Case 1 - Actinic Keratosis Drugs

Question 1

States the two pharmaceutical drugs used to treat Actinic Keratosis and their formulations

Answer 1

5-Fluorouracil (cream)

Imiquimod (cream)

Question 2

Describe the mode of action of Fluorouracil

Answer 2

Incorporates into RNA, in turn inhibiting DNA replication and destroying cancerous cells

Question 3

Describe the mode of action of Imiquimod

Answer 3

An immune response modifier, with anti-viral and anti-tumour action secondary to local cytokine induction in the skin

Question 4

Describe the adverse effects of Fluorouracil

Answer 4

Erythema, then scaling, tenderness, erosion, ulceration and necrosis.

Pain, burning, pruritus, rash, hyperpigmentation, photosensitivity.

Question 5

Describe the adverse effects of Imiquimod

Answer 5

Erythema, erosion, excoriation/flaking, oedema and itching of affected skin

Hyper/hypo-pigmentation, flu-like symptoms, reduction in haemoglobin, white blood cell count, etc.

Question 6

Discuss the use of Fluorouracil and Imiquimod in pregnant women or women of of child-bearing age

Answer 6

Fluorouracil - avoid using on pregnant or breast feeding women. Prescribe oral contraceptives alongside.

Imiquimod - use with caution on pregnant or breast-feeding women. Prescribe with oral contraceptives. If patient already pregnant, monitor closely.

Question 7

Describe patient advice of Fluorouracil

Answer 7

• Avoid excessive exposure to sunlight.

- Do not get cream in your eyes, nostrils or on your lips

Question 8

Describe the patient advice of Imiquimod

Answer 8

• May damage latex condoms and diaphragms.