Derm agents and conditions, allergic drug reactions*This is supposed to be in pharm* Flashcards
Methotrexate is what type of anti cancer drug
folate antimetabolite
Trastuzumab (Herceptin) is what kind of cancer treatment
Targeted therapy
A monoclonal antibody that attaches to HER2 receptors on breast cancer cells. This prevents the cells from growing and makes them a target for the immune system. (MAB)
Most MABs are what kind of cancer therapy
Targetted therapy- usually designed to target something specifically
If you get a medication (chemo) AFTER surgery or radiation, what kind of therapy is this
Adjuvant
If you get a medication (chemo) BEFORE surgery or radiation, what kind of therapy is this
Neoadjuvant
Anthracyclines (doxyrubicin) causes what kind of toxicity
Cardiomyopathy
Antimetabolites like hydroxyurea and methotrexate cause what toxicity
Pulmonary toxicity
What agent treats hormone receptor positive breast cancer
Aromatase inhibitors (Letrozole)
Inhibit estradiol receptors
Don’t want to expose patinet to more estradiol, decrease exposure
What drugs are most severe on immunosuppression
Induction chemotherapy drugs
Pegfilgrastim is an option for the treatment and prevention of
neutropenia
Based on Name- Gra (granulocytes) Stim (Stimulate)–> Stimulate granulocytes
What is an indication for systemic corticosteroids
Infusion reaction from MAB
Moderate immune toxicity from immunotherapy
Immune thrombocytopenia
How do you treat TLS
Resburicase and Allopurinol (anti uric acid)
Treatment for febrile neutropenia
Draw blood culture
Broad specturm antibiotics
G-CSFs
This term is for N/V despite optimal treatment to prevent it
Breakthrough
Contraindications to methotrexate use
Pregnancy and Severe renal impairment (needs renal to clear it)
Liver toxicity (any liver hx of chronic liver disease or cirrhosis, do not give)
What are some of the variables that affect pharmacological response
-Drug penetration (genitals, face, axilla are more permiable, need less drug)
-Concentration ( Higher concentration lead to more diffusion)
-Dosing schedule (Half life in the stratum corneum)
-Delivery vehicle (Ability to penetrate, Ointments>foams>creams>powders>aresols>gels>lotions>tinctures)
-Occlusion- apply plastic wrap so it stays on and traps heat
What is a super high potent steroid
Clobetasol and Halbetasol
What kind of steroid is clobetasol
High potency steroid
What kind of steroid is halbetasol
High potency steroid
What kind of steroid is triamcinolone
Moderate potency
What kind of steroid is triamcinolone
Moderate potency
What kind of steroid is hydrocortisone
Low potency
What is a low potency steroid
Hydrocortisone
What is a medium potency steroid
fluocinolone and triamcinolone
What derm conditions are highly responsive to steroids
Atopic dermatitis
Psoriasis of genitalia and face
–SO, only need low or moderate potency
Hydrocortisone or triamcinolone
What derm conditions are moderately responsive to steroids
Psoriasis of palms and soles
Lupus
Vitiligo
What derm conditions are least responsive to steroids
Alopecia, Acne cysts
What are toxicities of corticosteroids
Atrophic (purpura and striae (irreversable))
Perioral dermatits
Acne or rosacia
Delayed wound healing (DONT put on active wound)
How long do you perscribe class 1 steroids
Super high potent- 3 weeks
How long do you perscribe class 2-5steroids
12 weeks
How long do you perscribe class 6-7 steroids
No limit
Dietary triggers of acne
Skim milk
Whey protein
Comedone extraction
Comedonal non inflammatory acne treatment
Topical retinoids (benzoyl peroxide, azelaic acid, adapalene)
Mild acne treatment
Topical clindamycin/benzoyl peroxide/topical retinoids(adapalene)
Moderate acne treatment
PO Doxycycline or monocycline, benzoyl peroxide, topical retanoid (adapalene)
What are the topical retinoids
Adapalene, tretinoin, tazarotene
Severe nodules acne treatment
Isotrentinoin (and or oral contraceptives, spironalactone)
Targeted treatment of deep lesions for acne
Intralesional corticosteroid injection (triamcinolone acetonide
Safety concerns of retinoids
Retinoids are teratogenic- no pregnancy
Photosensitivity- sunburn risk
Retinization- Worse acne at first, and then better over time
Isotretinoin (acutane) Symptoms
Psychiatric
Decreased bone density and growth
Hypersensitivity reaction
Birth defects in pregnancy
Liver damage, high triglycerides
Black box warning for isotreninoin
Risk of life-threatening birth defects
What drug is an example of being in a REMS program
Isotretinoin has IPLEDGE registry and is in the REMS (Risk evaluation and mitigation strategy) program.
