Integumentary immune disorders Flashcards
(45 cards)
Erythematous papules and plaques covered with silvery scales - chronic - remissions and exacerbation are common
Psoriasis
Coal Tar Agents - Estar , PsoriGel
topical; for mild - moderate psoriasis; suppresses DNA synthesis, decreasing mitonic activity ; may stain clothing, skin and hair
Estar, PsoriGel - SE
- skin irritation - burning
- photosensitivity
- staining effect
Anthrolin (AnthraDerm, Lasan)
for moderate psoriasis; inhibits DNA synthesis thus suppressing proliferation of the epidermal cells. may stain clothing, hair and skin.
Anthrolin - SE
- erythema (redness) to normal skin; burn - cover medicated lesions ; wash off with mineral oil after 2 hrs
- inflamed eyes
- staining effect
Tazarotene (Tazaac, Avage) - vitamin A derivative
for mild-moderate psoriasis; reduces epidermal inflammation ; photosensitivity can occur ; X pregnancy - 2 forms of contraception used during treatment
Calcipotriene (Dovonexsynthetic Vitamin D)
for mild to moderate plaque psoriasis; burning, stinging and erythema may occur ; excess use may increase Ca levels
- Coal Tar Agents
- Anthrolin
- Tazarotene
- Calcipotriene
Topical agents - psoriasis
Retinoid; severe psoriasis; inhibits keratin formation and skin inflammation; pregnancy X ( pregnancy delayed up to 3 years after tx); avoid alcohol - convert med to toxic metabolite ; take with food ; derivative of vitamin A
Acitretin (Soriatane)
Folate Analog Metabolic Inhibitor; Inhibits rapid cell proliferation; block folic acid metabolism which interferes with DNA synthesis; can cause hepatotoxic and nephrotoxic problems - regular evaluation ; causes immunosuppresion - risk for lymphoma - evaluate WBCs
Methotrexate (Folate) - psoriasis, psoriatic arthritis, lupus , scleroderma
Calcineurin Inhibitor Immunosuppressant; suppresses immune response; used when other meds produced poor outcome ; causes general immune suppression; tablets or liquid (dilute); no grapefruit juice; SE: hypertension, nephrotoxicity
Cyclosporin A (Neoral, Sandiimmune)
Antimetabolite; off label use; antineoplastic ; causes myelosupression - especially neutropenia; nausea, vomiting, diarrhea, stomatitis ; wash hands and wear gloves when handling
Hydroxyurea (Hydrea)
Tumor Necrosis Factor Blocker; reduces levels of cytokines that cause joint destruction and inflammation; used to treat psoriatic arthritis - administered subcut - site irritation, headache and infection
Etanercept (Enbrel)
ingestion of Psoralen (photosensitizing drug) 2 hours before exposure UVA light; 2-3 hours per week; exposure gradually increased until tanning occurs; dark glasses during treatment and for the rest of the day following treatment; SE: cataracts, premature aging of the skin , skin cancer
PUVA - Psoralen and Ultraviolet A therapy
used when condition becomes more widespread; potency and distance constant; exposure time gradually increased; monitor for burning and tenderness; can be used in combination with topical treatment; SE: premature aging of the skin, skin cancer, actinic keratosis
Ultraviolet Light B (UVB) therapy
Abnormal, aggressive growth of epidermal cells - reach skin surface in 4-5 days vs usual 28-30 days; autoimmune reaction? - overstimulation of immune system - overproduction of skin cells & plaque formation
Psoriasis - pathophysiology
skin condition in which small, red, and scaly teardrop-shaped spots appear on the arms, legs, and middle of the body
Psoriasis - guttate
red, skin patches covered by silvery, white scales ; MOST COMMON
Psoriasis vulgaris
Pustular plaques, may be accompanied by fever & leukocytosis; MOST SEVERE FORM
Pustular psoriasis
Generalized erythema & scales - increases blood flow to skin - vasodilation can lead to dehydration from evaporation & fluid loss
Exfoliative psoriasis
Psoriasis - tx goals
Decrease inflammation & removal of scales
Teratogen
is a drug or other substance capable of interfering with the development of an embryo fetus that may lead to birth defects or developmental malformations.
Methotrexate - Folate Hydroxyurea - Hydrea Cyclosporin A - Neoral Acitretin - Soriatane Etanercept - Enbrel
Systemic and biological agents - psoriasis - suppress immune system slowing epidermal cellular division
PUVA - teach !!!
Observe for generalized redness with edema and tenderness - if present treatment must be interrupted until they subside ; wear dark glasses during treatment and for the remainder of the day
