Psoriasis: Treatment And Pharmacotherapy

Front 1

What is the genetic risk of psoriasis?

Back 1

41% if both parents have psoriasis
14% if one parent
4% if no genetic link

Front 2

Which types of twins have a higher concordance of psoriasis, monozygotic or dizygotic?

Back 2

Mpnozygotic

Front 3

Which type of T-cells are involved in the autoimmune mechanism of psoriasis?

Back 3

T-helper cells

Front 4

What do the T-helper cells do to cause the autoimmune response resulting in psoriasis?

Back 4

T-helper cells stimulate B-cells to release auto-antibodies

Front 5

The cytokine profile in psoriasis is knownas a T-helper cell type 1
(Th1) response. Which cytokines are produced by this subset of T
cells?

Back 5

Interferon-γ (IFN-γ ) and interleukin (IL)-2.

Front 6

Common triggers of psoriasis?

Back 6

Climate
Stress
Infection
Alcohol
Smoking
Certain medications

Front 7

Cytokines primarily responsible for psoriasis plaques?

Back 7

GR01α, TNFa and certain interleukins

Front 8

Physiological process of the growth of new blood vessels from pre-existing vessels responsible for alterations in dermal vascularity in psoriasis?

Back 8

Angiogenesis

Front 9

Raptiva?

Back 9

Efalizumab

Front 10

Raptiva MOA?

Back 10

Binds CD11a of LFA-1, thus blocking T-cell responses.

Front 11

The main climatic trigger of psoriasis is?

Back 11

Cold, dry weather

Front 12

The primary drug triggers of psoriasis are?

Back 12

ACE inhibitors
Beta-blockers
Chloroquine
Progesterone
Lithium
Indomethacin
Corticosteroid withdrawel

Front 13

The primary infectious triggers of psoriasis are?

Back 13

Streptococcal (strep throat, tonsillitis)
HIV
HPV (ED form)

Front 14

NSAID that can improve psoriasis?

Back 14

Meclofenamate

Front 15

In which layer of the skin does psoriasis begin?

Back 15

In the basal layer of the epidermis where keratinocytes form.

Front 16

Auspitz sign?

Back 16

Scale removal causing bleeding at point of attachment

Front 17

Köebner’s phenomenon?

Back 17

Scratch marks, sunburn or surgical wounds that leave psoriatic lesions in their place.

Front 18

What is the prevalence of psoriatic arthritis?

Back 18

10-25% of all psoriatics

Front 19

Severe psoriasis increase the risk of what other disease?

Back 19

Cancer, especially skin cancers

Front 20

Mild psoriasis is classified as?

Back 20

<3% of the skin

Front 21

Moderate psoriasis classification?

Back 21

3-10% of the skin

Front 22

Severe psoriasis?

Back 22

>10% of the skin

Front 23

80% of those with psoriatic arthritis also have?

Back 23

Psoriasis of the nails

Front 24

How much of the body surface is represented by the palm of 1 hand?

Back 24

1%

Front 25

True or false, psoriatic arthritis can be diagnosed by the presence of rheumatoid factor?

Back 25

False, psoriasis patients do not have rheumatoid factor.

Front 26

Which two disease must be ruled out when diagnosing psoriasis?

Back 26

Reiters disease and SLE.

Front 27

Most common forms of psoriasis?

Back 27

-Plaque-type (Psoriasis vulgaris)
-Erythrodermic (90% of BSA)
-Pustular
-Guttate

Front 28

Most rare and most severe form of psoriasis?

Back 28

Erythrodermic*
Acute inflammatory erythema and scales involving > 90% of body surface area (BSA)

Front 29

Most common form of psoriasis?

Back 29

Plaque-type (Psoriasis vulgaris)
Accounts for 90% of all psoriasis

Front 30

Type of psoriasis marked by small, scaly erythematous spots and that is most likely triggered by stressors like infections or drugs?

Back 30

Guttate

Front 31

Route of administration for mild to moderate psoriasis?

Back 31

Topical

Front 32

Route of administration for moderate-severe psoriasis?

Back 32

Phototherapy (light wave radiation, narrow UVV)

Front 33

Severe psoriasis (>20% BSA) is treated with?

Back 33

Systemic drugs

Front 34

First-line topical treatments for psoriasis?

Back 34

Emollients
Keratolytics
Corticosteroids
Vitamin D analogs
Retinoids

Front 35

Second-line topical treatments for psoriasis?

Back 35

Coal tar
Anthralin

Front 36

First-line systemic treatments for psoriasis?

