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Pharm SBL exam 2 > Derm drugs > Flashcards

Derm drugs Flashcards

1
Q

what is in a cream

A

–
mixture of ~half water/half oil (oil in water) with emulsifier (e.g. cetyl alcohol),
water evaporates
–
spread easily (i.e., good for large areas), are well absorbed , and wash off with
water
–
too thick to pump, so packaged in a tub or tube
–
better than ointments for oozing/”wet” skin conditions
–
lotions are similar albeit less viscous

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2
Q

what is in an ointment

A

mixture of ~20% water in ~80% oil
–
oil component is made from hydrocarbons such as mineral oil or petroleum jelly
–
feel greasy and are “occlusive “, meaning they stay on the surface of the skin and
are not well absorbed
–
best used on dry skin since they trap moisture
–
provide for more complete absorption of the active ingredient or medication
–
ointments are less likely to cause an allergic reaction than creams, which
contain preservatives

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3
Q

what are gels and pastes made from

A

(
Gels are made from polyionic colloids expanded with water)
(
Pastes are mixtures of oil, water and powder

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4
Q

what are emollients

A

Moisturizer component:

form an
oily layer on top of the skin that traps
water in the skin
common
emolients : petrolatum, lanolin,
mineral oil and dimethicone
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5
Q

what are humectants

A

Moisturizer component

draw water into the outer layer of the skin
common humectants
: glycerin, lecithin, and
propylene glycol

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6
Q

what are horny substance

A

keratin softners
part of a moisturizer component

loosening the bonds between the top layer of
cells helps dead skin cells fall off, helps the skin
retain water, and gives it a smoother, softer
feeling
common agents
: urea, alpha hydroxy acids
(e.g., lactic, citric, glycolic), allantoin

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7
Q

based on the skin type what moisturizer should i choose?

Normal

A

choose a water based moisturizer that has a light, nongreasy feel
•
these moisturizers often contain lightweight oils, such as cetyl alcohol,
or silicone derived ingredients, such as cyclomethicone

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8
Q

based on the skin type what moisturizer should i choose?

dry

A

choose a heavier, oil based moisturizer that contains ingredients such
as antioxidants, grape seed oil or dimethicone , which helps keep your
skin hydrated
•
petrolatum based products are preferable for very dry, cracked skin
since they prevent water from evapopating

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9
Q

based on the skin type what moisturizer should i choose?

oily

A

•
choose a water based product that is labeled “ noncomedogenic ” to
provide moisture while limiting acne breakouts

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10
Q

based on the skin type what moisturizer should i choose?

sensitive

A

choose a moisturizer with soothing ingredients such as chamomile or
aloe that does not contain potential allergens (e.g., fragrances, dyes) or
acids to minimize skin irritation

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11
Q

based on the skin type what moisturizer should i choose?

mature

A

choose an oil based moisturizer that contains petrolatum as the base to
keep skin hydrate plus antioxidants or alpha hydroxy acids to combat
wrinkles

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12
Q

what are the chemical compounds in sunscreens

A

UVB radiation (280 320 nm) causes most erythema/sunburn
and skin aging and photocarcinogenesis
•
UVA radiation (320 400 nm) causes skin aging and cancer
•
Sunscreens: chemical compounds that absorb ultraviolet light
–
p aminobenzoic acid ( PABA ) and its esters: active in UVB range
–
benzophenones : wider 250 360 nm range but less effective than PABA
–
dibenzoylmethanes : active in UVA range , particularly useful for
conditions such as drug induced photosensitivity and cutaneous lupus
erythematosus

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13
Q

what are the chemical components in sunshades

A

opaque materials that reflect light… classic

example is titanium dioxide

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14
Q

what bacteria can alcohol based hand disinfection not kill that you need soap and water?

