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Therapeutics III > PsA - Block 1 > Flashcards

PsA - Block 1 Flashcards

1
Q

What are the triggers of psoriasis?

A
  1. Stress
  2. Seasonal changes
  3. Medications
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2
Q

What medications can induce psoriasis?

A
  1. NSAIDs
  2. Anti-malarial/ACEI
  3. Inderal (B-blockers)
  4. Lithium
  5. Steroid withdrawal/SSRI
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3
Q

Lesion sx of plaque psoriasis?

A
  1. Clearly distinguished from normal skin
  2. Covered by silver, flaking scales
    * Auspitz sign: Removal accompanied by fine points of bleeding
  3. Koebner phenomenon: May develop at sites of trauma or injury
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4
Q

Skin sx of plaque psoriasis?

A

Mild psoriasis — defined as ≤ 3% BSA involvement

Moderate psoriasis — defined as 3 – 10% BSA or PASI ≥ 8

Severe psoriasis — “Rule of 10”
* BSA ≥ 10%
* PASI ≥10
* DLQI ≥ 10

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5
Q

What are the concerns of having untreated psoriasis?

A

PsA

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6
Q

What is psoriatic diagnosis based on? Classifications

A

Recognition of characterisitc psoriatic lesions

Mild, moderate, severe

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7
Q

What is the objective evaluation of the extent of psoriasis?

A
  1. BSA
  2. Psoriasis Area & Severity Index (PASI)
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8
Q

What is the estimation of BSA psoriatic involvement?

A
  1. Palm size = 1% BSA
  2. Head & neck involvement = 10% BSA
  3. Both upper limbs = 20% BSA
  4. Trunk involvement = 30% BSA
  5. Both lower limbs = 40% BSA
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9
Q

What are the tx for psoriasis?

A

Non-pharmacologic therapy -> used for all patients with psoriasis, regardless of disease severity

Pharmacologic therapy -> individualized to each patient

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10
Q

How is a therapy selected?

A

Based on disease severity, presence or absence of comorbidities, and other special considerations (i.e., patient preferences, cost, hepatic or renal dysfunction).

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11
Q

Tx for mild-moderate psoriasis?

A

Topical therapies -> 1st line recommendation

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12
Q

Tx for mod-severe dx?

A

Phototherapy and photochemotherapy

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13
Q

Extensive moderate to severe psorias tx?

A
  1. Use systemic therapies ± topical therapies
  2. Biologic agents
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14
Q

Tx for controlled psoriasis?

A

Least potent, least toxic med

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15
Q

What are the non-pharm tx for psoriasis?

A
  1. Stress reduction
  2. Skin moisturizers
  3. Oatmeal baths
  4. Skin protection
  5. Avoidance of harsh soaps and detergents
  6. Management of comorbidities (DLD, obesity, CVD)
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16
Q

What is the fingertip unit method?

A

1 FTU = 500mg

17
Q

The selection of TCS formulation is based on what factors?

A
  1. Assessment of dx severity
  2. Dx location
  3. Knowledge of patient preferences and age
  4. Cost/insurance converage
18
Q

When would you use a lower potency TCS?

A

Infants and psoriatic lesions on face, intertriginous areas, or areas of thin skin

19
Q

When would you use mid-to-high potency TCS?

A

Initial therapy to use for other areas on body

20
Q

When would you use highest potency TCS?

A

reserve use for patients with thick plaques or recalcitrant disease

21
Q

Topical retinoids

CI

A

Pregnancy

22
Q

Calcipotriol

Counseling

A
  1. Inactivated by ultraviolet A (UVA) light; apply after, NOT before UVA light exposure
  2. Inactivated by acidic substances (i.e., salicylic acid); avoid concomitant use

Topical Vitamin D3 Analogs

23
Q

preferred regimen, when used in topical therapy?

