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therapeutics Flashcards

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1
Q

sun protection advice

A

sun protection-behaviour, sunscreen, clothing, window filter

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2
Q

CAD

A

sun protection advice, topical CS/CI,
pred 2w, AZA(B),Cya(B),
MMF(C), AM(C), PUVA/NBUVB densisitation((B, risky!)\

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3
Q

PMLE/AP/SU/HV-

A

topical CS/CI, AH, PUVA/NBUVB desensitisation, AM, AZA, cyA

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4
Q

photodrug rxn

A 
memo/drug cessation(crucial,no alt, limited time-ct)
allergen  avoidance(patch/photopatch)
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5
Q

Pemphigus

A

pred 0.75-2mg/kg/d
↑25%qw↓10/5/2.5/1mg(40/20/10/5mg) q w

PV-MMF/AZA/dapsone/(A); MTX/CPA(B);
PF- MMF/AZA(A); Dapsone/MTX/CPA(B);

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6
Q

Rx considerations immunobullous

A

severity: BSA,disease area index; mucosal involvement,comorbidities, CI

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7
Q

pemphigoid

A

(0.3-1mg/kg/d) doxy/nicotinamide(A)

BP-AZA/MMF(A); dapsone/MTX/CPA(B)

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8
Q

indications for +adjuvant

A

> 1mg/kg/d pred, freq flares on tapering/morbidity or CI to steroid)

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9
Q

EBA-

A

dapsone/colcichine/pred(C); IVIG/ritux(B)

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10
Q

DH

A

( dapsone/pred);

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11
Q

Cx: MMP

A

Mucosal- MMP- ocular, ENT, GE ( OGD/colono) strictures

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12
Q

Treatment failure defn

A

progression/failure epitheliasation >3w pred(1.5mg/kg/d+-adjuvant)

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13
Q

immunobullous Treatment failure Recalcitrant disease-options

A

IvIG(A)/plasmapharesis, rituximab(B+-infx Cx)

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14
Q

role of dsg1/3 activity q6-12m;baseline in PV/PF

A

Monitoring-dz activity?stop Rx

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15
Q

FDE Rx:·

A

culprit drug/Xreacting, topical CS/Erosive-PP,gbFDE, PO pred

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16
Q

Mgt principles for vasculitis

A

symptomatic, 1st line, recalcitrant, 3rd line, specific
extracutaenous- RAI
Triggers- drug, causative dz-infx;
Topicals/leg elevation/NSAID AH aspirin

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17
Q

SVV

  1. palpable purpura
  2. hemorrhagic blister,necrosis
A

1.Colchicine(B, RCT-no effect but relapse in responders with cessation)+/-dapsone(B)
penicilin(ASOT)

  1. Prednisolone
    recalcitrant-Steroid sparing-AZA, MTX, CyA,
    CPA,IvIg, plasmapharesis
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18
Q

ANCA+ vasculitis

A

comanage RAI/renal/pulm, induction of remission(3-6m)-pred+MTX, maintenance(>24m) pred+MTX/AZA+Bactrim+bactroban(nasal)

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19
Q

CTD-associated vasculitis Rx

A

SLE- AM(A)-60% ↓flares; MTX(B);

RA-pred/penicillamine, MTX/AZA/CyP

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20
Q

PAN-prognosis

A

10% cutaneous benign relapsing prognosis, surveillance q6m systemic involvement(rare, 0/79 @7,7/9 @4y; pANCA);

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21
Q

PAN-Rx

A

Hep B associated(sPAN; GE antiviral IFN);
Rx all grade (B)
1st: NSAID/pred/dapsone/colchicine + wound care/dressings/infx
2nd: AZA, MMF, MTX, CPA
3rd: HBOT, ritux, IVIg, inflix, iloprost/bosentan(vasodilator, prostacyclin)

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22
Q

LV- Mgt principles

A

1.exclude 2-CTD, hypercoagulable, malignancies-solid haematological;

  1. 1st:smoking cessation, pentoxyfylline, aspirin, pred
    2nd: /AZA MMF(C)
    admit: methylpred/IvIg/ritux/HBOT(B)
  2. DIRECTED Rx-thrombotic dz: warfarin, LMW heparin, Tissue plasminogen activator
  3. APS- danazol, HCQ; homocysteinemia- folic acid B6/12 supplement
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23
Q

