random Flashcards
1
Q
How would you treat MTX overdose?
A
leukovorin 15-25 mg PO Q6 hrs x for up to 10 doses
2
Q
thalidomide - approval?
A
multiple myeloma: CAD
FDA: EN leprosum
3
Q
thalidomide - 3 derm uses?
A
PG Behcets Chronic spontaneous urticaria BP Pompholyx
4
Q
hydroxyurea - 5 s/e?
A
chemo drug so -> myelosupression, anagen effluvium, bacterial infecitons
known for ulcers and hyperpigmentation ; UTD eczema, xeroderma
HA, GI fox, anemia, arthralgia, 2’ malignancies from suppression
5
Q
MMF - active metabolite?
A
mycophenolic acid
6 MP - mercaptopurine is AZA, do not confuse
6
Q
MMP MOA?
A
MA: Marine -> + BAPTIzeD
T/B cells -> Iono monophosphate or xanthine monophosphate -> iono monophosphate dehydrogenase -> guanosine monophosphate -> purine metabolites blocked
T cells don’t have salvage pathway to go through
decreases B cell production, Ab synthesis
decreases purine synthesis
T cell production
pro-Inflammatory cell recruitment decreased due to down regulation of E/P selectins
ZZZ - fibrosis -> decreases action of fibroblasts involved in tissue fibrosis
dendritic cells - exerts effect on
7
Q
MMF MC S/E?
A
GGreaT CHIN
GI upset dose dempendent
divide doses, enteric coated tablets, take with food, give tiem
8
Q
MMF - 5 side effects?
A
GGreaT CHIN floating above water
GI - N/V/D, GI upset, loose stools, ANAL tenderness ~~~~~
GU - sterile pyuria ~~~, dysuria, frequency, urgency , NO nephrotoxicity
T - teratogenic EEC - ears, eyes, cleft
Carcinogenic - lymphomas, conflicting NMSCa
Heme - agranulocytosis, neutropenia, anemia
Infections - ZOster > bac > viral
Neuro - weakness, fatigue (“swim”), tinnitus (“water in ears”), insomnia
9
Q
drug that increases MMF availability?
A
probenecid
antivirals (acyclovir) decrease tubular excretion
salicylates - displace from protein
others in notes: cholestyramine, Abx
10
Q
what is the difference btwn MMF and MPA? brands?
A
mycophenolic acid = MMF
active metabolite MPA = myfortic`
11
Q
MMF - what does it act on ?
A
“lymphocytes”, T cells»_space; B cells - inhibits purine metabolites, T/B cells have no salvage pathway
12
Q
what does of MMF increases infection rates
A
> 2 g/day
13
Q
MMF typical dose?
A
start at 500 and slowly bring to 2-3 g /daily divided into BID (aka 1000 mg BID)
14
Q
difference between myfortic and cell cept
A
myfortic = EC-MPA (720mg, equivalent to 1 g MMF) cellcept = MMP
15
Q
MMF - c/i
A
absolute: pregnancy, hypersensitivity
relative: chin to belly button
lactation
peptic ulcer dz
cardiopulmonary dz
renal dz
hepatic dz
DRUG INTERACTION (CHLESTYRAMINE)
16
Q
MMF - how many weeks/months before pregnancy?
A
6 weeks
17
Q
CsA - 6 s/e?
A
HeLLMans Real Good or derm and non-derm
Hypertrichosis HyPOMg, HyperK, HyperUricemia Heme abn - anemia, lymphopenia, neutropenia Hyperplasia - Gingival Lipids - hypertriglycerema Liver - transaminase elevation Malignancy - CTCL, NMSCa
Renal
GI
Cutaneous: acne epidermoid cysts sebaceous hyperplasia NMSCa hypertrichosis gingival hyperplasia
or F THINGS - flushing trichomegaly trichodysplasia spinulosa hypertrichosis
infections NMSCa gingival hyperplasia, sebaceous hyperplasia, acne
18
Q
skin s-e (5) of CsA?
A
Cutaneous: acne epidermoid cysts sebaceous hyperplasia NMSCa hypertrichosis gingival hyperplasia
or F THINGS - flushing trichomegaly trichodysplasia spinulosa hypertrichosis
infections NMSCa gingival hyperplasia, sebaceous hyperplasia, acne
19
Q
drugs that will increase renal tox in CsA?
