1 - TOPICAL CALCINEURIN INHIBITORS Flashcards Preview

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Flashcards in 1 - TOPICAL CALCINEURIN INHIBITORS Deck (57):
1

Topical calcineurin inhibitors are free of the adverse effects of topical corticosteroids I.e. atrophy, striae, potential hypothalamo-pituitary-adrenal axis suppression

True

2

Cyclosporine (a calcineurin inhibitor) lacks topical activity because its large molecular weight results in poor epidermal penetration

True

3

Tacrolimus and pimecrolimus have lower molecular weights (than the oral calcineurin inhibitor cyclosporine) and so can penetrate inflamed skin

True

4

Tacrolimus is a macrolide produced by the soil bacterium Streptomyces tsukubaensis

True

5

Tacrolimus's structure and mechanism of action are similar to those of cyclosporine

True

6

Tacrolimus and pimecrolimus prevents cytokine production and blocks T cell activation and proliferation

True

7

Topical tacrolimus is FDA approved as second line therapy for the short term and non-continuous chronic treatment of moderate to severe atopic dermatitis in immunocompetent adults

True

8

Topical tacrolimus for atopic dermatitis is as effective as moderately potent topical corticosteroids for the trunk and extremities, and superior in efficacy to mild potency corticosteroids for the face and neck

True

9

Chronic atopic dermatitis lesions of the face and flexures are most justified for treatment with topical calcineurin inhibitors

True (topical calcineurin inhibitors have comparatively superior/similar potency to a TCS that would not have been used on the face/flexures due to risk of TCS adverse effects)

10

Tacrolimus 0.1% ointment is similar in efficacy to topical corticosteroids of class I (superpotent) and class II/III (high) potency

True

11

Once the atopic dermatitis has stabilised, proactive maintenance treatment with Tacrolimus 2 or 3 times weekly can significantly prevent flares in paediatric and adult patients

True

12

Tacrolimus ointment may reduce the number of flares and prolonged the time to first flare in atopic dermatitis

True

13

Topical Tacrolimus is more effective than pimecrolimus in adult atopic dermatitis patients

True

14

Topical tacrolimus and Pimecrolimus have similar safety and tolerability profile

True

15

Use of topical tacrolimus ointment in oral lichen planus can result in systemic absorption, though clinically significant adverse events associated with systemic absorption have not been observed

True

16

The efficacy of topical tacrolimus ointment in oral lichen planus is at least equal to those of topical clobetasol propionate 0.05% ointment (superpotent Class I TCS)

True

17

Although there have been 2 cases of oral SCC in oral lichen planus patients after treatment with tacrolimus ointment, further studies will clarify if there is a causal relationship

True

18

Topical tacrolimus 0.03% ointment is generally for paediatric patients and the 0.1% ointment is generally for adult patients

True

19

Topical tacrolimus 0.1% ointment is almost as efficacious as clobetasol propionate 0.05% ointment (superpotent class I TCS) in vitiligo on the face

True

20

Tacrolimus 0.1% ointment has a defined role in facial, inverse and genital psoriasis

True

21

Topical tacrolimus and pimecrolimus, either as monotherapy or combined with oral hydroxychloroquine is effective in cutaneous lupus erythematosus

True (topical tacrolimus and pimecrolimus was equal to clobetasol propionate 0.05% ointment in facial LE)

22

Topical tacrolimus 0.1% ointment and pimecrolimus 1% cream is useful in seborrheic dermatitis

True

23

Open studies have shown favourable results with topical tacrolimus in the treatment of Rosacea

True

24

Tacrolimus 0.1% ointment has shown favourable results in morphea (localised scleroderma)

True

25

Topical tacrolimus may result in local application site irritation

True

26

The localised application site irritation due to topical tacrolimus is transient and decreases in prevalence over time

True

27

Both topical tacrolimus and pimecrolimus are absolutely contraindicated in individuals with hypersensitivity to the active drug or components of the ointment/cream

True

28

Both topical tacrolimus and pimecrolimus are relatively contraindicated in children less than 2 years of age