Back 36

Retinoids
Immunosuppressants
Antimetabolites

Front 37

Second-line systemic treatments for psoriasis?

Back 37

Sulfasalazine
Biologic Response Modifiers (biologics)

Front 38

Topical Keratolytics for psoriasis?

Back 38

-Salicylic acid
-Urea,
-Hydroxy acids

Front 39

Topical steroids FDA approved for or specifically studied in psoriasis?

Back 39

-Betamethasone valerate 0.12% foam (Luxiq)
-Clobetasol propionate 0.05% foam (Olux and Olux-E)
-Clobetasol propionate 0.05% -shampoo (Clobex)
-Clobetasol propionate 0.05% spray (Clobex)
-Halobetasol proprionate 0.05% ointment, cream (Ultravate)
-Triamcinolone acetonide
-Fluticasone propionate ointment 0.005%

Front 40

Vitamin-D Analogues used for psoriasis?

Back 40

-Calcipotriene (Dovonex)
-Calcitriol (Vectical)
-Calcipotriene + betamethasone dipropionate 0.064% (Taclonex)

Front 41

Pros of vitamin-d analogues in psoriasis treatment?

Back 41

-As effective as a topical corticosteroids
-Well tolerated and convenient

Front 42

Dritho-Scalp, Drithocreme, Micanol?

Back 42

Anthralin

Front 43

Anthralin MOA?

Back 43

Antiproliferative action against keratinocytes to decrease plaque reduction

Front 44

Most effective agent for widespread, refractory plaques and guttate psoriasis?

Back 44

Anthralin

Front 45

Other combination therapies with vitamin-d analogues?

Back 45

-Phototherapy
-Methotrexate
-Cyclosporine
-Acitretin (Soriatane)

Front 46

MOA of vitamin D analogues in psoriasis?

Back 46

Binds vitamin D receptor, thus regulating cell proliferation and cell differentiation

Front 47

Monitoring required with vitamin-D analogues for psoriasis?

Back 47

Monitor serum and urinary calcium levels

Front 48

Taclonex?

Back 48

Calcipotriene + betamethasone dipropionate 0.064%

Front 49

Dovonex?

Back 49

Calcipotriene

Front 50

Goeckerman therapy?

Back 50

UVV phototherapy + coal tar treatments

Front 51

Counseling points for steroid combination therapy with psoriasis?

Back 51

Should not be applied to > 30% of BSA at a time. Limit use to 100 grams per week. Do not apply to face, axillae or groin.

Front 52

PUVA?

Back 52

Psoralen + ultraviolet light A

Front 53

Psoralens?

Back 53

Photoactive compounds: antiproliferative and immunomodulatory upon exposure to UVA light

Front 54

Psoralen products?

Back 54

methoxsalen, 8-methoxypsoralen (8-MOP), or bergapten (5-MOP)

Front 55

Drug class with this MOA: Modulation of epidermal differentiation, immunologic function, and anti-inflammatory action through activity within the keratinocyte nucleus.

Back 55

Systemic retinoids

Front 56

Contraindications for systemic retinoids?

Back 56

-Presence of liver or renal dysfunction
-Drug or ethanol abuse
-Hypertriglyceridemia
-Pregnancy

Front 57

Neoral?

Back 57

Cyclosporine

Front 58

Prograf?

Back 58

Tacrolimus

Front 59

CellCept?

Back 59

Mycophenolate mofetil

Front 60

Systemic antimetabolites?

Back 60

Methotrexate (Rheumatrex)
Hydroxyurea
6-Thioguanine

Front 61

MOA of Sulfasalazine?

Back 61

Parent drug is biotransformed into 5-ASA and sulfapyridine: immunosuppresive and anti-inflammatory

Front 62

Amevive?

Back 62

Alefacept

Front 63

Raptiva?

Back 63

Efalizumab

Front 64

Enbrel?

Back 64

Etanercept

Front 65

Remicade?

Back 65

Inflixamab

Front 66

Adalimumab?

Back 66

Humira

Front 67

Methotrexate dosing for psoriasis?

Back 67

2.5-5 mg q12 hrs x3 doses per week or 10-25 mg qwk.

Front 68

Retinoid of choice for severe psoriasis, particularly pustular or erythrodermic variants

Back 68

Acitretin (Soriatane)

Front 69

What is the Ingram method?

Back 69

UVB with anthralin

Front 70

Short-contact anthralin therapy (SCAT)?

Back 70

1- 5% anthralin applied for 10 minutes to an hour