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SG - Pharm 4 > Derm 4 > Flashcards

Derm 4 Flashcards

1
Q

What 3 agents reduce hyperpigmentation of the skin?

A
  • Hydroquinone
  • Mequinol
  • MBEH (monobenzyl ether of hydroquinone)
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2
Q

How do these reduce hyperpigmentation?

  • Hydroquinone
  • Mequinol
  • MBEH (monobenzyl ether of hydroquinone)
A

Inhibit tyrosinase, interfering with the biosynthesis of melanin

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3
Q

Temporary lightening

  • Can be combined w/ tretinoin or glycolic acid to speed up lightening
A
  • Hydroquinone
  • Mequinol
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4
Q

Irreversible depigmentation

  • May cause hypopigmentation at sites distant from the area of application
A

MBEH (Monobenzyl ether of hydroquinone)

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5
Q

What 2 agents help w/ reducing hypopigmentation?

A

Psoralens

  • Trioxsalen
  • Methoxypsoralen
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6
Q

What drugs?

  • Repigmentation of depigmented macules of vitiligo
  • Photo-activated by UVA light
  • Topical or oral psoralen
  • Risks of psoralen photochemotherapy
  • Cataracts and skin cancer
A

Psoralens

  • Trioxsalen
  • Methoxypsoralen
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7
Q

What are the 2 topical medications against sunlight?

A
  • Sunscreens
  • Sunblock
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8
Q

Which med against sunlight?

•Contain chemical compounds that absorb ultraviolet light

A

Sunscreens

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9
Q

Which med against sunlight?

•Contain opaque materials such as titanium dioxide that reflect light

A

Sunblock

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10
Q

What are the 3 classes of compounds used in sunscreens?

A
  • p-aminobenzoic acid (PABA) and its esters
    • Most effective available absorbers in the B region
  • benzophenones
    • Oxybenzone, dioxybenzone, and sulisobenzone
  • dibenzoylmethanes
    • Avobenzone
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11
Q

Sunscreens

  • SPF really only measures ___ protection
  • What chemical should you look for in sunscreen? (has complete UVA coverage)
  • ____ by L’Oreal was recently FDA approved and has better UVA/UVC coverage than ____
  • Apply __ mins before going out and replace every __ hours
A
  • UVB
  • Parsol 1789 or Avobenzone
  • Mexoryl (Antheliose)
  • 20 / 2
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12
Q

Broad spectrum sunscreens add what 3 things?

A
  • Oxybenzone
  • or
  • Avobenzone
  • and
  • Mexoryl
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13
Q

What is a new proposed sunscreen rating system?

A
  • UVA protection: 1-4 stars* (low/medium/high/very high protection)
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14
Q

Sunblocks

  • Contain ____ or ____
  • NO chemical rxn required to work (can go out immediately after application)
  • Not as good ___ coverage as sunscreen
  • Need to reapply ever __ hours
  • Apply large amounts to assure good coverage
A
  • zinc oxide paste / titanium dioxides
  • UVA
  • 2
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15
Q

_____ refers to the the process of breaking down or dissolving keratin. The result is a softening of the stratum corneum of the epidermis promoting peeling

A

Keratolytic / Destructive Agents

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16
Q

What are the 5 Keratolytic / Destructive Agents?

A
  • Salicylic acid
  • Urea
  • Podophyllum resin & podophyllotoxin
  • Fluorouracil
  • Aminolevulinic acid (ALA)
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17
Q

Which Keratolytic / Destructive Agent?

  • Used in as a keratolytic agent
  • Concentrations of 3-6%
  • Greater than 6%, destructive to tissues
  • Used in acne treatment, psoriasis, warts
  • Care must be exercised when using the drug on the extremities of diabetics or patients with peripheral vascular disease
A

Salicylic Acid

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18
Q

Which Keratolytic / Destructive Agent?

  • Softening and moisturizing effect on the stratum corneum
  • Makes creams and lotions “feel less greasy”
  • Humectant (increases water content of the stratum corneum) , used in concentrations of 2-20% in creams and lotions
    • Carmol 10, Nutraplus
  • Keratolytic agent, 20% concentration and greater
    • Hyperkeratosis of palms and soles
    • Carmol 20
  • Concentrations of 30-50% useful in softening the nail prior to avulsion
A

Urea

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19
Q

Which Keratolytic / Destructive Agent?