DGI Rx

A

Rx: im ceftriaxone 1g OD( until 48H after clinical improvement)+ doxy/azithro(CT)

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24
Q

purpura fulminans Rx

A

Rx: ICU-abx(immediate/directed/mitigate immunosuppresion) supportive/inotropic/ventilatory/fluid; debridement;

Rx: stop warfarin, start vitK/heparin/protein C concentrate

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25
purpura fulminans Q?
Ask: HD instability+ sepsis+immunocompromise/neutropenic, Phx CTD/APS/infx, warfarin
26
purpura fulminans ddx
1.occlusion: a)ecthyma gangrenosum b)septic vasculitis/emboli- c)lucio’s 2. acquired protein C dysfunction a) DIVC-meningococcemia/strep/saureus/Hib b) warfarin necrosis 3. catastrophic APLS 4. Calciphylaxis
27
CCLE prognosis
counsel (Risk of progression to SLE -DLE/tumid lupus10%,SCLE 50%)
28
CCLE counselling includes
``` sun protection(A)/smoking cessation(B*) *Affect severity/QOL not AM efficacy; vit D levels controversial role ```
29
CCLE Rx | indications for systemic(evidence?)
Potent Topicals-CS/TCI(A)/ILK(C) Systemic-widespread recalcitrant scarred disfigured 1st:Antimalarials(A); 2nd +Pred(C)(severe,2-4 w taper +AM);MTX(B,wenzel 2005 SCLE/Localised DLE not dissemin.) 3rd: MMF / AZA; dapsone/Acitretin(A);Thalidomide/IVig/clofazamine
30
DLE Scalp Rx, indications for systemic?
> 10% SSA/>8W Rx failure ILK→ AM(A), Isotretinoin(B↓TE)acitretin(A), MTX
31
DMS Mgt:
+myositis-RAI comanagement-1- 2mg/kg pred 1) cutaneous: photoPx, 1st: topical CS/TCI, AM(B), 2nd: acute disabling(all B) pred /MTX/AZA/MMF 2) Longitudinal Malignancy surveillance 6 mox 3 y
32
DMS and malignancy-local data | risk factors? onset?
(local 10 mo onset) | Phx malignancy, poor Rx response, unexplained dz flares ( *Ang 2000; ↑malignancy in myositis)
33
Mgt principles MORPHEA:
1. localised/generalised,* vs systemic( refer RAI+ nifedipine, aspirin); 2. active​:
34
morphea/SSc
1. 1st(B):Potent topical CS/ TCI/calcipotriol/ILK; 2.(B):*UVA1/PUVA/NBUVB MTX(>6mo)+-Pred(taper 2-4 w)/pulse methylpred,pred(6m) MMF
35
Mgt PRS
PRS, filler( stable >1 y photographic)
36
SCLEREDEMA Mgt-
cause(self resolving/no treatment/hyerglycemia independent); disability; PUVA/NBUVB/CS
37
scleromyxedema,prognosis, Rx
Challenging(C), chronic persistent,MM/systemic(poor) IvIG** CS(PO/topi/ILK); chemo-melphalan(hematological malignancy, sepsis) high dose dexa; IFNA, Cya,
38
LM: prognosis, Rx
skin-limited, good prognosis, no Rx
39
LP prognosis, Mgt:
``` self limiting, 20% relapsing, no RCT 1.topical CS/CI/calciportriol, 2.pred, AM, Acitretin 4. CyA sulfasalazine ```
40
LPP Rx -topicals, systemic (indications)
>10%SSA,Rx failure>3m; AM(B)/pred(C); CyA/MMF/acitretin(C)
41
oral LP mgt principles
1. aim-symptoms/ulcers/malignancy monitoring(0.4-5% transformation),biopsy 2.educate:smoking/alcohol/diet; oral hygiene, remove dental amalgam(97% benefit vs 40% +PT-amalgam, Me) 3. Rx oral candida, chlorhex mouthwash(plaque) triamcinolone,CI, topical CyA, PO pred5-10d/AZA/AM
42
PRP prognosis
Prognosis: classic(1,3, 80% 1-3 y remission)
43
Mgt- PRP
