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SBL > Derm Pharm > Flashcards

Derm Pharm Flashcards

1
Q

Malathion

A
  • topical
  • organophosphate cholinesterase inhibitor
  • Tx for ectoparasites
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2
Q

What is a sunshade?

A

opaque material that reflects light

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3
Q

Give the classic example of a sunshade.

A

Titanium Dioxide

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4
Q

What do humectants do?

A

draw water into the outer layer of the skin

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5
Q

Give examples of humectants.

A

glycerin
lecithin
propylene glycol

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6
Q

What organism requires you to wash your hands with soap and water, since hand sanitizer will not work to eliminate it?

A

C. diff

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7
Q

What is minoxidil used for?

A

Tx of hair loss

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8
Q

What is the mechanism of action for minoxidil?

A

vasodilation due to K+ channels opening

  • promotes hair growth by increasing anagen (growth phase); decreasing telogen (rest phase)
  • enlarges miniaturized follicles
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9
Q

What is the mechanism of action of 5-fluorouracil?

A

inhibits thymidylate synthetase

-fast-growing dysplastic cells can’t synthesize DNA

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10
Q

What are common drugs used to treat actinic keratosis?

A 
5-fluorouracil
imiquimod
ingenol mebutate
topical diclofenac
retinoids
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11
Q

What is the mechanism of action of imiquimod?

A

stimulates local cytokine induction, which activates TLR’s

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12
Q

What are the two stages of actinic keratosis treatment by ingenol mebutate?

A

1) disruption of cell membrane and mitochondria, leading to cell necrosis (chemoablation)
2) Ab-dependent cell cytotoxicity mediated by neutrophils (eliminates any remaining tumor cells)

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13
Q

What type of drug is ciclopirox?

A 
topical antifungal (broad spectrum)
-against dermatophytes, Candida and Malassezia
  • disrupts macromolecular synthesis
  • low incidence of adverse rxns or dermatitis
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14
Q

What type of drug is terbinafine?

A

topical antifungal
-against dermatophytes, not active against yeasts

–can cause local irritation, avoid mucous membranes

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15
Q

What is the mechanism of action of terbinafine?

A

-selective inhibition of squalene epoxidase (key enzyme in ergosterol synthesis)

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16
Q

What kind of drug is tolnaftate?

A

topical antifungal
-distorts hyphae and stunts mycelial growth

–rarely causes irritation or contact dermatitis

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17
Q

Against what organisms is tolnaftate active against?

A
  • various dermatophytes
  • Malassezia

-NOT candida

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18
Q

What is the mechanism of action for permethrin?

A
  • binds to insect Na+ channels and blocks membrane repolarization
  • topical Tx of ectoparasites
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19
Q

What is the mechanism of action of ivermectin?

A
  • binds to glutamate-gated Cl- channels (in invertebrates) and hyperpolarizes nerve and muscle cells)
  • oral Tx of ectoparasites
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20
Q

What is the mechanism of action of lindane?

A

-disrupts GABA-ergic transmission in insects

  • topical “last resort” Tx of ectoparasites
  • -“last resort” due to its toxicity
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21
Q

What are some common topical antimicrobials used to treat acne?

A
  • benzoyl peroxide
  • clindamycin
  • erythromycin
  • azelaic acid
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22
Q

What are possible adverse effects of benzoyl peroxide?

A
  • local skin irritation

- may bleach clothing/hair

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23
Q

What is a possible side effect of clindamycin?

A

-pseudomembranous colitis (rare)

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24
Q

In treating rosacea, what are some drugs that can be used to decrease the appearance of redness?

A
  • brimonidine (topical gel)

- oxymetazoline (topical cream)

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25
Q

What is the mechanism of action behind brimonidine? Oxymetazoline?

A

Vasoconstriction

  • brimonidine (alpha-2 agonist)
  • oxymetazoline (alpha-1a and alpha-2 agonist)
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26
Q

In treating redness in the eyes, what are some drugs that can be used?

A
  • naphazoline
  • tetrahydrozoline
  • phenylephrin
  • oxymetazoline
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27
Q

What is the common mechanism of action behind the drugs used to treat eye redness? (naphazoline, phenylephrin, oxymetazoline, tetrahydrozoline)

A

adrenergic receptor agonists

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28
Q

What is the only approved agent for chronic diabetic food ulcers?