Topical antibiotic treatment for acne most commonly
Clindamycin (Antibacterial activity against C. acnes, anti-inflammatory)
Drugs ending in cycline commonly have what kind of side effect
They are photosensitive- need to wear sun protection outside
When to avoid doxyxycline (tetracyclines)
Avoid pregnancy, breastfeeding, children <8 due to bone and teeth growth impairment
How should you discontinue doxycycline in acne treatment
Taper to lowest effective dose- don’t just automatically discontinue
Should you perscribe tetracyclines as a monotherapy?
NO! Need to perscribe with benzoyl peroxide, or else it causes resistance, use for as short a duration as possible (3-4 months)
What is the androgen reducing agent for women to treat acne
Spironolactone
Antiandrogen agent
Inhibit testosterone
Alternative is Oral contraceptives
Suppress LH to decrease androgens
YAZ, Ortho tri cyclean, Estrostep
Where is atopic dermatitis located on the body
Eczema Flexor surfaces
Backs of knees, inside of elbows
What is the atopic triad
Asthma, allergic rhinitis, atopic dermatis
When do you use topical calcineurin inhibitors
For atopic dermatitis that’s mild
Topical corticosteroid (medium potency) then low
Topical Calcineurin inhibitors if you want to avoid corticsteroid
What are 2 topical calcineurin inhibitors
Tacrolimus ointment, primecrolimus cream
What medications inhibit T lymphocyte activation
Topical calcineurin inhibitors
What do you perscribe for Vitiligo, linchen planus, and psoriasis(alternate to steroids)
Calcineurin inhibitors
Silvery, scaley, extensor surfaces (elbow, Knee), what do you think?
Psiorasis
What comorbidities are associated with psoriasis
Arthritis (30%)
Psychological disorders
Diabetes, hypertension, obesity
alcoholism
What medicaitions exacerabate psoriasis
ACE inhibitors, beta blockers, lithium, NSAIDS, Discontinuation of systemic steroids (After they stop, their psoriasis might flare up)
Strep pharyngitis is a known trigger of what kind of psoriasis
Guttate psoriasis
Psoriasis treatment general flowchart
Topical–> phototherapy–> systemic —> biologics
Mild Limited: Topicals( Vitamin D, High or ultra high steroids, clobetasol)
Moderate-Severe: Systemic (Oral retinoids or methotrexate
Severe or refractory: Cyclosporine, TNF inhibitors, JAK inhibitors, MABs
Psoriatic ARTHRITIS treatment
Mild: NSAIDS (but, can trigger more plaques)
Moderate-Severe: Methotrexate, TNF inhibitors
Scalp psoriasis treatment
Coal Tar shampoo daily (overnight scalp treatment with shower cap and was hoff)
Salicylic acid gel, mineral oil, corticosteroid solution for scalp during day
Intertriginous region (inverse psoriasis) on genitals and face treatment
Caution with higher potency steroids
Consider Vitamin D or calcineurin inhibitors (tacrolimus)
Nails, palms, soles psoriasis treatment
Corticosteroid solution (highest potency– clobetasol)
Topical retinoids (tarzarotene for nail)
Vitamin D analogues
CALCIpotrine, CALCIpotriol, CALCItriol
Common symptoms of Vitamin D analogues
Burning, itching, mild irritation, dryness, photosensitivity, HYPERCALCEMIA (max dose is 100g per week)
What are Vitamin D analogues used to treat
Intertriginous region psoriasis (genitals and face)
Methotrexate for psoriasis contraindications and considerations
Contraindications: Pregnancy, alcoholic liver disease, immunodeficiency
Considerations: Pt could be at risk of renal impairment, take CBCs, CMPs, hepatic labs to make sure pt is not already impaired
Roal Retinoids (Acitretin) for Psoriasis
Antiinflammatory, but cannot take with pregnancy, can be in blood and seminal fluid for 3 years.
