Derm Pharm (kruse) Flashcards
acute inflammation with oozing, vesiculation, and crusting is best tx with __
drying preparations
tinctures, wet dressings, lotions
chronic inflame with xerosis, scaling, and lichenification is best tx with __
lubrication preparations
creams and ointments
__ preparations are best to apply to the scalp and hairy areas while __ agents are useful in intertriginous areas
drying
lubricating
name the 2 most commonly used topical abx for mild to moderate cases of acne
clindamycin and erythromycin
should not be used as mono therapy b/c combo tx (w/retinoids, benzoyl peroxide) decreases resistance
___ is a topical antibacterial that inhibits cell wall synthesis and __ is also a topical antibacterial that increases permeability of the cell wall.
Bacitracin
gramicidin
both active against gram + orgs
this topical antibacterial inhibits protein synthesis (binds to bacterial isoleucyl-tRNA synthetase. Effective tx for impetigo caused by S aureus and group A beta-hemolytic strep
mupirocin
this topical antibacterial binds to ribosomal 50s subunit and inhibits normal bacterial protein biosynthesis. Effective against group A beta-hemolytic strep and MRSA
retapamulin
this topical antibacterial increases permeability of cell wall membrane and effective against gram negs such as P aeruginosa, E coli, enterobacter, and klebsiella
Polymyxin B sulfate
these topical antibacterials irreversibly bind 30s subunit and inhibit protein synthesis
Neomycin and Gentamycin
these topical abx for acne inhibits protein synthesis by reversibly binding to 50s ribosomal subunit
clindamycin and erythromycin
this topical abx inhibits nucleic acid synthesis; anti-inflamm effects. Effective against acne rosacea
metronidazole
this topical abx for acne inhibits P. acnes by competitive inhibition of p-aminobenzoic acid utilization and inhibits bacterial folic acid synthesis
Sodium sulfacetamide
__ are prototypical azoles used for almost all candidiasis infx that can be tx topically
clotrimazole and miconazole
inhibit synthesis of ergosterol by inhibiting fungal CYP450
used for tinea corporis (ringworm), tinea pedis (athletes foot), tinea cruris (jock itch), tinea versicolor and cutaneous candidiasis
this topical antifungal prep is broad spectrum, inhibits uptake of precursors of macromolecular synthesis. Used to tx topical dermatomycosis, candidiasis, tinea versicolor, and moderate onychomycosis of fingernails and toenails
ciclopirox olamine
these topical anti fungal preps inhibit squalene epoxidase and effective for topical tx of tinea corporis, tinea cruris, and tinea pedis
allylamines: terbinafine (Lamisil) and naftifine
Butenafine has similar MOA
this topical anti fungal prep is effective in tx of most cutaneous mycoses but is ineffective against candida. Used for tinea pedis, tinea cruris, and tinea corporis. Unknown MOA
Tolnaftate (Tinactin)
This topical anti fungal prep has broad anti fungal activity but rarely used topically. Cumulative organ toxicity
Amphotericin B (ampho-terrible)
This class of oral anti fungal agents are P450 inhibitors, used for systemic yeast infx that are seen in immunocompromised pts such as T1DM, leukemia, AIDS
Azoles
this oral anti fungal agent inhibits fungal cell mitosis at metaphase and binds to human keratin, making it resistant to fungal invasion. Tx dermatophyte infx (hair, skin, nails) but not candida infx
griseofulvin
this oral anti fungal agent has high 1st pass metabolism, accumulates in skin, nails, fat. Oral prep effective for tinea corporis, tinea capitis, and onychomycosis
terbinafine
These topical antiviral agents convert pharmacologically active triphosphate metabolites and inhibit viral DNA synthesis and viral replication. Modest benefit for herpes labialis
Acyclovir, valacyclovir, penciclovir, famciclovir
this immunomodulators is for tx of external genital and perianal warts in adults, actinic keratoses on face and scalp, biopsy-proven BCC of the trunk, neck, extremities. Unknown MOA
imiquimod
these immunomodulators inhibit T-cell activation and prevent release of inflamm cytokines and mediators from mast cells. Useful in tx of atopic dermatitis and psoriasis
tacrolimus and pimecrolimus
don’t use in immunocompromised pts or kids <2
common adverse events of retinoid acid and derivatives (topical retinoid preps)?
eythema, mild peeling, and dryness
avoid or minimize sun exposure
not recommended in pregnant women
this oral retinoid prep reduces sebaceous gland size and reduces sebum production
isoretinoin (accutane)
use for isoretinoin? common adverse events? severe side effects?
