psoriasis treatment Flashcards
1st line therapy for mild to moderate plaque psoriasis
TCS
AAA 1-2x/day x 2-4 weeks
When should you reassess psoriasis after starting TCS
4 weeks for adults
2 weeks for kids
2nd line topical therapy for mild-moderate plaque psoriasis
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
what to remember about colcitriol
it can lower vit d in children
Moderate to Severe Psoriasis
Do not treat with monotherapy, steroids and narrow band UVB possible systemic therapy
Otezla
diarrhea and N/V
BB- depression and suicidal ideation
No lab monitoring
Apremilast
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
Acitretin
What are the TNF alpha inhibitors?
infliximab, etanercept, adalimumab, certoliumab
what are the IL12/23
ustekinumab
IL17?
secukinumab, ixekizumab, brdalumab
IL-23
guselkumab, tildrakizumab, risankizumab
Etanercept
enbrel
>4 years
TNF
Adalimumab
Humira
TNF
Cimzia
Lowest risk in pregnancy and lactation
TNF alpha inhibitor
certolizumab
Simponi
golimumab
TNF alpha inhibitor
Remicade
TNF alpha inhibitor
infliximab
cannot give to liver problems, low blood count
TNF alpha inhibitors
etanercept
adalimumab
certolizumab
golimumab
infliximab
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
Il-12/IL-23
Contraindications:
serious infections
Malignancies
Common s/e:
cold/flu, URI, HA, Fatigue
IL12-23
Stelara
> 6 years
Ustekinumab
IL17
Cosyntex
> 6years
URI, nausea, fungal infections, diarrhea
Secukinumab
C/I- hypersensitivity, active infection, TB, IBD
Taltz/ IL17 inhibitor
>6 years
URI, nausea, fungal infections, diarrhea
ixekizumab
C/I- hypersensitivity, active infection, TB, IBD
Siliq
ISR, URI, nausea, fungal, diarrhea
risk of depression and suicidal ideation, requires REMS
brodalumamb
IL-23 inhibitors
Screen for TB
No monitoring
Tildrakizumab
Risankizumab
Guselkumab
T Cells
abatacept
h/n/uri/tinea/ cold& flu
C/I serious infections
COPD
JAK
Tofacitinib
headache, diarrhea, nausea, vomiting; uris
Warning/precautions with JAK inhibitors
Serious infections, mortality, malignancy, MACE, thrombosis, elevated liver enzymes and lipids, anemia, lymphoma, malignancies, gi perforations and ulcerations
