Derm drugs Flashcards
What is the composition of Jessner’s peel solution?
old people get a peel at the RSL 14% w/v each of; Rsorcinol Salicylic acid Lactic acid in 95% ethanol
How do you do short contact Dithranol Rx?
What is it used for?
what are AEs?
SHORT CONTACT DITHRANOL
Dithranol 1%
Salicylic acid 2%
In Yellow soft paraffin
Applied for 10-20mins and then removed with mineral oil. Gradually increase the time up to 2 hours. Aim for mild Erythema
for alopecia areata or psoriasis
What is modified Kligman’s formual and its variants?
For melasma or other depigmentation Modified Kligman’s (Pigmanorm in UK): Hydroquinone 5% (can make 3-5%) Tretinoin 0.1% (can make 0.05-0.1%) In 1% HCT cream
+/- 1-2% Kojic acid
+/- 0.5-2% Ascorbic acid
+/- 1-2% Sal acid
What are fluoroquinolones?
….oxacin drugs
eg
ciprofloxacin
moxifloxacin
What are recommendations for giving live vaccines to pts on biologics?
Stop drug and allow washout period of 4-5 half lives before giving vaccines Wait 6-12 weeks before restarting biologic Half lives; • Etanercept – 5 days • Infliximab – 7 days • Adalimumab – 14 days • Ustekimumab – 21 days • Secukinumab – 27 days
What are the contraindications of biologics?
CIs:
hypersensitivity to drug or constituents
Acute or chronic active infection – e.g. TB, hep B or C, HIV, strongyloides, VZV
Sepsis or at risk of sepsis
Also;
• Etanercept – Not for pts on interleukin1 inhibitor (anakinra) or other immune suppressents
• Infliximab – CCF, Not for pts on interleukin1 inhibitor (anakinra) or abatacept
• Adalimumab - mod-severe CCF, Not for pts on interleukin1 inhibitor (anakinra) or abatacept
• Ustekimumab - nil others (but avoid concurrent immunsuppressants)
• Secukinumab - nil others (but avoid concurrent immunsuppressants)
Relative CIs:
Pregnancy (MIMs info);
• Etanercept B2 (can use if benefits outweigh risk)
• Infliximab C (wait 6 months after last dose) – avoid in young women
• Adalimumab C (wait 5 months after last dose) – avoid in young women
• Ustekimumab B1 (can use if benefits outweigh risk)
• Secukinumab C (can use if benefits outweigh risk)
Lactation (get into breast milk – effects unknown; MIMs says should avoid all biologics while nursing but they are used by many specialists)
Children (no studies done on kids) - etanercept on PBS
Current or prior malignancy
Latex sensitivity – Ustekinumab and secukinumab (latex in needle cap)
Also;
• Etanercept – diabetes (hypo risk), CCF, MS
• Infliximab – liver disease, COPD (inc lung cancer risk), MS, Guillain-Barre
• Adalimumab – mild CCF (mod-severe is CI)
• Ustekimumab – nil others
• Secukinumab - Crohns
What are the risks of antibody development on biologics?
- Etanercept – Antidrug Abs very rare; 6% increase new Ab positivity - ANA, dsDNA, anticardiolipin Abs; Low risk of drug-induced lupus
- Infliximab -up to 10% anti-drug Abs (reduced efficacy, inc infusion rcns), can develop positive ANA but very low risk of drug-induced lupus
- Adalimumab – approx 5% anti-drug Abs but NO EFFECT on drug efficacy or side effects, can develop positive ANA but very low risk of drug-induced lupus
- Ustekinumab – approx 5% anti-drug Abs, mainly neutralizing – reduce efficacy but no inc injection site reactions
- Secukinumab -
What skin conditions are treated with dapsone?
Dermatitis herpetiformins - expect rapid response IgA,Linear Pyoderma gangrenosum, Pemphigus SLE, bullous Other dermatoses with increase Eos or Monocytes - but most effective against neutrophils Neutrophilic dermatoses like Bechets Erythema elevatum diutinum leprosy follicular mucinosis
T/F
should always stop biologic or other drug if pt develops lupus-like syndrome
True
What is low risk dosing for antimalarials regarding eye complications?
60kg) hydroxychloroquine
or
What symptoms should you ask about at HCQ review?
Eyes - Harry Potter Bums Ron Not Voldemort
Halos, photophobia, blurred vision, reduced near vision
SOB
Infections
GI upset
Skin - pigmentation, nails, hair, rashes, induction of psoriasis
What are the side effects of biologics?
Injection site reactions – most common w/ adalimumab
Allergy
URTI
Serious infections
Bone marrow suppression
Demyelinating disease
Lymphoma (around 5x increased risk) and pos other cancers
Depression, confusion, agitation, insomnia
Headache visual disturbance
GI upset
Lichenoid drug eruptions
Antibody development
Individual drugs – common or rare & important AEs
• Etanercept – hypoglycaemia in diabetics, pancytopenia/aplastic anaemia, CCF
• Infliximab – infusion rcns in up to 20% (can be severe), cytopenias rarely, rare liver failure or auto-immune hepatitis, in bowel Ca risk, Inc lung ca risk in COPD pts, neuro symptoms/ MS/ Guillain-Barre, serum-sickness-like rcns, CCF
• Adalimumab – rare cytopenias, aplastic anaemia, CCF
• Ustekinumab – back pain headache, dizziness, GI upset, URTI. Rae; reversible posterior leukencephalopathy syndrome (1 case) – presents w/ headache, seizures, confusion
• Secukinumab - Nasopharyngitis is very common side effect, URTI, oral HSV
*Infliximab infusion rcns can include flusing, feinting, anaphylaxis, chest pain, back pain, seating, rash, itching, urticaria, N&V, diarrhoea, abdo pain, dyspepsia, bronchospasm, pulmonary oedema/APO
What are Risk factors for MTX-induced liver toxicity?
LEOTARD Arse
Liver Dx or persistent abnormal LFTs or significant exposure to hepatotxic drugs
Ethanol Excess >2SD/day
Obesity – top cause
T2DM
Age >60
Renal failure
Drugs - NSAIDs, antibiotics, PPIs, diuretics
Arsenic exposure
NB
Liver tox occurs in Pso more than RA
High cumulative dose of MTX has relatively low contribution to liver risk
Other tox risk factors:
blood dyscrazia esp B12 def, lymphoma, ?IBD
How can MTX liver toxicity risk be reduced?
Exercise
Wt loss if obese
avoid alcohol
avoid other liver metabolised agents + NSAIDs, antibiotics, PPIs, diuretics
what is the equivalence of antiandrogen medications?
3mg drospirenone (as in Yaz/Yasmin) is equal to 1mg CPA or 25 mg spironolactone
