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Dermatology > Sweatman Psoriasis and Acne > Flashcards

Sweatman Psoriasis and Acne 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
what to retinoid NOT DO
they do not affet the bacteria involved with acne | they do not affect sebum production
26
what do retinoids in acne do
increase epidermal cell turnover and mitotic activity--> thickened corneum and this leads to sloughing and expulsion of exisiting comedones
27
human tissue composition of rar/rxr receptors
RAR (alpha,gamma) and RXR (alpha, beta)
28
taargetting RAR's leads to
cellular diff. and prolif
29
targetting RXR's leads to
apoptosis
30
rar targetters | acne, psoriasis, photaging
tretinoin, adapalene, tazarotene
31
targetters of rxr's | mycosis fungiodoides, and kaposi's sarcoma
beXarotene, alitretinoin
32
all oral retinoids are
teratogenic (vitamin a is crucial to embryogenesis)
33
accutane pt.'s also need
monitor for suicide
34
before oral oral retinoid check
blood (CBC) liver lipids(most common abnormality) babies (preg test)
35
RAR selective retinoids...monitor
mucocutaneous and musculoskeletal changes
36
RXR selective retinoids...monitor
physiochemical changes
37
retinoids and UV
increase photosensitivity and risk for severe sunburn
38
topical retinoids are used for
acne and photaging
39
topical retinoids and photoaging
inhibit MMP's in response to UV radiation and also induce epidermal hyperplasia in atrophic skin--> reducting keratinocyte atypia
40
two more nuclear target drugs for tx of psoriasis
Calcipotriene | Calcitriol
41
main side effect with calcipotriene
hyeprcalcemia and hypercalcuria with excesss dose
42
MOA for calcipotriene
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
with calcipotriene migiht have to co-admin
topical steroids | it is an irritant
44
calcipotriene can icnrease chances for
skin cancer-UV induced
45
active for of vitamin D
calcitriole--> topically only
46
better tolerated in intertrignois and sensitive regions
calcitriole
47
calcipotriene is selective for which receptors
RXR--> apoptisis
48
Benzoyl peroxide MOA
prodrug converted to benzoic acid on the skin--> ROS liberation is lethal for P. acnes
49
benzoyl peroxide is usually formulated with
adapalene or | antibiotics like erythromycin and clindamycin (macrolides)
50
macrolide MOA
inhibit 50 s ribosomal subunit | static or cidal dep. on concentration
51
bad news for clinda
P. acnes is resistant to topical form*change if no improvement in 4-8 weeks
52
drier skins
creams
53
oilier skins
gels or solutions
54
overall accomplishments of corticosteroids
>increased antiimflammatory lipocortins | >decreased endogenous inflammatory mediators
55
antinflammatory, anti-itch, vasoconstricitve
corticoctseroids
56
effectiveness of topical steroids is judged by
ability to cause blanching of the skin
57
list the corticosteroids in order of poentcy | MILD-MOD-POtent-Very POtent
Hydrocortisone Betamethasone Flucinonide Clobetasol
58
steroid tx respose is varied by
condition and anatomic location
59
HIGHLY resonsive to scorticosteroids
Psoriasis (Intertrginous) Atopic dermatitis (children) Seborrheic dermatitis Intertigo

Dermatology (12 decks)

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