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PHARM II TEST 2 > Derm Meds > Flashcards

Derm Meds Flashcards

1
Q

Remember when talking about skin that there are how many layers?

A

3…this is important for drug absorption (Epidermis, dermis, subcutaneous)

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2
Q

What are wet preparations best used for?

A

Acute inflammation with oozing and vesiculation lesions…have drying effect

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3
Q

What are lotions best used for?

A

Preferred for hairy areas…have a drying effect

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4
Q

Creams are best suited for what? Intermediate between drying prep and ointments (high water content)

A

Acute exudative inflammation, intertriginous areas (good stratum corneum penetration)

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5
Q

Penetrates chronic, thickened lesions well and provide protection of skin?

A

Ointments

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6
Q

Direct absorptive effect, reduce friction, absorb moisture, creates more surface area for evaporation?

A

Powders

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7
Q

Best for application to scalp and hairy areas?

A

Aerosols

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8
Q

Best for acne and exudative inflammation?

A

Gels

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9
Q

Do not apply these to weeping lesions or hairy areas?

A

Pastes

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10
Q

Good for application to scalp and hairy areas? Vehicle evaporated quickly

A

Tinctures

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11
Q

Pockets of gas trapped in a liquid, good for application to scalp and hairy areas?

A

Foam

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12
Q

Mild contact dermatitis treatments?

A

Wet dressings, astringents, colloidal oatmeal bath (aveeno)

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13
Q

Moderate contact dermatitis treatments?

A

Counterirritants (Camphor/Menthol), topical antihistamines, moderate to high potency topical steroid

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14
Q

Treatment for severe contact dermatitis (resistant atopic dermatitis)

A

Systemic corticosteroids

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15
Q

Sebrrheic Dermatitis treatments?

A

Antifugnal agents like ketoconazole shampoo

Anti proliferation agents

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16
Q

Atopic dermatitis (Eczema), IgE mediated response of the skin, treatments:

A

Eliminate allergen
Increase skin hydration (Cetaphil)
Acute weeping lesions: aluminum subacetate or colloidal oatmeal (aveeno)
Corticosteroids (medium-high potency)
Topical immunomodulators (TIMS) - Pimecrolimus cream (Elidel) or tacrolimus ointment
Systemic therapy: oral antihistamines

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17
Q

Inhibit T cell activation in inflamed skin by blocking transcription of pro-inflammatory cytokines…used for atopic dermatitis and chronic inflammatory skin disease and as alternatives to topical corticosteroids?

A

Topical Immunomodulators (TIMs) aka Calcineurin Inhibitors like Pimecrolimus cream (Elidel) and Tacrolimus ointment (Protopic)

*first line steroid sparing agent for atopic dermatitis and psoriasis of the face, flexural, or genital area

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18
Q

Which TIM is = low potently steroid and which = medium potency?

A

Tacrolimus (protopic) = medium

Pimecrolimus (Elidel) = low

Caution w/UV exposure

BB warning for rare cases of lymphoma/skin cancer - use these short term (less than 6 weeks)

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19
Q

Topical steroids are NOT used in Impetigo b/c it’s usually staph or strep caused, what do we treat with?

A

Mupirocin (Bactroban) = topical Abx of choice

System Abx = Dicloxacillin or Cephalexin (more effective than topical but more systemic effects)

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20
Q

Treatment of acne rosacea

A

Topical metronidazole is the DOC for papulopustular rosacea

Can use Azelaic Acid, sodium sulfacetamide and sulfur, brimonidine, and ivermectin cream also

21
Q

Acne drug w/dual mode of action…releases oxygen; Letha to the P.acnes (anaerobe) and increases turnover rate of epithelial cells?

A

Benzoyl Peroxide…effective for both inflammatory and non-inflammatory acne vulgaris…especially effective when combine with topical erythromycin

22
Q

Topical Abx for acne?

A

Clindamycin

Erythromycin

Combos of both of those with Benzoyl peroxide

23
Q

Systemic Abx for acne?

A

Tetracycline and Erythromycin rarely used due to resistance and GI issues

Minocylcline or Doxycycline are the MC used

Sulfamethoxazole and Trimethoprim are used in pts resistant to erythromycin/tetracyclines…but minocycline or doxy are preferred over this due to SEs

24
Q

Vitamin A analogs that reduce the production of sebum which is required by P. Acnes and reduce inflammation by inhibiting neutrophil and monocyte chemotaxis, used for acne after benzoyl trial and topic Abx failure, but can be first line

A

Retinoids…AEs: drying, redness, peeling skin, pustular flare may occur and may darker skin

NOT RECOMMENDED IN PREGNANCY AND DEGRADED BY UV LIGHT SO APPLY AT NIGHT

25
Q

Three topical retinoids?

A

Tretinoin, Adapalene (better tolerated/faster), and Tazarotene (best efficacy, preg cat X, INDICATED FOR PSORIASIS TOO)

26
Q

Oral Retinoids that’s the only effective one for severe cystic acne, but so bad for pregnancy that provider, pt, and pharmacy have to register to get it? CAT X

A

Isotretinoin PO…two forms of contraception MUST be used during therapy and for one month after treatment

AEs: Depresison and SIs

27
Q

Acne med with unknown MoA used for rosacea or acne, comparable efficacy to other acne meds w/minimal toxicity?

