Psoriatic Arthritis Flashcards
Tretinoin
(Tretin-X; Retin-A)
Topical: Retinoid (Topical vitamin A analog)
*increase cell turnover
*decrease cell cohesiveness
*Sensitivity to sun exposure, wind, cold
ADRs: skin irritation; redness; peeling
Pregnancy category C
Adapalene
(Differin)
Topical: Retinoid
3rd generation retinoid
Less peeling/ dryness and skin discoloration than tretinoin
Tazarotene
(Avage; Tazorac)
Topical: Retinoid
Prodrug and synthetic acetylenic retinoid —> tazarotenic acid
Alters gene expression
ADRs: redness; itching; stinging; burning
Ustekinumab
(Stelara) - 12 week SC dosing
MOA: IL-12/23 inhibitor — > reduced T-cell activation
ADEs: Infections, ISR, HA, fatigue.
*Rare: Reversible posterior leukoencephalopathy syndrome (RPLS) -> (headache, confusion, seizures); pustular psoriasis
Monitoring: Injection site reactions; Latent TB- TB testing prior to initiation ; Infections; Malignancy; Worsening psoriasis (pustular)
Moderate to severe plaque psoriasis
Psoriatic arthritis
Secukinumab
(Cosentyx) - 4 week SC dosing
IL-17 inhibitor
ADEs: Infections (nasopharyngitis, upper respiratory tract infection, mucocutaneous candida); neutropenia; exacerbations of Crohn disease?; uticaria; diarrhea
Monitoring: Injection site reactions; Latent TB- TB testing prior to initiation ; Infections
Apremilast (Otezla)
(Otezla) - titrate to 30mg BID dosing ORAL
PDE-4 inhibitor (targeted)
ADEs: N/D, HA, weight loss; DEPRESSION
Monitoring: Scr; weight; GI effects ; depression ; CYP3A4 metabolism; CrCl