A
CANTS Cimetidine ampho B/azoles NSAIDS (renal yo) Tacrolimus (same classs = bad news) Septra - every list
20
Q
relative C/I for CsA
A
2 Ds and a I
drugs - drugs that can interfere with absorption or metabolism of cyclosporine, esp renal dysfunction
drugs - phototherapy, MTX and other immunosupresants = > cancer increase
demographics - pregnant
demographics - lactating
demographics - <18 > 65
demographics - unreliable
infection - active infection
infection - vaccination , live
infection - immunodeficiency
21
Q
adalimumab - structure?
A
fully human mono Ab
22
Q
6 s/e of adalimumab?
A
injection site reaction drug induced LUPUS! increased risk of infections NMSCA increased risk malignancy increased risk
c/i with CHF and demyelinating conditions
23
Q
adalimumab - approval? dose?
A
PsO and PsA in adults Ank Spond RA UC /Crohns uveitis HS JIA
24
Q
adalimumab - PsO dosing
A
80 mg x 1 , 40 mg at W1 and Q2 W
25
advantage of quantiferon?
previous BCG, unreliable (faster results), pts on immunosurpession
26
atypical antipsychotics - MC s/e? 5 others?
sedation
metabolic - weight gain, hyperlipidemia, gynecomastea
DM, seizures, h/a
decreased sex drive
QT prolongation important
27
3 metabolic pathways of CsA?
CYP3A4, CYP3A5, p glycoprotein?
28
5 drugs that can increase CsA levels?
```
Stop Cyber Kids From Eating Grapefruit and Plums
Abx AntiHTN Other
Septra
statins
SSRIs
cimetidine
CCBs
cephalosporine
ketakonazole, other azoles
furosemide
erythromycin, other macros
Grapefruit
PROTEASE INHIBITORS aka antivirals
```
INHIBIT CYP 3A4
29
drugs that induct CYP3A4 aka can decrease CsA levels?
anti seizure meds basically (destimulate brain but stimulate CYPS)
```
CROPS
carbamazepine
RIFAMPIN
OCTREOTIDE
phenytoin
phenobarb
St jons wort
glucocorticoids in some lists
```
30
CsA dose?
3-5 mg/kg
| start at 3 mg divided BID
31
5 TNFs? administration ? molecule?
```
adalimumab, SQ, fully human
golimumab, SQ/IV, fully human
infliximab, IV, humanized (X) - chimeric
certolizumab pegol, SQ/IV, human
etanercept, SQ, fusion p75 TNF and FC - fully humanized
```
32
MOA of 5 FU
DNA and RNA
```
thymidylate synthase (TS) inhibitor
DO NOT CONFUSE with THYMIDINE KINASE - viral
```
blocks synthesis of nucleotides required for DNA (scarcity of dTMP)
incorporates into RNA - > damage and termination of translation
Nature:
5-Fluorouracil (5-FU) can activate p53 by more than one mechanism: incorporation of fluorouridine triphosphate (FUTP) into RNA, incorporation of fluorodeoxyuridine triphosphate (FdUTP) into DNA and inhibition of thymidylate synthase (TS) by fluorodeoxyuridine monophosphate (FdUMP) with resultant DNA damage.
33
5 FU - approved indications?
AK: BID x 2 weeks face, 4-6 weeks body
| sBCC BID 3-6 weeks
34
what cytokine does CsA down regulate?
IL 2
35
MTX - 3 ways to decrease GI tox?
SQ, decrease dose, split dose (esp PO into 3 doses Q 12)), folic acid
36
rituximab - cell target?
CD20 Mature T cells
37
ritux - 4 c/i?
CAN: hypersensitivity, severe infection, progressive multifocal leukoencephalopathy (IL)
BHA yo
hx of bronchospasm
HYPOtension
angioedema
aka infusion reaction - if any of these would make way worse
38
ritux dose?
1000 mg IV x 2 separated by 2 weeks
| or 375 mg/m2 Week x 4 heme
39
2 derm indications of ritux? others?
GPA, MPA
NHL, CLL, RA
Canadian : cd 20 + diffuse large B cell , follicular cd 20+ , nhl
40
ritux - 5 s/e
MC - infusion rxn ; A Right TITI
Anemia, Tumour lysis, Infection, Tumours (SCC< Merkle), Infusion
Usuals: HTN, N/URTI, arthralgia, pyrexia, pruritis
infection - bacterial, viral, fungal
progressive multifocal leukoencephalopathy
tumour lysis syndrome - rapid decline in renal fxn
malignancy (SCC and Merkel reported)
cytopenia - late onset usually (weeks to months, neutropenia)
infection reactivation like Hep B, JC virus
41
ritux - 6 investigations?