A 
alcohol based hand disinfection
–
is easier/faster than soap and water
–
rapidly effective against gram positive, gram negative and viral
pathogens
–
not effective against C. difficile so must use soap and water
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15
Q

MOA of antiseptics and disinfectants: Cell envelope

A

glutaraldehyde
cross
linking of proteins

EDTA,
other permeabilizers gram
negative bacteria: removal of Mg 2+2+, release of some LPS

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16
Q

MOA of antiseptics and disinfectants: Cytoplasmic inner membrane

A

quaternary amines
generalized
membrane damage involving phospholipid bilayers

chlorhexidine
low concentrations affect membrane integrity, high concentrations
cause congealing of cytoplasm

diamines
induction of leakage of amino acids

PHMB,
alexidine phase separation and domain formation of membrane lipids

phenols leakage, some cause uncoupling

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17
Q

MOA of antiseptics and disinfectants: cross linking of macromolecules

A

formaldehyde
cross
linking of proteins, RNA and DNA

glutaraldehyde
cross
linking of proteins in cell envelope and elsewhere in cell

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18
Q

MOA of antiseptics and disinfectants: DNA intercalation

A

acridines
intercalation of
acridine molecule between two layers of base pairs in
DNA

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19
Q

MOA of antiseptics and disinfectants: Interaction with thiol groups

A

silver compounds
membrane
bound enzymes (interaction with thiol groups)

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20
Q

MOA of antiseptics and disinfectants: effects on DNA

A

halogens
inhibition of DNA synthesis

hydrogen
peroxide, silver ions DNA strand damage

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21
Q

MOA of antiseptics and disinfectants: oxidizing agents

A

peroxygens
hydrogen peroxide: activity due to formation of free hydroxyl radicals
(•HO), which oxidizes thiol groups in enzymes and proteins
peracetic
acid: disruption of thiol groups in proteins

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22
Q

importance of chlorhexidine

A

a broad spectrum antimicrobial agent widely used in homes and hospitals
due to general efficacy on skin (including oral mucosa) and low irritability

bacterial spores
not
sporicidal but prevents development of spores;
inhibits spore outgrowth but not germination

mycobacteria
mycobacteriostatic
(mechanism unknown) but not
mycobactericidal

other
nonsporulating bacteria membrane
active agent, causing protoplast and
spheroplast lysis ; high concentrations cause
precipitation of proteins and nucleic acids

yeasts
membrane
active agent, causing protoplast lysis and
intracellular leakage, high concentrations cause
intracellular coagulation

viruses
low activity against many viruses; lipid enveloped
viruses more sensitive than nonenveloped ; effect
possibly on viral envelope (e.g., lipid moieties)

protozoa
has activity against
trophozoites , less toward cysts

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23
Q

Antibiotic resistance mechanism of biofilms

A

they neutralize the antibiotic and limit penetration

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24
Q

how does glycemic control play a factor in wound healing

A

poor glycemic control is significantly associated with worse outcomes

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25
Q

purpose of Becaplermin

A

Platelet derived growth factor that promotes cell proliferation and angiogenesis

only approved for treatment of chronic diabetic foot ulcers

black box warning for malignancy

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26
Q

does epidermal growth factor improve wound healing

A

no! does not significantly improve epithelialization

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27
Q

proper wound dressing?

A

general principles: wounds should be kept moist ,
and should not be exposed to air as done historically
–
occluded wounds heal 40% faster and have less scarring
–
wounds are exposed to their own fluid, a mix of
metalloproteases and cytokines
•
consensus opinion on choices:
–
hydrogels for debridement stage
–
foam and low adherence dressings for the granulation stage
–
hydrocolloid and low adherence dressings for
epithelialization stage

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28
Q

Bacitracin

A

Topical antibacterial agent

peptide antibiotic, inhibits
bacterial cell wall
synthesis
•
active against gram
positive organisms, also
active against most
anaerobic cocci,
neisseriae , tetanus bacilli,
diphtheria bacilli
•
often causes allergic
contact dermatitis, and
rarely immunologic
allergic contact urticaria
•
poorly absorbed through
the skin, so systemic
toxicity is rare
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29
Q

Neomycin

A

Topical antibacterial agent

aminoglycoside
antibiotic, binds to 30S
ribosomal subunit to
inhibit protein synthesis
•
active against gram
negative organisms
•
o ften causes allergic
contact dermatitis, and
cross sensitization to
other aminoglycosides
can occur
•
poorly absorbed through
the skin, so systemic
detection is rare
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30
Q

Polymixin B

A 
peptide antibiotic, binds
to phosphor lipids to
alter permeability and
damage bacterial
cytoplasmic membrane
•
effective against gram
negative organisms,
including P. aeruginosa,
E. coli, Enterobacter , and
Klebsiella
•
rarely causes allergic
reaction
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31
Q

Topical antifungal agents?

