PHARM psoriasis and acne

Question 1

adalimumab MOA

Answer 1

human monoclonal antibody that binds to the TNF-alpha binding site

Question 2

etanercept MOA

Answer 2

receptor-antibody fusion protein for the TNF-alpha binding site

Question 3

infliximab MOA

Answer 3

chimeric monoclonal antibody that binds to the TNF-alpha binding site (also has variable region of mouse monoclonal antibody on human IgG1

Question 4

how is infliximab administered?

Answer 4

IV

Question 5

how are adalimumab and etanercept administered?

Answer 5

SC

Question 6

what are the contraindications of infliximab?

Answer 6

heart failure

murine protein hypersensitivity

Question 7

what is the main contraindication of etanercept?

Answer 7

SEPSIS

Question 8

what are the common black box warnings of infliximab, etanercept, and adalimumab?

Answer 8

infection including: fungal/mycobacterial/viral
Neoplasia
TB

Question 9

MOA of ustekinumab?

Answer 9

disrupts IL-12 & IL-23 signal transduction (supreses formation of pro-inflamm. Th1 & Th17 cells

Question 10

what are the notable adverse effects for ustekinumab?

Answer 10

infections
neoplasia
Test for latent TB before starting treatment
Live virus vaccination contraindicated
Anaphylaxis

Question 11

what are the functions of vitamin A?

Answer 11

embryonic growth
morphogenesis
Differentiation & maintenance of epithelial tissues
Reproduction
Visual function

Question 12

what are the effects of retinoids?

Answer 12

• modulation of prolif. & differentiation
• inhib. of keratinization
• alterations of cellular cohesiveness
• decreased sebum secretion & Seb. gland size (isotretinoin)
• immunologic & anti-inflamm. effects
• tumor prevention & therapy
• induction of apoptosis
• effect on ECM components

Question 13

MOA of the retinoids?

Answer 13

• activate retinoic acid receptor/retinoid X receptor in suprabasal keratinocytes, causing activation of TFs
• these activate the synth. of heparin binding epidermal growth factor (HB-EGF) and amphiregulin (AR)
• these 2 caues proliferation of basal keratinocytes, thereby inducing thickened epidermis and peeling of the stratum corneum

Question 14

Targeting RARs predominantly affects what?

Answer 14

cellular differentiation and proliferation (tretinoin, adapalene & tazarotene used in acne, psoriasis & photoaging)

Question 15

Targeting RXRs predominantly has what effect?

Answer 15

induces apoptosis (used in mycosis fungoides & Kaposi sarcoma)

Question 16

what are the acute toxicities of the retinoids?

Answer 16

similar to Vitamin A intoxication:

• dry skin, nosebleeds from dry mucous membranes
• conjunctivitis
• reduced night vision
• hair loss

Question 17

what tests should you do before prescribing retinoids?

Answer 17

Pregnancy test (POTENT TERATOGEN-oral)
baseline: lipids, serum transaminases, CBC

Question 18

RAR-selective retinoids have what kind of adverse effects?

Answer 18

mucocutaneous & musculoskeletal

Question 19

RXR-selective retinoids have what kind of adverse effects?

Answer 19

physiochemical changes

Question 20

rapidly evolving leukocytosis develops in 20% of pts getting oral __________________-

Answer 20

tretinoin

Question 21

what are the 1st line agents for non-inflammatory acne often combined w/ other agents in the management of inflammatory acne?

Answer 21

topical retinoids

Question 22

how do the topical retinoids reduce fine wrinkles and dyspimentation associated with photoaging?

Answer 22

inhibition of MMPs in response to UV radiation

induce epidermal hyperplasia in atrophic skin and reduce keratinocyte atypia

Question 23

what are the adverse effects of the topical retinoids?

Answer 23

erythema, desquamation, burning, stinging

increase reactivity to UV radiation–>increased risk for severe sunburn

Question 24

what are the indications for topical retinoids?

Answer 24

correct abnormal follicular keratinization
reduce P. acnes counts
reduce inflamm.

Question 25

what is the main indication for calcipotriene?

