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therapeutics Flashcards

1
Q

sun protection advice

A

sun protection-behaviour, sunscreen, clothing, window filter

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2
Q

CAD

A

sun protection advice, topical CS/CI,
pred 2w, AZA(B),Cya(B),
MMF(C), AM(C), PUVA/NBUVB densisitation((B, risky!)\

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3
Q

PMLE/AP/SU/HV-

A

topical CS/CI, AH, PUVA/NBUVB desensitisation, AM, AZA, cyA

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4
Q

photodrug rxn

A 
memo/drug cessation(crucial,no alt, limited time-ct)
allergen  avoidance(patch/photopatch)
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5
Q

Pemphigus

A

pred 0.75-2mg/kg/d
↑25%qw↓10/5/2.5/1mg(40/20/10/5mg) q w

PV-MMF/AZA/dapsone/(A); MTX/CPA(B);
PF- MMF/AZA(A); Dapsone/MTX/CPA(B);

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6
Q

Rx considerations immunobullous

A

severity: BSA,disease area index; mucosal involvement,comorbidities, CI

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7
Q

pemphigoid

A

(0.3-1mg/kg/d) doxy/nicotinamide(A)

BP-AZA/MMF(A); dapsone/MTX/CPA(B)

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8
Q

indications for +adjuvant

A

> 1mg/kg/d pred, freq flares on tapering/morbidity or CI to steroid)

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9
Q

EBA-

A

dapsone/colcichine/pred(C); IVIG/ritux(B)

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10
Q

DH

A

( dapsone/pred);

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11
Q

Cx: MMP

A

Mucosal- MMP- ocular, ENT, GE ( OGD/colono) strictures

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12
Q

Treatment failure defn

A

progression/failure epitheliasation >3w pred(1.5mg/kg/d+-adjuvant)

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13
Q

immunobullous Treatment failure Recalcitrant disease-options

A

IvIG(A)/plasmapharesis, rituximab(B+-infx Cx)

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14
Q

role of dsg1/3 activity q6-12m;baseline in PV/PF

A

Monitoring-dz activity?stop Rx

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15
Q

FDE Rx:·

A

culprit drug/Xreacting, topical CS/Erosive-PP,gbFDE, PO pred

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16
Q

Mgt principles for vasculitis

A

symptomatic, 1st line, recalcitrant, 3rd line, specific
extracutaenous- RAI
Triggers- drug, causative dz-infx;
Topicals/leg elevation/NSAID AH aspirin

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17
Q

SVV

  1. palpable purpura
  2. hemorrhagic blister,necrosis
A

1.Colchicine(B, RCT-no effect but relapse in responders with cessation)+/-dapsone(B)
penicilin(ASOT)

  1. Prednisolone
    recalcitrant-Steroid sparing-AZA, MTX, CyA,
    CPA,IvIg, plasmapharesis
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18
Q

ANCA+ vasculitis

A

comanage RAI/renal/pulm, induction of remission(3-6m)-pred+MTX, maintenance(>24m) pred+MTX/AZA+Bactrim+bactroban(nasal)

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19
Q

CTD-associated vasculitis Rx

A

SLE- AM(A)-60% ↓flares; MTX(B);

RA-pred/penicillamine, MTX/AZA/CyP

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20
Q

PAN-prognosis

A

10% cutaneous benign relapsing prognosis, surveillance q6m systemic involvement(rare, 0/79 @7,7/9 @4y; pANCA);

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21
Q

PAN-Rx

A

Hep B associated(sPAN; GE antiviral IFN);
Rx all grade (B)
1st: NSAID/pred/dapsone/colchicine + wound care/dressings/infx
2nd: AZA, MMF, MTX, CPA
3rd: HBOT, ritux, IVIg, inflix, iloprost/bosentan(vasodilator, prostacyclin)

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22
Q

LV- Mgt principles

A

1.exclude 2-CTD, hypercoagulable, malignancies-solid haematological;

  1. 1st:smoking cessation, pentoxyfylline, aspirin, pred
    2nd: /AZA MMF(C)
    admit: methylpred/IvIg/ritux/HBOT(B)
  2. DIRECTED Rx-thrombotic dz: warfarin, LMW heparin, Tissue plasminogen activator
  3. APS- danazol, HCQ; homocysteinemia- folic acid B6/12 supplement
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23
Q

DGI Rx

A

Rx: im ceftriaxone 1g OD( until 48H after clinical improvement)+ doxy/azithro(CT)

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24
Q

purpura fulminans Rx

A

Rx: ICU-abx(immediate/directed/mitigate immunosuppresion) supportive/inotropic/ventilatory/fluid; debridement;

Rx: stop warfarin, start vitK/heparin/protein C concentrate

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25
Q

purpura fulminans Q?

