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Medications to Treat Psoriasis | 마이메르시 MyMerci
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Medications to Treat Psoriasis

NCLEX Review Guide: Medications to Treat Psoriasis

Topical Medications

Corticosteroids

  • Betamethasone, clobetasol, and hydrocortisone are first-line treatments that reduce inflammation and suppress immune response in psoriatic plaques. Monitor for skin atrophy and systemic absorption with prolonged use.
  • Apply thin layer to affected areas 1-2 times daily, avoiding face and intertriginous areas for high-potency steroids. Taper gradually to prevent rebound flare-ups.

Vitamin D Analogues

  • Calcipotriene (Dovonex) slows skin cell growth and reduces scaling by normalizing keratinocyte differentiation. Common side effects include skin irritation and burning sensation.
  • Apply twice daily to affected areas, avoiding face and mucous membranes due to potential irritation. Maximum weekly dose is 100g to prevent hypercalcemia.

Key Points

  • Combination therapy with corticosteroids and vitamin D analogues often more effective than monotherapy
  • Rotate treatment sites to prevent local side effects
  • Patient education on proper application technique essential for therapeutic success

Systemic Medications

Methotrexate

  • Immunosuppressant that inhibits DNA synthesis in rapidly dividing cells, reducing psoriatic plaque formation. Requires baseline CBC, liver function tests, and renal function assessment.
  • Administered weekly (not daily) with folic acid supplementation to reduce toxicity. Monitor for hepatotoxicity, bone marrow suppression, and pulmonary fibrosis.

Biologics

  • TNF-alpha inhibitors (adalimumab, etanercept) block inflammatory cytokines responsible for psoriatic inflammation. Screen for tuberculosis and hepatitis B before initiating therapy.
  • Administered via subcutaneous injection with specific dosing schedules varying by medication. Monitor for increased infection risk and malignancy development.

Memory Aid: Methotrexate Monitoring

"MTX-LABS": M-ethotrexate requires T-esting X-tra L-iver A-nd B-lood S-tudies

Nursing Considerations

Patient Education

  1. Demonstrate proper application technique for topical medications using thin, even layers
  2. Educate about importance of medication adherence and gradual improvement timeline
  3. Discuss trigger avoidance including stress, infections, and certain medications
  4. Emphasize sun protection and moisturizing routine for optimal skin health

Clinical Scenario

A 45-year-old patient with moderate psoriasis is prescribed calcipotriene cream. The patient reports burning and irritation after application. Nursing Action: Assess application technique, recommend applying to slightly damp skin, and consider combination therapy with mild corticosteroid.

Key Points

  • Monitor for signs of infection in patients on immunosuppressive therapy
  • Assess psychosocial impact and provide emotional support
  • Coordinate care with dermatology for treatment optimization

Commonly Confused Points

Medication Mechanism Key Monitoring Major Side Effect
Methotrexate DNA synthesis inhibitor Weekly CBC, LFTs Hepatotoxicity
Corticosteroids Anti-inflammatory Skin atrophy Systemic absorption
Biologics Cytokine inhibition Infection screening Immunosuppression

Study Tip

"PSORIASIS": P-atient education, S-ystemic monitoring, O-ptimal application, R-otate sites, I-nfection screening, A-dherence crucial, S-ide effects, I-mmunosuppression risks, S-upport needed

Quick Check

  • ☐ Can identify first-line topical treatments for psoriasis
  • ☐ Understands methotrexate monitoring requirements
  • ☐ Knows infection screening for biologic therapy
  • ☐ Can teach proper topical application technique
  • ☐ Recognizes common side effects of each medication class

Common Pitfalls

  • Confusing daily vs. weekly dosing for methotrexate
  • Forgetting to screen for TB before starting biologics
  • Not educating about gradual improvement timeline
  • Overlooking psychosocial impact of visible skin condition

Remember: You're preparing to provide compassionate, evidence-based care for patients with chronic skin conditions. Your knowledge of these medications will help improve their quality of life and treatment outcomes. Stay confident in your studies!

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