1. topical CS/calcineurin inhibitor 2. 1st:MTX+-acitretin(B) 2nd: Cya(C), AZA(C) 3rd: photoRx, (biologics) TNFa inhibitor(B)-etanercept, adalimumab infliximab, ustekinumab(C)( IL 12-23 inhibitor)
44
DRESS prognosis, Rx:
10% mortality, systemic involvement | supportive, pred(B), tapered 6-8w; other: pulse methylpred, CyA
45
AGEP Prognosis, Rx:
1. self limiting favorable 2. admit, BP/T, withdrawal drug, supportive( topical cs/AH), 3. extensive: short course pred
46
what is the role of drug testing in AGEP? -sensitivity? | WHEN ?HOW?
patch testing sensitivity 80%, post 6w-6mo crushed tablet, dilute 30% petrolatum/water, 0.1-10%(SCAR), back, reading 48/96H/D7
47
GPP mgt
Rx: acitretin/CyA/MTX(B) +clox(antistaph) ; 2nd: biologic, PUVA
48
SJS -TEN supportive Rx
1. MDT, burns unit/prompt withdrawal causative drug/all unnecessary meds
49
SJS TEN Prognosis:
SCORTEN- mortality ( score 1-5) ( 40, malignancy, HR >120, BSA detachment>10%, urea>10mmol/L, glucose>14 mmol/L, HCO3-
50
SJS TEN specific Rx, EVIDENCE?
absent RCTs, ALL (B) 1. CyA(3-5mg/kgIBW/d,IV/PO until epitheliasation) open phase 2 trial reduced death rate/detachment progression) 2. IVIg( TD 2-3 g/kg Dx 3-4 d) SGH: trend towards increased mortality) 3. CS(SJS not TEN, 1-2mg/kg/d 3-7d, arrest dz progression/shortened recovery period) 4. Other: plasmapharesis, anti TNFa inhibitors
51
Counselling for CADR
1. Educated -avoidance medication/ class tolerated drugs(DPT) 2. Documentation - Medic Awas card, Annotations,Letter, medical records, CMIS 3. Xreactivity:
52
Counselling Xreactivity penicillin allergy?
1. β-lactam +sulfur ring a)chemical side chain similarity of cephalosporin to penicillin 2. 1st gen Cephalexin
53
Counselling Xreactivity anticonvulsants DRESS allergy?
1. avoid all other aromatic anticonvulsants, consider nonaromatic i.e. valproate(not acute -hepatitis) anticonvulsants; 2. 1deg relative- increased risk
54
Aromatic -anticonvulsant
carbamazepine, phenytoin, phenobarbital, lamotrigine, felbamate, oxycarbamazepine, zonisamide;
55
Non-aromatic - anticonvulsant
levetiracetam, valproic acid,
56
Rx Sarcoidosis- principles
Rx(lupus pernio/extent/disfigurement ): 1. potent topicals, ILK, 2. pred(1mg/kg/d 4-6w slow taper, AM(C), MTX(B) , 3. other ( surgery, IL chloroquine, thalidomide, tetracyclines)
57
Sweet's Prognosis, RX
benign untreated persist months spontaneous involution 30% recurrences 1. pred 0.5-1mg/kg/d-duration4-6w,tapering 2-3 months suppressive, 2. KI, dapsone, colcicine, NSAID, monitor T/FBC/CRP/ESR for response 3. Local symptomatic treatment(bulla, compresses); 4. evaluate for underlying malignancy
58
sarcoidosis associations?
Ax Malignancy-sarcoidosis lymphoma syndrome,(ROS, FHx, breast/testicle self exam, age appropriate cancer screen, yearly for 5 years, lifestyle) AI: thyroiditis, IDDM, Sjogrens, thrombocytopenia, haemolytic anemia
59
Rx PG
​​1.limited
60
Behcet's Rx
lidocaine/topical CS/ILK; colchicine/dapsone(B); Severe mucocutaneous- thalidomide, MTX, pred systemic: pred/AZA/MMF/Cya(B); CYP/IVig
61
Rx: M marinum | other?
single agent 6-12w Bactrim,mino, doxy,klacid surgical excision
62
leprosy Rx multibaciliary
