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Dermatology > Common Drugs & Topical Dermatologic Medications > Flashcards

Common Drugs & Topical Dermatologic Medications Flashcards

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Dermatology Board Prep flashcards
1
Q

Oral Antifungals

A

Used for scalp and nail fungal disorders - need systemic drugs

Scalp: Griseofulvin is 1st line, Terbinafine (Lamisil) 2nd line

Nails: Terbinafine (Lamisil) 1st line, Itraconazole (Sporanox) 2nd line

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2
Q

Griseofulvin

A

1st line tinea capitis

MOA: fungistatic - inhibits cells division, binds human keratin - makes resistant to fungal invasion

Take w/ food for GI, fatty meal to increase absorption

Microsize - variable absorption; Ultramicrosize 1.5X absorption micro

CI: liver failure, porphyria, pregnancy (X), breast-feeding

Caution w/ Hx PCN allergy

SE: Photosensitivity, SJS/TEN, granulocytopenia, lupus-like syndrome

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3
Q

Terbinafine (Lamisil)

A

1st line for onychomycosis; 2nd line for tinea capitis

MOA: Creates ergosterol deficiency w/in fungal wall = cell wall

Superior for Trichophyton, not Microsporum

Hepatic metabolism

SE: HA, D, elevated LFTs, monitoring AST/ALT, weight loss

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4
Q

Itraconazole (Sporanox)

A

2nd line for onchomycosis

BBW: Negative inotropic effect after IV administration - D/C or reassess if heart failure occurs during treatment

CI: ventricular dysfunction, pregnancy, CHF, other CYP450 inhibitors

Capsules best absorbed in food, solution best w/ empty stomach

SE: N/D, edema, HA, rash, CHF, arrhythmia, hearing loss

Monitor: baseline and monthly LFTs, serum concentrations 2 wks after therapy

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5
Q

5-Alpha-reductase Inhibitor

A

Finasteride (Propecia)

1st line for androgenic alopecia in men - inhibits DHT conversion

Lower dose Proscar - lowers PSA after 6 months of use

More effective @ onset, 25% efficacy after 2 yrs therapy

SE: sexual dysfunction, gynecomastia, testicular pain, orthostatic, dizzy, depression, weakness

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6
Q

Common Antibiotics used in Derm

A

Cephalexin (Keflex) - covers staph and strep, not MRSA

Mupirocin (Bactroban) - for impetigo, covers MRSA

Tetracyclines (Doxy, Minocycline) - Direct anti-inflammatory effects

-Tick-borne, Acne, Rosacea, MRSA coverage

Clindamycin - Acne, rosacea, avoid w/ C. diff

-Use w/ benzyl peroxide

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7
Q

Isotretinoin (Accutane)

A

Severe recalcitrant, nodular (>5mm) acne

MOA: Irreversibly shrinks sebaceous glands, decreases sebum production and # sebum-dependent Propionibacterium acnes

Only medication that permanently alters course of acne

SE: very dry, ocular sx w/ meibomian gland dysfunction, depression, hypertriglyceridemia and elevated total and LDL cholesterol

Monitor: CBC, lipids, LFTs baseline, 4 wks, 8 wk

DC if TG >800, LFTs 3X upper normal limit

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8
Q

Topical Calcineurin Inhibitors

A

Tacrolimus (Protopic) - 2 ointment strengths, SE burning, HA, erythema

Pimecrolimus (Elidel) - cream, 1 strength, less burning

For atopic dermatitis, lichen planus, vitiligo, psoriasis

MOA: inhibits T-lymphocyte activation to decrease AI response

BBW for increased risk skin and lymphoma cancers

CI: <2 yo, systemic immunosuppressants, immunocompromise

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9
Q

Drug-induced lupus-like syndrome

A

Arthralgia, myalgia, malaise, fever, rash, serositis (inflammation serous lining)

They’ve usually been on the drug for >1 month

Tx: Stop drug - usually spontaneously resolve, sx treatment w/ NSAIDS

-Hydroxychloroquine if not after 4-8 weeks, +/- systemic steroids for quick relief in case of pleurisy/pericarditis