unmanageable severe cystic acne
common: resemble hypervitaminosis A: dryness and itching
severe: suicide risk, teratogen
this acne preparation releases free-radical oxygen which oxidizes bacterial proteins in the sebaceous follicles decreasing the # of anaerobic bacteria and decreasing irritating-type free FAs. Antimicrobial against P. acnes
benzoyl peroxide
this acne prep has antimicrobial activity against P. acnes as well as in vitro inhibitory effects on conversion of T –> DHT
azelaic acid
also used to tx hyperpigmentation
UV light can be used for __
psoriasis
PUVA-Psoralen followed by UVA radiation
__ is a topical therapy for psoriasis that keeps skin moist and minimizes itching and tenderness
__ are for topical tx of psoriasis that are Vitamin D3 analogs that have hypo proliferative effects on keratinocytes
__ is a topical tx for psoriasis that is a retinoid acid derivative
Emollients
Calcipotriene, calcitriol
Tazarotene
this drug for psoriasis inhibits calcineurin and thereby inhibits transcription of IL-1 and IL-2 receptors
cyclosporine
sytemic tx for psoriasis reserved for __?
pts w/more than 10% body surface area involvement or less extensive, but debilitating disease
this systemic tx for psoriasis inhibits DHF reductase, used in combo with phototherapy or bio agents
MTX
this is the systemic retinoid of choice in psoriasis used in combo with UVB or PUVA tx
aciretin
this biologic response modifier for psoriasis interferes with lymphocyte activation, is a dimeric fusion protein and should be discontinued when CD4 counts remain <250
alefacept
these TNF inhibitors are biologic response modifiers for tx psoriasis.
etanercept, infliximab, adalimumab
this biologic response modifier for tx psoriasis targets and interferes with IL-12 and IL-23. Possible link with major CV events
ustekinumab
lowest efficacy topical corticosteroid? Highest efficacy?
lowet=0.25-2.5% Hydrocortisone
highest=0.05% Clobetasol propionate
this keratolytic agent is approved for tx of acne, seborrheic dermatitis, psoriasis, hyperkeratosis
salicylic acid
careful…salicylate toxicity, avoid use with other salicylates
this keratolytic agent inhibits thymidylate synthetase and blocks synthesis of DNA and RNA
fluorouracil
first generation H1-receptor antagonists for tx pruritus? side effects?
Diphenhydramine and promethazine
some anticholinergic activity and are sedating
2nd gen H1-receptor antagonists for pruritis? Metabolism? anticholinergic effects?
cetirizine, loratadine, desloratadine, fexofenadine HCl
Metabolized by CYP3A4 and CYP2D6 –> don’t coadminister w/imidazole, antifungals, macrolides
lack anticholinergic effects and non sedating (don’t cross BBB)
this trichogen is used for androgenic alopecia, more responsive to vertex balding, tx must be continued or any drug-induced hair growth will be lost
Minoxidil (rogaine)
this trichogen is for androgenic alopecia and BPH, competitive and selective inhibitor of type 2 isoenzyme of steroid 5a-reductase; blocks T — DHT in prostate gland, epididymis, seminal vesicles, liver, and inner root sheath of hair follicles
finasteride (propecia)
these BRAF inhibitors for melanoma are kinase inhibitors of BRAF V600E mutation –> increase the risk for new primary cutaneous malignancies (SCC, keratoacanthoma, new primary melanomas)
Vemurafenib and dabrafenib
this BRAF inhibitor for melanoma is a kinase inhibitor of BRAF V600E or V600K mutations –> increased risk of cardiomyopathy
Trametinib
serious adverse events with BRAF inhibitors?
All are associated with serious HS runs, including severe dermatologic runs as well as ophthalmologic complications
this agent for melanoma is a CTLA-4 blocker Ab approved for tx of unresectable or metastatic melanoma
Ipilimumab
__ is approved for adjuvant tx of stage III node-positive melanoma pts
pegylated IFN-alpha 2b
this antineoplastic is approved for tx of cutaneous lesions in pts w/AIDS-related Kaposis sarcoma
aliretinoin
this antineoplastic agent is available in both oral formula and a topical gel for tx of cutaneous T cell lymphoma
bexarotene
__ is the 1st hedgehog pathway inhibitor available for oral tx of metastatic BCC or locally advanced BCC in adults who are not candidates for surgery or radiation
Vismodegib
these antineoplastic agents are histone deacetylase inhibitors approved for tx of cutaneous T cell lymphoma in pts with progressive, persistent, or recurrent disease. Adverse events: PE, DVT, thrombocytopenia, anemia, GI disturbances
vorinostat and romidepsin
