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Derm Pharm 2020 > 2 - Topical and Intralesional Chemotherapeutic Agents > Flashcards

2 - Topical and Intralesional Chemotherapeutic Agents Flashcards

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Dermatology Board Prep flashcards
1
Q

5-FU is an antimetabolite and structural analog of uracil

A

True

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2
Q

5-FU and its metabolites are misincorporated into RNA and disrupt RNA synthesis

A

True

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3
Q

5-FU metabolites also block the function of thymidylate synthetase, interfering with DNA synthesis as well

A

True

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4
Q

Topical 5-FU is not significantly systemically absorbed

A

True

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5
Q

The selective effect allows the use of topical 5-FU over a broad area of skin without concern for damaging normal skin

A

True

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6
Q

5-FU is converted to 3 active metabolites:

(1) fluorodeoxyuridine monophosphate
(2) fluorodeoxyuridine triphosphate
(3) fluorouridine triphosphate

A

True

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7
Q

The key enzyme which converts 5-FU to dihydrofluorouracil is dihydropyrimidine dehydrogenase (DPD)

A

True

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8
Q

80% of 5-FU is catabolised in the liver

A

True

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9
Q

Topical 5-FU is used in the field treatment of AKs in that it is more selective for AK than for normal skin

A

True

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10
Q

Topical 5-FU is useful in the treatment of SCC in situ or superficial BCC

A

True

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11
Q

Topical 5-FU is not more effective than other treatments in the treatment of warts

A

True

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12
Q

Topical 5-FU may be useful in the treatment of multiple disseminated porokeratosis

A

True

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13
Q

Topical 5-FU is contraindicated in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency, the key enzyme in metabolism of 5-FU

A

True (should not be used due to a case of life threatening toxicity from topical 5-FU in a patient who had deficiency of DPD)

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14
Q

Topical 5-FU is contraindicated in pregnancy

A

True (pregnancy category X)

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15
Q

Allergic contact dermatitis has been reported in topical 5-FU use

A

True

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16
Q

Systemic adverse effects are rare in topical 5-FU use

A

True

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17
Q

The most common adverse effects from topical 5-FU use are localised to areas of treatment I.e. Erythema, irritation, burning, pain, pruritus, hypopigmentation, hyperpigmentation

A

True

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18
Q

Topical corticosteroids used concurrently with topical 5-FU and for 1-2 weeks beyond cessation of topical 5-FU application to relieve the inflammatory reaction does not impact on topical 5-FU efficacy

A

True

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19
Q

Mechlorethamine (Nitrogen Mustard) is an alkylating agent highly reactive with DNA as donation of alkyl groups to DNA disrupts normal cell function

A

True

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20
Q

The ultimate cause of cell death from Mechlorethamine (Nitrogen Mustard) is unknown

A

True

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21
Q

Topical Mechlorethamine (Nitrogen Mustard) is not systemically absorbed

A

True (no known significant systemic absorption of topical Nitrogen Mustard and no systemic toxicities from cutaneous absorption have been observed in long term use in Mycosis Fungoides)

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22
Q

The mechanism of action of topical Mechlorethamine (Nitrogen Mustard) is unknown

A

True

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23
Q

The primary indication for topical Mechlorethamine (Nitrogen Mustard) is the treatment of Mycosis Fungoides

A

True

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24
Q

Topical Mechlorethamine (Nitrogen Mustard) is not contraindicated in a previous history of multiple cutaneous SCCs

A

True (but need to use with caution if patients have had other skin damaging therapies such as radiation)

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25
Q

Irritant or allergic (delayed type hypersensitivity) contact dermatitis is the most common effect of topical Mechlorethamine (Nitrogen Mustard)

A

True (irritant contact dermatitis more common than allergic contact dermatitis)

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26
Q

Urticaria and anaphylactic reactions are rare in topical Mechlorethamine (Nitrogen Mustard)

A

True

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27
Q

Irritant contact dermatitis from topical Mechlorethamine (Nitrogen Mustard) is most common and particularly if used on the face or in skin folds

A

True

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28
Q

Allergic contact dermatitis is more common in topical Mechlorethamine (Nitrogen Mustard) aqueous formulation than ointment formulation

A

True

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29
Q

Irritant or contact dermatitis from topical Mechlorethamine (Nitrogen Mustard) can be managed by reducing the frequency of applications

A

True

30
Q

Irritant or contact dermatitis from topical Mechlorethamine (Nitrogen Mustard) can be managed by reducing the strength of the application

A

True

31
Q

Topical corticosteroids can be helpful in the management of Irritant or contact dermatitis from topical Mechlorethamine (Nitrogen Mustard)

A

True (Topical Mechlorethamine/Nitrogen Mustard can be discontinued briefly and topical corticosteroids applied to reduce the inflammation, after which the topical Mechlorethamine/Nitrogen Mustard can be restarted at a lower concentration)

32
Q

Patients with allergic contact dermatitis to topical Mechlorethamine (Nitrogen Mustard) can undergo a formal desensitisation protocol

A

True

33
Q

Non-melanoma skin cancers have been reported in patients treated with topical Mechlorethamine (Nitrogen Mustard)

A

True (although most of these patients were also treated with multiple skin damaging therapy i.e. Phototherapy or radiation, or used topical Mechlorethamine/Nitrogen Mustard in the genital areas)

34
Q

There is no evidence of increased risk for secondary cutaneous malignancy in non-genital skin with long term use of topical Mechlorethamine (Nitrogen Mustard) as monotherapy