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10
Q

Correct vehicles for the types of inflammation

A

Acute inflammation = aqueous drying preparation

Chronic inflammation = greasy, lubricating coumpound

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11
Q

Tachyphylaxis

A

Progressive decrease in clinical response w/ repeated applications

-Body becomes tolerant to the pharmaceutical effect of drug

To prevent: drug holidays, switch between alternative agents

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12
Q

Powder

Solution

Tincture

A

Powder: absorb moisture, decrease friction - good for wide intertriginous areas

Solution: Lotion w/ minimal oil/solid component + active ingredient

Tincture: ETOH/HydroETOH solution - causes pain and irritation w/ erosions or abrasions

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13
Q

Lotions

Creams

Ointments

A

Lotions: least potent, powder suspension in water - drying, cooling w/ evaporation - useful w/ hairy/large areas

-Emollient lotions: oils dispersed in water w/ surfactant - leave reside

Creams: Middle potency; semisolid emulsions of equal oil&water

-Penetrate stratum corneum well, preservatives = more SE

Ointment: Most potent; water droplets suspended in oil/petrol

-Facilitate heat retention

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14
Q

Gels

Aerosols/Sprays

Foams

Shampoo

A

Gels: Drying w/ hydrophilic base - good for exudative inflammation, scalp/hairy, acne

Aerosols/Sprays: Drying w/ ETOH base - best for scalp

Foams: Drying - pressurized bubbles in liquid film

Shampoo: Seborrheic dermatitis

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15
Q

Topical Corticosteroids

A

MOA: pass stratum corneum to cause vasoconstriction, decrease inflammation, and decrease cellular proliferation

TOC for most inflammatory conditions - pruritic eruptions, dermatitis, hyperplastic dx (psoriasis), infiltrative dx (sarcoid)

Use sparingly on face and genitals, don’t use potent <12 yo, suppress hypothalamic-pituitary systems

Absorption increased with hydrated or inflamed skin

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16
Q

Topical Corticosteroid Classes and Typical Uses

A

Class I = super potent - reserved typically for palms & soles

Class II-III = potent - don’t use on face or intertriginous

Class IV-V = Intermediate - for large areas

Class VI-VII = Mild - for eyelid & genitals, rare SE, treat in 1-2 wk intervals

Face, intertriginous, genitals most susceptible to atrophy, telangiectasia, acneiform eruption

17
Q

Topical Antibacterials and Coverage

A

Bactroban (Mupirocin) - Staph (+MRSA), Strep, E. coli, H. flu, N. gonorrhea

Neomycin - G- except pseudomonas, 50X staph power of Bacitracin, greater allergy sensitivity

Gentamycin - Pseudomonas, staph, GABHS

Silver Sulfadiazine (Silvadine) - Staph, Pseudomonas, Candida

  • Sulfa allergy crossover, SE leukopenia w/ burns
  • used for 2nd/3rd degree burns & chronic ulcers
18
Q

Topical Antifungal Agents

A

Polyene Class

Allyamine Class

Imadazole Class

Ciclopirox Olamine (Loprox)

Selenium Sulfide

Tolnaftate

19
Q

Polyene Class

A

Topical antifungal - bind ergosterol in cells membrane to make more permeable

Nystatin - Candida of skin and mucous membrane, poor oral absorption so no systemic/cutaneous benefit

Amphotericin B - Superficial Candida, ineffective w/ dermatophytes or tinea versicolor

-May stain clothes/skin yellow-orange

20
Q

Allylamine Class

A

Topical Antifungal - Inhibit squaline epoxidase (ergosterol synthesis enzyme)

Terbinafine (Lamisil) - OTC for dermatophytes

Naftifine (Naftin) - Rx for Tinea corporis, cruris, versicolor

21
Q

Imidazole Class

A

Topical antifungal - Inhibit lanosterol 14-alpha-demethylase enzyme (no lanosterol conversion to ergosterol)

