Psoriasis Therapeutics Part 2 Flashcards
name the topical retinoid used is psoriasis
tazarotene
how does tazarotene work in psoriasis
decreases inflammation and regulates the differentiation of keratinocytes
role in therapy for tazarotene in psoriasis
SECOND LINE
alternative to topical CS/vitamin D analog
true or false
tazarotene is teratogenic
TRUE
pregnancy category X
in which vehicles does tazarotene come and which is preferred
cream and gel
cream is preferred because it is moisturizing
gel is very drying
how often is tazarotene applied and when
once daily in PM to completely dry skin
start at 0.05% and may increase to 0.1% if tolerated
how long to see improvement after using tazarotene for psoriasis every day
2-4 weeks
side effects of tazarotene and pt education
itching, burning, irritation, erythema
PHOTOSENSITIVITY - avoid prolonged exp to sun and use SPF15 or higher
TERATOGENIC
which therapy is actually OFF LABEL for psoriasis
calcineurin inhibitors
for which psoriasis are calcineurin inhibitors effective for psoriasis and under what conditions
for plaque psoriasis - when occlusions used after applying them
BLACK BOX WARNING calcineurin inhibitors
rare cases of lymphoma and skin malignancy
name the 2 topical calcineurin inhibitors that can be used off label for psoriasis and which is preferred
pimecrolimus cream and tacrolimus ointment
TACROLIMUS OINTMENT IS PREFERRED
how often are topical calcineurin inhibitors applied
2x a day
name the topical PDE4 inhibitor used for psoriasis
roflumilast
true or false
roflumilast is 1st line for psoriasis
FALSE
an alternative 2nd line to retinoids (topical) and topical calcineurin inhibitors
what is a major advantage of ruflumilast over other topical therapies for psoriasis
it can be used in sensitive areas like in groin, thin skin, and under armpit (intertriginous)
better tolerated than the other topical therapies
roflumilast is used for treatment of what kind of psoriasis
plaque
how often is roflumilast applied and it is indicated for what age
over 12
every day for ~12 weeks
is roflumilast a cream or ointment
cream
ADRs of roflumilast
are they common
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
topical aryl hydrocarbon receptor modulating agent used in psoriasis
Tapinarof
how does Tapinarof work to help plaque psoriasis
modulates helper t cell type 17 (Th17) cytokines like IL-17A and IL-17F
normalizes the skin barrier and has antioxidant activity
how often is Tapinarof applied?
name some ADR
every day
contact derm, headache, folliculitis
Tapinarof is like _____ line treatment for plaque psoriasis
3rd
what drug class was originally used to treat plaque psoriasis?
give 4 examples
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
keratolytics should not be applied to which areas
genitals, mucous membranes, skin that is healthy
why are tars and anthralin not really preferred for psoriasis treatment
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
which psoriasis treatment must be applied in a downward, 1 direction motion
tars - crude coal tars
keratolytic side effects
contact derm
tenderness at app site
phototherapy vs photochemotherapy
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
true or false
phototherapy is used in combination with topical and systemic therapies
true
name the ORAL retinoid for psoriasis
it is a _____ derivative
Acitretin
vitamin A
is Acitretin teratogenic
YES
have to wait 3yrs after dicontinuing b4 becoming pregnant
how can you remember the AE/monitoring parameters of Acitretin
same as isotretinoin
monitor lipids, esp triglycerides, liver function, glucose
dries you out - dry lips, nose, eyes, skin, itching, alopecia
explain how to counsel a patient starting acitretin
obviously don’t get pregnant, but also take with food to increase absorption and avoid alcohol for 2 months even after discontinuing
what class is cyclosporine
a SYSTEMIC calcineurin inhibitor for SEVERE psoriasis
lowest effective dose used
around how long to see psoriasis improvements when using cyclosporine
4 weeks
cyclosporine is CONTRAINDICATED with…..
PUVA
big concerns with cyclosporine
has many drug interactions, renal toxicity and HTN, hypertriglyceridemia, headaches
have to monitor blood levels, renal function, and lipid profile - LOT of toxicities
which is typically used more often for psoriasis - cyclosporin or methotrexate?
methotrexate
methotrexate is typically useful for pts with what kind of psoriasis
PSORIATIC ARTHRITIS
some monitoring parameters for MTX
CBC, liver and renal fxn, chest XRAY
TERATOGENIC
side effects MTX
nausea, pulmonary toxic, megaloblastic anemia, pancytopenia (low RBS, WBC, AND PLATELETS)
What is apremilast
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
pt education for apremilast
don’t crush or chew, report signs of infection or signs of depression
when are biologics used in psoriasis
for SEVERE psoriasis - greater than 10% BSA when systemic treatment is needed but methotrexate/cyclosporine are not tolerated or effective
a patient has persistent psoriasis that relapses quickly when taken off of therapy
what is a treatment option to consider?
biologics
if a pt has psoriatic arthritis, who should they consult before starting biologic therapy
a rheumatologist
name 2 advantages of biologics over MTX/cyclosporine
-less toxic to liver, kidneys, and bone marrow
-work quicker and are more efficacious
cons of biologics vs MTX/cyclosporine
increased risk of infections and tb reactivation
exacerbate CSF
injection reactions
demyelinating diseases