(12-24DCR) | dapsone 100mg OD, clofazimine300mg x 1m, 50mg OD Rifampicin 600mg 1x m;
63
leprosy paucibaciliary:
6DR( Dapsone 100mg OD, rifampicin600mg 1xm)
64
leprosy mgt priciples
Notify, psychosocial support+ clinical assessment household contacts; discharge- clinical cure, -ve SSS, biopsy; 3m on Rx SSS, then 6 mo relapse rv, yearly SSS
65
Rx leprosy reaction Type 1:
refer infx, admission/limb immobilisation/symptomatic/orthop nerve decompression Type 1: ct MDT,pred ,
66
Rx leprosy reaction Type 2
type 2: ct MDT, pred
67
SPTCL Rx
Rx Solitary- surgical, RT,Prednisolone, CyA, MTX; Refractory / haemophagocytic syndrome Multiagent doxorubicin-based chemotherapy ± radiotherapy / stem-cell transplant
68
TB Rx(monitoring?)
``` notify, cutaneous infection, AFB c/s subtype , baseline glu(Z), VA, LFT, Cr, HIV, monitor LFT, VA,qm x 3m 2HREZ( 5,10,15, 25mg/kg/d)+ 4HR+ pyridoxine10mg OD ```
69
TBprognosis if untreated/treated?
untreated-risk of miliary dissemination,
70
CRP Rx
po minocycline 50% effective, isotret/acitretin/salicyclic acid, azithro
71
Prurigo pigmentosa Rx, prognosis
minocycline(antiinflammatory,neutrophil chemotaxis); dapsone, doxy,isotret/NBUVB,hydroquinone/azelaic; Px: good but relapsing
72
MF principles, RX
1. Goal-prevent disease progression ;Refer Cutaneous Lymphoma 2. MDT Oncologist / Radiation tumor( interferon; cost, convenience, toxicity Sepsis) 3. skin-directed treatment; Long term surveillance - (All B) Topical Steroids /nitrogen mustard/ tazarotene gel - PUVA(psolaren 0.6mg/kg/d) / Re-PUVA/Narrow band UVB - RT/EBT/ IFN-a; ECP; chemotherapy doxorubicin, cyclophosphamide, vincristine,prednisolone (CHOP). MonoclonaL Ab: denileukin diftitox, BMT
73
LYP/PCACL Prognosis?
Rx:excellent prognosis, size, surveillance- systemic lymphoma
74
LYP/PCACL Rx,
- Observation, Topical steroids imiquimod ; | - generalised with scarring -MTX PUVA / NBUVB,tazoretene -localized/large:Surgical excision, RT
75
PLEVA/PLC prognosis,
Prognosis: Spontaneously resolve several w/progress PLC(mo-y)
76
PLEVA/PLC Rx
Rx: PO Emycin 250mg qds >2m(B); tetra(C), photoRx/MTX/CyA(C)
77
extranodal NKT lymphoma prognosis, Rx
Rx poor prognosis; oncologist ,ENT ,Multiagent chemotherapy,radiotherapy
78
B Cell lymphomas prognosis
PCMZL upper limbs Excellent PCFCL H&N, trunk Excellent PCLBCL, LT,poor 5-year survival 50%
79
B Cell lymphomas PCMZL PCFCL RX
:localised Sx/RT Multifocal- Rx symptomatic ILK/ IFN-α/rituximab
80
PPK Mx:
self-paring/trim nails, avoid trauma/friction, emollient, PP soaks(blisters) Topical Keratolytics retinoids calcipotriol, acitretin
81
cGVHD
Rx: photoprotect,concomitant photosensitising(voriconazole*,levoflox) topicals, progressive(C) :po pred, AM, acitretin,photoRx(*malignancy) refer PT
82
aGVHD
Rx: topicals, PO pred/iv methylpred(1mg/kg BD) 50% controlled, 2nd: MMF, biologics
83
LSA
-Rx: 1.Control with ↓SE, 1st: superpotent topical CS 3m(B) circumcision(B) 2nd: >3m topical CS/TCI(lack safety data); surgery/dilator; 2.psychosexual counselling 3. VIN/genital SCC( X 2-5%)
84
EI
Rx: underlying cause, MTB, supportive- rest, stocking, NSAID, MMF, CS
85
HV
