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108 Cards in this Set
- Front
- Back
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What am I:
a chronic inflammatory skin disorder mediated by cytokines that are produced by T-cells that may have recurrent exacerbations and remissions increase proliferation of epidermis |
psoriasis
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What am I:
a scoring method for psoriasis using a uniform method to determine the extent of skin involvement mild < 12 moderate 12-18 severe >18 |
PASI
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What am I:
scoring method for psoriasis that summarizes the extent of the disease relative to baseline |
PGA
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What am I:
a scoring method for psoriasis that incorporates the patient's quality of life into the overall skin assessment |
NPF-PS
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What are the aggravating factors of psoriasis?
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climate (better in warm, worst in cold)
stress alcohol smoking infection trauma drugs |
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What are the drugs that have been reported to trigger psoriasis lesions?
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lithium
beta blockers NSAIDs tetracyclines synthetic antimalarials |
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What are the treatment goals of psoriasis?
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reduce appearance of lesions
improve QOL reduce toxicity of medications |
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What am I:
first line topical treatment of psoriasis remove scalse and smooth skin |
keratolytics
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What is the most common used keratolytic?
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salicylic acid
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True or False:
salicylic acid can increase absorption of topical corticosteroids |
True
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What am I:
first line topical treatment of psoriasis hydrate skin to prevent recurrence |
emollients
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What are the possible side effects of emollients?
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folliculitis
irritant contact dermatitis |
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How often do emollients need to be used for psoriasis?
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several times daily
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What am I:
first line treament for psoriasis decreases erythema, scaling, and pruritis |
corticosterioids
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what areas of the body is the cream form of corticosteroids preferred over the ointment?
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axilla, groin, and other areas where folliculitis can develop
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What type of corticosteroids have weak anti-inflammatory effects, low level of vasoconstriction, and is safe in children?
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low potency corticosteroids
hydrocortisone dexamethasone methylprednisolone |
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What type of corticosteroids are best for thick, chronic psoriatic plaqes, used for short peroids and on small surface areas
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high potency corticosteroids
betamethasone clobetasol fluocinonide halobetasol |
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What are the topical side effects of topical side effects?
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local tissue atrophy
stiae acne purpura distended capillaries |
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What are the systemic side effects of the topical steroids?
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adremal suppression
hyperglycemia toleracne to topical steroids rebound flare ups of psoriasis after D/C of therapy |
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What am I:
first line topical treatment of psoriasis vitamin D analogue regulate skin cell production and development |
calcipotriene
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What are the side effects of calcipotriene?
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burning
itching hypercalcemia |
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When do you expect to see an improvement with calcipotriene therapy?
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2-8 weeks
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What am I:
a first line topical treatmetn for psoriasis normalize keratinization and have antinflammatory effects synthetic retinoinds |
tazarotene
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What are the side effects of tazarotene?
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pruritis
burning erythema |
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What drug can tazarotene be givin with to reduce side effects and increase efficacy?
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corticosteroids
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What am I:
second line treatment of psoriasis inhibits cell reproduction |
coal tar
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what are the side effects of coal tar?
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irritation
unpleasant odor stains skin/clothes photosensitivity possible carcinogenicity |
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What am I:
second line topical agent for psoriasis slow epidermal cell turnover |
anthralin (0.1-1%)
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What are side effects of anthralin?
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staining of skin and clothes
irritation inflammation |
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How should antralin be administered?
A. start on high strenth right away B. start on low strength and titrate to higher strength C. given as short contact therapy |
B. start low and titrate up
C. short contact |
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What am I:
first line agent for psoriasis IV monoclonal antibody TNF-a inhibitor FDA approved for chronic plaque psoriasis |
infliximab
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True or False:Infiximab can result in new or worsening psoriasis
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True
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What am I:
first line agent for psoriasis dimeric fusion protein TNF-a inhibitor FDA approved for moderate to severe plaqe psoriasis in adults |
etancercept
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True or False:
entancercept does not cause new or worsening psoriasis |
False
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What are some of the side effects of infliximab?
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pharyngitis
common side effects (headache, diarrhea, infection, etc) |
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What are some of the side effects of entanercept?
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common side effects (N/V, rash, infection, abdominal pain, etc)
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What form is etanercept available as?
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pre-filled auto-injections
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What am I:
first line systemic treatment of psoriasis recombinant human IgG1 monoclonal antibody TNF-a inhibitor FDA approved for moderate to severe psoriasis in adults |
adalimumab
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True to False:
adalimumab can cause new or worsening psoriasis |
True
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What are some of the side effects of adalimumab?
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Rhinitis
common side effects (infection, rash, headache, etc) |
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How is adalimumab supplied?
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pre-filled pen
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How is the administration of adalimumb different from etanercept?
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adalimumab not recommended on outer upper arm
etanercept requires stretching of the skin adalimumab requires squeezing of the skin |
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What am I:
human IgG1k monoclonal antibody IL-12 and IL-23 antagonist FDA approved for moderate to severe plaque psoriasis in adults |
ustekinumab
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True or False:
ustekinumab must be administered by a healthcare provider |
True
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How is ustekinumab supplied?
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45 and 90mg pre-filled syringe and single use vial
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what are some of the side effects of ustekinumab?
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nasopharyngitis
common side effects (headache, fatigue, infection, etc) |
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True or False:
Ustekinumab can cause new or worsening psoriasis |
False
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What am I:
human protein which inhibits T cell activation FDA approved for moderate to severe plaque forming psoriasis |
alefacept
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What are the monitoring parameters of alefacept?
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weekly CD4 monitoring
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Is alefacept indicated in pediatric patients?
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no
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What drugs must be administered by a healthcare professional?
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ustekinumab
alefacept |
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What are the common side effects of alefacept?
