Psoriasis Treatment Flashcards
Adalimumab
• Administration
• Structure
• MOA
Alefacept
• Administration
• Structure
• MOA
Apremilast
• Administration
• Structure
• MOA
Etanercept
• Administration
• Structure
• MOA
Infliximab
• Administration
• Structure
• MOA
Uztekinamab
• Administration
• Structure
• MOA
Psoriasis
• Retinoids used to treat
• Biologics used to treat
• Other drugs used
- *Psoriasis** is treated using…
- *retinoids** (Acitretin and Tazarotene)
Inhibitors of inflammatory mediators (adalimumab, alefacept, apremilast, etanecept, infliximab, ustekinumab)
Others include Calcipotriene and Calitriol.
Acne drugs used to treat
• Retinoids
• Steriods
• Others
- *Acne** is treated using…
- *retinoids** (Adapalene, isotretinoin, tazarotene, and tretinoin, ATRA)
steroids (Hydrocortisone, betamethasone valerate, flucinonide, clobetasol proprionate)
Others include Benzoyl peroxide, Clindamycin/Erythromycin, Salicylic acid
What is the potency of the corticosteriods used to treat acne?
Potency of corticosteroids
Clobetasol propionate > Budesonide > Betamethasone > Hydrocortisone
What side effects are common to all biologics used in the treatment of psoriatic arthritis?
• what biologics are these especially common in?
- *SIDE EFFECTS COMMON TO ALL:**
- *• Immunosuppression** – don’t initiate with an active infection, report symptoms of infection (especially Respiratory)
• Malignancy – decreased immune surveillance = increased malignancy (adalimumab, etancercept, infliximab especially); lymphomas are most common
Which biologics should not be given to people with heart problems?
• which cause lupus?
• CHF or HypoTN, angina, dysrthythmia – INFLIXIMAB, adalimumab, rituximab (actual contraindication with infliximab)
• Lupus Like Syndrome – Adalimumab, Etanercept, Infliximab
Which biologics can cause injection site reactions?
• Which can cause an elevation of LFTs?
- LFTs – infliximab
- Injection Site rotation needed – Adalimumab, Alefacept, Etanercept
What effects of the retinoids make them useful in the treatment of psoriasis?
Effects of Retinoids – Modulate proliferation and Differentiation, Stimulate Keratinization, and Alter cellular cohesiveness. Importantly, in the treatment of acne these can decrease sebum and reduce sebaceous gland size.
In general how do retinoids work?
GENERAL MOA: Retinoids bind to the RXR/RARa receptors (nuclear transcriptional repressors that recruit co-repressors (NTCO1) in the absence of the retinoid ligand). This blocks cell differenentiation and proliferation. When Retinoids bind genes are transcribed at the appropriate rate. Drugs that preferentially bind RARa are better for correct differentiation and proliferation or cells, while retinoids targeting RXR tend to induce apoptosis.
Why are retinoids beneficial in psoriasis?
• What drugs are used in psoriasis?
In the treatment of psoriasis RARa targeting drugs are preferred, these upregulate HB-EGF (heparin-binding epidermal growth factor receptor) and AR (amphiregulin) stimulate basal bell proliferation and cause thickening of the epidermis and flaking of tissue.
Acitretin and Tazarotene used in psoriasis
What retinoids are used in the treatment of acne?
Adapalene
Isotretinoin
Tazarotene
Tretinoin
How do the side effects of the RAR targeting drugs differ from those of the RXR targeting drugs?
RARa targeting drugs
• Side effects: mucocutaneous and musculoskeletal symptoms
RXR targeting drugs
• Side effects: Physiological changes
How do the side effects of retinoids differ depending on the method of administration?
• what are these side effects?
GENERALIZED SIDE EFFECTS :
• Resemble vitamin A intoxication – dry skin, EPISTAXIS, CONJUNCTIVITIS, reduced night vision, ALOPECIA
• Topical: Erythema, desquamation, burning, stinging, PHOTOSENSITIVE SKIN
What is the 1st line therapy in acne?
• what else are these used for?
Topical Retinoids:
• 1st line therapy in inflammatory acne
• Wrinkle Therapy (UV responsive MMPs inhibited, Epidermal Hypeplasia)
Calcipotriene
• Administration
• MOA
• Indication
Calcipotriene
Administration – topical
MOA
Binds to vit. D receptor and associates with RXR to binds DNA vit. D response elements this modulates epidermal differentiation and inflammation.
INDICATION
Psoriasis
Calcipotriene
• Side effects
Calcipotriene
SIDE EFFECTS
High doses: Hypercalcemia and Hypercalciuria (Abdominal pain, constipation, depression, HTN, anorexia, polydipsia)
Topical Irritant – attenuate with Corticosteroids
Increased risk of skin cancer (UV induced)
Calcitriol
• Administration
• MOA
• Indication
Calcitriol
Administration – topical
MOA
AKA active vitamin D3; Binds to vit. D receptor and associates with RXR to binds DNA vit. D response elements this modulates epidermal differentiation and inflammation.
INDICATION
Psoriasis; better for sensitive skin
Calcitriol
• Side effects
Calcitriol
SIDE EFFECTS
High doses: Hypercalcemia and Hypercalciuria (Abdominal pain, constipation, depression, HTN, anorexia, polydipsia)
Increased risk of skin cancer (UV induced)
What are the more potent corticosteroids used in ACNE treatment? where are they used?
• weak ones?
More potent drugs like Clobetasol and Budesonide should be used on more keratinized surfaces while the weaker drugs like betamethasone and hydrocortisone should be used on the face and more sensitive skin.