A

topical imidazoles , block ergosterol synthesis, have a wide
range of activity against dermatophytes and yeasts
–
miconazole … topical application as a cream or lotion; vaginal cream
or suppositories for use in vulvovaginal candidiasis
–
clotrimazole … topical application to the skin as a cream or lotion;
vaginal cream and tablets for use in vulvovaginal candidiasis
–
efinaconazole … onychomycosis treatment, given for 48 weeks,
complete cure in ~15 % 18%
–
ketoconazole … cream for topical treatment of dermatophytosis and
candidiasis, shampoo or foam for seborrheic dermatitis

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32
Q

ciclopirox

A

Topical antifungal agent

prescription synthetic broad spectrum topical antimycotic agent,
disrupts macromolecular synthesis
–
activity against dermatophytes, Candida and Malassezia
–
low incidence of adverse reactions and contact dermatitis

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33
Q

terbinafine

A

Topical antifungal agent

allylamine , selectively inhibits squalene epoxidase, a key enzyme for
the synthesis of ergosterol
–
highly active against dermatophytes but less active against yeasts
–
cream can cause local irritation, avoid contact with mucous
membranes

34
Q

Tolnaftate

A

synthetic antifungal compound, mechanism uncertain but distorts
hyphae/stunts mycelial growth
–
effective topically against various dermatophyte and malessezia
infections but not Candida
–
generally well tolerated and rarely causes irritation or allergic contact
dermatitis

35
Q

Nystatin

A

Topical antifungal agent

binds to fungal sterols, alters membrane permeability
–
limited to topical treatment of cutaneous and mucosal candida
infections (hold in mouth before swallowing) because of its
narrow spectrum and negligible absorption from the
gastrointestinal tract following oral administration
–
non irritating topically; mild nausea and diarrhea if swallowed

36
Q

Amphotericin B

A

Topical antifungal agent

binds to fungal sterols, alters membrane permeability
–
limited to topical treatment of cutaneous candida infections
–
well tolerated, but may cause a temporary yellow staining of the
skin

37
Q

Topical antiviral agent

A 
synthetic guanine analog with
inhibitory activity against
herpes simplex types 1 and 2
–
u sed for the treatment of
recurrent orolabial herpes
simplex virus infection (herpes
labialis ) in immunocompetent
adults
–
o intment, cream and buccal
tablet formulations available
38
Q

what are some non pharmacological interventions for pruritis

A

Skin moisturization dry skin can cause or exacerbate pruritus;
thus, all patients with generalized symptoms should use gentle
cleansers and apply emollients daily
•
Cool environment heat can worsen symptoms, so light weight
clothing, air conditioned environments, and the use of
lukewarm water during showers or baths may reduce symptoms;
cooling lotions (calamine, those with menthol) can provide
additional relief.
•
Avoidance of skin irritants wool clothing and cleansing
products are among common irritants
•
Stress reduction psychological support and behavioral
interventions that help patients to cope are important including
holistic approaches such as meditation, acupuncture, and yoga.
•
Physical interventions Break the itch scratch cycle by
occluding localized areas of pruritus with occlusive dressings

39
Q

Topical therapies for Pruritus: Topical calcineurin inhibitors

A 
Tacrolimus 0.03% and 0.1% ointment
Particularly useful in
anogenital pruritus , may
experience transient burning and stinging
Pimecrolimus 1% cream
40
Q