A

becaplermin

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29
Q

What is the mechanism of action of becaplermin?

A

PDGF that promotes cell proliferation and angiogenesis

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30
Q

What is a MAJOR risk of becaplermin?

A

-Black Box warning for malignancy

–use of >3 tubes increases risk of malignancy 4x

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31
Q

During the debridement stage of wound healing, what is the choice of wound dressing?

A

hydrogels

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32
Q

During the granulation stage of wound healing, what is the choice of wound dressing?

A

foam or low-adherence dressings

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33
Q

During the epithelialization stage of wound healing, what is the choice of wound dressing?

A

hydrocolloid or low-adherence dressings

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34
Q

True or False: wounds should be kept dry.

A

False

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35
Q

Why should wounds be kept covered and moist for healing?

A
  • wounds are exposed to their own fluids, which is a mix of metalloproteases and cytokines
  • occluded wounds heal 40% faster; less scarring
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36
Q

What three antibacterial agents are in a standard triple antibiotic ointment such as Neosporin?

A
  • bacitracin
  • neomycin
  • polymixin B
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37
Q

Against what type of microbials is bacitracin active?

A
  • -gram-positive
  • -most anaerobic cocci
  • -neisseria
  • -tetanus bacilli
  • -diptheria bacilli
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38
Q

Against what type of microbials is neomycin active?

A

gram-negative

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39
Q

Against what type of microbials is polymixin B active?

A

gram-negative

including: P. aeruginosa, E. coli, Enterobacter, and Klebsiella

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40
Q

What is the mechanism of action of bacitracin?

A

inhibits bacterial wall synthesis

a peptide antibiotic

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41
Q

What is the mechanism of action of neomycin?

A

binds to 30S ribosomal subunit and inhibits protein synthesis

(an aminoglycoside antibiotic)

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42
Q

What is the mechanism of action of polymixin B?

A

-damages bacterial cytoplasmic membrane by binding to phospholipids and altering membrane permeability

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43
Q

What is the method of application of salicylic acid and what condition(s) is it used to treat?

A

–topical Tx for pruritis

-acne, dandruff, and calluses

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44
Q

What is the mechanism of action of salicylic acid?

A
  • COX inhibition
  • causes epidermal cells to shed more readily (keratolytic effect) by dissolving the intercellular cement

-opens clogged pores

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45
Q

What do you need to be aware of for skin surfaces treated with salicylic acid?

A

-treated areas are photosensitized and need to be protected from the sun

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46
Q

What can be caused by prolonged used of salicylic acid?

A

-toxicity in children and those with reduced kidney or liver function

47
Q

What is the method of application and condition treated by capsaicin?

A
  • topical Tx for pruritus

- particularly neuropathic pruritus

48
Q

What is the mechanism of action of capsaicin?

A
  • activates TRPV1 (transient release potential vanilloid-1)
  • -ion channel in cutaneous nerve fibers
  • stimulates neurons to release (and deplete) certain neuropeptides, including Substance P
  • can induce lasting desensitization of neurons to stimuli
49
Q

True or False: antiseptic wash solutions (iodine, chlorhexidine, hydrogen peroxide) promote wound healing

A

FALSE - they can potentially IMPEDE wound healing because of their toxic effects on normal tissue

50
Q

Why is it important to debride wounds?

A
  • removes dead tissue
  • limits protease production
  • conserves local resources needed for healing
51
Q

What are common types of debridement?

A
  • -low-pressure irrigation w/ normal saline
  • -surgical for removing large areas of necrotic tissue
  • -enzymatic
  • -biologic (maggot therapy)
52
Q

What is the effect of chlorhexidine on bacterial spores?

A
  • prevents development of spores

- does NOT prevent germination

53
Q

What is the effect of chlorhexidine on mycobacteria?

A
  • mycobacteriostatic

- NOT mycobactericidal

54
Q

What is the effect of chlorhexidine on non-spore-forming bacteria?

A
  • protoplast and spheroplast lysis

- high concentrations cause protein and nucleic acid precipitation

55
Q

What is the effect of chlorhexidine on yeasts?

A
  • protoplast lysis and intracellular leakage

- high concentrations cause intracellular coagulation

56
Q

What is the effect of chlorhexidine on viruses?

