Q6 - Allergies/Derm/Psoriasis

Question 1

1st line for chronic, mod-severe symptoms (sneezing, itching, rhinorrhea, congestion)

Answer 1

Intra nasal steroids.

Question 2

Tx for milder, intermittent symptoms

Answer 2

Oral antihistamines.

Question 3

Antihistamines have little effect on _______

Answer 3

Nasal congestion. Work for itching, sneezing, rhinorrhea and hypersensitivity reactions.

Question 4

MOA of antihistamines:
Don’t confuse with H2 blockers _____

Answer 4

Block histamine from binding to receptors which blocks vasodilation, vascular permeability and leakage of fluid from capillaries.
H2 receptors in GI which decrease acid secretion.

Question 5

1st generation antihistamines (H1) are associated with ________.

Answer 5

Heavier sedation - they cross the BBB which 2nd generations do NOT.

Question 6

Oxymetazoline Afrin (intra nasal) - only use for 3 days to avoid rebound congestion.

Question 7

Can take a few weeks to see effects from acne therapy.

Question 8

Isotretinoin is PO, Tretinoin and Adapalene are topical retinoids.

Question 9

Severe disease of psoriasis = >10% BSA

Question 10

Topical calcineurin inhibitors preferred for the face

Question 11

Psoriasis on the scalp, external ear canal - potent steroid in a solution (shampoo, foam, spray)
Psoriasis on face and intertriginous areas - low-potency ointment or cream
Psoriasis on extensor surfaces - potent preparations (betamethasone or clobetasol)

Question 12

Which steroids belong to which potency group?

Answer 12

I = most potent (V high)
VII = lowest potency
I = clobetasol, fluocinonide cream
II = betamethasone, fluocinonide ointment (0.1%), mometasone ointment
III = floucinonide cream (0.05%)
IV = mometasone lotion, triamcinolone cream/spray
V = desonide
VI = fluocinonide oil/sol/cream
VIII = hydrocortisone (1%%)

Question 13

Methotrexate MOA, CI, SE

Answer 13

MOA: irreversibly binds and inhibits dihydrofolate reductase, inhibiting folate, thymidylate synthetase and purine; has immune modulator and anti-inflammatory activity. promote apoptosis of the impaired keratinocytes
CI in pregnancy, breastfeeding, liver disease, immunodeficiency.
SE N/v/d, increased LFTs, slope is, photosensitivity.

Question 14

No live vaccines while taking biologic agents - risk for serious infection.
REMS program required - BBW for SI and behavior with Brodalumab.
SE with biologic agents?

Answer 14

Diarrhea, URI