Psoriasis - Systemic Treatment Flashcards by RIA RICCI RABISANTO

It is a Neoral 100mg/ml Suspension & 100 mg capsules

Cyclosporin A

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Binds cyclo-philin producing a complex that blocks calcineurin which reducing the effect of the NFAT in T cells that results in inhibition of interleukin 2

Cyclosporin A

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High-dose method for Cyclosporin A is

5 mg/kg daily, then tapered

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Low-dose method for Cyclosporin A

2.5 mg/kg daily, increased every 2-4 wk up to 5 mg/kg daily, then tapered

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When Cyclosporin A is dosed, it binds cyclo-philin producing a complex that blocks ____________

calcineurin

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When Cyclosporin A is dosed, they Binds
___________ producing a complex that blocks calcineurin

cyclo-philin

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It Binds cyclo-philin producing a complex that blocks calcineurin which reduces the effect of the ______ __ _________

NFAT in T cells

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is a family of transcription factors shown to be important in immune response that are also involved in the development of cardiac, skeletal muscle, and nervous systems.

Nuclear factor of activated T-cells (NFAT)

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One or more members of the NFAT family is expressed in most cells of the

immune system

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Side effects of cyclosporin A are

Nephrotoxicity
Hypertension
Immuno-suppression
Neurotoxicity
Increased risk of malignancy

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Contraindication of Cyclosporin A

Prior bone marrow depression
Pregnancy
Lactation
Renal abnormalities

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Methotrexate is available on

2.5 mg tab & 50 mg/lm vial

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It Blocks dihydrofolate reductase leading to inhibition of purine and pyrimidine synthesis which leads to accumulation of anti-inflammatory adenosine

Methotrexate

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METHOTREXATE Blocks ___________ ___________ leading to inhibition of purine and pyrimidine synthesis→Leading to
accumulation of anti-inflammatory adenosine

dihydrofolate reductase

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METHOTREXATE Blocks dihydrofolate reductase leading to inhibition of ______ & ___________ __________

purine and pyrimidine synthesis

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METHOTREXATE Blocks dihydrofolate reductase leading to inhibition of purine and pyrimidine synthesis→Leading to
accumulation of anti-inflammatory ______________

Adenosine

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METHOTREXATE Start with a test dose of _____ ___ and then gradually increase dose until a therapeutic level is
achieved

2.5 mg

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average range of methotrexate, _______ ___ weekly; maximum, _______ ____ weekly

10-15 mg, 25- 30 mg

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Side effects of methotrexate

Chronic use = hepatic fibrosis
Fetal abnormalities or death
Pulmonary fibrosis

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You may not take methotrexate due to these conditions:

Liver toxicity
Pregnancy

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Binds to retinoic acid receptors & May contribute to improvement by normalizing keratinization and proliferation of
the epidermis

ACITRETIN

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Acitretin __ mg/cap

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Acitretin Binds to _________ _____ receptors

Retinoic acid

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Acitretin May contribute to improvement by normalizing _____________ and _______________ of the epidermis

keratinization & proliferation

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The Acitretin dosage initiate at __________ mg daily

25-50

Acitretin side effects are:

(HALF-d) Hepatotoxicity Alopecia Lipid abnormalities Fetal abnormalities or death

Contraindications of Acitretin are

Severe infections Malignancy

COMPLICATIONS of Acitretin

Depression Fluid and electrolyte imbalance Hypertension Infection Joint damage Low self esteem Metabolic syndrome Stress

HEALTH EDUCATION

Apply medication cream or ointment Avoid drinking alcohol and smoking Cover the affected area over night Eat healthy diet Expose small amount of skin to sunlight Take daily bath Use moisturize

first line of defence against microbial infection as a physical barrier

Human skin

by secreting ____ ___, sebaceous fluid and fatty acids to inhibit growth of pathogens

low pH

by possessing its own normal flora, thus deterring colonization by other pathogenic organisms

Human skin

a bacterial infection of the skin and tissues beneath the skin.

Cellulitis

a deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue

Furunculosis

a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include: redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed

Abcess

Abcess Signs and symptoms of abscesses include

redness, pain, warmth, and swelling

Abscess swelling may feel ____________ when pressed

fluid-filled

involve microbial invasion of the skin and underlying soft tissues

Skin and soft tissue infections (SSTIs)

The skin has an extremely diverse ecology of organisms that may produce __________

infection.

Clinical manifestations of SSTIs are the culmination of a two-step process involving

(1) invasion (2) interaction of bacteria with host defences.

cardinal signs of SSTIs involve the features of inflammatory response, with other manifestations such as

* bullae * fever * rapid progression of lesions

diagnosis of ______ is difficult because they may commonly masquerade as other clinical syndromes.

SSTIs

The selection of antimicrobial therapy is predicated on

clinical complications disease severity instrument of entry knowledge of the potential pathogens

* For uncomplicated mild to moderate infections, the ____ ______ suffices

oral route

Complicated severe infections, ____________ ______________ of ____________ is warranted.

intravenous administration of antibiotics

SSTIs range from mild infections, such as ____________, to serious life threatening infections, such as _________ ________

pyoderma, necrotizing fasciitis

minimum diagnostic criteria are:

edema erythema, pain / tenderness warmth

Bacteria, initially in low numbers, colonize different layers of the skin architecture

PATHOGENESIS

As bacteria increase in number where the integumentary barrier is disrupted, invasion by these colonizing bacteria ensues and a______ develops

Skin and soft tissue infections (SSTIs)

Involvement of pores in the epidermis may lead to

folliculitis, furuncles/ carbuncles

infection or inflammation of the hair follicles of the skin.

