psoriasis treatment

Question 1

1st line therapy for mild to moderate plaque psoriasis

Answer 1

TCS

AAA 1-2x/day x 2-4 weeks

Question 2

When should you reassess psoriasis after starting TCS

Answer 2

4 weeks for adults
2 weeks for kids

Question 3

2nd line topical therapy for mild-moderate plaque psoriasis

Answer 3

Tapinarof 1% (VTAMA)
ages >18
most common s/e folliculitis

Roflumilast (zoryve)
12 and up
s/e diarrhea, headache, hypertension

Cacitriol & calcipotriene
Mix with petrolatum to reduce irritation

Tazarotene Gel, apply zince oxide on healthy skin to reduce irritation

Question 4

what to remember about colcitriol

Answer 4

it can lower vit d in children

Question 5

Moderate to Severe Psoriasis

Answer 5

Do not treat with monotherapy, steroids and narrow band UVB possible systemic therapy

Question 6

Otezla
diarrhea and N/V
BB- depression and suicidal ideation
No lab monitoring

Answer 6

Apremilast

Question 7

Soriatane
C/I in pregnancy and sever liver or kidney function
avoid use of women in childbearing age
contraception for 3 years after treatment
no alcohol
Monitor LFTs and Lipids

Answer 7

Acitretin

Question 8

What are the TNF alpha inhibitors?

Answer 8

infliximab, etanercept, adalimumab, certoliumab

Question 9

what are the IL12/23

Answer 9

ustekinumab

Question 10

IL17?

Answer 10

secukinumab, ixekizumab, brdalumab

Question 11

IL-23

Answer 11

guselkumab, tildrakizumab, risankizumab

Question 12

Etanercept

Answer 12

enbrel
>4 years
TNF

Question 13

Adalimumab

Answer 13

Humira
TNF

Question 14

Cimzia
Lowest risk in pregnancy and lactation
TNF alpha inhibitor

Answer 14

certolizumab

Question 15

Simponi

Answer 15

golimumab
TNF alpha inhibitor

Question 16

Remicade
TNF alpha inhibitor

Answer 16

infliximab
cannot give to liver problems, low blood count

Question 17

TNF alpha inhibitors
etanercept
adalimumab
certolizumab
golimumab
infliximab

Answer 17

absolute contraindications:
hypersensitivity, active infections, TB

Relative contraindications:
CHF
Family hx of demyelinating disease
Hx of lymphoma

AE:
serious infection
fungal infection
hep b reactivation
low blood count
lupus like syndrome
lymphoma

Question 18

Il-12/IL-23

Answer 18

Contraindications:
serious infections
Malignancies

Common s/e:
cold/flu, URI, HA, Fatigue

Question 19

IL12-23
Stelara
> 6 years

Answer 19

Ustekinumab

Question 20

IL17
Cosyntex
> 6years
URI, nausea, fungal infections, diarrhea

Answer 20

Secukinumab

C/I- hypersensitivity, active infection, TB, IBD

Question 21

Taltz/ IL17 inhibitor
>6 years
URI, nausea, fungal infections, diarrhea

Answer 21

ixekizumab

C/I- hypersensitivity, active infection, TB, IBD

Question 22

Siliq
ISR, URI, nausea, fungal, diarrhea

risk of depression and suicidal ideation, requires REMS

Answer 22

brodalumamb

Question 23

IL-23 inhibitors

Answer 23

Screen for TB
No monitoring

Tildrakizumab
Risankizumab
Guselkumab

Question 24

T Cells

Answer 24

abatacept

h/n/uri/tinea/ cold& flu

C/I serious infections
COPD

Question 25

JAK

Answer 25

Tofacitinib
headache, diarrhea, nausea, vomiting; uris

Question 26

Warning/precautions with JAK inhibitors

Answer 26

Serious infections, mortality, malignancy, MACE, thrombosis, elevated liver enzymes and lipids, anemia, lymphoma, malignancies, gi perforations and ulcerations