PHARM: Psoriasis and Acne

Question 1

MOA of Adalimumab

Answer 1

Human mAb (with IgG1) targeted at TNF-alpha

Question 2

ROA of Adalimumab

Answer 2

SC

Question 3

MOA of Etanercept

Answer 3

Receptor-Ab fusion protein (with p75 TNF receptor and Fc IgG1) targeted at TNF-alpha.

Question 4

ROA of Etanercept

Answer 4

SC

Question 5

MOA of Infliximab

Answer 5

Chimeric mAb (with variable region of mouse mAb on human IgG1) targeted at TNF-alpha.

Question 6

ROA of Infliximab

Answer 6

IV

Question 7

What is the BBW for all monoclonal antibodies (targeted against TNF-alpha) used to treat psoriasis?

Answer 7

BBW: Infection, including fungal/mycobacterial/viral, neoplasms, and Tb. NOT with immunosuppressives or concurrent vaccinations

Question 8

What is a specific contraindication to etanercept?

Answer 8

SEPSIS

Question 9

What is a specific contraindication to infliximab?

Answer 9

Contraindicated with heart failure and murine protein hypersensitivity

Question 10

What is one trait of all monoclonal antibodies used to treat psoriasis?

Answer 10

IMMUNOSUPPRESSION

Question 11

What is the MOA of Ustekinumab?

Answer 11

mAb directed at interleukin (binds to p40 subunit integral to IL-12 and IL-23 activation to suppress formation of pro-inflammatory Th1 and Th17)

Question 12

What are some adverse effects of Ustekinumab?

Answer 12

Infections, neoplasa, anaphylaxis. (pre-test for Tb)

Question 13

Ustekinumab is contraindicated in what people?

Answer 13

Contraindicated with live virus vaccines.

Question 14

List the drugs used to treat psoriasis that target retinoic acid receptors (RAR).

Answer 14

Acitretin (oral)

Tazorotene (oral or topical)

Question 15

List the drugs used to treat acne that target retinoic acid receptors (RAR).

Answer 15

Tazorotene
Adapalene
Isotretinoin
Tretinoin (ATRA)

Question 16

Drugs that target RAR do what? (broad)

Answer 16

Alters cellular differentiation and proliferation

Question 17

Topical drugs that target RAR do what?

Answer 17

correct abnormal follicular keratinization, reduce P. acnes counts, and reduce inflammation.

Question 18

True or false: all drugs that target RAR are teratogenic.

Answer 18

FALSE: only oral drugs

Question 19

What is the most common laboratory abnormality in patients taking RAR drugs?

Answer 19

Hyperlipidemia (serum lipids, serum trnasaminases, CBC and pregnancy test before use!)

Question 20

What are the main systemic areas that are influenced by people taking RAR drugs?

Answer 20

Mucocutaneous

Musculoskeletal

Question 21

What is the acute toxicity of RAR drugs comparable to? List some symptoms.

Answer 21

Vitamin A intoxication

-dry skin, nosebleeds from dry membranes; conjunctivitis; reduced night vision; hair loss.

Question 22

What are some symptoms unique to topical RAR drug use?

Answer 22

increase risk of sunburn; erythema; burning

Question 23

What is a unique adverse effect of Isotretinoin?

Answer 23

must monitor for depression/ suicidal ideas

Question 24

What is the MOA of calcipotrene?

Answer 24

Binds to Vit D receptor; complex associates with RXR-alpha and binds DNA vitamin D response elements to modulate epidermal differentiation and inflammation

Question 25

What is calcipotrene used to treat?

Answer 25

psoriasis

Question 26

What are the adverse effects of calcipotrene?

Answer 26

Topical irritant (reduced by concurrent corticosteroids) In EXCESS- hypercalcemia and hypercalcuria increased susceptibility to UV-induced skin cancer

Question 27

What is the MOA of calcitrol?

Answer 27

Hormonally active form of Vitamin D3

Question 28

Why is calcitrol given over calcipotrene?

Answer 28

it is way better tolerated in sensitive skin areas

Question 29

What is the MOA of benzoyl peroxide?

Answer 29

Topical pro-drug converted to benzid acid that works by free radical liberation that is lethal for P. acnes.

Question 30

What can benzoyl peroxide be combined with?

Answer 30

Can be formulated with antimicrobials or adapalene!

Question 31

Why might it be beneficial to combine an antimicrobial with benzoyl peroxide?

Answer 31

The benzoyl peroxide may prevent anti-microbial resistance

Question 32

What are the AEs of benzoyl peroxide?

Answer 32

- Drying of skin: peeling, erythema, irritation - Bleach hair or colored fabrics; - AVOID contact with eyes or mucous membranes

Question 33

What may be a big issue with giving antibiotics to treat acne? How do you prevent this?

Answer 33

Resistance may occur. Give drugs for 4-8 weeks until switching due to unresponsiveness. If responsive, use until NO NEW spots appear.

Question 34

What is salicyclic acid?

Answer 34

Topical keratolytic that causes desquamation of horny layer of the skin.

Question 35

What can salicyclic acid treat?

Answer 35

acne psoriasis warts

Question 36

What are the AEs of salicyclic acid?

Answer 36

Contact irritation Neonatal toxicity (via breasmilk) Prolonged administration over large areas may lead to salicylism (especially in children and patients with renal/ hepatic impairment)

Question 37

What are some symptoms of salicylism?

Answer 37

- Tinitus and dizziness (early) | - Seizures, Renal/liver failure, and organ edema (late)

Question 38

What is the "mild" corticosteroid?

Answer 38

Hydrocortisone

Question 39

What is the "moderate" corticosteroid?

Answer 39

Betamethasone valerate

Question 40

What is the "potent" corticosteroid?

Answer 40

Fluocinonide

Question 41

What is the "very potent" corticosteroid?

Answer 41

Clobetasol Proprionate

Question 42

How do corticosteroids work?

Answer 42

bind to cytoplasmic steroid receptors and complex migrates to nucleus to produce trans-activating and trans-repressive effects on nuclear transcription. (Increase anti-inflammatory lipocortins and decrease release of endogenous inflammatory mediators)

Question 43

True or false: corticosteroids do not treat the underlying cause of acne.

Answer 43

TRUE: Just reduces the symptoms of the inflammation (does not alter underlying cause).

Question 44

What is special about fluorinated corticosteroids?

Answer 44

SHOULD NOT BE APPLIED TO FACE )→ leads to perioral dermatitis

Question 45

What are the two major dermatologic adverse effects to topical steroids?

Answer 45

Dermal atrophy | Corticoid rosacea

Question 46

What is dermal atrophy?

Answer 46

shink, wrinkled "cigarette paper"-appearing skin with prominent telangiectases and tendency for purpura and ecchymosis

Question 47

What is corticoid rosacea?

Answer 47

Persistent erythema, telangiectatic vessels, pustules, and papules in central facial distribution