A
  • -low activity against many viruses

- -lipid-enveloped viruses are more sensitive

57
Q

What is the effect of chlorhexidine on protozoa?

A
  • activity against trophozoites

- less activity toward cysts

58
Q

What do topical calcineurin inhibitors treat?

A

-anogenital pruritis

59
Q

What is the term for immune-mediated, chronic relapsing hair loss?

A

alopecia areata

60
Q

What is the Tx for Alopecia Areata?

A
  • corticosteroids (topical or intralesional)
  • topical immunotherapy with a contact allergen (such as diphenylcyclopropenone - DPCP) causes contact dermatitis, which causes hair growth
61
Q

What is isotretinoin and what is it used to treat?

A
  • oral retinoid

- acne

62
Q

What is a MAJOR risk of isotretinoin?

A
  • teratogenicity

- -absolutely contraindicated in pregnancy

63
Q

For how long should you wash your hands?

A

15-30 seconds

64
Q

What is the most common mistake in handwashing?

A

not washing long enough

65
Q

What is the categorical difference in use between antiseptics and disinfectants?

A
  • antiseptics are for skin

- disinfectants are for inanimate surfaces

66
Q

What is the mechanism of action of glutaraldehyde?

A

–targets the cell envelope and cross-links proteins

67
Q

What is the mechanism of action of quaternary amines?

A

-generalized membrane damage involving the phospholipid bilayers

68
Q

What is the mechanism of action of halogens?

A

-oxidation of thiol groups to disulfides, sulfoxides, or disulfoxides

69
Q

What is the mechanism of action of peroxygens?

A

-formation of free hydroxyl radicals, oxidizes thiol groups in enzymes

70
Q

What is the Tx for Herpes Simplex and its method of application?

A
  • topical acyclovir

- ointment, cream, and buccal tablets available

71
Q

What is the mechanism of action of acyclovir?

A

-guanine analog with inhibitory activity

72
Q

From a metabolic standpoint, what is a major factor in wound healing?

A

glycemic control

73
Q

What is the weird topical therapy for psoriasis?

A

tar

74
Q

What are some oral antibiotics used in treating acne?

A
  • -tetracycline
  • -doxycycline
  • -minocycline
  • -erythromycin
  • -azithromycin
  • -trimethoprim-sulfamethoxazole
75
Q

What are side effects of tetracycline?

A
  • tooth discoloration
  • GI distress
  • photosensitivity

–contraindicated in pregnancy and children

76
Q

What are the side effects of doxycycline?

A
  • photosensitivity
  • GI distress

–contraindicated in pregnancy and children

77
Q

What are the side effects of minocycline?

A
  • -dizziness
  • -drug-induced lupus
  • -skin discoloration

–contraindicated in pregnancy and children

78
Q

What are the side effects of erythromycin and azithromycin? And what category of antibiotic are they?

A
  • GI distress

- macrolides

79
Q

What are the side effects of trimethoprim-sulfamethoxazole?

A
  • SJS (Stevens-Johnson Syndrome)

- TEN (toxic epidermal necrolysis)

80
Q

What are some common systemic causes of pruritis?

A
  • chronic renal failure
  • biliary obstruction
  • diabetes, hyperthyroidism, hypercalcemia
  • Hodgkin Lymphoma, polycythemia, IDA
81
Q

What type of medication is nystatin and what does it treat?

A
  • topical antifungal
  • limited to cutaneous and mucosal candida

-may cause diarrhea if swallowed

82
Q

What is the mechanism of action of nystatin and amphotericin B?

A

-alters membrane permeability by binding to fungal sterols

83
Q

What type of medication is amphotericin B and what does it treat?

A
  • topical antifungal
  • limited to cutaneous candida

-may cause temporary yellow staining of the skin

84
Q

What are some factors that affect cutaneous absorption?

A
  • regional (axilla is more permeable than forearm)
  • concentration gradient
  • dosing schedule
  • vehicles/occlusion
85
Q

What is the term for female pattern hair loss?

A

androgenic alopecia in women

86
Q

In female pattern hair loss (androgenic alopecia), if minoxidil (first-line Tx) fails, what category of drugs are used next and which drugs are in that category?