Topical therapies for Pruritus: Doxepin

A

H1 antagonist

5% cream
Avoid in children, 20 to 25 percent risk of sedation

41
Q

Topical therapies for Pruritus: Menthol

A

TRPM8 agonist

0.025 to 0.1% cream
Particularly useful in
neuropathic itch , may
experience initial transient burning

42
Q

Topical therapies for Pruritus: Local anesthetics

A 
Pramoxine 1 to 2.5%
found in a variety of OTC remedies along with
hydrocortisone; e.g., useful for pruritus on face and
that associated with CKD
Lidocaine patch 5%
Useful in
neuropathic pruritus
Eutectic mixture of lidocaine 2.5%
and prilocaine 2.5%
Useful in neuropathic pruritus
43
Q

how are topical steroids administered

A

Use low potency on face, genitals and skin folds (class 7)

elsewhere, generally start high potency to gain control and titrate downward for maintenance (class 1)

44
Q

Capsaicin

A

Activates TRPV1 (heat) channels

topical sensation for pruitus

substance derived from chili peppers that has been used for the treatment of
chronic pain and pruritus
•
t he mechanism of action for capsaicin involves its ability to activate transient
release potential vanilloid 1 (TRPV1), an ion channel in cutaneous nerve fibers
•
activation of TRPV1 stimulates neurons to release and eventually deplete certain
neuropeptides, including substance P
•
c apsaicin also induces lasting desensitization of neurons to a variety of stimuli

45
Q

function of salicylic acid

A

known since ancient times for its anti inflammatory activities
–
a COX inhibitor
–
unripe fruits are natural sources
•
also found in many skin care products (e.g., for treatment of acne,
dandruff)
–
causes epidermal cells to shed more readily ( keratolytic ), has
antibacterial properties, and opens clogged pores
–
keratolytic effects caused by its ability to dissolve the intercellular
cement; applied in more concentrated solutions (e.g., 6% in
petrolatum) to calluses for 1 hr before washing away
–
treated areas are photosensitized, need protection from sun
•
prolonged use can cause salicylate toxicity, especially in children
and those with reduced kidney or liver function

46
Q

Systemic therapies for pruritus: NaSSA

A

antidepressant

m
irtazapine 7.5 to 15 mg
at night
Useful in
nocturnal pruritus , may cause increased weight and appetite
47
Q

Systemic therapies for Pruritus: SSRIs

A

paroxetine 10 to 40 mg per
day
Consider in psychiatric patients with pruritus and paraneoplastic
pruritus

fluvoxamine 25 to 150 mg
per day
Consider in psychiatric patients with pruritus and paraneoplastic
pruritus

sertraline 75 to 100 mg per
day
Useful in
cholestatic pruritus

48
Q

Systemic therapies for pruritus: µ
opioid receptor
antagonists

A

naltrexone 25 to 50 mg per
day
Useful in patients with
cholestatic and CKD associated pruritus ; may
cause nausea, vomiting and drowsiness; reverses analgesia and may
precipitate acute withdrawal in patients receiving opioid analgesics

49
Q

systemic threapies for pruritus: κ
opioid receptor
agonist/µ opioid
receptor antagonist

A

butorphanol 1 to 4 mg
intranasally per day
Useful in
nocturnal and intractable pruritus ; may cause nausea and
vomiting as well as drowsiness; may precipitate acute withdrawal in
patients receiving opioid analgesics; some potential for abuse due to
concomitant weak µ opioid receptor agonist activity

50
Q

systemic therapies for pruritus: anticonvulsants

A

gabapentin 100 to 3600
mg per day useful
in neuropathic pruritus , may cause drowsiness and weight gain;
usually given in two to three divided daily doses; dose alteration for
renal insufficiency may be needed

pregabalin
150 to 300 mg
per day

51
Q

systemic therapies for pruritus: substance P antagonists

A

aprepitant 80 mg per day
more commonly used to control nausea/vomiting of
chemotherapy, but
has shown benefits in patients with intractable pruritus (e.g., Sézary
syndrome)