CBC (cytopenias)
HIV
Hep B/C
TB + CXR
CBC Q2 weeks during Tx and Q1-3 weeks thereafter
for pemphigus, titres Q6-12 months, titres will rise before sx - retreat
42
ritux - 5 off label skin indications?
```
BP, PV, PF, paraneoplastic, EBA, MMP
DM and SCLE
GVHD
VASCULITIS - including eGPA/GPA (official indication), cryoglobulinemia, HPS
B cell lymphoma
```
43
which drug should not be combined with ritux?
cisplatin - increased tox
44
Vaccines - live and not recommended on immunosuppressants?
ROME Is MY Best Vacation
Rubella
oral polio
Mealses,
Influenza, oral
Mumps
Yellow fever
bCG
VZV
SHINGRIX is not LIVE, zostavax is live but less effective
45
when to administer vaccines before biologics?
ideally 4 weeks prior
PHARma
```
Polio IM
pneumococcus
HPV
Hep A/B
Rabies
```
ma
46
which cells are CD20+
transitional B cell
mature B clel
memory B cell
Plasma cell (CAN BE CD20 + or negative)
essentially CD20 - plasma cells in the bone marrow continue producing Ig and CD20- cells that are long lived continue to protect against antimicrobial Ab, but short lived plasmas which tend to be reactive are wiped
47
ritux - MOA
CHIMERIC murine human Ab against CD 20 (chimeric so like infliximab way more infusion rxns)
-> depletes CD20+ B cells which tend to be auto reactive (immature, transitional, mature and memory)
kill cells via 3 ways -> complement mediated, Ab-dependent via NK cells, inhibition of growth signals and induction of apoptosis
also shown to decrease regulatory T cells
48
MTX + septra -> risk?
myelosupression/bmt failure
49
biologics - which vaccines c/i?
Rome Is my best vacation
| VZV, MMR, BCG, influenza oral, oral polio, zostavax
50
dupi - which 2 IL targeted
targets IL 4 R
Type 1 - IL 4
Type 2 - IL 4 and13
51
3 IL 23s?
guselkumab, tildakizumab, risankizumab
Tilda swinton wearing Bjorks Goose dress - couldn't rise to sky
52
guselkumab dose?
SQ 100 Q0, 4 and Q8 (g 8 se)
53
skyrizi dose?
150 W 0, 4, 12 and Q12
54
skyrizi - approval for?
IL 23, PsO
55
tildrakizumab - IL, approval, dose?
100 mg (sky rizi is the only one 150 in IL 23 b.c "higher in the sky")
PsO - adults
SQ 0, 4, Q12
56
IL 23 s - s/e
URTIs MC
injection site rxns
arthralgia
GI reported including diarrhea
increased transaminases in PsA Guselkumab
57
IL 23s MOA?
binds to p19 subunit of IL 23- > prevents its interaction with IL 23 R -> Th 17 downregulated - > decreased production of IL 17 A, F, 21, 22 etc
58
PsO biologics approved for use in kids?
SEE Ur Ix (ex)
TNF alpha - etanercept
IL 17 - ixekizumab, secukinumab (not bro)
IL 12/23 - yes, ustekizumab
IL 23 - none
59
4 RF for pancytopenia w/ MTX?
FOLaTe Rocks Daily - no folate, old, aLbumin, TMX - Septra, renal dz, incorrect dose (daily)
```
lack of folate
Old
renal dz -> MTX skyrockets
hypoalbulinemia (goes with malnutrition nd hepatic imp)
drug interactions like septra
```
Risk factors for pancytopenia include advanced age, renal impairment, infection and hypoalbuminemia. Myelosupression is more likely if MTX is taken daily.
60
3 things folate improves in MTX?
anemias, GI s/e
DECREASED LIVER TOX
aka 3 basic s/e
61
5 skin dz worsened by TNF alphas?