Photoprotect, tinted windows Phototherapy, b carotene fish oils AM, AZA, CyA Thalidomide
86
EPP
1) photoprotect VL (Ti,O, ZnO 400-410nm) 2) skin- b carotene m a MSH 3) cholestasis/cholelithiasis - cholestyramine/charcoal
87
RPC
Rx:topical(CS, retinoid, salicylic acid, methol)AH(doxepin)amitryptilline,CS retinoid,Abx, MTX,photoRx; avoid trauma/destructive-cryo laser ablation
88
cut mets
mgt:palliative/Sx/RT/hormonal/Chemo(large aggressive)
89
aneoderma
Rx: unsuccessful, ILK, aspirin/dapsone/antimalarials/surgical excision-scar formation
90
degos
Rx: aspirin, clopidogrel., heparin pentoxyfylline, no effective systemic
91
NLD
independent of glycemic control, potent topical/ILK, target microangiopathy (stanazolol, pentoxyfylline)
92
NXG
Rx: none recommended, alkylating(chlorambucil),PO/ILK pred, Sx, RT, AM, MTX
93
Rx: RDS
asymptomatic self limiting, destructive/disseminated- PO CS, RT, excision, thalidomide
94
Prognosis XD
prognosis: self healing/persistent/progressive-organ dysfunction+CNS
95
XD
Rx: RT(airway), cyclophosphamide(mucosal)
96
xanthoma-
Cx: acute pancreatits Rx: pharmacologic/dietary fibrates- gemfibrozil, fenofibrate ( dysbetalipoproteinemia- plane, tuberous); imcrease lipoprotein lipSe, reduce VLDL synthesis
97
Rx GA
Rx: AM,CyA, MTX, dapsone, PhotoRx, biologics
98
OFG
Rx: Topical corticosteroids;doxy/mino/dapsone/MTX/Clofazimine
99
rhinoscleroma-
Rx: surgical, 6w-6m single tetra/sulfonamide/cipro
100
alopecia mucinosa
surveillance-rpt Bx MF; primary-ILK/top CS+mino/isotret/AM(C)+-cephalexin infx)
101
cutaneous plasmacytosis
Rx: chronic relapsing, pred/TCI/ILK/PUVA/CPA, favorable prognosis, low malignant transformation, ,
102
rX Hailey hailey,
general-clothes,friction/sweat/botox, CS/CyA/MTX/biologics, infective-antmicrobial/iodosorb, surgical excision/grafting/ablative(co2/alex)
103
angosarc prognosis
prognosis 5% 5Y
104
melanoma margins+ LND?
Rx: margins MIS/2mm( 0.5/1/2 cm); acral/facial- Mohs | St 1/2-ELND no survival benefit , SLND( first mets site) improved dz free survival ( not overall)
105
melanoma adj rx
Adj: St2/3 high risk resected e.g. IFN-a Mets: palliative resection, RT, chemo( dacabarzine); immunoRx(IFN-a); molecular target( BRAF- vemurafenib; KIT- imatinib)
106
NMSC
Mgt: Low risk:Excision +4mm Margin /Photodynamic Therapy/5-Fluorouracil/ Imiquimod; High risk/SCC/nodular BCC- excision margin+4mm assessment; FU- 1/3/6 moX 5Y;High risk- life
107
MGT multiple NMSC high risk
1) FU 6-12mo,photoprotect, Low threshold Bx 2) Ablative,Acitretin,,Aggressive (Ex>6mm +margins;Mohs 3) Modulate immunosuppression /MTOR inhibitors
108
Acitretin dose chemoprevention
10 mg EODx2w; 10 mg ODx2w: 20 mg OD, upwards to 25mg or tail
109
Mgt: Low risk NMSC
Excision +4mm Margin | PDT/5-FU/ ImQd;
110
High risk/SCC/nodular BCC-
excision margin+4mm assessment | ; FU- 1/3/6 moX 5Y;
111
Vismodegib MOA indication
Vismodegib Hedgehog pathway inhibitor; FDA-failed surgical/RT advanced /metastatic BCC, Gorlin; response 14.7 -20.3 months
112
Vismodegib ADR
ADR muscle spasms, alopecia, taste loss, weight loss, fatigue

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