40.3 Psoriatic Drugs
4 min read•june 18, 2024
Psoriasis treatments come in many forms, from topical creams to powerful . Each type works differently to calm inflammation and slow skin cell growth. Understanding how these meds work helps us use them safely and effectively.
When using psoriasis drugs, it's crucial to watch for side effects and follow instructions carefully. Some can increase infection risk or cause other issues. Nurses play a key role in educating patients and monitoring for problems to ensure the best outcomes.
Psoriatic Drugs
Key features and mechanisms of action for common psoriasis medications
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- Topical treatments
- Corticosteroids reduce inflammation and slow skin cell growth by suppressing the immune system and decreasing the production of inflammatory mediators ()
- () regulate skin cell growth and differentiation by binding to vitamin D receptors and modulating gene expression
- () normalize skin cell growth and reduce inflammation by binding to retinoic acid receptors and regulating gene transcription
- (, pimecrolimus) suppress immune response and reduce inflammation by inhibiting the activity of calcineurin, a key enzyme in T-cell activation
- Systemic treatments
- inhibits DNA synthesis, reducing skin cell proliferation and inflammation by blocking the activity of dihydrofolate reductase, an enzyme essential for DNA replication
- suppresses T-cell activity, reducing inflammation by inhibiting calcineurin and preventing the production of inflammatory cytokines
- normalizes skin cell differentiation and reduces inflammation by binding to retinoic acid receptors and modulating gene expression
- inhibits , reducing inflammation by increasing intracellular levels of cyclic AMP, which suppresses the production of inflammatory mediators
- Biologic treatments
- TNF-α inhibitors (, , ) block TNF-α, reducing inflammation by neutralizing the activity of this pro-inflammatory cytokine
- ###/23_Inhibitors_0### () block IL-12 and , reducing inflammation by preventing the activation and differentiation of T-cells involved in the pathogenesis of psoriasis
- (, ) block , reducing inflammation by neutralizing the activity of this pro-inflammatory cytokine, which plays a central role in the development of psoriatic
Potential side effects, drug interactions, and contraindications of psoriatic treatments
- Topical treatments
- Side effects include skin irritation and thinning of the skin (atrophy) with long-term corticosteroid use
- Drug interactions are minimal for topical treatments
- Contraindications include hypersensitivity to active ingredients
- Systemic treatments
- Methotrexate
- Side effects include liver toxicity, bone marrow suppression, and gastrointestinal upset (nausea, vomiting, diarrhea)
- Drug interactions with NSAIDs, trimethoprim, and probenecid can increase the risk of toxicity
- Contraindications include pregnancy, liver disease, and immunodeficiency
- Cyclosporine
- Side effects include , hypertension, and increased risk of infections
- Drug interactions with statins, calcium channel blockers, and digoxin can increase the risk of adverse effects
- Contraindications include uncontrolled hypertension and renal insufficiency
- Acitretin
- Side effects include , dry skin and mucous membranes, and elevated liver enzymes
- Drug interactions with tetracyclines, methotrexate, and alcohol can increase the risk of adverse effects
- Contraindications include pregnancy and severe liver or kidney disease
- Apremilast
- Side effects include diarrhea, nausea, and upper respiratory tract infections
- Drug interactions with strong CYP3A4 inducers (rifampin) can decrease the effectiveness of apremilast
- Contraindications include hypersensitivity to apremilast
- Methotrexate
- Biologic treatments
- Side effects include increased risk of infections and injection site reactions (redness, swelling, pain)
- Drug interactions with live vaccines and other immunosuppressants can increase the risk of adverse effects
- Contraindications include active infections, malignancy, and heart failure (TNF-α inhibitors)
Essential nursing considerations when administering psoriasis medications
- Assess patient's understanding of the medication, dosage, and administration
- Monitor for adverse effects and report to the prescriber as needed
- Provide patient education on proper medication administration and storage
- Encourage adherence to the prescribed treatment regimen by discussing the importance of consistent use and addressing any barriers to adherence
- Assess patient's response to treatment and document findings in the medical record
- Perform baseline and periodic laboratory tests as ordered (liver function tests, complete blood count) to monitor for potential side effects