```
Pso
SLE
vasculitis
infections like candida, HSV
lichenoid dermatitis
eczematous dermatitis
DM
```
62
TNF alphas - MOA?
blocks TNF aphas
- reduces neutrophil chemotaxis
- down regulates intracellular adhesion molecules
- reduces Th1 response (not in Wolverton though)
- reduces keratinocyte proliferation
- down regulates IL 22 receptors -> decreased pro inflammatory cytokines
63
etanercept - approval and structure?
P 75 x 2 fused with Fc TNF alpha and beta
| PsA, PsO, RA, Ank Spons, JIA (b/c kids)
64
etanercept age for PsO?
kids 4 + (others are ixekixumab, secukinumab and stellara)
65
etanercept dosing adults and kids?
50 mg BIW x 12 weeks, than OW
| kids 0.8 mg/kg/week
66
etanercept - s/e
TB reactivation, recurrent infections, do not initiate on active infections, lymphomas,
DO NOT USE WITH ANAKINRA OR DMARDS
relative CHF
personal or family history of demyelinating
```
other
vaccinations - must be current
infections
anaphylaxis
pancytopenia
lymphomas
preggo B
```
67
infliximab - structure dose? indications
chimeric
5 mg/kg, adults only
RA, Ank spond, PsO, PsA, IBD
5 mg /kg W0,2, 5 Q8
68
TNF alpha - 5 off label uses
```
ada is HS + but others can be used too
neutrophilic dermis like PG and behcets
granulomatous dermis like sarcoid
vasculitis: takayasu, kawasaki
PRP and other Pso like disorders
```
69
absolute c/i in TNFs?
AAA - anakinra
hypersensitivity
infections - active or chronic
relative CHF, demyelinating
70
infliximab - drug specific s/e?
infusion reactions - headaches, flushing, dyspnea, bornchospasms, BP drop, cheapest pain, anaphylaxis
give tylenol and antihistamine before
also reports of liver failure, jaundice etc
71
adalimumab - structure , approvals?
```
HS 12+
PsO
PsA
RA
JIA
ank spond
IBD - both
uveitis
```
human gig recombinant Ab TNF alpha only (TNF alpha and beta in etanercept)
dose 80 mg W0, 40 mg W1, 3, 5 , 7 Q2 thereafter for PsO
!!!!HS: 160 mg W0, 80 mg W 2, 40 mg W 4 Qw
72
adalimumab - dosing
human gig recombinant Ab TNF alpha only (TNF alpha and beta in etanercept)
dose 80 mg W0, 40 mg W1, 3, 5 , 7 Q2 thereafter for PsO
!!!!HS: 160 mg W0, 80 mg W 2, 40 mg W 4 QW
73
certolizumab pegol - preggo category and dose?
preggo: no official category : "may be safe to continue in pregnancy"
humanized Ab
does not cross placenta because PEG and not IgG
RA, PsA, PsO, Ank sond
400 mg W 0, 2, 4 -> 200 mg W2 w
74
TNF alpha required labs?
TB, Hep B, C - historically repeated annually, now if not high risk can skip
rare cases of anemia, pancytopenia, LFT elevations - CBC and LFTs before start especially infliximab
75
TNF alphas - s/e ? (again)
```
infection
malignancy
CHF
demyelinating disorders
injection site/infusion site
skin - SLE, AD, PsO and others
```
reports of heme and LFT abn
76
MOA IVIG?
Fast (or FAT :) ) CAT moves slowly on steroids
blocks FAS from interacting with its ligand
Complement inhibition
reduction in C3/C5 convertase aka they don't get cleaved and membrane attack complex not formed
decreases Ab production by active B cells
T cell - reduces the number of auto reactive T cells, supresses T cells
slowly - inhibits cellular adhesion and migration into target tissues
increases sensitivity to glucocorticoid receptors
77
IVIG - approval? 5 common derm uses?
formally immunodeficiencies only
MC Kawasaki w/ ASA (2 g/kg/day)
DM and AI blistering - PV/BP/PF/MMP, EBA, LABD
also scleroderma, SLE, AD, urticaria, etc
78
IVIG c/i - absolute and relative?
