Psoriasis Therapeutics Flashcards by amanda kastel

true or false

psoriasis is immune mediated

true

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true or false

we can cure psoriasis

false - goal is just to control

normalize the skin and increase the pliability

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true or false

psoriasis can be drug induced

true

important to ask what meds people are on

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1st line for limited plaque psoriasis

1st line for moderate-severe plaque psoriasis

limited - topical corticosteroids + emollients (moisturizer)
(alternative is topical vitamin D, topical retinoids, coal tar and anthralin)

moderate-severe: phototherapy or systemic therapies (retinoids - not iso, methotrexate, cyclosporine, apremilast, biologics) ADJUNCTIVE WITH TOPICAL

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alternative agents for limited plaque psoriasis (besides topical corticosteroid + emollient)

topical vitamin D
topical retinoids
coal tar preparations
anthralin
Topical calcineurin inhibitors

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systemic agents for moderate-severe plaque psoriasis

retinoids
methotrexate
cyclosporine
apremilast
biologic immune modifying agents

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true or false

isotretinoin is a systemic agent that can be used for psoriasi

FALSE - only acne

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patient adherence may be the largest barrier to treatment success with ______ therapies for psoriasis

topical

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true or false

in moderate-severe plaque psoriasis, the systemic therapies can also have topical therapies as adjunctive agent

TRUE

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explain treatment algorithm for mild-moderate psoriasis

topical agents

if not working—

topical agents + phototherapy

if not working…

topical agents + systemic agent

ALL ARE USED WITH MOISTURIZERS

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explain treatment algorithm for moderate-severe psoriasis

systemic agent with or without topical agent or phototherapy

if not working….

more potent systemiic agent and 2 or more systemic agents in rotation with or without topical

if not work

biologic with or without other agents(biologic can also be first line, but very costly)

ALL USED WITH MOISTURIZER

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When using topical agents for mild-moderate plaque psoriasis, around how long does it take to see improvement

1-2 months

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can combination regimens be used for mild-moderate plaque psoriasis

yes - localized phototherapy + topical

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for moderate-severe plaque psoriasis, they are initially treated with _____ if possible

phototherapy, in combination with topical therapies

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as mentioned, for mod-severe plaque psoriasis, first line is photherapy + topical if needed

if there is a contraindication to phototherapy, or they have PSORIATIC arthritis, what is used instead?

systemic agents like retinoids, methotrexate, cyclosporine, and biologic immine-modifiers

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a BSA of how much is considered mild/moderate/severe?

mild is less than 3% BSA

moderate is 3-10% BSA

severe is greater than 10% BSA

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what biologic therapies are used for plaque psoriasis? (general class)

TNFa blockers and IL17A blockers

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name 3 TNFa blockers used in moderate-severe plaque psoriasis

adalimumab
infliximab
etanercept

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name 3 IL-17A blockers used in plaque psoriasis

Brodalumab
Ixekizumab
Secukinumab

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which vehicle is the BEST for psoriasis topical preparations and explain why

OINTMENTS

they’re hydrating, remove the scales and have the greatest bioavailability

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disadvantage of using ointments and what is done to counteract this

very greasy - pt may not like

so, we typically use creams during the day and ointments at night if this is an issue

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advantages/disadvantages of creams for psoriasis

advantage - high pt acceptance and less greasy than ointments

disadvantage - not as hydrating as ointments are

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which 2 vehicles are drying and thus not preferred for psoriasis?
which of these is the MOST drying

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gels and lotions

gels are the most drying

advantages and disadvantages of gels and lotions for psoriasis

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gels - nongreasy and can be applied to hairy areas/ high pt acceptance

lotions - again, easy to apply to hairy area, including scalp. high pt acceptrance

disadvantage - both are drying. lotions have low bioavailability

where are lotions preferred to be applied

intertriginous (where the skin rubs together) and hair areas, face can be applied to scalp

where are gels preferred to be applied

hairy areas (but still extremely drying - not preferred at all)

what areas are ointments applied

smooth skin with short or little hair

what areas are creams applied

smooth or hairy areas, and intertrignous areas (where skin rubs together)

the optimal vehicle choice is often the one that what?