Clotrimazole (Lotrimin, Mycelex) - OTC for tinea corporis, pedis, cruris, versicolor

Miconazole (Monistat) - OTC for all tineas and Candida vaginal infections

Ketoconazole (Nizoral) - Rx cream for tinea & Candida; OTC & Rx Shampoo for seborrheic dermatitis

Econazole (Spectazole) - Rx cream for all tineas

22
Q

Ciclopirox Olamine (Loprox)

A

Topical Antifungal - Rx, broad spectrum hydroxypyridine agent

Cream/lotion: dermatophytes, Candida albicans, Tinea versicolor

Penlac nail lacquer: mild/moderate onychomycosis

23
Q

Selenium Sulfide (Selsun, Exsel)

A

Topical Antifungal - OTC antimitotic, antibacterial, antifungal

Seborrheic dermatitis and tinea versicolor

24
Q

Tolnaftate (Tinactin, Cruex)

A

Topical Antifungal - OTC inhibits squalene epoxidase

Works against tinea versicolor, all dermatophyte fungi

Ineffective against Candida albicans

25
Q

Acne Preparations

A

Azelaic Acid

Benzoyl Peroxide

Topical Retinoids - Retinoic Acid

Topical Antibacterials

26
Q

Azelaic Acid

A

Reduces P. acnes population, reduces shedding and inflammation - naturally occurring on skin

Effective for mild/moderate inflammation, non-inflammatory, and dark spots - well tolerated

SE: drying, lightening of skin

Azelex, Finacea gel and cream

27
Q

Benzoyl Peroxide

A

OTC - Kills P. acnes, no anti-inflammatory effect

Improves effectiveness (topical) and reduces resistance (oral) w/ antibiotics

SE: Irritation, bleach hair & fabric, allergy

28
Q

Topical Retinoids

A

Vitamin A derivative - primarily anti-inflammatory, unclog pores and prevent comedone formation

Retinoic Acid (Retin-A): increases epithelial cell turnover, promotes collagen synthesis and angiogenesis

  • Adapalene (Differin) - less irritating, mild retinoid
  • Tazarolene (Tazorac) - only >12 yo, prego X - also useful w/ psoriasis

Benzyl peroxide inactivates - use at different times

29
Q

Topical Antibacterials for Acne

A

Oral build up resistance

Clindamycin: often + Benzoyl, good w/ P.acnes, well tolerated w/ less irritation

Erythromycin: 1st line, use w/ benzoyl - no monotherapy

Sodium Sulfacetamide: acne vulgaris and rosacea - CI w/ sulfa allergy

Dapsone 5%: anti-inflammatory & antibacterial - turns skin orange

30
Q

Topical Meds for Parasitic Infections

A

Permethrin Cream - OTC & Rx for lice & scabies - DOC for kids, apply to entire body

Lindane lotion - alternative for older kids/adults

Ivermectin (Stromectol) - oral, 1X and again 2 wks

-Good for severe infestation w/ weakened immune system

31
Q

Topical Immunosuppressants

A

Calcineurin Inhibitors - 2nd line for atopic dermatitis on face, eyelids, neck, skin folds - less SE than topical steroids

MOA: inhibit cytokine production, decrease T cell activation

BBW for increased cancer risk - avoid <2yo or for extended periods or in immunocompromised pts

32
Q

Topical Medications for Skin Cancer and Actinic Keratosis

A

5-FU (Efudex)

Imoquimod

33
Q

5-FU (Efudex)

A

MOA: Interfere w/ DNA synthesis in fast growing cells

Actinic keratosis & low-grade basal cell skin cancer

Causes burning, peeling, blistering skin - avoid sun

34
Q

Imiquimod

A

MOA: Immunomodifier, promotes apoptosis in skin cancer cells

For basal cell cancer, actinic keratosis, genitals warts

Causes burning, peeling blistering skin + systemic fatigue and flu-like illness

Do not use in pts w/ other cancers

Dermatology (6 decks)

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