A

Ask: HD instability+ sepsis+immunocompromise/neutropenic, Phx CTD/APS/infx, warfarin

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26
Q

purpura fulminans ddx

A

1.occlusion: a)ecthyma gangrenosum b)septic vasculitis/emboli- c)lucio’s

  1. acquired protein C dysfunction
    a) DIVC-meningococcemia/strep/saureus/Hib
    b) warfarin necrosis
  2. catastrophic APLS
  3. Calciphylaxis
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27
Q

CCLE prognosis

A

counsel (Risk of progression to SLE -DLE/tumid lupus10%,SCLE 50%)

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28
Q

CCLE counselling includes

A 
sun protection(A)/smoking cessation(B*) 
*Affect severity/QOL not AM efficacy; vit D levels controversial role
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29
Q

CCLE Rx

indications for systemic(evidence?)

A

Potent Topicals-CS/TCI(A)/ILK(C)
Systemic-widespread recalcitrant scarred disfigured
1st:Antimalarials(A);
2nd +Pred(C)(severe,2-4 w taper +AM);MTX(B,wenzel 2005 SCLE/Localised DLE not dissemin.)

3rd: MMF / AZA; dapsone/Acitretin(A);Thalidomide/IVig/clofazamine

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30
Q

DLE Scalp Rx, indications for systemic?

A

> 10% SSA/>8W Rx failure ILK→ AM(A), Isotretinoin(B↓TE)acitretin(A), MTX

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31
Q

DMS Mgt:

A

+myositis-RAI comanagement-1- 2mg/kg pred

1) cutaneous: photoPx,
1st: topical CS/TCI, AM(B),
2nd: acute disabling(all B) pred /MTX/AZA/MMF
2) Longitudinal Malignancy surveillance 6 mox 3 y

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32
Q

DMS and malignancy-local data

risk factors? onset?

A

(local 10 mo onset)

Phx malignancy, poor Rx response, unexplained dz flares ( *Ang 2000; ↑malignancy in myositis)

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33
Q

Mgt principles MORPHEA:

A
  1. localised/generalised,* vs systemic( refer RAI+ nifedipine, aspirin);
  2. active​:
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34
Q

morphea/SSc

A
  1. 1st(B):Potent topical CS/ TCI/calcipotriol/ILK;

2.(B):*UVA1/PUVA/NBUVB
MTX(>6mo)+-Pred(taper 2-4 w)/pulse methylpred,pred(6m) MMF

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35
Q

Mgt PRS

A

PRS, filler( stable >1 y photographic)

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36
Q

SCLEREDEMA Mgt-

A

cause(self resolving/no treatment/hyerglycemia independent); disability;
PUVA/NBUVB/CS

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37
Q

scleromyxedema,prognosis, Rx

A

Challenging(C), chronic persistent,MM/systemic(poor)

IvIG** CS(PO/topi/ILK);
chemo-melphalan(hematological malignancy, sepsis)
high dose dexa; IFNA, Cya,

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38
Q

LM: prognosis, Rx

A

skin-limited, good prognosis, no Rx

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39
Q

LP prognosis, Mgt:

A 
self limiting, 20% relapsing, 
no RCT
1.topical CS/CI/calciportriol, 
2.pred, AM, Acitretin
4. CyA sulfasalazine
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40
Q

LPP Rx -topicals, systemic (indications)

A

> 10%SSA,Rx failure>3m; AM(B)/pred(C); CyA/MMF/acitretin(C)

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41
Q

oral LP mgt principles

A
  1. aim-symptoms/ulcers/malignancy monitoring(0.4-5% transformation),biopsy
    2.educate:smoking/alcohol/diet; oral hygiene, remove dental amalgam(97% benefit vs 40% +PT-amalgam, Me)
  2. Rx oral candida, chlorhex mouthwash(plaque)
    triamcinolone,CI, topical CyA,

PO pred5-10d/AZA/AM

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42
Q

PRP prognosis

A

Prognosis: classic(1,3, 80% 1-3 y remission)

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43
Q

Mgt- PRP

A
  1. topical CS/calcineurin inhibitor
  2. 1st:MTX+-acitretin(B)
    2nd: Cya(C), AZA(C)
    3rd: photoRx,
    (biologics) TNFa inhibitor(B)-etanercept, adalimumab infliximab, ustekinumab(C)( IL 12-23 inhibitor)
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44
Q

DRESS prognosis, Rx:

A

10% mortality, systemic involvement

supportive, pred(B), tapered 6-8w; other: pulse methylpred, CyA

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45
Q

AGEP Prognosis, Rx:

A
  1. self limiting favorable
  2. admit, BP/T, withdrawal drug, supportive( topical cs/AH),
  3. extensive: short course pred
46
Q

what is the role of drug testing in AGEP? -sensitivity?

