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Intro to D&D Final > Psoriasis Therapeutics > Flashcards

Psoriasis Therapeutics Flashcards

1
Q

true or false

psoriasis is immune mediated

A

true

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2
Q

true or false

we can cure psoriasis

A

false - goal is just to control

normalize the skin and increase the pliability

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3
Q

true or false

psoriasis can be drug induced

A

true

important to ask what meds people are on

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4
Q

1st line for limited plaque psoriasis

1st line for moderate-severe plaque psoriasis

A

limited - topical corticosteroids + emollients (moisturizer)
(alternative is topical vitamin D, topical retinoids, coal tar and anthralin)

moderate-severe: phototherapy or systemic therapies (retinoids - not iso, methotrexate, cyclosporine, apremilast, biologics) ADJUNCTIVE WITH TOPICAL

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5
Q

alternative agents for limited plaque psoriasis (besides topical corticosteroid + emollient)

A

topical vitamin D
topical retinoids
coal tar preparations
anthralin
Topical calcineurin inhibitors

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6
Q

systemic agents for moderate-severe plaque psoriasis

A

retinoids
methotrexate
cyclosporine
apremilast
biologic immune modifying agents

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7
Q

true or false

isotretinoin is a systemic agent that can be used for psoriasi

A

FALSE - only acne

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8
Q

patient adherence may be the largest barrier to treatment success with ______ therapies for psoriasis

A

topical

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9
Q

true or false

in moderate-severe plaque psoriasis, the systemic therapies can also have topical therapies as adjunctive agent

A

TRUE

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10
Q

explain treatment algorithm for mild-moderate psoriasis

A

topical agents

if not working—

topical agents + phototherapy

if not working…

topical agents + systemic agent

ALL ARE USED WITH MOISTURIZERS

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11
Q

explain treatment algorithm for moderate-severe psoriasis

A

systemic agent with or without topical agent or phototherapy

if not working….

more potent systemiic agent and 2 or more systemic agents in rotation with or without topical

if not work

biologic with or without other agents(biologic can also be first line, but very costly)

ALL USED WITH MOISTURIZER

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12
Q

When using topical agents for mild-moderate plaque psoriasis, around how long does it take to see improvement

A

1-2 months

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13
Q

can combination regimens be used for mild-moderate plaque psoriasis

A

yes - localized phototherapy + topical

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14
Q

for moderate-severe plaque psoriasis, they are initially treated with _____ if possible

A

phototherapy, in combination with topical therapies

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15
Q

as mentioned, for mod-severe plaque psoriasis, first line is photherapy + topical if needed

if there is a contraindication to phototherapy, or they have PSORIATIC arthritis, what is used instead?

A

systemic agents like retinoids, methotrexate, cyclosporine, and biologic immine-modifiers

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16
Q

a BSA of how much is considered mild/moderate/severe?

A

mild is less than 3% BSA

moderate is 3-10% BSA

severe is greater than 10% BSA

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17
Q

what biologic therapies are used for plaque psoriasis? (general class)

A

TNFa blockers and IL17A blockers

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18
Q

name 3 TNFa blockers used in moderate-severe plaque psoriasis

A

adalimumab
infliximab
etanercept

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19
Q

name 3 IL-17A blockers used in plaque psoriasis

A

Brodalumab
Ixekizumab
Secukinumab

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20
Q

which vehicle is the BEST for psoriasis topical preparations and explain why

A

OINTMENTS

they’re hydrating, remove the scales and have the greatest bioavailability

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21
Q

disadvantage of using ointments and what is done to counteract this

A

very greasy - pt may not like

so, we typically use creams during the day and ointments at night if this is an issue

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22
Q

advantages/disadvantages of creams for psoriasis

A

advantage - high pt acceptance and less greasy than ointments

disadvantage - not as hydrating as ointments are

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23
Q

which 2 vehicles are drying and thus not preferred for psoriasis?
which of these is the MOST drying

A

gels and lotions

gels are the most drying

24
Q

advantages and disadvantages of gels and lotions for psoriasis

A

gels - nongreasy and can be applied to hairy areas/ high pt acceptance

lotions - again, easy to apply to hairy area, including scalp. high pt acceptrance

disadvantage - both are drying. lotions have low bioavailability

25
Q

where are lotions preferred to be applied

A

intertriginous (where the skin rubs together) and hair areas, face
can be applied to scalp

26
Q

where are gels preferred to be applied

A

hairy areas (but still extremely drying - not preferred at all)

27
Q

what areas are ointments applied

A

smooth skin with short or little hair

28
Q

what areas are creams applied

A

smooth or hairy areas, and intertrignous areas (where skin rubs together)

29
Q

the optimal vehicle choice is often the one that what?