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pharyngitis
common side effects |
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What am I:
T cell inhibitor taken off the market due to onset of progressive multifocal leukoencephalopathy |
efalizumab
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What am I:
oral retinoid use for treatment of psoriasis correct abnormal cell proliferation indicated for severe psoriasis |
acitretin
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What is the active metabolite of etretinate?
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acitretin
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What is contraindicated in acitretin?
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pregnancy and blood donation for 3 years after last dose
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What precaution must be taken in terms of alcohol when taking acitretin?
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avoid alcohol during treatment and 2 months after stopping
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What has a longer half life: acitretin or etretinate
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etretinate
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What are the side effects of acitretin?
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cheilitis
hair loss dry skin reduce HDL hypertriglyceridemia conjunctivitis decreased visual acuity hepatotoxicity skeletal changes |
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What has more side effects:
acitretin or etretinate |
etretinate
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What am I:
second line systemic treatment of psoriasis immunosuppressive agent that inhibits T cell activation and release of inflammatory mediators |
cyclosporine
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What are the adverse effects of oral cyclosporine?
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nephrotoxicity
hypertension malignancy hypomagnesemia hyperkalemia hepatotoxicity hyperglycemia infection neurotoxicity gingival hyperplasia |
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When should systemic cyclosporine be discontinued?
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if inadequate response after 6 wks on max tolerated dose
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What am I:
second line systemic treatment of psoriasis macrolide immunosuppressant inhibits T cell activation |
tacrolimus
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True or False: tacrolimus is FDA indicated for the treatment of psoriasis
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False
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What are the adverse effects of tacrolimus?
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parasthesis
insomnia hypertension tremor diarrhea nausea |
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What am I:
second line systemic treatment of psoriasis folate antagonist leads to decreased cell replication |
methotrexate
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What drug is indicated for moderate to severe psoriasis refractory to topical treatments and phototherapy
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methotrexate
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How often should methotrexate be administered?
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weekly
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What can be used if there is a methotrexate toxicity?
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leucovorin
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What are the side effects of methotrexate?
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hepatoxicity
GI symptoms hematologic toxicity headache |
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What antibiotic should be avoided while on methotrexate?
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bactrim
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What drug is indicated for moderate to severe psoriasis refractory to topical treatments and phototherapy
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methotrexate
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How often should methotrexate be administered?
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weekly
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What can be used if there is a methotrexate toxicity?
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leucovorin
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What are the side effects of methotrexate?
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hepatoxicity
GI symptoms hematologic toxicity headache |
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What antibiotic should be avoided while on methotrexate?
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bactrim
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What is contraindicated with methotrexate?
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pregnacy
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What can be given with methotrexate to decrease GI symptoms?
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folic acid
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What precautions should be taken while taking methotrexate?
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avoid in patients with active infection
avoid use of other antifolates |
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What are the alternative treatments of psoriasis?
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mycophenolate mofetil
sulfasalazine 6-thioguanine hydroxyurea |
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What am I:
treatment for psoriasis involving UVB |
phototherapy
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When should phototherapy be used?
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when patient have widespread psoriasis or unresponsive to topical therapy
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What am I:
treatment for psoriasis involving PUVA |
photochemotherapy
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When should photochemotherapy be used?
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when patient have moderate to severe psoriasis and is unresponsive to topical and systemic therapies
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What am I:
treatment for psoriasis methoxsalen (oral photosensitizer) is ingested then patient is exposed to UVA light 2-3 times a week |
photochemotherapy
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What am I:
an oral photosensitizer |
methoxsalen
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What psoriasis treatments have level 1 evidence?
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topical corticosteroids
anthralin vit D analogs (calcipotriene) cyclosporine entaracept infliximab adalimumab |
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What products should be given to treat mild to moderate psoriasis?
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topical products
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What are the first line topical products?
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keratolytics (salicylic acid)
emollients topical corticosteroids vit D analog (calcipotriene) tazarotene |
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What are the second line topical products?
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coal tar
antralin |
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What products should be used in patients with widespread psoriasis or are unrespronsive to topical products?
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topical products
add on phototherapy |
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What product should be used in patients with moderate to severe psoriasis?
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systemic drugs
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What are the first line systemic products?
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infliximab
etanercept adalimumab ustekinumab alefacept |
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What are the second line systemic products?
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acitretin
cyclosporine tacrolimus methotrexate |
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What am I:
PASI score of < 12 |
mild psoriasis
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What am I:
PASI score of 12-18 |
moderate psoriasis
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What am I:
PASI score of > 18 |
severe psoriasis
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What is dose should infliximab be given to treat psoriasis?
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5mg/kg given in 3 doses, then Q8 wks
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What dose should entanercept be given to treat psoriasis?
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50mg SC BID for 3wks, then weekly
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What dose should adalimumab be given to treat psoriasis?
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80mg SC now, then 40mg SC Q2 weeks
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What dose of ustekinumab be given to treat psoriasis in patients who weight less than or equal to 100kg?
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45mg SC now. After 14 weeks, give 45mg SC Q12 weeks
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What dose of ustekinumab be given to treat psoriasis in patients who weight greater than 100kg?
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90mg SC now. After 14 weeks, give 90mg SC Q12 weeks
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What dose should alefacept be given to treat psoriasis?
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15mg IM weekly for 12 weeks, then every 12 weeks as needed
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What dose should acitretin should be given to treat psoriasis?
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25-50mg daily
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What dose should cyclosporine be given to treat psoriasis?
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2.5-5mg/kg daily divided BID
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What dose should tacrolimus be given to treat psoriasis?
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0.05-0.15mg/kg daily
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What dose should methotrexate be given to treat psoriasis?
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7.5-25mg weekly
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