Answer 25

psoriasis

Question 26

how is calcipotriene administered?

Answer 26

topical

Question 27

calcipotriene MOA

Answer 27

binds to vitamin D receptor, complex associates w/ RXR-alpha & binds DNA vitamin D response elements (modulation of epidermal differentiation & inflamm.-->improvement in psoriatic plaques)

Question 28

calcipotriene can be a topical irritant and this can be reduced by what?

Answer 28

concurrent corticosteroids

Question 29

what 2 classic adverse effects happen when calcipotriene is given as an extra large dose?

Answer 29

hypercalcemia | hypercalciuria

Question 30

which topical drug used to treat psoriasis increases a pt's susceptibility to UV-induced skin ccancer?

Answer 30

calcipotriene

Question 31

which is more potent regarding calcium metabolism, calcipotriene or calcitriol when given systemically?

Answer 31

calcitriol is 100-200xs more potent than calcitriene

Question 32

what is ustekinumab indicated for?

Answer 32

psoriasis

Question 33

what is benzoyl peroxide used for?

Answer 33

acne (effective topical pro-drug converted in skin to benzoic acid)

Question 34

benzoyl peroxide MOA

Answer 34

free radical liberation kills nearby P. acnes

Question 35

why is benzoyl peroxide often formulated w/ antimicrobials like clindamycin/erythromycin/adapalene?

Answer 35

helps to prevent the development of antimicrobial resistance

Question 36

what are the adverse effects of benzoyl peroxide?

Answer 36

drying of skin: marked peeling, erythema, & irritation - contact dermatitis including rash, pruritis, blistering, crusting or swelling of skin - cool compresses or topical steroids to reduce symptoms and increase healing

Question 37

what areas of body should you avoid when using benzoyl peroxide?

Answer 37

eyes and mucous membranes

Question 38

what is teh goal with acne treatment in general?

Answer 38

simplify the regiment as much as possible - increases compliance and decreases skin irritation - drier skin-creams; oilier skin-gels or solutions

Question 39

Name a mild corticosteroid

Answer 39

hydrocortisone

Question 40

name a moderate corticosteroid

Answer 40

betamethasone valerate

Question 41

name a potent corticosteroid

Answer 41

fluocinonide

Question 42

name a very potent corticosteroid

Answer 42

clobetasol propionate

Question 43

Drug responsiveness varies by what 2 variables?

Answer 43

condition (disease) | anatomic location

Question 44

low potent preparations of steroids are supposed to be used on what areas of the body?

Answer 44

face & intertriginous areas

Question 45

when are very potent corticosteroids used?

Answer 45

usually required on hypereratotic or lichenified dermatoses and for disease of the palms and soles

Question 46

what happens to the absorption of steroids with inflamed skin of atopic dermatitis and in severe exfoliative diseases like erythrodermic psoriasis?

Answer 46

absorption is increased several fold

Question 47

where is the wrong place to use fluorinated steroids?

Answer 47

the face (may give rise to adverse rxns like perioral dermatitis)

Question 48

what are 2 main adverse effects of topical corticosteroids?

Answer 48

1. dermal atrophy (cigarette paper appearing skin w/ telangiectasias & tendency for purpura & ecchymosis) 2. Corticoid rosacea (persistent erythema, telangiectatic vessels, pustules, and papules in central facial distribution

Question 49

these adverse effects are found with which drug? perioral dermatitis, steroid acne, alterations of cutaneous infections, hypopigmentation, hypertrichosis; intcreased intraocular pressure; and allergic contact dermatitis

Answer 49

topical steroids

Question 50

which acne treatment is metabolic product of aspirin?

Answer 50

salicylic acid

Question 51

salicyclic acid MOA

Answer 51

causes desquamation of horny layer of skin

Question 52

what will happen if you use prolonged administration of salicylic acid over large areas especially in children or hepatic imparment?

Answer 52

increase the risk of salicylism

Question 53

what are the 2 must known EARLY indicators of salicylate intoxication?

Answer 53

dizziness | tinnitus