Psoriasis - Systemic Treatment Flashcards
It is a Neoral 100mg/ml Suspension & 100 mg capsules
Cyclosporin A
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
High-dose method for Cyclosporin A is
5 mg/kg daily, then tapered
Low-dose method for Cyclosporin A
2.5 mg/kg daily, increased every 2-4 wk up to 5 mg/kg daily, then tapered
When Cyclosporin A is dosed, it binds cyclo-philin producing a complex that blocks ____________
calcineurin
When Cyclosporin A is dosed, they Binds
___________ producing a complex that blocks calcineurin
cyclo-philin
It Binds cyclo-philin producing a complex that blocks calcineurin which reduces the effect of the ______ __ _________
NFAT in T cells
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)
One or more members of the NFAT family is expressed in most cells of the
immune system
Side effects of cyclosporin A are
Nephrotoxicity
Hypertension
Immuno-suppression
Neurotoxicity
Increased risk of malignancy
Contraindication of Cyclosporin A
Prior bone marrow depression
Pregnancy
Lactation
Renal abnormalities
Methotrexate is available on
2.5 mg tab & 50 mg/lm vial
It Blocks dihydrofolate reductase leading to inhibition of purine and pyrimidine synthesis which leads to accumulation of anti-inflammatory adenosine
Methotrexate
METHOTREXATE Blocks ___________ ___________ leading to inhibition of purine and pyrimidine synthesis→Leading to
accumulation of anti-inflammatory adenosine
dihydrofolate reductase
METHOTREXATE Blocks dihydrofolate reductase leading to inhibition of ______ & ___________ __________
purine and pyrimidine synthesis
METHOTREXATE Blocks dihydrofolate reductase leading to inhibition of purine and pyrimidine synthesis→Leading to
accumulation of anti-inflammatory ______________
Adenosine
METHOTREXATE Start with a test dose of _____ ___ and then gradually increase dose until a therapeutic level is
achieved
2.5 mg
average range of methotrexate, _______ ___ weekly; maximum, _______ ____ weekly
10-15 mg, 25- 30 mg
Side effects of methotrexate
Chronic use = hepatic fibrosis
Fetal abnormalities or death
Pulmonary fibrosis
You may not take methotrexate due to these conditions:
Liver toxicity
Pregnancy
Binds to retinoic acid receptors & May contribute to improvement by normalizing keratinization and proliferation of
the epidermis
ACITRETIN
Acitretin __ mg/cap
25
Acitretin Binds to _________ _____ receptors
Retinoic acid
Acitretin May contribute to improvement by normalizing _____________ and _______________ of the epidermis
keratinization & proliferation
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