WHEN ?HOW?

A

patch testing sensitivity 80%,
post 6w-6mo
crushed tablet, dilute 30% petrolatum/water, 0.1-10%(SCAR), back, reading 48/96H/D7

47
Q

GPP mgt

A

Rx:
acitretin/CyA/MTX(B) +clox(antistaph) ;
2nd: biologic, PUVA

48
Q

SJS -TEN supportive Rx

A
  1. MDT, burns unit/prompt withdrawal causative drug/all unnecessary meds
49
Q

SJS TEN Prognosis:

A

SCORTEN- mortality ( score 1-5) ( 40, malignancy, HR >120, BSA detachment>10%, urea>10mmol/L, glucose>14 mmol/L, HCO3-

50
Q

SJS TEN specific Rx, EVIDENCE?

A

absent RCTs, ALL (B)
1. CyA(3-5mg/kgIBW/d,IV/PO until epitheliasation)
open phase 2 trial reduced death rate/detachment progression)
2. IVIg( TD 2-3 g/kg Dx 3-4 d)
SGH: trend towards increased mortality)

  1. CS(SJS not TEN, 1-2mg/kg/d 3-7d, arrest dz progression/shortened recovery period)
  2. Other: plasmapharesis, anti TNFa inhibitors
51
Q

Counselling for CADR

A
  1. Educated -avoidance medication/ class tolerated drugs(DPT)
  2. Documentation - Medic Awas card, Annotations,Letter, medical records, CMIS
  3. Xreactivity:
52
Q

Counselling Xreactivity penicillin allergy?

A
  1. β-lactam +sulfur ring a)chemical side chain similarity of cephalosporin to penicillin
  2. 1st gen Cephalexin
53
Q

Counselling Xreactivity anticonvulsants DRESS allergy?

A
  1. avoid all other aromatic anticonvulsants, consider nonaromatic i.e. valproate(not acute -hepatitis) anticonvulsants;
  2. 1deg relative- increased risk
54
Q

Aromatic -anticonvulsant

A

carbamazepine, phenytoin, phenobarbital, lamotrigine, felbamate, oxycarbamazepine, zonisamide;

55
Q

Non-aromatic - anticonvulsant

A

levetiracetam, valproic acid,

56
Q

Rx Sarcoidosis- principles

A

Rx(lupus pernio/extent/disfigurement ):

  1. potent topicals, ILK,
  2. pred(1mg/kg/d 4-6w slow taper, AM(C), MTX(B) ,
  3. other ( surgery, IL chloroquine, thalidomide, tetracyclines)
57
Q

Sweet’s Prognosis, RX

A

benign untreated persist months spontaneous involution 30% recurrences

  1. pred 0.5-1mg/kg/d-duration4-6w,tapering 2-3 months suppressive,
  2. KI, dapsone, colcicine, NSAID, monitor T/FBC/CRP/ESR for response
  3. Local symptomatic treatment(bulla, compresses);
  4. evaluate for underlying malignancy
58
Q

sarcoidosis associations?

A

Ax Malignancy-sarcoidosis lymphoma syndrome,(ROS, FHx, breast/testicle self exam, age appropriate cancer screen, yearly for 5 years, lifestyle)

AI: thyroiditis, IDDM, Sjogrens, thrombocytopenia, haemolytic anemia

59
Q

Rx PG

A

​​1.limited

60
Q

Behcet’s Rx

A

lidocaine/topical CS/ILK; colchicine/dapsone(B);
Severe mucocutaneous- thalidomide, MTX, pred
systemic: pred/AZA/MMF/Cya(B); CYP/IVig

61
Q

Rx: M marinum

other?