```
absolute - anaphylaxis
relative - RA (RF up - nephrotox)
IgA deficiency (anaphylaxis)
renal disease
cryoglobulinemia
CHF (fluid overload
```
79
IVIG - preggo category
C
80
IVIG = S/E
Thiin as Fluid
```
thromboembolic events
heme - hemolysis, anemia
infections - theoretic
infusion rxnx
neuro - ASEPTIC MENINGITIS
As - AsSEPTIC, anaphylaxis
```
fluid overload - CHF, renal
fluid filled lesions on hands
81
IVIG - labs?
cryo, IgA level, RF, CBC, Cr/renal, Hep B/C, HIV, TB
82
IVIG dose
2 g/kg/cycle over 4-5 hrs, divided into 3 doses on 3 days
| Q4 weeks
83
MOA - MTX
inhibition of DIhydrofolate reductase = irreversible
inhibition of thymidilate SYNTHASE - reversible (time Sensitive)
reduction in folate synthesis -> blocks DNA synthesis
AICAR - decreased adenosine, antiinflammatory
84
c/i drug with MTX?
septra
85
rituximab target and mode of administration
anti CD20 - wipes mature B cells, memory B cells and plasma cells that are CD20+
IV 1 g DO and 14 than repeat PRN
CBC at administration and Q2 weeks during tx and follow Q3 months thereafter
86
5 CsA c/i s?
hypersensitivity to cyclosporine
HTN - uncontrolled
malignancy - active, CTCL
renal failure or sign decrease in function
demographics - preggo, lactating, <18 > 65, unreliable
drugs - CANTS, phototherapy, MTX
immuno - immunodeficiency, active infection, vaccines
87
CsA - 6 labs?
i2 BP measures at least one day apart
| CBC, LFTs, Cr/Urea, U/A, FASTING lipids, Mg, K, uric acid, preggo, Hep, TB, HIV
88
what can you use in CsA hyperlipidemia?
rosuvastatin, fluvastatin, exercise
89
what can you use in CsA HTN?
nifedipine
90
what do you do if renal markers up by >25%? >50%
repeat in 2 weeks, if still elevated/sustained, decrease CsA by 1 mg/kg/day for 2-4 weeks and recheck, if normal continue and if not d/c
50% - dc until normalizes
91
CsA - dose?
3- 5 mg/kg/day - recommended to start at 2.5 - 3
do not continue for more than 1 year in FDA
IDEAL weight
92
MTX - 5 drugs that interact?
septra - BMT supression
dapsone - BMT suppression
Nsaids, salicylates - increase levels (NO pain meds)
CsA/other immunosuppressants - too much
others: probenecid, phenytoin, - increase tox
ALCOHOL< RETINOIDS -> hepatotoxic increase
93
TNF alpha 7 s/e?
```
infections
injection
CANCERS - NMSCa, Lymphomas
SKIN - Pso, Lupus, AD, etc
CHF
demyelinating
`
```
94
MTX - Pso indications (4)?
```
plaque that is not responsive (>20 % BSA)
erythrodermic
affecting EMPLOYMENT
pustular
PsA
poor response to Photo and retinoids
```
(not on monograph, just says severe disabling PsO)
95
CsA s/e - 3 MC?
hypertrichosis #1
gingival hyperplasia
NMSCa
sebaceous hyperplasia, acne, epidermoid cysts etc
96
what is chimeric? dimeric?
chimeric _ mouse and human fused - infilixibam
| dimeric ? humanized but fused - ex etanercept?
97
CsA - 2 types of renal toxicity
interstitial fibrosis /tubular dysfunction
| prerenal - afferent arteriole vasoconstriction
98
transdermal drug delivery - 5 factors that influence it?
```
stratum corneum thickness
site
sebaceous gland density
hydration of stratum corneum
drug concentration
vesicle used
occlusion
skin barrier dysfucntion/erosion/ulceration
```
99
5 factors that can enhance transdermal drug delivery?
```
physical:
iontophoresis
ultrasound - thermal or cavitational
fractionated photothermolysis
microneedling
peels aak stripping
mechanical abrasion
```
```
chemical:
water
solvents
surfactants
nanoparticles
```
bio
peptides
100
transdermal drug delivery - advantages?
```
avoids GI metabolism
avoids hepatic metabolism
reduces patient cost
improves patient compliance
avoids pain of injection
improved efficacy (skin drug on skin)
```
101
ideal transdermal drug?
small molecular weight
lipophilic
small concentration/dose needed to treat condition (so compounding not crazy)
102
Ritux - MC and most worrisome S/E?