A

True

35
Q

Post inflammatory hyperpigmentation or hypopigmentation from topical Mechlorethamine (Nitrogen Mustard) gradually improves with time

A

True

36
Q

Patients should not apply topical Mechlorethamine (Nitrogen Mustard) to genital skin

A

True (risk of secondary cutaneous malignancy)

37
Q

There are no large randomised trials comparing the efficacy of total skin topical Mechlorethamine (Nitrogen Mustard) application versus treatment of affected areas only

A

True

38
Q

Topical carmustine is a nitrosurea compound used in the treatment of Mycosis Fungoides

A

True

39
Q

Nitrosureas (I.e. carmustine @ BCNU) are DNA alkylating agents leading to interstrand or intrastrand cross-linking of DNA

A

True

40
Q

Topical carmustine (BCNU) is available in solution or ointment form

A

True (although experience with the ointment is considerably less than the solution and there are no published series of patients treated with this modality)

41
Q

Class I topical corticosteroids had less adverse reactions than topical carmustine (BCNU) ointment

A

True

42
Q

Erythema simulating a sunburn mainly in body folds is a common side effect from topical carmustine (BCNU) especially in the solution form

A

True (severe reactions are often followed by benign telengiectasias)

43
Q

Telengiectasias from topical carmustine (BCNU) solution are benign but may rarely persist for years

A

True (usually resolves within months)

44
Q

Irritant or allergic contact dermatitis may occur with topical carmustine (BCNU)

A

True (treatment must be stopped if moderate-severe erythema, pruritus develop during treatment)

45
Q

There is higher risk of systemic absorption from topical carmustine (BCNU) when used in children

A

True (higher body surface area in children -use with caution)

46
Q

Systemic absorption of topical carmustine (BCNU) may cause Bone marrow suppression including mild leukopenia and mild anaemia

A

True (thrombocytopenia has not been noted)

47
Q

Thrombocytopenia has not been noted from bone marrow suppression of systemic absorption of topical carmustine (BCNU)

A

True (only leukopenia and anaemia have been noted)

48
Q

The face, genitals and intertriginous areas are not treated with topical carmustine (BCNU) unless involved

A

True

49
Q

Intralesional chemotherapeutic agents used in Dermatology include Vinblastine, Vincristine and Bleomycin

A

True

50
Q

Vinblastine and vincristine are vinca alkaloids that disrupt microtubular function leading to arrest of cell division in metaphase and cell death

A

True

51
Q

Vinblastine and vincristine are vinca alkaloids used intralesionally for treatment of Kaposi’s sarcoma lesions

A

True

52
Q

Intralesional Vinblastine injections are painful

A

True (Lignocaine is added in an attempt to reduce injection pain although this did not reduce the pain of the injection)

53
Q

Lignocaine added to intralesional Vinblastine (to reduce pain of injection) did not reduce the efficacy of Vinblastine

A

True

54
Q

The therapeutic effect of intralesional Vinblastine is enhanced by injection of hyaluronidase before Vinblastine

A

True

55
Q

Intralesional Vinblastine adverse effects include pain, inflammation, blistering and post inflammatory hyperpigmentation

A

True

56
Q

Severe pain and ulceration is rare in intralesional Vincristine

A

True (erythema, burning pruritus more common)

57
Q

The overall response rate of classic Kaposi’s sarcoma nodular lesions to intralesional Vincristine was 99%

A

True

58
Q

Bleomycin is a fermentation product of the bacterium Streptococcus verticillus

A

True

59
Q

Intralesional Bleomycin may be used off label in viral warts, vascular anomalies keloids and hypertrophic scars

A

True

60
Q

Intralesional Bleomycin’s cytotoxic effect results from its ability to cause oxidative damage to the deoxyribose backbone of the DNA chain which lead to single and double stranded breaks in DNA

A

True

61
Q

Intralesional Bleomycin is not the first line agent in treatment of viral warts

A

True (used for treatment of viral warts refractory to standard therapies)

62
Q

Intralesional Bleomycin has demonstrated a slightly higher cure rate for MOSAIC plantar warts than other conventional therapies

A

True

63
Q

Intralesional Bleomycin resulted in complete resolution of infantile maxillofacial haemangiomas with no serious adverse effects

A

True

64
Q

Intralesional Bleomycin is a safe and effective treatment for macrocystic lymphatic malformations, superficial oral mucosal lymphatic malformations, and localised depot macrocystic lesions

A

True

65
Q

Pain is the most frequent adverse effect of intralesional Bleomycin

A

True (erythema with swelling, and burning sensation also may occur)

66
Q

Intralesional Bleomycin can cause blistering and tissue necrosis at the site of injection

A

True

67
Q

Intralesional Bleomycin has led to nail dystrophy or nail loss when used for periungual warts

A

True (care should be taken to avoid injecting into the nail matrix)

68
Q

Persistent Raynaud’s phenomenon, anaphylaxis, and flagellate hyperpigmentation are uncommon in intralesional Bleomycin

A

True (more common in intravenous administration)

69
Q

Intralesional Bleomycin should be injected directly into a wart in such a way so as to try to blanch it

A

True

70
Q

Topical chemotherapeutic agents include:

1) 5-Fluorouracil
(2) Mechlorethamine (nitrogen mustard
(3) Carmustine (BCNU)

A

True

71
Q

Intralesional chemotherapeutic agents include:

(1) Vinblastine
(2) Vincristine
(3) Bleomycin

A

True

Derm Pharm 2020 (47 decks)

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