52
Q

treatment for rosacea to get the red out

A

•
brimonidine … α 2 adrenergic agonist applied as a
topical gel , vasoconstricts by stimulating post
synaptic vascular α 2 receptors.
•
oxymetazoline … mixed α 1A α 2 adrenergic agonist
vasoconstrictor applied as a topical cream , approved
2017

53
Q

treatment for eyes to get the red out

A

naphazoline , tetrahydrozoline , phenylephrine and
oxymetazoline … eye drops are all adrenergic
receptor agonists

54
Q

what drugs kill ectoparasites

A

•
malathion … topical agent, organophosphate
cholinesterase inhibitor
•
permethrin … topical agent, binds to insect
Na channels, blocks membrane
repolarization
•
ivermectin … administered orally, binds to
glutamate gated Cl channels in invertebrates,
hyperpolarizes the nerve and muscle cells
•
lindane … topical agent, toxicity causes to be
used only after other agents fail, disrupts
GABAergic transmission in insects

55
Q

Tretinoin

A

Topical retinoids for acne

Once daily, at
bedtime
Creams:
0.025%, 0.0375%,
0.05%, 0.1%
Polyolprepolymer
2
cream: 0.025%
Gels:
0.01%, 0.025%,
0.05%
Microsphere gels:
0.04%,
0.1%
Polyolprepolymer
2 gel:
0.025%
Gel (micronized):
0.05%
Local skin irritation,
dryness, and flaking; sun
sensitivity
NOTE:
Atralin ® contains
soluble fish proteins, use
with caution in patients
with known sensitivity or
allergy to fish
56
Q

Adapalene

A

topical retinoid for acne

Once daily, at
bedtime
Cream:
0.1%
Gels:
0.1%, 0.3%
Lotion:
0.1%
Local skin irritation,
dryness, and flaking; sun
sensitivity
57
Q

tazarotene

A

Topical retinoid for acne

Tazarotene
Once daily, at
bedtime
Creams:
0.05%, 0.1%
Gels:
0.05%, 0.1%
Pregnancy category X;
local skin irritation,
dryness, and flaking; sun
sensitivity
58
Q

Benzoyl

peroxide

A

Topical antimicrobial for acne

Twice daily
Multiple 2.5 to 10% gels,
lotions, creams, pads,
masks, cleansers
Local skin irritation;
may bleach hair or
clothing
59
Q

Clindamycin

A

Topical antimicrobial for acne

Twice daily
Once daily
(
1% gel, lotion, pledget,
solution, foam
Rare risk of
pseudomembranous
colitis
60
Q

Erythromycin

A

Topical antimicrobial for acne

Twice daily
2% gel, solution, pledget

oral antibiotic
500 mg twice daily (base)
Gastrointestinal distress

61
Q

Azaleic acid

A

Topical antimicrobial for acne

Twice daily
20% cream, 15% gel
Local skin irritation

•
a dicarboxylic acid , a white powder found in wheat, rye
and barley where it is involved in the plant defense
response to an infection
•
it kills acne bacteria and decreases the production of
keratin
•
it is used to treat mild to moderate acne, and also treats
post inflammatory hyperpigmentation

62
Q

Tetracycline

A 
Oral antibiotic for acne
500 mg twice daily
Photosensitivity, gastrointestinal
distress; contraindicated in
pregnancy and young children
63
Q

Doxycycline

A 
Oral antibiotic for acne
50 to 100 mg twice daily or
150 mg once daily
Photosensitivity, gastrointestinal
distress; contraindicated in
pregnancy and young children
64
Q

Minocycline

A

Oral antibiotic for acne

50 to 100 mg twice daily
or
1 mg/kd/day of extended
release formulation (round
to nearest available
strength: 45, 65, 90, or 135
mg tablets)
Dizziness, drug
induced lupus, skin
discoloration; contraindicated in
pregnancy and young children
65
Q

Azithromycin

A

oral antibiotic for acne

Intermittent dosing due to
long drug half life; optimum
regimen unknown
Gastrointestinal distress

66
Q

Trimethoprim

sulfamethoxazole

A

oral antibiotic for acne

160 mg/800 mg once to
twice daily
Stevens
Johnson syndrome, toxic
epidermal necrolysis
67
Q