- Administer biologic treatments via subcutaneous injection or intravenous infusion as prescribed, ensuring proper technique and patient comfort
- Maintain a sterile technique when administering injectable medications to reduce the risk of infection
- Educate patients on signs and symptoms of infection (fever, chills, redness, swelling) and when to seek medical attention
Patient education plan for safe and effective use of psoriasis treatments
- Explain the purpose, action, and expected outcomes of the prescribed medication in plain language to promote understanding and adherence
- Demonstrate proper application of topical treatments and provide written instructions with step-by-step guidance and visual aids
- Teach patients how to self-administer injectable medications, if applicable, using a hands-on approach and providing opportunities for practice and feedback
- Emphasize the importance of adhering to the prescribed treatment regimen by discussing the benefits of consistent use and the potential consequences of non-adherence
- Discuss potential side effects and how to manage them, providing practical strategies and resources for symptom relief (moisturizers, cold compresses)
- Encourage patients to report any adverse effects or concerns to their healthcare provider promptly to ensure timely intervention and adjustments to the treatment plan
- Advise patients on lifestyle modifications that may improve psoriasis symptoms, such as stress reduction techniques (deep breathing, meditation) and regular use of moisturizing skin products
- Provide resources for additional information and support, including patient handouts, support groups, and reliable online sources (National Psoriasis Foundation)
- Schedule follow-up appointments to monitor treatment progress and adjust the plan as needed, ensuring regular communication and collaboration with the healthcare team
- Remind patients of the importance of regular check-ups and screenings, especially when using systemic or biologic treatments, to detect and prevent potential complications (infections, malignancies)
Key Terms to Review (65)
Acitretin: Acitretin is an oral retinoid used primarily to treat severe psoriasis. It works by modulating the growth of skin cells.
Adalimumab: Adalimumab is a monoclonal antibody used as an immunosuppressant to treat autoimmune conditions like rheumatoid arthritis and psoriasis. It works by inhibiting tumor necrosis factor-alpha (TNF-alpha), a substance in the body that causes inflammation.
Apremilast: Apremilast is an oral phosphodiesterase 4 (PDE4) inhibitor used in the treatment of psoriatic arthritis and plaque psoriasis. It works by modulating the immune response and reducing inflammation associated with these conditions.
Biologic psoriatic drugs: Biologic psoriatic drugs are medications derived from living organisms used to treat moderate to severe psoriasis by targeting specific parts of the immune system. These drugs help reduce inflammation and plaque formation on the skin.
Biologics: Biologics are complex drugs derived from living organisms, used to treat various medical conditions. They include proteins, nucleic acids, or cells that mimic natural substances in the body.
Biologics: Biologics are a class of drugs derived from living organisms, such as proteins, antibodies, or other biological substances. They are designed to target specific molecules or processes in the body, often used to treat complex diseases like autoimmune disorders, cancer, and infectious diseases.
Calcineurin Inhibitors: Calcineurin inhibitors are a class of immunosuppressant drugs that work by blocking the activity of the enzyme calcineurin, which is essential for the activation and proliferation of T-cells. These medications are commonly used to prevent organ rejection in transplant recipients and to manage autoimmune conditions like psoriasis.
Calcipotriene: Calcipotriene is a synthetic derivative of vitamin D3 used topically to treat plaque psoriasis. It helps regulate the growth and differentiation of skin cells.
ClobaDerm: ClobaDerm is a high-potency corticosteroid cream used to treat inflammatory skin conditions like psoriasis. It reduces inflammation, itching, and redness by suppressing immune responses in the skin.
Clobetasol: Clobetasol is a potent topical corticosteroid used to treat inflammatory skin conditions such as psoriasis. It works by reducing inflammation and suppressing the immune response in affected areas.
Coal tar lotion: Coal tar lotion is a topical medication used to treat skin conditions such as psoriasis and seborrheic dermatitis. It works by reducing scaling, itching, and inflammation.
Coal tar shampoo: Coal tar shampoo is a topical treatment used to alleviate symptoms of scalp psoriasis, dandruff, and seborrheic dermatitis. It works by slowing the growth of skin cells and reducing itching and scaling.