A

the patient will use!!! if pt doesnt want ointment, dont give it to them. they will not use it

ADHERENCE IS THE BIGGEST THING
keep patient’s preferences in mind always

30
Q

if you had to pick 2 things that are “first line” for psoriasis, what would they be

A

topical corticosteroids! and topical vitamin d analogs

topical retinoids and calcineurin inhibitors and PDE4 inhibitors are more 2nd line

31
Q

how do topical CS work in psoriasis

A

ANTI INFLAMMATORY

32
Q

what CS potencies are typically used in psoriasis?
explain

A

mid-high potencies

DO NOT START LOW. as the lesions get better. we can start to decrease the potency (usually at around 2 weeks) OR apply less frequently. the goal is to be able to control psoriasis and work our way down to the lowest possible potency to avoid ADRS

33
Q

name a situation in which LESS potent CS’s would be used 1st for psoriasis instead of mid-high

A

for sensitive areas like the groin and face

34
Q

explain how to apply topical CS for psoriasis

A

apply the drug, and then wrap in an occlusive dressing to increase penetration (typically for elbows and knees)

35
Q

true or false

if a patient is using topical corticosteroids for psoriasis, they should NOT abruptly discontinue

A

TRUE

can lead to rebound flares

36
Q

since the pt may have varying potencies of topical corticosteroids at different stages of psoriasis….

A

education is very important!!!

37
Q

common side effects of TOPICAL corticosteroids

include some pt education

A

purpura (purple-red spots), striae, telangiectasias, skin ATROPHY

skin atrophy is actually desired at areas affected by psoriasis

however, we don’t want this on the healthy skin around it

to prevent this, educate pt to put a layer of emollient/vaseline on the normal skin to reduce the chance of AE on healthy skin

38
Q

SYSTEMIC side effects of oral CS — not really topical

A

HPA suppression, glucose intolerance, cushing syndrome

39
Q

how many groups of topical CS are there and which class is the most potent

A

1-7

class 1 is SUPERPOTENT

40
Q

True or false

we typicall start with high doses of topical CS for psoriasis

A

TRUE

and then work our way down as lesions get better

41
Q

TRUE OR FALSE

emollients should only be used if the psoriasis is severe

A

FALSE - should be used at every stage to moisturize the skin and minimize the symptoms of itching and tenderness

42
Q

what are the 2 kinds of emollients and differentiate them

A

occlusive and humectant

occlusive works by keeping moisture IN and can’t leave the epidermis by forming an oily film on the skin.

humectant enhances the hydrating properties of emollients by pulling more water in

43
Q

side effects of using emollients

A

can cause acne and exacerbate existing acne, dermatitis, but generally well tolerated

44
Q

name 3 OCCLUSIVE emollients

A

petrolatum, lanolin, silicone

45
Q

name 3 humectant emollients

A

glycerin
urea
pyrolidone carboxylic acid

46
Q

-when are emollients typically applied?
are they used in combination with anything else?
which vehicles are preferred and why?

A

after a hydrating bath or shower, 2-3 times a day

can be used with other topical agents

creams and ointments preferred over lotions bc they’re thicker and more occludsive

47
Q

how often are emollients typically applied in psoriasis

A

2-3 times a day

48
Q

true or false

vitamin D analogs are 2nd line for psoriasis

A

false - also first line like topical CS

sometimes used in combo with them, but not often - usually 1 or other

49
Q

are vitamin D analogs safe for pregnancy

A

questionable - they’re category C

50
Q

name 2 topical vitamin D analogs used in psoriasis

A

calcipotriene

calcitriol

51
Q

typicall ADRS of topical vitamin D analogs

A

mild irritant, contact derm, burning, pruritis, edema, peeling, erythema

52
Q

SYSTEMIC side effect of topical vit d analogs
is it common

A

hypercalcemia
VERY RARE - only if using A LOT

53
Q

how often are topical vitamin d analogs applied

how long does it take to start seeing improvement

A

2x a day

around 2 weeks and can take up to 8 to see the full effect
if there’s no improvement by 8 weeks, consider other therapy

54
Q

if using a topical vitamin D analog AND phottherapy, when should each be done

A

apply the vitamin D AFTER UVA because it can be inactivated by it

55
Q
A

Intro to D&D Final (22 decks)

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