A

Short-contact anthralin therapy (SCAT)

24
Q

Phototherapy & Photochemotherapy

Types, CI

A

Types:
* UV-A: PUVA
* narrow band UV-B: preferred (administered with coal tar (Goeckerman regimen) or anthralin (Ingram regimen)

CI: patients with history of melanoma or multiple non-melanoma skin cancers

25
Q

Salicylic acid

Counseling

A
  1. Do NOT combine with ultraviolet B (UVB) phototherapy, as its filtering effect reduces UVB efficacy!
  2. Do NOT use with calcipotriol, as it inactivates the vitamin D3 analog!
26
Q

Acitretin

CI, Warning, ADR, Monitoring

A

CI: Pregnancy, Methotrexate, Tetracyclines
Warnings: Depression, photosensitivity, pseudotumor cerebri
ADR: mucocutaneous effects
Monitoring: pregnancy testing
Counseling: Acitretin should NOT be used for women of child-bearing age UNLESS
* Able/willing to use effective contraceptive during therapy duration (AND) at least 3 years after discontinuing the medication
* Obtain two (2) negative pregnancy tests before initiating therapy, once monthly during therapy, and every three (3) months for three (3) years after discontinuing therapy
* Avoid use of alcohol during therapy and for two (2) months after discontinuing therapy

27
Q

Cyclosporine

CI, ADR, Counseling

A

CI: Uncontrolled HTN
ADR: nephrotoxicity, hypertension, hypertriglyceridemia, hyperkalemia
Counseling: Do NOT administer with live vaccines

28
Q

Methotrexate

CI, Counseling

A

CI: pregancy, lacation
Counseling:
* Foilic acid supplementation
* Screen high-risk patients for Hepatitis B and C before starting therapy.
* Patients should use effective birth control for 3 months (males) and one (1) ovulatory cycle (females) after discontinuing therapy

29
Q

Tofacitinib

BBW, Warning, ADR, Monitoring, Counseling

A

BBW: ≥ 50 years old with ≥ 1 CV risk factor treated at higher doses
Warning: Gi perforations
ADR: Elevated BP and lipids
Monitoring: Lipids, BP
Counseling: Off-label for plaque psoriasis
* Do NOT administer with biologic DMARDs, potent immunosuppressants, or live vaccines
* Use caution in Asian patients due to increased frequency of side effects

30
Q

Apremilast

CI, Warning, ADR, Monitoring

A

CI: pregnancy, breastfeeding
Warning: : GI effects (nausea, vomiting, diarrhea), weight loss, neuropsychiatric effects (depression, suicidal ideation, mood changes)
ADR: severe nausea, vomiting & diarrhea, weight loss, depression, suicidal ideation
Monitoring: signs & symptoms of depression, mood changes, suicidal thoughts
Counseling:
* Take medication with or without food.
* Counsel patients that this medication should NOT be crushed, chewed, or split
* dose titration to minimize GI effects
* Requires titration is CrCl <30mL/min

31
Q

Route of admin for TNF-a inhibitors?

A

Intravenous (IV) — infliximab

Subcutaneous (SC) — etanercept, adalimumab, certolizumab pegol

32
Q

Dosing frequency of TNF-a inhibitors?

A

Etanercept — once weekly
Adalimumab — once every 2 weeks
Certolizumab — once every 2 weeks
Infliximab — once every 8 weeks

33
Q

TNF-a inhibitors

Warning, Monitoring, CI

A

Warning: HF
Monitoring: Before therapy initiation: tuberculosis (TB) and hepatitis B screening
CI: Do NOT administer with other biologic DMARDs or live vaccines

34
Q

For patients on infliximab therapy premidication?

A

antihistamines, acetaminophen, & corticosteroids to reduce risk of infusion reactions

35
Q

IL-12/IL-23 inhibitors

Brands, Monitoring, CI

A

Stelara (ustekinumab)
Monitoring: screenings for hepatitis B, hepatitis C, TB, & HIV
CI: Do NOT administer with live vaccines

36
Q

IL 17 Inhibitors

Brands, CI, Warning, Counseling

A
  1. Cosentyx (secukinumab)
  2. Taltz (ixekizumab)
  3. Siliq (brodalumab)
  4. Bimzelx (bimekizumab)

CI: Chrohn’s (brodalumab)
Warning suicidal ideation (brodalumab, bimekizumab)
Counseling: Do NOT administer with live vaccines
* Use caution when using IL-17 inhibitors for patients with history of inflammatory bowel disease
* Avoid use of brodalumab in patients with Crohn’s disease.
* Black box warning for suicidal ideation (brodalumab)

37
Q

IL-23 inhibitors

Brand, Monitoring, Counseling

A
  1. Tremfya (guselkumab)
  2. Ilumya (tildrakizumab)
  3. Skyrizi (risankizumab)

Monitoring: screenings for hepatitis B, hepatitis C, TB & HIV
Counseling: Do NOT administer with live vaccines!

Therapeutics III (40 decks)

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