Hormonal agents for acne:

Oral contraceptives

A

Once daily
Nausea, breast tenderness, weight
gain, thromboembolic events

68
Q

Hormonal agents for acne Spironolactone

A 
25 to 200 mg/day in one
or two equally divided
doses; doses of 50 to
100 mg/day may be as
effective as higher doses
and reduce side effects
especially useful for
adult women with
menstrual cycle related
breakouts of acne on
lower face, etc.; some
dermatologists combine
with oral contraceptives
Contraindicated in pregnancy;
menstrual irregularity, breast
tenderness, minor gastrointestinal
symptoms, orthostatic
hypotension, hyperkalemia,
dizziness, headaches, fatigue
69
Q

Oral retinoid for acne

A 
0.5 mg/kg/day,
increasing to 1
mg/kg/day in one or two
equally divided doses;
total dose 120 to 150
mg/kg over 20 weeks
Teratogenicity (absolutely
contraindicated in pregnancy),
mucocutaneous effects,
hypertriglyceridemia, others
70
Q

topical therapies for Psoriasis

A

Emollients and Corticosteroids for initial choice for mild to moderate psoriasis

Topical Vitamin D analogs
Calcipotriene and calcitriol to reduce the keratinocyte proliferation

tar

Tazarotene (retinoid gel)

Calcineurin inhibitors (tacrolimus, pimecrolimus)

Anthralin

Salt water bath

71
Q

UV light therapies for Psoriasis

A

photochemotherapy (PUVA) … uses UVA radiation
(under strict medical supervision), which penetrates
deeper into the skin without causing sunburn
•
patients typically ingest the plant photosensitizer psoralen ~
2 hrs before treatment ~ 3X/week until remission;
mechanism unknown
•
must be protected from sun exposure
•
increases risk of melanoma

72
Q

Apremilast

A 
for psoriasis
inhibits
phosphodiest
erase 4
(PDE4)
specific for
cyclic
adenosine
monophosph
ate ( cAMP ) 
 cAMP levels
in cells

regulates
numerous
inflammatory
mediators…

 nitric oxide
synthase,
TNF α, IL 23

 IL 10
•
moderate to
severe plaque
psoriasis
•
active
psoriatic
arthritis
•
LIBERATE trial
shows ~55%
patients have
≥ 75%
reduction in
Psoriasis Area
and Severity
Index (PASI)…
comparable to
etanercept

administered
orally , well
absorbed

hepatic
metabolism,
primarily
CYP3A4

half life of 6
9 hrs

pills ~$70 ea

severe
diarrhea,
nausea and
vomiting
possible;
weight loss

headache
most common
CNS
complaint, but
depression,
suicidal
ideation,
mood changes
have been
observed
73
Q

Crisaborole

A

PDE4 inhibitor for topical therapy of dermatitis

74
Q

Ustekinumab

A 

human
monoclonal
antibody, targets
proinflammatory
cytokines IL 12
and IL 23

blunts IL 12/IL 23
effects, so :

 natural killer cell
activation

 CD4+ T cell
differentiation and
activation

 MCP 1, TNF α ,
CXCL 10, IL 8
expression

plaque
psoriasis

psoriatic
arthritis

Crohn
disease

given subQ at
8 12 week
intervals
following
induction at 0
and 4 wks

•>$13k/dose

generally well tolerated, but
increases risk for infections

may increase risk for
squamous cell carcinomas

hypersensitivity reactions
75
Q

secukinumab

A 
human
monoclonal
antibody, targets
proinflammatory
cytokine
interleukin 17A

blunts IL 17A
effects, thereby
decreasing its
ability to induce
the production of
many other
proinflammatory
signaling
molecules:

 cytokines IL 6,
GC CSF, IL 1 β , TGF
β , TNF α

 chemokines IL 8,
GRO α abd NCP 1

 prostaglandins

ankylosing
spondylitis

plaque psoriasis

psoriatic
arthritis

administered
subcutaneously…
typically 150 mg
at weeks 0, 1, 2,
3,and 4 and then
every 4 weeks
thereafter