Hepatotoxicity
Moniter liver enzymes and serum lipids
Biologics class for psoriasis treatment
TNF-a inhibitors
Taken as IV infusions
What are the TNF-a inhibitors that treat psoriasis and psoriatic arthritis
- Infliximab (Remicade) IV influsion
Adalimumab (Humira), Certolizumab, Etanercept (Enbrel)
BBWs for biologics for psoriasis
Serious infections–>stop if they have any active infections
Lymphoma and other malignancies
Dont give live vaccines
What baseline testing is required for biologics as a treatment for psoriasis
CBC and CMP
TB screening
Hepatitis and HIV
What is the administration for biologics for psoirasis
IV infusion(Infliximab for severe pustular flares) or SC injection( for long term, humira or enbrel)
JAL-STAT interruptors (Janus/Tyrosine kinase inhibitors)
NIBs ( Tofacitinib, etc)
-Know they are immune suppressive in the same way MABS are.
Treatment for mild-moderate androgenetic alopecia
Topical minoxidil (Rogaine)
Oral finasteride (Propecia)
Rogaine is used to treat
Hair loss– Increases blood flow to hair follicles
Ro-Gaine= GROW-Againe
Treats androgenetic alopecia
Propecia is used for
Androgenic alopecia (PRO-Pecia= pro-hair)
Alopecia areata treatment when mild-moderate
Mild to moderate- Corticosteroids (High-Potency Topical treatment (halobetasol, clobetasol), intralesional injection)
Topical Minoxidil
Alopecia areata treatment when severe
JAK inhibitors (-nibs, duroxilitinib)
Topical immunotherapies
Exacerbating factors of rosacea
Heat, Sun, spicy food, alcohol, stress
Nonpharmacologic treatment of rosacea
-Avoid exacerabating factors
- Ice water
-Broad spectrum sunscreen (zinc, titanium)
Mild-limited treatment for rosacea
Metronidazole (gel/cream)
Ivermectin (cream, orally for severe cases)
If not work, Sodium sulfacetamide or benzoyl peroxide, retinoids
Moderate-severe treatment for rosacea
Oral tetracyclines, minocycline or doxycycline
Sodium sulfacetamide indications
Acne vulgaris, rosacea (Bacrtim, muprocin)
IF someone is allergic to bacrim, what medication do you not perscribe for rosacia
Sodium sulfacetamide
Topical medications for atenic keratoses and superficial basal cell carcinoma
Imiquimod (Give once a day, nightly)and 5-flourouracil (5-FU) (two times daily)
Squamous cell carcinoma treatment
Not topical medications
Malignant melanoma treatment
Systemic immunotherapy
Imiquimod and 5-flourouracil are indicated for which treatments
Atenic keratoses and superficial basal cell carcinomas
How to give imiquimod
Leave on for 8 hours, then wash off with soap and water.
How to give 5-FU
Cytotoxic- wash hands or use applicator or gloves
Counceling on 5-FU or imiquimod
Are photosensitive, so avoid direct sunlight and wear protective clothing
Wash hands after using them
May feel ill after using them (just shows its working)
Type 1 allergic reaction description
IgE mediated, mast cell release, diarrhea, usually 1-2 hours after exposure
Caused by penicillin, blood products, vaccines
Which reaction is IgE mediated
Type 1
Which drug reaction is IgG or IgM mediated
Type 2 reaction
Type 2 reaction characteristicss
IgG or IGM mediated
Cytotoxic
Hemolytic anemia, neutropenia, thrombocytopenia, onset is days to weeks
Which drug reaction is cytotoxic
Type 2
Which reaction type is immune complex mediated
Type 3
Which reaction type is T cell mediated
Type 4
Which drug reaction can onset by seizure medications
Type 3- also tetracyclines
Type 4- also allopurinol and sulfas
Hydralazine and Procanimide can cause what type of allergic reaction
Type 2
Which type of reaction appears days to weeks after exposure
Type 2, Type 3, and Type 4 can all be days to weeks (Type 4 is 1-2 days on subsequent exposure)
Minocycline, sulfa drugs, allopurinol, seizure medications can cause what type of reaction
Type 4 drug reaction
T cell mediated
What are the key symptoms of anaphylaxis
Stridor, Hives, Wheezing, Cough, SOB, Incontinence, Cramping abdominal pain/diarrhea, collapse)
Anaphylaxis treatment that is non pharmacologic
Remove offending agent
Place patient in sitting position with lower extremities elevated
Moniter vital signs
Administer oxygen
If hypotensive, give fluids and IV vasopressors
Anaphylaxis treatment that is pharmacologic
Epinephrine IM (5-10 mins)
Diphenhydramine (benadryl), Famotidine (Pepsid)
Corticosteroid
Albuterol
Treatment for bronchospasm in anaphylaxis
Albuterol
What kind of bern is in dermis with pain, blisters, and swelling
Superficial partial