Cutar: Cutar is a topical corticosteroid used to reduce inflammation and alleviate symptoms of dermatologic disorders such as psoriasis. It helps to relieve itching, redness, and swelling on the affected skin areas.
Cyclosporine: Cyclosporine is an immunosuppressant drug primarily used to prevent organ rejection in transplant patients and to treat various autoimmune disorders. It works by inhibiting the activation and proliferation of T-cells, a critical component of the body's immune response.
Cytokines: Cytokines are small signaling proteins secreted by various cells in the body, particularly immune cells, that play a crucial role in regulating the immune response, inflammation, and other physiological processes. They act as chemical messengers, allowing cells to communicate with each other and coordinate their activities.
Dermovate: Dermovate is a potent topical corticosteroid used to treat inflammatory skin conditions like psoriasis and eczema. It helps reduce swelling, redness, and itching.
Enbrel: Enbrel (etanercept) is a biologic medication used to treat autoimmune conditions by inhibiting tumor necrosis factor (TNF). It is commonly prescribed for conditions such as rheumatoid arthritis and psoriasis.
Etanercept: Etanercept is a biologic medication that acts as a tumor necrosis factor (TNF) inhibitor, used primarily to treat autoimmune diseases such as rheumatoid arthritis and psoriasis. It works by binding to TNF, preventing it from interacting with its receptors and thereby reducing inflammation.
Etrivex: Etrivex is a brand name for clobetasol propionate shampoo, a potent topical corticosteroid used to treat scalp psoriasis. It helps reduce inflammation, itching, and redness associated with the condition.
Exorex: Exorex is a topical treatment primarily used to manage psoriasis. It contains coal tar, which helps to reduce scaling, itching, and inflammation associated with the condition.
Hepatotoxicity: Hepatotoxicity is the occurrence of liver damage due to exposure to certain substances, including drugs. It can lead to serious health complications and requires careful monitoring.
Hepatotoxicity: Hepatotoxicity refers to the potential for certain drugs, chemicals, or other substances to cause liver damage or dysfunction. It is a critical consideration in the development and use of various medications and treatments.
Humira: Humira (adalimumab) is a biologic medication used to reduce inflammation by inhibiting tumor necrosis factor-alpha (TNF-alpha). It is commonly prescribed for autoimmune conditions such as rheumatoid arthritis and psoriasis.
IL-12: IL-12 is a pro-inflammatory cytokine that plays a crucial role in the immune response and the pathogenesis of various autoimmune and inflammatory diseases, including psoriasis. It is a key regulator of the Th1 immune response and promotes the differentiation of naive T cells into Th1 cells.
IL-12/23 Inhibitors: IL-12/23 inhibitors are a class of medications that work by blocking the action of two specific cytokines, interleukin-12 (IL-12) and interleukin-23 (IL-23), which are involved in the inflammatory response associated with certain autoimmune and inflammatory skin conditions, such as psoriasis.
IL-17: IL-17, also known as interleukin-17, is a pro-inflammatory cytokine that plays a crucial role in the pathogenesis of various autoimmune and inflammatory disorders, including psoriasis. It is primarily produced by a specialized subset of T cells called Th17 cells and acts as a key mediator in the inflammatory response.
IL-17 Inhibitors: IL-17 inhibitors are a class of biologic drugs that target and block the activity of the interleukin-17 (IL-17) cytokine, which plays a central role in the development and progression of certain inflammatory conditions, such as psoriasis.
IL-23: IL-23 is a pro-inflammatory cytokine that plays a crucial role in the pathogenesis of psoriasis, a chronic inflammatory skin condition. It is a heterodimeric protein composed of the p19 and p40 subunits, which together stimulate the differentiation and proliferation of Th17 cells, a subset of T helper cells that are central to the development of psoriatic lesions.
Immunomodulators: Immunomodulators are a class of drugs that can alter the immune system's response, either by enhancing or suppressing it. These agents are used in the treatment of various autoimmune disorders and conditions where the immune system plays a central role, such as multiple sclerosis and psoriasis.
Infliximab: Infliximab is a monoclonal antibody used as an immunosuppressant to treat various inflammatory diseases. It works by inhibiting tumor necrosis factor-alpha (TNF-α), a substance in the body that causes inflammation.