may need 300
mg/dose for
severe plaque
psoriasis

•>$3k/150 mg

generally well
tolerated, but
increases risk for
infections

may causes
exacerbations of
inflammatory bowel
disease

hypersensitivity
reactions
76
Q

ixekuzumab

A

a humanized monoclonal

antibody against iL 17A with similar indications similar to secukinumab

77
Q

Treatment options for hypertropic actinic keratosis

A

Liquid nitrogen cryotherapy
•
Surgical therapy
•
Pharmacotherapy
–
Topical 5 fluorouracil (see
–
Imiquimod … a topical immune response modifier that stimulates local
cytokine induction, is an effective therapy
–
Ingenol mebutate …a substance derived from the sap of the Euphorbia peplus
plant, is an effective treatment; has two stages: 1) initial disruption of cell
plasma membranes and mitochondria leading to cell necrosis ( chemoablation )
ans 2) neutrophil mediated antibody dependent cellular cytotoxicity that
eliminates remaining tumor cells
–
Topical diclofenac … an NSAID, benefits suggest PG’s may be important for skin
carcinogeneis
–
Retinoids … (discussed
•
Photodynamic (Red Light) therapy : LED emits strong 635 nm light
•
Dermabrasion : surgical skin planing
•
Chemical peels : e.g., with trichloroacetic acid

78
Q

Topical 5-fluorouracil

A

inhibits thymidylate synthetase , a critical enzyme
in the synthesis of DNA
•
the lack of DNA synthesis in fast growing
dysplastic cells prevents cell proliferation and
causes cell death
•
has been used with good success in patients with
multiple AKs; effective in >90% who can tolerate
it and also treats undectable AKs
•
causes inflammation and destruction of the
lesions (see next slide) rash looking inflammatory response
•
after 4 6 weeks skin will have progressed from
erythema through blistering, necrosis with
erosion, and then re epithelialization

79
Q

Treatment of basal cell or squamous cell carcinoma

A 
•
surgical removal/ablation:
–
curettage and electrodessication
–
Mohs micrographic surgery
–
X ray radiation
–
cryosurgery
–
photodynamic therapy
–
laser surgery
•
topical medications:
–
imiquimod
–
5 fluorouracil
•
advanced BCC
–
vismodegib or sonidegib : both oral “hedgehog”
signaling pathway inhibitors
80
Q

management of alopecia areata

A

chronic, relapsing immune mediated inflammatory
disorder affecting hair follicles resulting in non
scarring hair loss
–
disorder ranges from small patches of alopecia on any hair
bearing area to the complete loss of scalp, eyebrow,
eyelash, and body hair
–
u ntreated, ~50% will grow hair back in < 1 year, but
recurrence is likely
–
intralesional or topical corticosteroids
–
topical immunotherapy … contact allergen such as
diphenylcyclopropenone ( is used to cause contact dermatitis,
which causes hair growth for unknown reason

81
Q

male pattern baldness treatment

A

–
minoxidil :
•
vasodilates due to K channel opening
•
promotes hair growth by increasing the duration of anagen
(growth phase), shortening telogen (rest phase), and enlarging
miniaturized follicles
–
finasteride
•
oral inhibitor of dihydrotestosterone (DHT) production, can cause
sexual dysfunction
•
use increases hair count
–
s urgery … transplantation of hair follicle units (natural
groupings of ~ 4 hairs) from regions resistant to hair loss
into regions of hair loss

82
Q

Female pattern hair loss treatment

A

–
minoxidil (first line)line):
•
vasodilates due to K channel opening
•
promotes hair growth by increasing the duration of
anagen (growth phase), shortening telogen (rest
phase ), and enlarging miniaturized follicles
–
anti androgens (second line when minoxidil fails)
•
spironolactone (androgen partial
•
finasteride (blocks dihydrotestosterone synthesis)
•
f lutamide (androgen

Pharm SBL exam 2 (6 decks)

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