A

Azelaic Acid (Azelex for acne and Finacea fo rosacea)

Mild skin effects and hypopigmentation possible w/dark complexion

28
Q

A-2 agonist that may reduce erythema through direct vasoconstriction…used to topical treatment of persistent erythema of Rosacea in 18y/o and older

A

Brimonidine

Intermittent flushing and systemic BP lowering effects reported

29
Q

First line for mild to moderate psoriasis? But efficacy only goes up as potency increases -> can lead to skin atrophy/changes

A

Topical CSs

30
Q

Drug that carcinogenic to animals, bad smelling, not used much anymore, for poor people for mild/moderate plaque psoriasis…but less effective than topical CSs?

A

Coal Tar

31
Q

These are used for psoriasis in a way that’s not known, regulates the concentration of calcium and phosphate in the blood and promotes healthy growth and remodeling of bone…

A

Vitamin D3 Analogs (Calcitriol, Calcipotriol, Calcipotriene and Betamethasone dipropionate)

32
Q

Adjunct to topical CSs, often used in combo, more for maintenance because onset is slower, for mild psoriasis as monotherapy or moderate to severe in combo…

A

Vitamin D3 Analogs…AEs = skin discomfort, calcium monitoring, can’t use calcipotriene/betamethasone dipropionate on face, flexures, or genital areas

33
Q

Topical retinoid (vitamin A derivative) that reduces inflammation by inhibiting neutrophil/monocyte chemotaxis?

A

Tazarotene gel, cream, foam

34
Q

Tazarotene can be used for mild plaque psoriasis w/topical CS and for acne, but what are the three main AEs?

A

CAN NOT be used on genitals or skin folds

Photosensitivity (use sunscreen)

Teratogenic risk

35
Q

Oral retinoid that reduces inflammation by inhibiting neutrophil and monocyte chemotaxis?

A

Acitretin (Soriatane) PO

36
Q

Acitretin can be used as monotherapy or adjunct to other treatments…less risk of organ toxicity than methotrexate or cyclosporine, but what main AEs?

A

High teratogenic (no pregnancy for 3 years post use)

And mucocutaneous dryness, alopecia, hypertiglyceridemia, hepatotoxicity, premature closure of epiphyseal closure in kids

37
Q

Pimecrolimus and Tacrolimus are two drugs of this category (aka calcineurin inhibitors) that inhibit T cell activation in inflamed skin by blocking transcription of pro-inflammatory cytokines

A

Topical Immunomodulators (TIMs)

38
Q

TIMs are a first-line steroid sparing agent for atopic dermatitis and psoriasis of the face, flexural, or genital area…caution with UV exposure due to possible cancer risk, what are the two drugs we talked about?

A

Tacrolimus (protopic)

Pimecrolimus (Elidel)

39
Q

Cyclosporine PO is used mainly for what?

A

Disease that is too severe, refractory, or extensive for topicals

Lots of AEs/interactions, less effective than biologics, but these are cheaper

40
Q

Apremilast is a PDE4 inhibitor, reduces inflammatory mediators, used for what?

A

Moderate to severe psoriasis in pts who are candidates for phototherapy or systemic therapy

Less effective than cyclosporine but fewer AEs (and less severe AEs)

DI: CYP3A4 inducers like rifampin, carbamazepine

41
Q

Folic acid antagonist that inhibits purine synthesis by acting on dihydrofolate dehydrogenase used for disease that is too severe, refractory, or extensive for topicals (palms, soles, scalp, more than 10% body)

Less efficacious than biologics, but much cheaper

A

Methotrexate

42
Q

Methotrexate you worry about stomatitis risk, but reduce that with folic acid supplements, need CBC monitoring, pulm function monitoring, liver function monitoring and preg cat X (at least one menstrual cycle for women, 3 months for men), what’s the reversal agent?

A

Leucovorin (Folinic Acid)

43
Q

Biologics MoA?

A

Block pro-inflammatory cytokines or bind to T-cells to prevent stimulation

44
Q

What are the 4 biologics we talk about?

A

Adalimumab (Humira): Human IgG Ab to TNF-a

Infliximab (Remicade): Chimeric ab to TNF-a (most effective*****)

Etanercept (Enbrel): TNF-a antagonist

Ustekinumab (Stelara): Human ab to IL-12/23

45
Q

Biologics are for moderate to severe psoriasis, can be combined with methotrexate/acitretin, but risks are what?

A

Infections: TB, lupus, cancers, etc

Less toxic to some organs though compared to methotrexate, acitretin, and cyclosporine

46
Q

To physically destroy affected wart tissue we use?

A

Keratolytic agents (salicylic acid, podofilox, podophyllum resin, imiquimod)

47
Q

Wart med that is a topical immunomodulator that induces local cytokine induction?

A

Imiquimod cream used for cutaneous, genital, perinatal (external) warts

Or for actinic keratosis on face/scalp

Superficial basal cell carcinomas

Don’t use in pregnancy

48
Q

Wart meds for external warts that cause necrosis of tissue used on, CI in pregnancy?

A

Podofilox or Podophyllum resin

49
Q

Med derived from green tea leaves that upregulates apoptosis-associated genes and to modulate and downregulate genes involved in proinflammatory response to HPV infection, applied for 16 weeks, expensive?

A

Sinecatechins ointment

PHARM II TEST 2 (7 decks)

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