the patient will use!!! if pt doesnt want ointment, dont give it to them. they will not use it ADHERENCE IS THE BIGGEST THING keep patient's preferences in mind always

if you had to pick 2 things that are "first line" for psoriasis, what would they be

topical corticosteroids! and topical vitamin d analogs topical retinoids and calcineurin inhibitors and PDE4 inhibitors are more 2nd line

how do topical CS work in psoriasis

ANTI INFLAMMATORY

what CS potencies are typically used in psoriasis? explain

mid-high potencies DO NOT START LOW. as the lesions get better. we can start to decrease the potency (usually at around 2 weeks) OR apply less frequently. the goal is to be able to control psoriasis and work our way down to the lowest possible potency to avoid ADRS

name a situation in which LESS potent CS's would be used 1st for psoriasis instead of mid-high

for sensitive areas like the groin and face

explain how to apply topical CS for psoriasis

apply the drug, and then wrap in an occlusive dressing to increase penetration (typically for elbows and knees)

true or false if a patient is using topical corticosteroids for psoriasis, they should NOT abruptly discontinue

TRUE can lead to rebound flares

since the pt may have varying potencies of topical corticosteroids at different stages of psoriasis....

education is very important!!!

common side effects of TOPICAL corticosteroids include some pt education

purpura (purple-red spots), striae, telangiectasias, skin ATROPHY skin atrophy is actually desired at areas affected by psoriasis however, we don't want this on the healthy skin around it to prevent this, educate pt to put a layer of emollient/vaseline on the normal skin to reduce the chance of AE on healthy skin

SYSTEMIC side effects of oral CS --- not really topical

HPA suppression, glucose intolerance, cushing syndrome

how many groups of topical CS are there and which class is the most potent

1-7 class 1 is SUPERPOTENT

True or false we typicall start with high doses of topical CS for psoriasis

TRUE and then work our way down as lesions get better

TRUE OR FALSE emollients should only be used if the psoriasis is severe

FALSE - should be used at every stage to moisturize the skin and minimize the symptoms of itching and tenderness

what are the 2 kinds of emollients and differentiate them

occlusive and humectant occlusive works by keeping moisture IN and can't leave the epidermis by forming an oily film on the skin. humectant enhances the hydrating properties of emollients by pulling more water in

side effects of using emollients

can cause acne and exacerbate existing acne, dermatitis, but generally well tolerated

name 3 OCCLUSIVE emollients

petrolatum, lanolin, silicone

name 3 humectant emollients

glycerin urea pyrolidone carboxylic acid

-when are emollients typically applied? are they used in combination with anything else? which vehicles are preferred and why?

after a hydrating bath or shower, 2-3 times a day can be used with other topical agents creams and ointments preferred over lotions bc they're thicker and more occludsive

how often are emollients typically applied in psoriasis

2-3 times a day

true or false vitamin D analogs are 2nd line for psoriasis

false - also first line like topical CS sometimes used in combo with them, but not often - usually 1 or other

are vitamin D analogs safe for pregnancy

questionable - they're category C

name 2 topical vitamin D analogs used in psoriasis

calcipotriene calcitriol

typicall ADRS of topical vitamin D analogs

mild irritant, contact derm, burning, pruritis, edema, peeling, erythema

SYSTEMIC side effect of topical vit d analogs is it common

hypercalcemia VERY RARE - only if using A LOT

how often are topical vitamin d analogs applied how long does it take to start seeing improvement

2x a day around 2 weeks and can take up to 8 to see the full effect if there's no improvement by 8 weeks, consider other therapy

if using a topical vitamin D analog AND phottherapy, when should each be done

apply the vitamin D AFTER UVA because it can be inactivated by it

Psoriasis Therapeutics Flashcards

(55 cards)