Q

acitretin is contraindicated in

A

pregnancy

38
Q

program to monitor acitretin

A

Take Action to Prevent Pregnancy (TAPP)

39
Q

program material for TAPP

A

patient agreement/informed consent form
authorization for use
voluntary patient survey and registration form

40
Q

differences between TAPP and IPLEDGE

A

males have no limit on duration of treatment
females need a pregnancy test every 3 months for at least 3 years after stopping
no blood donation for 3 years after stopping (both males and females)

41
Q

Otexzla (apremilast)

A

PDE4 inhibitor
stops inflammation
2nd line for mod-severe psoriasis

42
Q

warnings/precautions for Otexzla

A

depression
weight decrease
GI symptoms

43
Q

Important considerations for patients when taking Otexzla

A

titrate to recommended dose over 4-7 days to avoid risk of GI symptoms

44
Q

Sotyktu (deuvravacitinib)

A

selective inhibitor of tyrosine kinase 2 (JAK family)
2nd line for mod-severe psoriasis

45
Q

over immunosuppressive therapy for 2nd line treatment of moderate-severe psoriasis

A

cyclosporine (neoral, sandimmune)
methotrexate

46
Q

biologic response modifiers for 3rd line treatment of moderate-severe psoriasis

A

entrercept (Enbrel)
adalimumab (Humira)
certolizumab (Cimzia)
Infliximab (Remicade)

47
Q

biologic response modifiers (BRM)

A

binds to TNF cytokines
regulate the body’s immune response to infection and inflammation

48
Q

for patients with failure to response to TNF inhibitors,

A

another agent in this class may be tried

49
Q

anti-interleukin cytokine biologic agents for third line treatment of moderate-severe psoriasis

A

Stelara
Cosentyx
Taltz
Tremfya
Siliq
Ilumya
Skyrizi

50
Q

are TNF inhibitors or anti-interleukin cytokine biologic agents preferred for moderate-severe psoriasis?

A

anti-interleukin cytokine biologic agents

51
Q

warning/precautions for BRMs

A

formation of neutralizing anti-drug antibodies – loss of efficacy
hypersensitivity reactions within 2 hours of infusion
JAK inhibitor warnings

Pharmacotherapeutics (6 decks)

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