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55 Cards in this Set
- Front
- Back
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What are non-drug triggers for psoriatic flares?
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cold, dry weather, photosensitivity, stress (40%), infection,& skin injury
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What is Koebner response?
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psoriasis that's triggered by skin injury when the area of skin that is trying to regenerate itself becomes psorotic
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what are some drugs that can trigger psoriatic flares?
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BBs, chloroquine, ACE-I, progesterone, Li, drug rashes
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What are the 3 classifications of psoriasis?
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mild: <5% BS
m0d: 5-20% BS severe: >20% |
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What are the 4 treatment approaches in order for psoriasis?
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1. topical (70-80%)
2. systemic PO drug tx 3. phototherapy 4. biologicals (severe recalcitrant type) |
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What are non-pharmacologic methods for treating psoriasis?
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climatology (bathing in the sea:thalassotherapy or balneotherapy) and exposure to sunlight (heliotherapY)
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How do topical emollients work to treat psoriasis?
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they hydrate the stratum corneum & enhance desquamation; minimize itching
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How to topical keratolytics work to treat p?
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remove scales
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what topical keratoytics r used?
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salicylic acid preps (2-10%)
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What to avoid when applying salicylic acid preps?
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applying to large inflamed areas to prevent salicylism
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symptoms of salicylism?
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N,V, tinnitus, hyperventilation
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What is the role of topical corticosteroids in treating psoriasis?
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they reduce inflammation, inhibit cell proliferation, anti-pruritic
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What are the SEs of topical steroids?
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ses are based on potency
burningm local irritation, thinning of skin, acne on area applied, HYPOpigmentation, dilated blood vessels/bruising |
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Low potency topical steroids include?
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HYDROCORTISONE 1% (Hytone, penecort, Syncort)
FLUOCINOLONE 1%-Synalar |
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Low to medium potency topical steroids include?
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2%
Hydrocotisone valerate (WESCORT) Hydrocortisone (LOCOID) Desonide (TRIDESILON) |
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Medium potency steroids include?
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fluticasone propionate (CUTIVATE)
clocortolone pivalate (CLODERM) |
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high potency steriods include?
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betamethasone (DIPROLENE)
mometasone fuorate (ELOCON) halobetasol propionate (ULTRAVATE) diflorasone diacetate (MAXIFLOR, FLORONE, PSORCON) |
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What strength steroids recommended for the scalp?
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potent steroids like fluocinonide 0.05% in etoh solution
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What strength steroids recommended for the face?
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low potency creams
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What strength steroids recommended for elbows, knees?
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high potent ointments w/ added occlusion
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What is the general time limit for continuous steroid use?
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3 weeks (want to prevent tachyphylaxis)
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What is the MOA of coal tar for psoriasis?
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inhibits enzymes tha tcontribute to psoriasis associated with cell proliferation
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What are the problems with coal tar?
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messy, stinky, skin irritant that causes phototox
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MOA of anthralin (DRITHOCREME)?
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inhibits DNA synthesis & cell proliferation (related to coal tar)
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what is anthralin recommended for?
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chronic NOT ACUTE OR INFLAMED ERUPTIONS psoriasis
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MOA & brand of calcipotriene?
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DOVONEX, vit d3 analog that regulates cell proliferation & suppresses lymphocytic activity
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pros and cons of using calcipotriene (DOVONEX)?
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pros: well-tolerated, convenient, safe, effective for long term use
con: expensive |
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dosing of calcipotriene (DOVONEX)?
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BID FOR 8-10 DAYS
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TAZAROTENE use?
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tazarotene is a topical retinoid, VIT A derivative used for mild to moderate psoriasis
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tazarotene pros, cons?
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pro: improvement in 1 week in 70% of pts, systemic tox unlikely
con: expensive, cat x localized irritation |
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Name the 2 topical calcineurin inhibitors used for psoriasis
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tacrolimus 0.1% (ELIDEL)
pimecrolimus 1& (PROTOPIC) |
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What are tacrolimus 0.1% (ELIDEL) & pimecrolimus (PROTOPIC) good for?
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facial lesions & axillary psoriasis
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what was the 2005 FDA alert about topical tacrolimus (ELIDEL) & pimecrolimus (PROTOPIC)?