PHoNe for A C*nt and TITI
MC: pyrexia, hypertension, URTI, nausea, arthralgias
CYTOPENIAS - delayed (months sometimes), neutropenia; good reason for CBC Q3 mo
Tumour lysis , 24 hrs sudden decrease in renal fxn
Infection - reactivation or new
Tumours - SCC and Merkel reported
Infusion reaction - MC of all
BOLOGNA
Progressive multifocal leukoencephalopathy has been reported
Serious infections (bacterial, fungal, or viral) up to 1 year after completing therapy and reactivation of viral infections may occur, especially hepatitis B virus reactivation with fulminant hepatitis
Cardiac arrhythmias and angina can occur and may be life-threatening.
Bowel obstruction and perforation have been described
Stevens–Johnson syndrome/toxic epidermal necrolysis and onset of paraneoplastic pemphigus have been described
103
rituximab - c/i?
```
allergic to the drug
infusion drug SO:
CARDIAC ARRHYTHMIAS
angina pectoris
high tumour burden -> tumour lysis
active infection and hepatitis B carriers (reactivation)
```
104
what cells does ritux NOT affect?
PRO B cells (CD 20-), PLASMA cells are CD 20-
preB cells +, naive cells are, memory and plasma BLASTS are, some
105
what cells does ritux target (be specific)
CD 20 +
pre B, naive B, memory B cells, plasma BLASTS
MA: MEMORY of BLASTS on PRENAtal wing of the hospital
106
Omalizumab - MOA?
Omalizumab is a humanized IgG1 monoclonal antibody that selectively binds to and decreases serum levels of free human IgE. It also down-regulates the number of high-affinity IgE receptors on mast cells, basophils, and dendritic cells (Bologna)
107
Omalizumab common s/e - 3
```
Injection site reactions Bologna 10-15%
URITS
headaches
sinusitis
pharyngitis
viral infections
```
most dangerous anaphylaxis - prescribe epipen
preggo B
108
omalizumab dose?
subcutaneous injection of 150 or 300 mg every 4 weeks for CIU,
109
omalizumab - 3 cutaneous s/e
injection site
anaphylaxis
serum sickness like reaction
eGPA (eos)
110
topical jaks in bologna?
Preliminary studies have shown benefit from topical application of tofacitinib 2% ointment for atopic dermatitis or psoriasis, and ruxolitinib 2% cream for facial vitiligo106
i think sofa is still 2% but ruxo is now 1.5%
111
2 c/i to IL 17 (bologna)?
chronic/recurrent infections or inflammatory bowel disease,
112
s/e IL 17 bologna?
MC nasopharyngitis, upper respiratory tract infections, and injection-site reactions
anaphylaxis, angioedema, and urticaria
Mucocutaneous candidiasis, most often oral or vulvovaginal, develops in ~5% of patients
. Neutropenia (<1500 cells/mm3) occurs in ~1–2% of patients
IBD
depression in broda
113
dupilumab - target?
Dupilumab (Dupixent®) is a monoclonal antibody that targets the IL-4 receptor α subunit (IL-4Rα)
114
MC side effect t- dupi (bologna)
conjunctivitis (see Table 128.6), with each occurring in ~10% of patients.
115
IL 1 c/i and indications? Bologna
Currently, there are three approved IL-1 antagonists: anakinra, canakinumab, and rilonacept. Dermatologic uses of these medications include treatment of cryopyrin-associated periodic syndrome (CAPS) and the pustular eruptions and bone lesions (e.g. osteomyelitis) of the autosomal recessive deficiency of the IL-1 receptor antagonist (DIRA)
c/i hypersensitivity to drug, infection
116
which class should not be co-administered with IL -1
TNF alphas
117
s/e of anti-IL 1s? bologna , 2
serious infections, flu-like symptoms, and injection site reactions
118
what is anakinra?
glycosylated human IL-1 receptor antagonist
119
imiquimod - 3 concentrations, 3 approvals?
2.5%, 3.75%, and 5% creams, i
(1) anogenital warts
(2) actinic keratoses (AKs) on the face or scalp
and (3) superficial basal cell carcinoma (BCC) measuring up to 2 cm in diameter on the trunk, neck, or extremities (excluding the hands and feet)1
120
imiquimod - list 4 off label uses including one non-viral infection?
common warts20, Bowen disease (squamous cell carcinoma in situ)21, nodular BCC, lentigo maligna, melanoma metastases, T-cell lymphoma, Paget disease, and leishmaniasis as well as prevention of keloid recurrence following surgical excision22
121
imiquimod - dose for warts? BCCs ? AKs?