A

single agent 6-12w
Bactrim,mino, doxy,klacid
surgical excision

62
Q

leprosy Rx multibaciliary

A

(12-24DCR)

dapsone 100mg OD, clofazimine300mg x 1m, 50mg OD Rifampicin 600mg 1x m;

63
Q

leprosy paucibaciliary:

A

6DR( Dapsone 100mg OD, rifampicin600mg 1xm)

64
Q

leprosy mgt priciples

A

Notify, psychosocial support+ clinical assessment household contacts; discharge- clinical cure, -ve SSS, biopsy; 3m on Rx SSS, then 6 mo relapse rv, yearly SSS

65
Q

Rx leprosy reaction Type 1:

A

refer infx, admission/limb immobilisation/symptomatic/orthop nerve decompression
Type 1: ct MDT,pred ,

66
Q

Rx leprosy reaction Type 2

A

type 2: ct MDT, pred

67
Q

SPTCL Rx

A

Rx Solitary- surgical, RT,Prednisolone, CyA, MTX; Refractory / haemophagocytic syndrome Multiagent doxorubicin-based chemotherapy ± radiotherapy / stem-cell transplant

68
Q

TB Rx(monitoring?)

A 
notify, cutaneous infection, AFB c/s subtype ,
baseline glu(Z), VA, LFT, Cr, HIV, monitor LFT, VA,qm x 3m
2HREZ( 5,10,15, 25mg/kg/d)+ 4HR+ pyridoxine10mg OD
69
Q

TBprognosis if untreated/treated?

A

untreated-risk of miliary dissemination,

70
Q

CRP Rx

A

po minocycline 50% effective, isotret/acitretin/salicyclic acid, azithro

71
Q

Prurigo pigmentosa Rx, prognosis

A

minocycline(antiinflammatory,neutrophil chemotaxis);
dapsone, doxy,isotret/NBUVB,hydroquinone/azelaic;
Px: good but relapsing

72
Q

MF principles, RX

A
  1. Goal-prevent disease progression ;Refer Cutaneous Lymphoma
  2. MDT Oncologist / Radiation tumor( interferon; cost, convenience, toxicity Sepsis)
  3. skin-directed treatment; Long term surveillance
    - (All B) Topical Steroids /nitrogen mustard/ tazarotene gel
    - PUVA(psolaren 0.6mg/kg/d) / Re-PUVA/Narrow band UVB
    - RT/EBT/ IFN-a; ECP;

chemotherapy doxorubicin, cyclophosphamide, vincristine,prednisolone (CHOP). MonoclonaL Ab: denileukin diftitox, BMT

73
Q

LYP/PCACL Prognosis?

A

Rx:excellent prognosis, size, surveillance- systemic lymphoma

74
Q

LYP/PCACL Rx,

A
  • Observation, Topical steroids imiquimod ;

- generalised with scarring -MTX PUVA / NBUVB,tazoretene -localized/large:Surgical excision, RT

75
Q

PLEVA/PLC prognosis,

A

Prognosis: Spontaneously resolve several w/progress PLC(mo-y)

76
Q

PLEVA/PLC Rx

A

Rx: PO Emycin 250mg qds >2m(B); tetra(C), photoRx/MTX/CyA(C)

77
Q

extranodal NKT lymphoma prognosis, Rx

A

Rx poor prognosis; oncologist ,ENT ,Multiagent chemotherapy,radiotherapy

78
Q

B Cell lymphomas prognosis

A

PCMZL upper limbs Excellent
PCFCL H&N, trunk Excellent
PCLBCL, LT,poor 5-year survival 50%

79
Q

B Cell lymphomas PCMZL PCFCL RX

A

:localised Sx/RT Multifocal- Rx symptomatic ILK/ IFN-α/rituximab

80
Q

PPK Mx:

A

self-paring/trim nails, avoid trauma/friction, emollient, PP soaks(blisters)
Topical Keratolytics retinoids calcipotriol, acitretin

81
Q

cGVHD

A

Rx: photoprotect,concomitant photosensitising(voriconazole,levoflox) topicals, progressive(C) :po pred, AM, acitretin,photoRx(malignancy) refer PT

82
Q

aGVHD

A

Rx: topicals, PO pred/iv methylpred(1mg/kg BD) 50% controlled, 2nd: MMF, biologics

83
Q

LSA

A

-Rx: 1.Control with ↓SE, 1st: superpotent topical CS 3m(B) circumcision(B) 2nd: >3m topical CS/TCI(lack safety data); surgery/dilator; 2.psychosexual counselling 3. VIN/genital SCC( X 2-5%)

84
Q

EI

A

Rx: underlying cause, MTB, supportive- rest, stocking, NSAID, MMF, CS

85
Q

HV

A

Photoprotect, tinted windows
Phototherapy, b carotene fish oils
AM, AZA, CyA
Thalidomide