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possible limk btw tacrolimus and pimecrolimus & causes of lymphoma & skin cancers in children & adults therefore recommended as 2nd line agent esp in kids
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What is methotrexate (RHEUMATREX) used for?
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mod-sever psoriasis
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MOA of methotrexate (RHEUMATREX)?
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it's an antimetabolite folic acid analog that blocks purine & thymidine synthesis effecting rapidly proliferating cells
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methotrexate (rheumatrex) dosing? (effects seen at much lower doses than needed for antineoplastic effects)
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2.5-7.5 mg PO at 12 hr intervals for 3 doses per week;
2.5 mg PO QD x 5 days then 2 days off very imp pt understand b/c accidental toxicity due to non-compliance and med errors |
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How long to see improvement with methotrexate (rheumatrex)?
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4 weeks for most-try to dose reduce & return to topical treatments if poss
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Methotrexate (RHEUMATREX) ses?
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GI: N/V and mucositis
HEPATOTOX w/chronic use, indolent, biopsy when cum dose >1.5g BMS rare perhaps dec w/ folic acid supp |
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Drug interactions with methotrexate (RHEUMATREX)?
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DECREASED RENAL ELIMINATION WITH nephrotoxins, salicylates, NSAIDS, probenacid, most b-lactams
DISPLACEMENT OF MTX FOR PROTEIN BINDING SITES W/ salicylates, phenytion, warfarin, retinoids, bactrim, probenacid, barbs HEPATOTOX w/concomitan liver toxins |
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What are the PO retinoids for psoriasis?
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acitretin (SORIATANE) metabolite of the now DC'd etretinate
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what are is the PO retinoid acitretin (SORIATANE) used for?
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severe, recalcitrant psoriasis
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MOA of PO retinoids acitretin (SORIATANE)?
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anti-inflammatory actions, regulates cell reproduction
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What are the toxicities of the PO retinoid acitretin (SORIATANE)?
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HYPERVITAMINOSIS A SYNDROME:
skin thinning, thin soft nails, reversible hair loss, rash, hepatotox w/ 2ary pancreatitis, hyperlipemics esp TGs, irreversible extraspinal tendon & ligament calcification |
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teratogenicity of acitretin (PO retinoid)?
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while etretinate is stored in fat tissue for up to 3 yrs, acitretin is undetectable in 4 weeks EXCEPT WHEN DRINKING ETOH WHICH CONVERS A BACK TO E!!! IMPORTANT BC CAT X BOTH MUTAGENIC & TERATOGENIC
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List 6 more systemic therapies for psoriasis?
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CSA, TAC, mycophenolate, sulfasalazine, hydroxyurea, thioguanine
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What is PUVA?
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Psoralen & UV radiation a combo of systemic and phototherapy for severe, incapacitating, unresponsive psoriasis
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MOA of PUVA?
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psoarlens react w/ nucleic acids & intercalates w/base pairs W/UVA light (320-400 nm) DNA becomes irradiated and leads to covalent bonding of psoralens to DNA & pyrimidine bases
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CON of PUVA?
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tmt takes 8 hours for 2-3 times/week
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What MABs used to treat psoriasis inhibt T cell activation?
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efalizumab (RAPTIVA) SC INJ & alafacept (AMEVIVE) IV or I(M
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What MABs used to treat psoriasis are anti-tumor necrosis factor alpha?
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etanercept (ENBREL)SQ & infliximab (REMICADE))
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for mabs what does o mean? a, axo? e?, u,zu? xi? i?
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o=murine
a, axo=rat e=hamster u,zu=humanized xi=chimeric i=primate |
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Adrs of biologicals?
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infusion related rxns (like pseudo allergic, premedicate salumedro, benadryl, apap);
constitutional like symptoms (feel flu-like-fever, malaise); serious infections (acute & reactivation of chronic inf); risk of 2 malignancies (lymphomas), myelosupp, long term effects still not known |
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BB warning for biologicals?
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active infection contraindication to biologicals
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compare efficacy of efalizumab (RAPTIVA) & alefacept (AMEVIVE)?
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more pts have improvement with efalizumab (raptiva) than with alefacept (amevive) but time to relapse was longer -meaning pts r psoriasis free longer-with alefacept (amevive)
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psoriasis genetic link?
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HLA-Cw6 more prevalence
HLA-B17 OR B27 more severe dx |