AGS (alphabetic)
AKs - 2/week x 16 w - clearance 50%
genital warts - 3/week x 16 w 50%
sBCC - 5x/week x 6 weeks 75% clearance
(Bologna)
122
imiquimod MOA?
induces TLR7 - and through interferon gamma thought to switch Th1 response and cell mediated immunity
123
imiquimod - preggo category?
B
124
imiquimod - s/e
erythema, edema, scale, erosion, ulceration at application sites
more intense with ++ actinic damage
erosive pustular dermatosis of the scalp
flu like - fatigue, headache, diarrhea, myalgia - 1-2%
125
tralo indication and MOA?
mod/severe AD in adult
anti IL 13 - inhibits its interaction with IL 13 receptor (IL 13 R alpha 1 and 2)
126
tralo dose?
600 x 1 _> 300 Q2 weeks subq
127
tralo c/i ?
hypersensitivity
128
tralo MC side effect? 3 others?
```
URTI (unlike dupi)
injection site
conjunctivitis
keratitis
hypereos
```
129
dupi - indications (3)
think of atopic march
AD 6+
asthma 12+
rhino sinusitis Adult
130
dupi - MOA?
IL 4 receptor antagonist
antagonizes type alpha subunit of IL 4 R, shared by IL 4 and 13
131
dupi dose by weight > 60 <> 30 <>15 kg?
> 60 kg/adult 600 mg x 1 (2 sides) -> 300 Q2 weeks
30-60 400 mg x 1 -> 200 Q2 weeks
<30 but > 15 kg 600 mg x 1 -> 300 Q4 weeks
132
off label uses of dupi?
AA, PF, PF, etc
133
5 ocular s/e of dupi?
dry eyes, itchy eyes, keratitis, blepharitis, conjunctivitis (break to allergic, bacterial, viral, eye irritation, eye inflammation etc)
134
dupi EASI 75?
50%
135
dupi - top 3 s/e?
injection site #1
conjunctivitis #1 (shared)
HSV #2
herpes simplex #3
136
difference in MOA between Tralokizumab and Dupilumab?
dupilumab is antagonist of IL 4 RECEPTOR -> blocks T1 IL 4 R and T2 IL 4 and IL 13
DupeR
tralokinumab is IL 13 neutrolizing Ab (aka IL 13 vs IL 4 > 13 and Ab not Receptor target)
IL 13 helpful in AD and itch induction
137
Tralokizumab dose? indication?
moderate severe AD in adults
600 mg SQ -> 300 mg SQ Q2 weeks
138
SteLLara MOA and dosing?
IL 12 and 13 IgG1 antagonist
PsO, PsA, IBD (crohns and ulcerative colitis)
6+ for PsO (MA: dupi 6, stellara 6, most kids are 6)
0.75 mg/kg in kids < 60 kg
45 mg SQ in adults < 100 kg
90 mg SQ in adults > 100 kg
W0, 4 and then Q12 (anti IL 12 !!! and 23 :) )
139
Stelara c/i and warnings?
hypersensitivity
active infection, chronic infection, recurrent infection -> CAN LEAD TO SEVERE
caution with malignancy
LATEX capp
hypersensitivity including angioedema/anaphylaxis
allergic alveolitis/eosinophilic PNA reported
can be used with AZA, MMP, MTX
140
Stelara - s/e - 7
```
rhinitis
pharyngitis
URTIS - other
h/a
arthralgia
---- MC
dizziness
N/V
pruritis
```
```
DEPRESSION recorded
injection site reactions
acne with IBD
nasal congestion
HSV, cellulitis, dental infections, candida vulvaginitis, etc
```
PASI 50 - 90%
75 - 71% and 90 50% aka 50-70 - 90
141
What interventions can be combined with oral retinoids?
CsA (not hepatotoxic),
PUVA, UVB (even though can be photosensitiz.)
biologics
142
how long post last use do you need to wait before pregnancy with isotretinoin? acitret? bexarotene? and half lives of each? dose of each?
isotretinoin 10-20 hrs, wait 1 month post, 0.5 -1 mg/kg/d
acitretin 50 hrs , wait 3 yrs? (monograph is 2 months, but theoretic risk of conversion to etretinate which has 120 d half life)
bexarotene 1 MONTH before and 1 month post (per monograph), 9 hrs, 300 mg/m2/d
alitret 9 hrs 30 mg/d 1 month post pregnancy
