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Intro to D&D Final > Psoriasis Therapeutics Part 2 > Flashcards

Psoriasis Therapeutics Part 2 Flashcards

1
Q

name the topical retinoid used is psoriasis

A

tazarotene

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2
Q

how does tazarotene work in psoriasis

A

decreases inflammation and regulates the differentiation of keratinocytes

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3
Q

role in therapy for tazarotene in psoriasis

A

SECOND LINE

alternative to topical CS/vitamin D analog

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4
Q

true or false

tazarotene is teratogenic

A

TRUE

pregnancy category X

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5
Q

in which vehicles does tazarotene come and which is preferred

A

cream and gel

cream is preferred because it is moisturizing

gel is very drying

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6
Q

how often is tazarotene applied and when

A

once daily in PM to completely dry skin

start at 0.05% and may increase to 0.1% if tolerated

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7
Q

how long to see improvement after using tazarotene for psoriasis every day

A

2-4 weeks

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8
Q

side effects of tazarotene and pt education

A

itching, burning, irritation, erythema

PHOTOSENSITIVITY - avoid prolonged exp to sun and use SPF15 or higher

TERATOGENIC

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9
Q

which therapy is actually OFF LABEL for psoriasis

A

calcineurin inhibitors

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10
Q

for which psoriasis are calcineurin inhibitors effective for psoriasis and under what conditions

A

for plaque psoriasis - when occlusions used after applying them

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11
Q

BLACK BOX WARNING calcineurin inhibitors

A

rare cases of lymphoma and skin malignancy

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12
Q

name the 2 topical calcineurin inhibitors that can be used off label for psoriasis and which is preferred

A

pimecrolimus cream and tacrolimus ointment

TACROLIMUS OINTMENT IS PREFERRED

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13
Q

how often are topical calcineurin inhibitors applied

A

2x a day

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14
Q

name the topical PDE4 inhibitor used for psoriasis

A

roflumilast

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15
Q

true or false

roflumilast is 1st line for psoriasis

A

FALSE

an alternative 2nd line to retinoids (topical) and topical calcineurin inhibitors

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16
Q

what is a major advantage of ruflumilast over other topical therapies for psoriasis

A

it can be used in sensitive areas like in groin, thin skin, and under armpit (intertriginous)

better tolerated than the other topical therapies

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17
Q

roflumilast is used for treatment of what kind of psoriasis

A

plaque

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18
Q

how often is roflumilast applied and it is indicated for what age

A

over 12

every day for ~12 weeks

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19
Q

is roflumilast a cream or ointment

A

cream

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20
Q

ADRs of roflumilast

are they common

A

GI adverse events, application site reactions

GI adverse events very rare and likely not from topical therapy. also, it’s a cream so it doesn’t penetrate as much as an ointment would

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21
Q

topical aryl hydrocarbon receptor modulating agent used in psoriasis

A

Tapinarof

22
Q

how does Tapinarof work to help plaque psoriasis

A

modulates helper t cell type 17 (Th17) cytokines like IL-17A and IL-17F

normalizes the skin barrier and has antioxidant activity

23
Q

how often is Tapinarof applied?
name some ADR

A

every day

contact derm, headache, folliculitis

24
Q

Tapinarof is like _____ line treatment for plaque psoriasis

A

3rd

25
Q

what drug class was originally used to treat plaque psoriasis?

give 4 examples

A

keratolytics

they eat away at the plaque and dead skin. promote “desquamation” of the thick scales and break them down

salicylic acid
glycolic acid
urea
lactic acid

26
Q

keratolytics should not be applied to which areas

A

genitals, mucous membranes, skin that is healthy

27
Q

why are tars and anthralin not really preferred for psoriasis treatment

A

they’re sticky and smell bad

also, for anthralin, you have to apply it and then wash it off - it’s an extra step involved

28
Q

which psoriasis treatment must be applied in a downward, 1 direction motion

A

tars - crude coal tars

29
Q

keratolytic side effects

A

contact derm
tenderness at app site

30
Q

phototherapy vs photochemotherapy

A

start at phototherapy UVA for mod-severe plaque psoriasis

if not working, add the photoactive drug to enahnce efficacy (psoralen/oxsoralen) 2 hours b4 with food or milk to help absorb

31
Q

true or false

phototherapy is used in combination with topical and systemic therapies

A

true

32
Q

name the ORAL retinoid for psoriasis

it is a _____ derivative

A

Acitretin

vitamin A

33
Q

is Acitretin teratogenic

A

YES

have to wait 3yrs after dicontinuing b4 becoming pregnant

34
Q

how can you remember the AE/monitoring parameters of Acitretin

A

same as isotretinoin

monitor lipids, esp triglycerides, liver function, glucose

dries you out - dry lips, nose, eyes, skin, itching, alopecia

35
Q

explain how to counsel a patient starting acitretin

A

obviously don’t get pregnant, but also take with food to increase absorption and avoid alcohol for 2 months even after discontinuing

36
Q

what class is cyclosporine

A

a SYSTEMIC calcineurin inhibitor for SEVERE psoriasis

lowest effective dose used

37
Q

around how long to see psoriasis improvements when using cyclosporine

A

4 weeks

38
Q

cyclosporine is CONTRAINDICATED with…..

A

PUVA

39
Q

big concerns with cyclosporine

A

has many drug interactions, renal toxicity and HTN, hypertriglyceridemia, headaches

have to monitor blood levels, renal function, and lipid profile - LOT of toxicities

40
Q

which is typically used more often for psoriasis - cyclosporin or methotrexate?

A

methotrexate

41
Q

methotrexate is typically useful for pts with what kind of psoriasis

A

PSORIATIC ARTHRITIS

42
Q

some monitoring parameters for MTX

A

CBC, liver and renal fxn, chest XRAY

TERATOGENIC

43
Q

side effects MTX

A

nausea, pulmonary toxic, megaloblastic anemia, pancytopenia (low RBS, WBC, AND PLATELETS)

44
Q

What is apremilast

A

ORAL small molecule PDE4 inhibitor (NOT a biologic) use in mod-severe plaque psoriasis (arouns3-10% BSA - not really for severe) in pts who are candidates for systemic therapy

45
Q

pt education for apremilast

A

don’t crush or chew, report signs of infection or signs of depression

46
Q

when are biologics used in psoriasis

A

for SEVERE psoriasis - greater than 10% BSA when systemic treatment is needed but methotrexate/cyclosporine are not tolerated or effective

47
Q

a patient has persistent psoriasis that relapses quickly when taken off of therapy

what is a treatment option to consider?

A

biologics

48
Q

if a pt has psoriatic arthritis, who should they consult before starting biologic therapy

A

a rheumatologist

49
Q

name 2 advantages of biologics over MTX/cyclosporine

A

-less toxic to liver, kidneys, and bone marrow

-work quicker and are more efficacious

50
Q

cons of biologics vs MTX/cyclosporine

A

increased risk of infections and tb reactivation

exacerbate CSF

injection reactions

demyelinating diseases

51
Q
A

Intro to D&D Final (22 decks)

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