IN THE CLINIC
IMMUNOLOGY
STRX
Tx of Plaque Psoriasis
Unit 2 review
100

What color is the plaque on the skin when psoriasis is present?

silver plaques

100

What are the APC cells located in the skin?

Macrophages, Langerhans Cells, Dendrites

100

What are the 5 layers of the epidermis?

Stratum Corneum

Stratum Lucidum

Stratum Granulosum

Stratum Spinosum

Stratum Basale

100

Name some non prescription Rx Tx methods for plaque psoriasis

using moisturizers and emollients that clear the plaques and minimize itchiness, avoiding picking scabs, dietary interventions

100

What are the three dermatophytes?

Microsporum

Trichophyton

Epidermophyton

200

Describe Nail Pitting

Nail pitting is when small depressions appear on the surface of the nails

200

What is the purpose of the cytokines in the skin (think specifically for psoriasis)

They increase keratinocyte proliferation 

200

In what part of our skin are langerhans cells present?  What is their function? Be specific. 

The stratum spinosum. Function is to act as an APC to T-cells

200

Explain why taking stelara (an immunosuppressant) could potentially help with this individual's plaque psoriasis?

Stelara decreases the activation of T-cells, which are normally over-excited (excrete lots of cytokines) and cause plaque psoriasis

200

How does humidity affect our ability to cool down when exercising?

It makes sweating less efficient in it's ability to release heat

300

What does natural history mean?

The natural history of disease is the course a disease takes in individual people from its pathological onset ("inception") until its eventual resolution through complete recovery or death.

300

What are some possible causes of the immune response that is triggered and results in plaque psoriasis?

Genetics component, Trauma, infection

300

Define parakeratosis and hyperkeratosis. Are they present in plaque psoriasis?

Parakeratosis- keratinization with retain nuclei in the stratum corneum


Hyperkeratosis-thickening of the stratum corneum due to an abnormal quantity of keratin present


Both are present in plaque psoriasis

300

What are some other drug alternatives to stelara?

Cimzia

Enbrel

Humira

300

What type of neurotransmitters and receptors does the sympathetic nervous system act on to cause vasoconstriction and vasodilation?

vasoconstriction: norepinephrine acts on alpha receptors (adrenergic) on smooth muscles

vasodilation: Ach acts on muscarinic (cholinergic) receptors

400

What are the normal histological findings of plaque psoriasis?

thin stratum basale, thickens in the other layers (mostly in the stratum corneum and stratum spinosum)


400

In what layer do neutrophils normally collect in the epidermis?

Stratum Corneum Layer

400

Describe the difference between a macule, papule, and plaque

Macule: discolored, flat, less than 5mm

Papule-raised, discolored, less than 5mm

plaque-elevated, firm, rough lesion with flat top and surface greater than 5mm

400

What are the pros and cons of treatment with stelara

pros-people treated stated that they felt better, and had more physical improvement compared to not using the medicine (placebo)


cons-increased risk of infection, increase risk for cancer, posterior reversible encephalopathy syndrome, and allergic reactions

400

Explain the characteristics of local anesthetics that contribute to their functionality. 

The aromatic ring makes it lipophilic, allowing it to cross the cell membrane into the cell. It is also a weak base because of the tertiary amine. This allows it to become ionized in the acidic environment within the cell, which activates the drug to bind intracellularly to the ion-gated sodium channel and cause them to close. 

500

If you wanted to run a full thickness biopsy of a plaque, what technique(s) would you use? 

excision, punch

500

What are the interleukins involved in the immuno response that leads to the development of plaque psoriasis?

IL12, IL23, IL17

500

Describe why the stratum spinosum is named the stratum spinosum. Also, what is the specific type of junction that is present?

Due to the "spines" of spot weld desmosomes that are present. 
500

Diagram the mechanism of action of Stelara

blocks interleukin 12 and 23, which normally help activate T-cells. It does this by binding to the p-40 subunit of both IL12 and IL 23 so they cannot bind to their receptors. 

500

Explain the mechanism of Azoles and Allylamines. Explain why Azoles are not toxic to humans. 

Give an example of azoles and allylamines

Azoles (such as itraconazole) inhibit the synthesis of Ergosterol, which is the lipid that is in the cell membrane of fungus. 

Allylamines (such as terbinafine) inhibit squalene epoxidase, which converts squalene to ergosterol. This causes an increase in the amount of squalene inside the cell and it is toxic to the cell.