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Dermatology > Sweatman Psoriasis and Acne > Flashcards

Sweatman Psoriasis and Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

most common autoimune dz in the US

A

psoriasis

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2
Q

drugs that treat psoriasis target….

A

the cytokines involved that cause over growth of normal skin cells

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3
Q

Pro inflammatory cytokines involved in psoriasis released by t cells

A

TNF

IFN

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4
Q

Nomenclature for adalimumab

A

lim=immune system

u- humanized

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5
Q

Human Mab

A

Adalimumab

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6
Q

receptor-antibody fusion protein

A

etanercept

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7
Q

chimeric monoclonal antibody

A

infliximab

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8
Q

administration routs for the TNF blockers

A

sc= adamlimumab and etanercept

infliximab=IV

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9
Q

binding site and overall goal for these drugs–>

A

bind to TNF-alpha–> and prevent them from receiving TNF signal (prevent damage from happening to the TNF cell target)

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10
Q

components of Adalimumab

A

IgG1

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11
Q

components of etanercept

A

p75 TNF receptor and Fc IgG1

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12
Q

components of INfliximab

A

variabel region of mouse Mab on human IgG1

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13
Q

only tnf blocker with hypersensitivity as a possibility

A

inflixiamab (murine derived)

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14
Q

BBW’s for tnf blockers

A

infection *FUNGAL,/MYCOBACTERIAL/VIRAL
NEOPLASIA
TUBERCULOSIS

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15
Q

DO NOT USE TNF BLOCKERS WITH

A

VACCINES

IMMUNOSUPRESSIVES

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16
Q

ABSOLUTE CONTR’S WITH ADALIMUMAB

A

NONE

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17
Q

ABSOLUTE CONTRA’S WITH ETANERCEPT

A

SEPSIS

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18
Q

ABSOLUTE CONTRA’S WITH INFLIXIMAB

A

HEART FAILURE

MURINE HYPERSENSISTIVITY

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19
Q

MAB THAT TARGETS IL 12 and IL23

overexpressed in psoiriasis plaques

A

ustekinumab (stelara)

  • -> bind p40 subunit integral to IL 12/23 activation
  • therebydisrupting signal transuction
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20
Q

supresses Th1 and Th17 cell populations

A

ustekinumab

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21
Q

adverse effects of ustekinumab

A

inc. risk of infection and neoplasia
-live virus vaccines contra
test for tb
anaphylaxis

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22
Q

retinoids to treat psoriasis

A

acitretin

tazarotene

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23
Q

main effect retinoid has on acne tx

A

decreased sebum secretion and sebaceous gland size (isotretinoin)

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24
Q

discuss retinoid in tx of acne

psoriasis mechs unknown

A

retinoids bind to RXR/RAR receptors in SUBBASAL KERATINIOCYTES–> travel to nucleus to increase transcription of HB-EGF and Amphiregulin–> these act on egf-r –cause proliferation of basal keratinocytes–> thickend epidermis–> peeling/flaking of stratum corneum

25
Q

what to retinoid NOT DO

A

they do not affet the bacteria involved with acne

they do not affect sebum production

26
Q

what do retinoids in acne do

A

increase epidermal cell turnover and mitotic activity–> thickened corneum and this leads to sloughing and expulsion of exisiting comedones

27
Q

human tissue composition of rar/rxr receptors

A

RAR (alpha,gamma) and RXR (alpha, beta)

28
Q

taargetting RAR’s leads to

A

cellular diff. and prolif

29
Q

targetting RXR’s leads to

A

apoptosis

30
Q

rar targetters

acne, psoriasis, photaging

A

tretinoin, adapalene, tazarotene

31
Q

targetters of rxr’s

mycosis fungiodoides, and kaposi’s sarcoma

A

beXarotene, alitretinoin

32
Q

all oral retinoids are

A

teratogenic (vitamin a is crucial to embryogenesis)

33
Q

accutane pt.’s also need

A

monitor for suicide

34
Q

before oral oral retinoid check

A

blood (CBC)
liver
lipids(most common abnormality)
babies (preg test)

35
Q

RAR selective retinoids…monitor

A

mucocutaneous and musculoskeletal changes

36
Q

RXR selective retinoids…monitor

A

physiochemical changes

37
Q

retinoids and UV

A

increase photosensitivity and risk for severe sunburn

38
Q

topical retinoids are used for

A

acne and photaging

39
Q

topical retinoids and photoaging

A

inhibit MMP’s in response to UV radiation and also induce epidermal hyperplasia in atrophic skin–> reducting keratinocyte atypia

40
Q

two more nuclear target drugs for tx of psoriasis

A

Calcipotriene

Calcitriol

41
Q

main side effect with calcipotriene

A

hyeprcalcemia and hypercalcuria with excesss dose

42
Q

MOA for calcipotriene

A

binds Vit-D receptor, complex associates with RXR-alpha subunit and binds DNA vit response element–> modulates epidermal diff, and inflamm, leading to improved psoriasis plaques

43
Q

with calcipotriene migiht have to co-admin

A

topical steroids

it is an irritant

44
Q

calcipotriene can icnrease chances for

A

skin cancer-UV induced

45
Q

active for of vitamin D

A

calcitriole–> topically only

46
Q

better tolerated in intertrignois and sensitive regions

A

calcitriole

47
Q

calcipotriene is selective for which receptors

A

RXR–> apoptisis

48
Q

Benzoyl peroxide MOA

A

prodrug converted to benzoic acid on the skin–> ROS liberation is lethal for P. acnes

49
Q

benzoyl peroxide is usually formulated with

A

adapalene or

antibiotics like erythromycin and clindamycin (macrolides)

50
Q

macrolide MOA

A

inhibit 50 s ribosomal subunit

static or cidal dep. on concentration

51
Q

bad news for clinda

A

P. acnes is resistant to topical form*change if no improvement in 4-8 weeks

52
Q

drier skins

A

creams

53
Q

oilier skins

A

gels or solutions

54
Q

overall accomplishments of corticosteroids

A

> increased antiimflammatory lipocortins

>decreased endogenous inflammatory mediators

55
Q

antinflammatory, anti-itch, vasoconstricitve

A

corticoctseroids

56
Q

effectiveness of topical steroids is judged by

A

ability to cause blanching of the skin

57
Q

list the corticosteroids in order of poentcy

MILD-MOD-POtent-Very POtent

A

Hydrocortisone
Betamethasone
Flucinonide
Clobetasol

58
Q

steroid tx respose is varied by

A

condition and anatomic location

59
Q

HIGHLY resonsive to scorticosteroids

A

Psoriasis (Intertrginous)
Atopic dermatitis (children)
Seborrheic dermatitis
Intertigo

Dermatology (12 decks)

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