True

29

Both topical tacrolimus and pimecrolimus are absolutely contraindicated in individuals with an active skin infection at the site to be treated

True

30

Exposure to topical tacrolimus or pimecrolimus is not associated with an increase in the overall cancer rate

True

31

The use of topical tacrolimus may be associated with an increased risk of T-cell lymphoma

True (although this may be inconclusive as another study found no increased risk of lymphoma in patients treated with topical calcineurin inhibitors, and that patients with atopic dermatitis itself was associated with an increased lymphoma risk although this study did not find any cases of lymphoma in topical calcineurin inhibitors users)

32

There is a theoretical risk that topical calcineurin inhibitors may cause lymphoma, although available data on lymphoma following topical calcineurin inhibitor use are inconsistent and insufficient to draw a conclusion about the causal role

True

33

Available data have found no evidence indicating that skin cancer is associated with topical calcineurin inhibitor use

True

34

Combining UVB and tacrolimus seems to have a limited direct photocarcinogenic potential on keratinocytes compared to UVB alone

True

35

Systemic absorption of topical tacrolimus in atopic dermatitis is low and not clinically significant

True (although marked systemic absorption has been observed in Netherton's syndrome)

36

Patients with Netherton's syndrome treated with topical tacrolimus are at risk for systemic absorption of topical tacrolimus

True (serum levels elevated, although no signs or symptoms of toxicity have been observed) - tacrolimus can be switched to pimecrolimus

37

Topical tacrolimus may cause enhanced facial flushing after alcohol ingestion

True

38

Topical Tacrolimus may cause Rosacea-like dermatitis

True (although ironically topical tacrolimus has shown favourable results in Rosacea)

39

Topical tacrolimus may cause acne

True

40

Topical tacrolimus may cause reactivation of HPV infection

True

41

Pimecrolimus is a semi synthetic derivative of the macrolide ascomycin, with a similar structure to that of tacrolimus

True

42

Pimecrolimus appears to have a role in atopic dermatitis of the head and neck

True

43

The need for topical corticosteroids for atopic dermatitis on the head and neck is reduced with pimecrolimus cream

True

44

Intervention with Pimecrolimus cream at the first signs and symptoms of a subsequent recurrence of atopic dermatitis reduced the number of flares/prevented progression to flares requiring topical corticosteroids

True

45

The efficacy of pimecrolimus 1% cream in oral lichen planus is equal to topical Triamcinolone Acetonide 0.1% paste (moderately potent Class IV/V TCS)

True

46

Pimecrolimus 1% cream + NB-UVB is superior to placebo + NB-UVB for facial vitiligo lesions

True

47

Pimecrolimus 1% cream is equal in efficacy to mometasone furoate 0.1% cream (High potency Class II/III TCS) and clobetasol propionate 0.05% ointment (Superpotent Class I TCS) for facial vitiligo lesions

True

48

The role of pimecrolimus in inverse psoriasis is inconclusive

True (unlike tacrolimus, which has shown clear benefit for facial, genital and inverse psoriasis)

49

Pimecrolimus 1% cream has comparable efficacy to ketoconazole for seborrheic dermatitis, but adverse effects appeared more with pimecrolimus

True

50

Pimecrolimus 1% cream is effective in corticosteroid-induced Rosacea

True

51

Topical Pimecrolimus has successfully treated Netherton's syndrome

True (increased absorption and systemic toxicity from topical tacrolimus)

52

There is no increase of systemic absorption of topical pimecrolimus with increasing body surface area treated

True (and no drug related systemic adverse events)

53

The order of decreasing potency for topical calcineurin inhibitors are Tacrolimus 0.1% > Tacrolimus 0.03% > Pimecrolimus 1%

True

54

Topical pimecrolimus has not been associated with drug related systemic events

True

55

The use of pimecrolimus cream results in minimal systemic absorption

True

56

Topical pimecrolimus does not increase the risk of malignancy

True (this risk is unclear with topical tacrolimus and lymphoma due to mixed data)

57

Topical pimecrolimus may cause enhancement of molluscum contagiosum

True