Ixekizumab: Ixekizumab is a monoclonal antibody that selectively binds to and neutralizes the pro-inflammatory cytokine interleukin-17A (IL-17A), which plays a crucial role in the pathogenesis of psoriasis and other inflammatory conditions. By inhibiting the activity of IL-17A, ixekizumab helps reduce the symptoms and progression of psoriatic disease.
Keratinocytes: Keratinocytes are the predominant cell type in the epidermis, the outermost layer of the skin. They are responsible for the production of keratin, a structural protein that provides strength and protection to the skin.
Methotrexate: Methotrexate is a chemotherapeutic and immunosuppressive drug used to treat various conditions, including cancer, autoimmune disorders, and inflammatory diseases. It works by inhibiting the enzyme dihydrofolate reductase, which is essential for the synthesis of DNA and cell division, thereby disrupting the growth and proliferation of rapidly dividing cells.
Methoxsalen: Methoxsalen is a psoralen derivative used in combination with UVA light therapy to treat severe psoriasis. It works by making the skin more sensitive to ultraviolet light, which helps control rapid cell growth.
Nephrotoxicity: Nephrotoxicity refers to the harmful effects that certain drugs, chemicals, or toxins can have on the kidneys, leading to impaired kidney function or damage. This is an important consideration when prescribing or administering medications, as many drugs can potentially cause nephrotoxicity if not monitored and managed properly.
Oxsoralen: Oxsoralen is a medication used in photochemotherapy, primarily for the treatment of severe psoriasis. It is a form of psoralen that sensitizes the skin to ultraviolet light.
PASI Score: The Psoriasis Area and Severity Index (PASI) is a widely used tool to assess the severity and extent of psoriasis, a chronic inflammatory skin condition. The PASI score provides a quantitative measure of the disease's impact, which is crucial for evaluating treatment effectiveness and guiding clinical decision-making.
Pediatric clients: Pediatric clients are children and adolescents who require medical care, including pharmacological treatments. Special considerations must be made for their unique physiological and developmental needs.
Phosphodiesterase-4: Phosphodiesterase-4 (PDE4) is an enzyme that plays a crucial role in the regulation of cellular processes, particularly in the context of inflammatory and immune responses. It is a member of the phosphodiesterase family, responsible for the degradation of the second messenger molecule, cyclic adenosine monophosphate (cAMP), which is involved in various signaling pathways.
Phototherapy: Phototherapy is a medical treatment that uses controlled exposure to specific wavelengths of light, typically ultraviolet (UV) light, to treat various skin conditions, including psoriasis. It is a commonly used approach in the management of psoriatic disorders.
Plaque Psoriasis: Plaque psoriasis is a common chronic inflammatory skin condition characterized by the formation of raised, red, and scaly patches or plaques on the skin. It is the most prevalent type of psoriasis, affecting up to 90% of people with this autoimmune disorder.
Plaques: Plaques are abnormal accumulations of protein or other substances that form in tissues and organs. In the context of multiple sclerosis, plaques are areas of damaged myelin in the central nervous system.
Polyderm: Polyderm is a topical medication used to treat psoriatic lesions. It contains a combination of active ingredients that reduce inflammation, slow down the growth of skin cells, and alleviate itching.
Psoriatic Arthritis: Psoriatic arthritis is an autoimmune disorder that causes joint inflammation and pain, often in people who also have the skin condition psoriasis. It is a chronic, progressive form of arthritis that can lead to significant joint damage and disability if left untreated.
Psoriderm: Psoriderm is a topical medication used to manage and treat the symptoms of psoriasis, including redness, scaling, and itching. It typically contains coal tar as its active ingredient.
Remicade: Remicade (infliximab) is a monoclonal antibody used to treat autoimmune conditions by inhibiting tumor necrosis factor-alpha (TNF-α). It is commonly used for conditions like Crohn's disease, ulcerative colitis, rheumatoid arthritis, and psoriasis.
Retinoids: Retinoids are a class of chemical compounds derived from vitamin A that are used to regulate epithelial cell growth. They are commonly used in the treatment of various dermatologic disorders, including psoriasis.
