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pharmacotherapy 4270 > Psoriasis (Final Exam) > Flashcards

Psoriasis (Final Exam) Flashcards

1
Q

psoriasis is a _-cell mediated inflammatory disease due to a complex interplay between genetic and environmental factors

A

T

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2
Q

the result of psoriasis is this type of skin disorder, where there is an increased cell turnover

A

hyperkeratosis

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3
Q

what is the major gene locus for psoriasis

A

PSOR1

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4
Q

what are some environmental factors that may cause psoriasis

A
  • trauma
  • stress
  • infections
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5
Q

what are some medications that may cause psoriases

A
  • beta-blockers
  • lithium
  • antimalarials
  • steroid withdrawal
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6
Q

what is the Koebner phenomenom

A

induction of psoriasis due to trauma (tattoo, sunburn)

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7
Q

this type of psoriasis is associated with strep infections

A

guttate (drop-like) psoriasis

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8
Q

true or false: HIV induced immune alterations may produce acute onset, severe psoriasis

A

true

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9
Q

this can be associated with psoriasis. may be severe and may lead to excoriations. antipruritic agents can be used to treat this such as hydroxyzine (Atarax) - can be sedating therefore take at night

A

itching

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10
Q

this occurs in 5-20 pts with psoriasis. may be severe and psoriatic nail involvement is common. treatment is similar to RA

A

psoriatic arthritis

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11
Q

true or false: psychiatric disorders are common in people with psoriasis

A

true - depression is common due to physical appearance of plaques

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12
Q

this may be associated with psoriasis; is a strong predictor of CVD, stroke, DM. cluster of risk factors include abdominal obesity, dyslipidemia, hypertensions, insulin resistance/glucose intolerance, prothromotic state, pro inflammatory state

A

metabolic syndrome

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13
Q

what are some other immune-mediated disorders that may be present with psoriasis

A
  • chron’s disease
  • MS
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14
Q

this is a possible comorbidity of psoriasis; cutaneous T-cell lymphoma, non-melanoma skin cancer (basal-cell carcinoma, squamous cell carcinoma)

A

malignancies

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15
Q

this is the most common type of psoriasis

A

plaque psoriasis

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16
Q

this type of psoriasis is often preceded by a strep infection

A

guttate (drop-like) psoriasis

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17
Q

this type of psoriasis spares areas commonly involved with plaque psoriasis. appears in skin fold (e.g. back of knees)

A

inverse psoriasis

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18
Q

this type of psoriasis may be an emergency if generalized. pustules can merge to form “lakes of pus”

A

pustular psoriasis

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19
Q

this type of psoriasis is usually life-threatening. presents with erythema, desquamation and edema

A

eryhtrodermic psoriasis

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20
Q

this type of psoriasis only affects the palms of hands and soles of feet

A

palmar/plamtar psoriasis

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21
Q

clinical manifestations of this type of psoriasis include:
- plaque like lesions with silvery-white, loosely adherent scales
- Auspitz sign (when scales are lifted, some lesions show fine bleeding points)
- lesions have sharply defined borders which are palpable
- lesions are bright, red/violet color
- lesions are possible on scalp, arms, legs, trunk, face, back, etc.
- can have yellowish lesions on nails
- thicker lesions on elbows and knees

A

plaque psoriasis

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22
Q

what are some non-pharmacological tx for psoriasis

A
  • stress reduction
  • non-medicated moisturizers (fragrance free)
  • avoid irritants on skin
  • avoid skin trauma (wear loose fitting garments + SPF)
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23
Q

what is the algorithm for treating mild-moderate psoriasis

A
  1. topical agents
  2. topical agents + phototherapy
  3. topical agent + systemic agents

(+ moisturizers)

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24
Q

what is the algorithm for moderate-severe psoriasis

A
  1. systemic agent (e.g. MTX) +/- topical agent or phototherapy; consider biologic agent esp if comorbidities
  2. more potent systemic agent or biologic agent +/- topical agent
  3. biologic agent (if not already used) +/- other agents

(+ moisturizers)

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25
Q

what is the potency of the following topical corticosteroids
- hydrocortisone 0.5%, 1%
- desonide 0.05%

A

low

26
Q

what is the potency of the following topical corticosteroids
- betamethasone dipropionate 0.05% cream/gel, fluocinonide 0.05%, halocinonide 0.1%

A

high

27
Q

what is the potency of the following topical corticosteroids
- betamethasone dipropionate 0.05% ointment, colbetasol propionate 0.05%

A

super high

28
Q

what is the potency of the following topical corticosteroids
- betamethasone valerate 0.05%, 0.1%, betamethasone dipropionate 0.05% lotion

A

medium

29
Q

true or false: cream bases are more potent than ointment or lotions

A

false - ointment is the most potent

30
Q

what potency of corticosteroid should be used for trunks, arms and legs

A

start with medium potency than titrate up or down as needed

31
Q

this potency of corticosteroids is used for face and skin folds

A

low

32
Q

this potency of corticosteroids is used for thicker plaques such as palms, soles and elbows

