Psoriasis (exam 1)

Question 1

Psoriasis presentation

Answer 1

sharp demacrated, erythematous papule and plaques with silver white fine scales

Question 2

where is psoriasis typically found?

Answer 2

on the elbows, knees and scalp
can sometimes affect the nails

Question 3

which is the most common type of psoriasis

Answer 3

chronic plaque psoriasis

Question 4

what can cause psoriasis?

Answer 4

cell mediated immune mechanisms
autoimmune disease
genetics
polymorphisms of vitamin D receptor

Question 5

medications that can exacerbate psoriasis

Answer 5

lithium carbonate
beta blockers
antimalarials
tetracyclines

Question 6

what can exacerbate psoriasis?

Answer 6

smoking, alcohol, stress, infection
injury, trauma
medications

Question 7

goals of therapy of psoriasis

Answer 7

decrease the size/thickness of plaques
improve quality of life
remission

Question 8

chronic plaque psoriasis diagnosing criteria

Answer 8

mild - less than 5% BSA
moderate - 5-10% BSA
severe - more than 10% BSA

Question 9

consideration for addition of agents in psoriasis is based on

Answer 9

disease severity
cost
convenience

Question 10

mild to moderate psoriasis first line

Answer 10

topical agents

Question 11

mild to moderate psoriasis second line

Answer 11

topical agents and phototherapy (if feasible)

Question 12

mild to moderate psoriasis third line

Answer 12

topical agents and systemic therapy

Question 13

what topical agents are typically given as first line for mild-moderate psoriasis

Answer 13

moisturizers (emollients)

intermittent topical corticosteroids

Question 14

once mild-moderate psoriasis is controlled

Answer 14

step down to lower doses/potencies that maintain control of disease

Question 15

for psoriasis, topical corticosteroids are generally continued

Answer 15

as long as the patient has thick active lesions

Question 16

once clinical improvement of mild-moderate psoriasis occurs, application of topical corticosteroids should be

Answer 16

reduced as intermittent maintenance

Question 17

what can be used to avoid long term intermittent topical corticosteroids?

Answer 17

topical immunosuppressives
salicylic acid
tazarotene
calciptriene (Dovonex)
calcitrol (Vectical)

Question 18

synthetic vitamin D analogs reduce _______________ by binding to receptors in ______________________

Answer 18

cell proliferation

epidermal keratinocytes

Question 19

coal tar (T gel) and anthralin (Zithranol or Dritho-creame) are used only in

Answer 19

adults

Question 20

coal tar and anthralin MOA

Answer 20

inhibition of keratinocyte proliferation and anti-inflammatory

Question 21

when coal tar or anthralin are used in combination with ultraviolet B light,

Answer 21

they inhibit epidermal DNA synthesis reducing plaque elevation

Question 22

side effects of coal tar and anthralin

Answer 22

increases sensitivity to UV light and the sun
local irritation
unpleasant odor
stains skin and clothing

Question 23

new alternative topical treatments for mild-moderate psoriasis

Answer 23

Vtama (tapinarof) cream
Zoryve (roflumilast) cream

Question 24

chronic plaque psoriasis plaques typically ______________________ of treatment

Answer 24

recur after cessation

Question 25

maintenance regimen for mild-moderate plaque psoriasis

Answer 25

intermittent treatment with previous topical corticosteroid add a vitamin D analog can do just vitamin D analog alone

Question 26

severe psoriasis first line therapy

Answer 26

biologics

Question 27

treatment for moderate to severe psoriasis

Answer 27

phototherapy systemic non biologics biologic agents

Question 28

moderate to severe psoriasis first line therapy

Answer 28

systemic oral agent with topical agent or phototherapy or consider BRM if comorbidities

Question 29

moderate to severe psoriasis second line therapy

Answer 29

more potent systemic oral agent or 2 or more systemic agents in rotation with topical agent

Question 30

moderate to severe psoriasis third line therapy

Answer 30

biologic response modifier with other agents

Question 31

ultraviolet A vs B

Answer 31

A - penetrates deeper in the skin, takes 20 minutes per session B - exposure times first few sessions 30-60 seconds

Question 32

how many times is light therapy used per week? what to do when there is a satisfactory response?

Answer 32

2-3 times per week taper to lowest required to maintain improvement

Question 33

PUVA

Answer 33

psoralens and ultra violet A

Question 34

Uvadex (oral methoxsalen)

Answer 34

shorter photosensitization onset produces a triplet electronic state taken 1.5-2 hours before UVA light exposure

Question 35

three common combination therapies of photochemotherapy

Answer 35

psoralen and UVA Anthralin and UVB coal tar products and UVB

Question 36

acitretin

Answer 36

systemic retinoid normalizes epidermal differentiation diminishes hyper proliferation and inflammation

Question 37

acitretin is contraindicated in

Answer 37

pregnancy

Question 38

program to monitor acitretin

Answer 38

Take Action to Prevent Pregnancy (TAPP)

Question 39

program material for TAPP

Answer 39

patient agreement/informed consent form authorization for use voluntary patient survey and registration form

Question 40

differences between TAPP and IPLEDGE

Answer 40

males have no limit on duration of treatment females need a pregnancy test every 3 months for at least 3 years after stopping no blood donation for 3 years after stopping (both males and females)

Question 41

Otexzla (apremilast)

Answer 41

PDE4 inhibitor stops inflammation 2nd line for mod-severe psoriasis

Question 42

warnings/precautions for Otexzla

Answer 42

depression weight decrease GI symptoms

Question 43

Important considerations for patients when taking Otexzla

Answer 43

titrate to recommended dose over 4-7 days to avoid risk of GI symptoms

Question 44

Sotyktu (deuvravacitinib)

Answer 44

selective inhibitor of tyrosine kinase 2 (JAK family) 2nd line for mod-severe psoriasis

Question 45

over immunosuppressive therapy for 2nd line treatment of moderate-severe psoriasis

Answer 45

cyclosporine (neoral, sandimmune) methotrexate

Question 46

biologic response modifiers for 3rd line treatment of moderate-severe psoriasis

Answer 46

entrercept (Enbrel) adalimumab (Humira) certolizumab (Cimzia) Infliximab (Remicade)

Question 47

biologic response modifiers (BRM)

Answer 47

binds to TNF cytokines regulate the body's immune response to infection and inflammation

Question 48

for patients with failure to response to TNF inhibitors,

Answer 48

another agent in this class may be tried

Question 49

anti-interleukin cytokine biologic agents for third line treatment of moderate-severe psoriasis

Answer 49

Stelara Cosentyx Taltz Tremfya Siliq Ilumya Skyrizi

Question 50

are TNF inhibitors or anti-interleukin cytokine biologic agents preferred for moderate-severe psoriasis?

Answer 50

anti-interleukin cytokine biologic agents

Question 51

warning/precautions for BRMs

Answer 51

formation of neutralizing anti-drug antibodies -- loss of efficacy hypersensitivity reactions within 2 hours of infusion JAK inhibitor warnings