  • Major use of ______ - condyloma acuminatum
  • Application should be restricted to wart tissue only
  • Cytotoxic agent with specific affinity for mitotic spindle
  • Normal assembly of the spindle is prevented and epidermal mitoses are arrested
  • Wash off the preparation 2-3 hours after initial application
  • Contraindicated during pregnancy
A

Podophyllum Resin & Podophyllotoxin

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20
Q

Which Keratolytic / Destructive Agent?

  • Used topically for actinic keratoses
  • Erythema, vesiculation, erosion, superficial ulceration, necrosis, and reepithelialization
  • Healing process continues for 1-2 months after therapy is discontinued
  • Excessive exposure to sunlight during treatment increases the intensity of the reaction
A

Fluorouracil

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21
Q

What are the 5 drugs used for warts?

A
  • Salicylic acid
  • Topical retinoids
  • Podophyllum resin
  • Imiquimod
  • Trichloroacetic acid

(Pretty TITS)

22
Q

Which drug for warts?

  • Activates immune cells through the toll-like receptor 7 (TLR7)
  • Secrete cytokines (primarily interferon-α (INF-α), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)
  • Used for treatment of warts (FDA approved condylomata), actinic keratoses, basal cell and squamous cell carcinoma and lentigo maligna melanoma
A

Imiquimod

23
Q

Which drug for warts?

  • Condylomata
  • Caution: Serious injuries, including skin damage, burns, swelling, and pain may occur following improper application
A

Trichloroacetic Acid

24
Q
  • What are agents for hair growth called?
  • What are the 3 agents called?
A

Trichogenic Agents

  • Topical minoxidil (Rogaine)
  • Finasteride (Propecia)
  • Bimatoprost (Latisse)
25
Q

Which Trichogenic Agent?

  • Reversing the progressive miniaturization of scalp hairs in androgenic alopecia
  • Vertex balding is more responsive to therapy than frontal balding

•MOA: Stimulation of hair growth is secondary to vasodilation, increased cutaneous blood flow, and stimulation of resting hair follicles.

  • The effect is not permanent
  • Cessation will lead to hair loss in 4-6 months
A

Topical minoxidil (Rogaine)

26
Q

Which Trichogenic Agent?

Blocks production of dihydrotestosterone

  • Oral finasteride, 1 mg/d
  • Promotes hair growth
  • Prevents further hair loss in many men with androgenic alopecia
  • Not for use in women of child-bearing age
  • Treatment for at least 3-6 months is necessary
  • Adverse effects include: decreased libido, ejaculation disorders, and erectile dysfunction.
A

Finasteride (Propecia)

27
Q

Which Trichogenic Agent?

  • Prostaglandin analogue
  • Eyelashes
  • Adverse effects: red or itchy eyes, skin pigmentation, permanent brown pigmentation of iris
A

Bimatoprost (Latisse)

28
Q

What is the name of the Anti-Trichogenic Agent?

A

Eflornithine

29
Q

Anti-trichogenic Agent - Eflornithine

  • Irreversible inhibitor of _____ that catalyzes the biosynthesis of _____.
  • _____ required for cell division
  • (affects rate of hair growth)
  • Effective in reducing _____ in 30% of women when applied twice daily for ___ months
  • Return to pre-treatment levels __ weeks after discontinuation.
A
  • ornithine decarboxylase / polyamines
  • Polyamines
  • facial hair growth / 6 months
  • 8 weeks
30
Q

Treatment for Psoriasis

  • _____ psoriasis is most common
  • Well demarcated erythematous plaques with overlying _____.
  • ____ plaque psoriasis is typically symmetric & bilateral
  • Plaques may exhibit ____ (bleeding after removal of scale)
  • _______ (lesions induced after trauma)
  • Initial tx is generall ______
  • ______.
A
  • Plaque
  • silvery scale
  • Chronic
  • Auspitz sign
  • Koebner phenomenon
  • High potency topical steroid
  • Phototherapy
31
Q

Which Topical drug for Psoriasis?

  • Vitamin D3 analog
  • Cream, ointment or scalp solution
  • Rare reports of hypercalcemia
  • May be used in combination with topical steroids or in rotation
A

Dovonex

32
Q

Which Topical drug for Psoriasis?

  • Liquor carbonis detergens (LCD) and liquor picis carbonis (LPC)
  • Shampoo, soap and ointment
  • Treatment for dandruff and psoriasis
  • Denorex, Balnetar, Tegrin, T/Gel, and Neutar
A

Tars

33
Q

Which Topical drug for Psoriasis?