Retinoids: Retinoids are a class of chemical compounds that are structurally and functionally related to vitamin A. They are known for their diverse therapeutic applications, particularly in the treatment of acne and psoriasis.
Secukinumab: Secukinumab is a human monoclonal antibody that selectively binds to and neutralizes the proinflammatory cytokine interleukin-17A (IL-17A). It is primarily used for the treatment of plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis by reducing inflammation and improving the symptoms associated with these autoimmune disorders.
Soritane: Soritane, also known as acitretin, is an oral retinoid used in the treatment of severe psoriasis. It works by normalizing skin cell growth and reducing inflammation.
Stellara: Stellara is a biologic medication used to treat moderate to severe plaque psoriasis and psoriatic arthritis. It works by targeting specific proteins in the immune system to reduce inflammation and slow the overproduction of skin cells.
Systemic psoriatic drugs: Systemic psoriatic drugs are medications taken orally or by injection that work throughout the entire body to treat moderate to severe psoriasis. These drugs include biologics, oral retinoids, and immunosuppressants.
Systemic Therapy: Systemic therapy refers to the administration of medications or treatments that affect the entire body, rather than targeting a specific area or organ. It is a crucial approach in the management of various medical conditions, including psoriasis, where the goal is to address the underlying systemic nature of the disease.
Tacrolimus: Tacrolimus is an immunosuppressant drug primarily used to prevent organ rejection in transplant patients. It works by inhibiting the activation and proliferation of T-cells, thereby reducing the body's immune response and lowering the risk of graft rejection. Tacrolimus is also utilized in the treatment of certain dermatological conditions, such as psoriasis and atopic dermatitis, due to its anti-inflammatory properties.
Tazarotene: Tazarotene is a topical retinoid used in the treatment of acne and psoriasis. It works by modulating skin cell proliferation and differentiation.
Tazorac: Tazorac is a brand name for tazarotene, a topical retinoid used primarily to treat acne and psoriasis. It works by affecting the growth of skin cells and reducing inflammation.
Teratogenicity: Teratogenicity refers to the ability of a substance, such as a drug or chemical, to cause developmental abnormalities or birth defects in a developing fetus. It is a crucial consideration in the context of various medical conditions and treatments.
TNF-alpha: TNF-alpha, or Tumor Necrosis Factor-alpha, is a pro-inflammatory cytokine that plays a central role in the pathogenesis of psoriasis. It is a key mediator of the inflammatory response and is involved in the regulation of immune cells, apoptosis, and cellular homeostasis.
TNF-alpha Inhibitors: TNF-alpha inhibitors are a class of medications that block the activity of the inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha). These drugs are primarily used to treat autoimmune and inflammatory conditions, such as psoriasis, by reducing the immune system's overactive response.
Topical Corticosteroids: Topical corticosteroids are a class of anti-inflammatory medications that are applied directly to the skin to treat various dermatological conditions. They work by reducing inflammation, itching, and redness in the affected areas.
Topical psoriatic drugs: Topical psoriatic drugs are medications applied directly to the skin to manage symptoms of psoriasis. They aim to reduce inflammation, slow skin cell growth, and alleviate scaling and itching.
Triamcinolone: Triamcinolone is a synthetic corticosteroid medication used to treat a variety of inflammatory skin conditions, including psoriasis, eczema, and dermatitis. It is also utilized in the management of other dermatological conditions and as a topical treatment for burns.
Ultraviolet (UV) light therapy: Ultraviolet (UV) light therapy involves the use of UV light to treat various skin conditions, including psoriasis. It helps by slowing down the excessive growth of skin cells.
Ustekinumab: Ustekinumab is a monoclonal antibody used to treat moderate to severe plaque psoriasis, psoriatic arthritis, and Crohn's disease. It works by targeting interleukin-12 (IL-12) and interleukin-23 (IL-23), which are involved in inflammatory processes.
Vitamin D Analogs: Vitamin D analogs are synthetic derivatives of vitamin D that mimic the actions of the active form of vitamin D, calcitriol. They are primarily used in the treatment of psoriasis, a chronic skin condition characterized by the abnormal growth and shedding of skin cells.