A

higher

33
Q

what are some local a/e of topical corticosteroids

A
  • skin atrophy
  • striae
  • telangiectasia (abnormal dilation of capillaries and arterioles)
  • steroid rosacea, acne
  • hypopigmentation
  • delayed wound healing
  • contact sensitization
  • decreased skin elasticity
34
Q

what are some systemic a/e of topical corticosteroids

A
  • HPA axis suppression (from potent topical steroids)
  • Cushing syndrome
  • Addisons crisis
  • retarded growth in children
  • hyperglycaemia, glaucoma, cataracts
35
Q

this treatment option is used for mild-moderate psoriasis. normalizes keratinocyte differentiation and has anti-proliferative and anti-inflammatory effects. e.g. Tazarotene and Tretinoin

A

Topical retinoids

36
Q

what are some a/e of topical retinoids

A

skin irritation - erythema, purities, burning (especially upon initial use)

37
Q

which group of individuals should topical retinoids not be used in

A

women of childbearing age unless effective contraception is being used (teratogenic - contraindicated in pregnancy)

38
Q

this treatment option can be sleeted as initial therapy for mild to moderate psoriasis. it enhances keratinocyte differentiation and inhibits proliferation and may be anti-inflammatory. e.g. Calcipotriol/Cacipotriene (Dovobet) and Calcitrol

A

vitamin D analogs

39
Q

this can be used for mild to moderate psoriasis. is keratolytic and may have anti proliferative and anti-inflammatory effects. it is staining and has an unpleasant odour. may cause stinging or other irritation

A

coal tar

40
Q

this treatment option has a direct anti-proliferative effect on epidermal keratinocytes. used only on thick plaque areas. highly irritating to normal skin. usual concentration 0.1-0.4%. SCAT has 10x higher concentrations therefore duration of application is only 20 mins - 2 hrs and normal skin should be protected using zinc oxide ring

A

Anthralin

41
Q

what are the two types of phototherapy

A

PUVA (UVA + psoralens)
UVB alone

42
Q

is broadband or narrow band UVB preferred

A

narrow

43
Q

what is the most common type of phototherapy used and why

A

NB-UVB because efficacious and decreased risk of cancer

44
Q

this is a systemic therapy option for psoriasis. it is an oral retinoid. it is more potent if used with PUVA. this is teratogenic. a/e include hypervitaminosis A, hyperostosis, hyperlipidemia, increase in liver enzymes, hepatitis, leukopenia, cataracts

A

acitretin

45
Q

low doses of this medication are usually used in psoriasis and is only taken once weekly

A

MTX

46
Q

what are some s/e of methotrexate

A

hepatotoxicity, microcytic anemia, pulmonary fibrosis, severe skin reactions

47
Q

true or false: MTX can be used in pregnancy

A

false

48
Q

this medication is doses at lower doses for psoriasis. s/e include nephrotoxicity, increased BP, decreased magnesium, tremor, gum hyperplasia. numerous drug interactions.
monitoring: BP, renal function, TG’s, CBC, uric acid, potassium, magnesium

A

cyclosporine

49
Q

these inhibit JAK1, JAK2, JAK3 and TyK2. can be taken as 5 mg BID or 11 mg daily (XR formulation therefore can’t be split)

A

JAK inhibitors (Tofacitinib)

50
Q

what are some side effects Tofacitinib (JAK inhibitor)

A

bone marrow suppression, lymphopenia, neutropenia, anemia, serious infections, CV 9 reduced HR and prolonged PR interval), GI perforations, hepatotoxicity

51
Q

what needs to be monitored for Tofacitinib

A

CBC, Hb, Scr, LFT’s, lipids at baseline and periodically

52
Q

true or false: it is common for Tofacitinib to be used with other DMARDs and immunosuppressants z9e.g. cyclosporine)

A

false - these shouldn’t be used together

53
Q

these lead to increased intracellular cAMP, one end effect = reduced production of pro-inflammatory mediators

A

selective PDE-4 inhibitors

54
Q

this is an oral selective PDE-4 inhibitor that is approved for tx of psoriasis and psoriatic arthritis

A

apremilast

55
Q

this is a topical selective PDE-4 inhibitor that is an ointment approved for utopian dermatitis with limited clinical trial evidence for psoriasis

A

Crisaborole

56
Q

what are some side effects common to all biologics

A

increased risk of infection
potential risk of malignancies

57
Q

________ have a potential risk of worsening CHF or new onset CHF

A

TNF-inhibitors

58
Q

what do the following biologics target:
Infliximab (Remicade), adalimumab (Humira), Etanercept (Enbrel)

A

TNF-alpha

59
Q

what does the following biologic target
Ustekinumab (Stelara)

A

IL-12 and IL-23

60
Q

what do the following biologics target:
Secukinumab (Cosentyx), Ixekizumab (Taltz), Brodalumab (Siliq) and Bimekizumab (Bimzelx)

A

IL-17 inhibitors

61
Q

what do the following biologics target
Guselkumab (Tremfya), tildrakizumab (Ilumya) and Risankizumab (Skyrizi)

A

IL-23

62
Q
A

pharmacotherapy 4270 (19 decks)

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