  • Binds to beta and gamma retinoid receptors
  • Topical synthetic retinoid general prescribed with topical corticosteroids
  • ADE-skin irritation, photosensitivity
  • Topical Retinoid
A

Tazarotene

34
Q

Which systemic drug for Psoriasis?

•Binds to alpha, beta and gamma retinoid receptors—inhibits expression of IL-6 (proinflammatory cytokine)

•MUST NOT be used by women who are pregnant or may become pregnant while undergoing treatment or at any time for at least 3 years after treatment is discontinued

  • Ethanol MUST be strictly avoided during treatment with acitretin and for 2 months after discontinuing therapy
  • Patients MUST NOT donate blood during treatment and for 3 years after acitretin is stopped
A

Retinoid metabolite

  • Acitretin
35
Q

Which systemic drug for Psoriasis?

  • Phosphodiesterase-4 enzyme inhibitor
  • decreases intracellular levels of cAMP
  • Decreases expression of inflammatory mediators
  • Such as IL-23, TNF-ɑ, nitric oxide synthase

ADEs

  • Diarrhea
  • Nausea
  • URI
A

Apremilast

36
Q

Which systemic drug for Psoriasis?

  • Folate antagonist
  • Prevents the action of folic acid on cellular function
  • 2.5mg and 10mg tablets and solution for injection
  • 15 mg Weekly, but can vary
  • Single or divided dose

Contraindications

  • Avoid in pregnancy and breastfeeding (category X)
  • Males are advised not to father children while on MTX or for at least 3 months afterwards
A

Methotrexate

37
Q

Which systemic drug for Psoriasis?

  • Should not be taken by patients with low blood counts (anemia, leukopenia, thrombocytopenia)
  • Not for patients with severe liver disease
  • Controversy about liver biopsy at accumulated 1.5 gm
  • Use with caution in patients with mild liver disease, kidney disease (CrCl < 50ml/min), infections, obesity or diabetes.

•Labs:

CBC, LFTs, Creatinine, Chest Xray

A

Methotrexate

38
Q

What are the 2 types of Biologic Agents for Psoriasis?

A
  • Tumor necrosis factor alpha (TNF alpha) blockers
    • Enbrel
    • Humira
    • Remicade
    • Simponi
    • Blocks excess cytokine
  • Interleukin 12/23
    • Stelara
    • associated w/ psoriasis inflammation
39
Q

Which Biologic Agent for Psoriasis?

  • Injected in legs, abd, arms typically by individual or family member
A
  • Enbrel
  • Humira
  • Simponi
40
Q

Which Biologic Agent for Psoriasis?

  • Subcutaneous injection by health care provider
A

Stelara

41
Q

Which Biologic Agent for Psoriasis?

  • IV infusion in office or infusion center
  • Half life: 9 days
  • Antibody
A

Remicade

42
Q

3 contraindications for Biologic Agents for Psoriasis

A
  • Immunocompromised
  • Active infection
  • Screen for tuberculosis (TB)
43
Q

2 risks of using biologic agents in Psoriasis

A
  • Increase risk of infection
  • Impact on developing fetuses or nursing infants is not known…
44
Q

3 common side effects of biologic agents for psoriasis

A
  • Respiratory infections
  • Flu-like symptoms
  • Injection site reactions
45
Q

Rare Side Effects of Biologic Agents for Psoriasis

A
  • Serious nervous system disorders
    • MS, szs, optic neuritis
  • Hemolytic anemia
  • Lymphoma
46
Q

Onset of benefit for immunotherapy / biologic agent?

(Humira, Enbrel, Remicade)

A

2 - 4 weeks

47
Q

Which Biologic Agent for Psoriasis?

  • Half life: 5 days
  • Receptor
A

Enbrel

48
Q

Which Biologic Agent for Psoriasis?

  • Half life: 12-14 days
  • Antibody
A

Humira

49
Q

SE of which Immunotherapy?

  • Injection site rxns, URI (colds, sinusitis, bronchitis)
A

Humira & Enbrel

50
Q

SE of which Immunotherapy?

  • Infusion rxns (itching, hives, rash, nausea, HA)
  • URI (colds, sinusitis, bronchitis)
A

Remicade

SG - Pharm 4 (16 decks)

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