A
  • -anti-androgens
  • spironolactone (androgen partial agonist)
  • finasteride (blocks DHT synthesis)
  • flutamide (androgen antagonist)
87
Q

Topical imidazoles are what kind of drug, and what is their mechanism of action?

A
  • topical antifungals

- block ergosterol synthesis

88
Q

What are examples of imidazoles?

A
  • miconazole
  • clotrimazole
  • efinaconazole (onychomycosis)
  • ketaconazole (CYP inhibitor)
89
Q

What are examples of systemic drugs for treatment of psoriasis?

A
  • methotrexate
  • apremilast (oral)
  • retinoids
  • calcineurin inhibitors
  • biologic agents
90
Q

What is the mechanism of action of apremilast?

A

PDE4 inhibitor

  • -increases cAMP levels
  • -decreases NO synthase, TNF-alpha, and IL-23
  • -increases IL-10
91
Q

What is the mechanism of action of ustekinumab?

A
  • -human monoclonal Ab that targets IL-12 and IL-23
  • -decreases activation of NK cells
  • -decreases CD4+ T-cell differentiation
92
Q

What are side effects of ustekinumab and secukinumab?

A

increased risk of infection

93
Q

What is the mechanism of action of secukinumab?

A
  • -human monoclonal Ab that targets IL-17A

- -decreases IL-6, IL-8, and prostaglandins

94
Q

What enzyme does finasteride inhibit?

A

5-alpha reductase

95
Q

What is the usual reason for a wound to lack adequate oxygenation during healing?

A

-sympathetic overactivity, causing local vasoconstriction

–caused by low blood volume, pain, hypothermia

96
Q

What do emollients do?

A

-form an oily layer on top of the skin, trapping water

97
Q

What are examples of emollients?

A

-petroleum, lanolin, mineral oil, dimethicone

98
Q

What do horny substance (keratin) softeners do?

A
  • loosen bonds between the top layer of cells

- help dead skin cells fall off

99
Q

What are examples of horny substance (keratin) softeners?

A
  • urea
  • alpha hydroxy acids (lactic, citric, glycolic)
  • allantoin (end of purine metabolism in mammals)
100
Q

Name some characteristics of biofilm.

A
  • antibiotics have limited penetration

- microbes develop a phenotype that replicates slowly

101
Q

What are some hormonal agents that are used to treat acne?

A
  • combo oral contraceptives (estrogen and progestin)

- spironolactone (K+ sparing diuretic)

102
Q

What is the mechanism of action of spironolactone?

A

-K+ sparing diuretic that is a partial agonist at androgen receptors

103
Q

In what population of patient is spironolactone useful to treat acne?

A

adult women with breakouts related to their menstrual cycle

104
Q

What is the general principle when starting glucocorticoid therapy?

A
  • start with the highest potency to gain control and titrate down for maintenance
  • use low potency on face, genitals, and skin folds
105
Q

Why do synthetic detergents irritate skin less than soaps?

A
  • a lower pH, closer to that of skin (5.5-7.0)

- soap has a pH of 9.0-10.0

106
Q

What is the most important component of infection control?

A

-hand hygiene

107
Q

What is azaleic acid?

A

-dicarboxylic acid (white powder found in wheat, rye, barley; involved in plant defense to infection)

  • -Tx for acne, bactericidal, decreases keratin production
  • -Tx for post-inflammatory hyperpigmentation
108
Q

Name characteristics of creams.

A
  • half water, half oil with emulsifier
  • spread easily, well absorbed, wash off with water
  • better for “wet” skin
109
Q

Name characteristics of ointments.

A
  • 80/20, oil/water
  • feel greasy, stays on surface
  • more complete absorption of active ingredient
  • best on “dry” skin
  • less likely to cause allergic reaction
110
Q

What are gels?

A

-made from polyionic colloids expanded with water

111
Q

What are pastes?

A

-mixtures of oil, water, and powder

112
Q

What are some topical medications for basal cell carcinoma?

A

–imiquimod (immunse response modifier that stimulates local cytokines and activates TLR’s)

–5-fluorouracil (inhibits thymidylate synthetase)

113
Q

What are medications for advanced basal cell carcinoma?

A
  • vismodegib
  • sonidegib

–oral “hedgehog” signaling pathway inhibitors

114
Q

True or False: epidermal growth factor improves epithelialization

A

False

SBL (4 decks)

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