Folliculitis

a painful infection that forms around a hair follicle and contains pus.

* FURUNCLES

Furuncles is also known as

boil

collection of boils that develop under the skin

Carbuncle

A furuncle starts as a

red lamp

When bacteria infect hair follicles, the follicles can swell and turn into

boils & carbincles

Infection of the superficial layers of skin is labelled

erysipelas,

deeper infection involvement of the dermis and/or subcutaneous tissues is labelled

cellulitis

a common, potentially serious bacterial skin infection. The affected skin appears swollen and red and is typically painful and warm to the touch.

Cellulitis

Cellulitis usually affects the ______ __ ______ ____ but it can occur in the face, arms and other areas

Skin on lower legs

* involvement of yet deeper skin structures may lead to

fasciitis and myositis

means inflammation of the muscles that you use to move your body. An injury, infection, or autoimmune disease can cause it.

Myositis

Two specific kinds of myositis are

polymyositis and dermatomyositis.

Causes muscle weakness, usually in the muscles closest to the trunk of your body.

Polymyositis

For individuals with thick adipose tissues (eg, overweight or obese individuals), involvement of fat tissue causes

Panniculitis

a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue (the fatty layer under the skin – panniculus adiposus).

Panniculitis

Symptoms of Panniculitis include

Tender skin nodules Weight loss Fatigue

the fatty layer under the skin

panniculus adiposus

a damaging immune response by the body to a substance, especially pollen, fur, a particular food, or dust, to which it has become hypersensitive.

Allergy

an immune system response to a foreign substance that's not typically harmful to your body.

Allergy

These foreign substances are called

allergens.

* Your immune system's job is to keep you healthy by

fighting harmful pathogens.

result of your immune system's response to a substance.

* Allergies

A person becomes allergic when their body develops ___________ against a substance.

antigens

a life-threatening reaction

anaphylaxis.

Immune responses can be mild, from

coughing and a runny nose

allergy is an immediate immune reaction of the body to allergens and is mostly mediated by

IgE (Immunoglobulin E) antibodies

Hypersensitivity reactions are categorized into four major types:

type I, type II, type III, type IV.

Type I, II, and III reactions are the result of

antibody actions

type IV reactions involve

T cell lymphocytes cell-mediated immune responses.

a severe allergic reaction of rapid onset affecting many body systems.

Anaphylaxis

Anaphylaxis is due to the release of ____________ ________ & ____________ from mast cells and basophils, typically due to an immunologic reaction but sometimes non-immunologic mechanism.

inflammatory mediators and cytokines

These allergic reactions are systemic or localized, as in allergic dermatitis. The reaction is the result of an antigen cross-linking with membrane-bound IgE antibody of a mast cell or basophil.

Type 1

hypersensitivity, in the Gell and Coombs classification of allergic reactions

* Type II

An antibody mediated process in which IgG and IgM antibodies are directed against antigens on cells or extracellular material

* Type II hypersensitivity

extracellular material

basement membrane

antigens on cells (such as

circulating red blood cells

characterized by tissue damage caused by the activation of complement in response to antigenantibody (immune) complexes that are deposited in tissues.

Type III, or immune-complex, reactions

The clinical manifestations of type III hypersensitivity reactions relate to the tissue deposition, for example

vasculitic (skin) serum sickness (systemic) nephritis (kidneys) extrinsic allergic alveolitis (lungs)

Is characterized by cell-mediated response rather than antibodies as in other types of hypersensitivity reactions. Specifically, the T lymphocytes are involved in the development of the sensitivity, hence called cell-mediated hypersensitivity

Type IV hypersensitivity

T lymphocytes are

white blood cells

In this hypersensitivity, inflammation occurs when the sensitizing chemical comes in contact with the skin surface. T

contact hypersensitivity

) These allergic reactions are systemic or localized, as in allergic dermatitis

* Type I: Immediate Hypersensitivity (Anaphylactic Reaction)

* Type I: Immediate Hypersensitivity is also known as

(Anaphylactic Reaction)

Type II of allergy is also known as

Cytotoxic Reaction

Cytotoxic Reaction is

(Antibody-dependent)

Type III of allergy is also knwon as

Immune Complex Reaction.

Type IV of allergy is also knwon as

Cell-Mediated

Cell-Mediated is also known as

(Delayed Hypersensitivity)

Some common oral or injection treatments for skin conditions include:

* Antibiotics: Antifungal agents:

These antibiotics are used to treat many skin conditions.

Oral antibiotics

* Common antibiotics include

dicloxacillin erythromycin tetracycline.

Oral antifungal drugs for skin conditions include

fluconazole itraconazole

* Most infections due to Gram-positive organisms can be treated with quite a small number of antibiotics. These 3 antibiotics should be enough to cover 90% of Gram-positive infections

Penicillin, erythromycin cloxacillin

cephalosporins includes

ceftriaxone-cefotaxime, ceftazidime

fluoroquinolones includes

ciprofloxacin, levofloxacin

, aminoglycosides includes

gentamicin amikacin

broad-spectrum penicillins with or without β-lactamase inhibitors includes

amoxicillin-clavulanic acid, piperacillin-tazobactam

are broad-spectrum antibiotics, active against both Gram-positive and Gram-negative bacteria.

Tetracyclines

Tetracyclines use is decreasing to increasing instances of

bacterial resistance

* Tetracyclines still find use in treatment of acne, urinary tract, and respiratory tract infections, as well as

chlamydia infections