Common Drugs & Topical Dermatologic Medications Flashcards
Oral Antifungals
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
Griseofulvin
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
Terbinafine (Lamisil)
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
Itraconazole (Sporanox)
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
5-Alpha-reductase Inhibitor
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
Common Antibiotics used in Derm
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
Isotretinoin (Accutane)
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
Topical Calcineurin Inhibitors
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
Drug-induced lupus-like syndrome
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
Correct vehicles for the types of inflammation
Acute inflammation = aqueous drying preparation
Chronic inflammation = greasy, lubricating coumpound
Tachyphylaxis
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
Powder
Solution
Tincture
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
Lotions
Creams
Ointments
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
Gels
Aerosols/Sprays
Foams
Shampoo
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
Topical Corticosteroids
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
Topical Corticosteroid Classes and Typical Uses
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
Topical Antibacterials and Coverage
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
Topical Antifungal Agents
Polyene Class
Allyamine Class
Imadazole Class
Ciclopirox Olamine (Loprox)
Selenium Sulfide
Tolnaftate
Polyene Class
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
Allylamine Class
Topical Antifungal - Inhibit squaline epoxidase (ergosterol synthesis enzyme)
Terbinafine (Lamisil) - OTC for dermatophytes
Naftifine (Naftin) - Rx for Tinea corporis, cruris, versicolor
Imidazole Class
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
Ciclopirox Olamine (Loprox)
Topical Antifungal - Rx, broad spectrum hydroxypyridine agent
Cream/lotion: dermatophytes, Candida albicans, Tinea versicolor
Penlac nail lacquer: mild/moderate onychomycosis
Selenium Sulfide (Selsun, Exsel)
Topical Antifungal - OTC antimitotic, antibacterial, antifungal
Seborrheic dermatitis and tinea versicolor
Tolnaftate (Tinactin, Cruex)
Topical Antifungal - OTC inhibits squalene epoxidase
Works against tinea versicolor, all dermatophyte fungi
Ineffective against Candida albicans
Acne Preparations
Azelaic Acid
Benzoyl Peroxide
Topical Retinoids - Retinoic Acid
Topical Antibacterials
Azelaic Acid
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
Benzoyl Peroxide
OTC - Kills P. acnes, no anti-inflammatory effect
Improves effectiveness (topical) and reduces resistance (oral) w/ antibiotics
SE: Irritation, bleach hair & fabric, allergy
Topical Retinoids
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
Topical Antibacterials for Acne
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
Topical Meds for Parasitic Infections
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
Topical Immunosuppressants
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
Topical Medications for Skin Cancer and Actinic Keratosis
5-FU (Efudex)
Imoquimod
5-FU (Efudex)
MOA: Interfere w/ DNA synthesis in fast growing cells
Actinic keratosis & low-grade basal cell skin cancer
Causes burning, peeling, blistering skin - avoid sun
Imiquimod
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