86
Q

EPP

A

1) photoprotect VL (Ti,O, ZnO 400-410nm)
2) skin- b carotene m a MSH
3) cholestasis/cholelithiasis - cholestyramine/charcoal

87
Q

RPC

A

Rx:topical(CS, retinoid, salicylic acid, methol)AH(doxepin)amitryptilline,CS retinoid,Abx, MTX,photoRx; avoid trauma/destructive-cryo laser ablation

88
Q

cut mets

A

mgt:palliative/Sx/RT/hormonal/Chemo(large aggressive)

89
Q

aneoderma

A

Rx: unsuccessful, ILK, aspirin/dapsone/antimalarials/surgical excision-scar formation

90
Q

degos

A

Rx: aspirin, clopidogrel., heparin pentoxyfylline, no effective systemic

91
Q

NLD

A

independent of glycemic control, potent topical/ILK, target microangiopathy
(stanazolol, pentoxyfylline)

92
Q

NXG

A

Rx: none recommended, alkylating(chlorambucil),PO/ILK pred, Sx, RT, AM, MTX

93
Q

Rx: RDS

A

asymptomatic self limiting, destructive/disseminated- PO CS, RT, excision, thalidomide

94
Q

Prognosis XD

A

prognosis: self healing/persistent/progressive-organ dysfunction+CNS

95
Q

XD

A

Rx: RT(airway), cyclophosphamide(mucosal)

96
Q

xanthoma-

A

Cx: acute pancreatits
Rx: pharmacologic/dietary
fibrates- gemfibrozil, fenofibrate ( dysbetalipoproteinemia- plane, tuberous); imcrease lipoprotein lipSe, reduce VLDL synthesis

97
Q

Rx GA

A

Rx: AM,CyA, MTX, dapsone, PhotoRx, biologics

98
Q

OFG

A

Rx: Topical corticosteroids;doxy/mino/dapsone/MTX/Clofazimine

99
Q

rhinoscleroma-

A

Rx: surgical, 6w-6m single tetra/sulfonamide/cipro

100
Q

alopecia mucinosa

A

surveillance-rpt Bx MF; primary-ILK/top CS+mino/isotret/AM(C)+-cephalexin infx)

101
Q

cutaneous plasmacytosis

A

Rx: chronic relapsing, pred/TCI/ILK/PUVA/CPA, favorable prognosis, low malignant transformation, ,

102
Q

rX Hailey hailey,

A

general-clothes,friction/sweat/botox, CS/CyA/MTX/biologics, infective-antmicrobial/iodosorb, surgical excision/grafting/ablative(co2/alex)

103
Q

angosarc prognosis

A

prognosis 5% 5Y

104
Q

melanoma margins+ LND?

A

Rx: margins MIS/2mm( 0.5/1/2 cm); acral/facial- Mohs

St 1/2-ELND no survival benefit , SLND( first mets site) improved dz free survival ( not overall)

105
Q

melanoma adj rx

A

Adj: St2/3 high risk resected e.g. IFN-a
Mets: palliative resection, RT, chemo( dacabarzine); immunoRx(IFN-a); molecular target( BRAF- vemurafenib; KIT- imatinib)

106
Q

NMSC

A

Mgt: Low risk:Excision +4mm Margin /Photodynamic Therapy/5-Fluorouracil/ Imiquimod; High risk/SCC/nodular BCC- excision margin+4mm assessment; FU- 1/3/6 moX 5Y;High risk- life

107
Q

MGT multiple NMSC high risk

A

1) FU 6-12mo,photoprotect, Low threshold Bx
2) Ablative,Acitretin,,Aggressive (Ex>6mm +margins;Mohs
3) Modulate immunosuppression /MTOR inhibitors

108
Q

Acitretin dose chemoprevention

A

10 mg EODx2w; 10 mg ODx2w: 20 mg OD, upwards to 25mg or tail

109
Q

Mgt: Low risk NMSC

A

Excision +4mm Margin

PDT/5-FU/ ImQd;

110
Q

High risk/SCC/nodular BCC-

A

excision margin+4mm assessment

; FU- 1/3/6 moX 5Y;

111
Q

Vismodegib MOA indication

A

Vismodegib Hedgehog pathway inhibitor; FDA-failed surgical/RT advanced /metastatic BCC, Gorlin; response 14.7 -20.3 months

112
Q

Vismodegib ADR

A

ADR muscle spasms, alopecia, taste loss, weight loss, fatigue

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