dermatologic drugs

Question 1

solution

Answer 1

medication is disolved in a solvent

stays around for the shortest period of time for a topical agent since it is purely liquid, no oil

Question 2

lotion

Answer 2

powder in water or oil suspension

Question 3

cream

Answer 3

water in oil emulsion

Question 4

ointment

Answer 4

oil in water emulsion

stays around longer- more oil than water so its more viscous

Question 5

topical potency

Answer 5

penetration is increased with penetration of the skin- this can be increased by: decreased integrity of the skin, the skin is thinner, children(greater surface area to mass)

Question 6

polymyxin B- neomycin/ neosporin

Answer 6

topical antimicrobial
for superficial bacterial skin infx’s, eyes & external ear. prohylactically against skin abrasions/burns etc.
MOA- bactericidal. polymyxin interupts stucture of cell membrane. bacitracin interferes with peptoglycans of cell wall
-may be prepared with corticosteroid added
SE- local skin irritation, rarely anaphylaxis. avoid use with perforated TM- neomycin is ototoxic

**Aminoglycocide’s are renal toxic

Question 7

mupirocin/ Bactroban

Answer 7

topical antibiotic
for IMPETIGO. highly active against staph & strep. usu used in conjunction with oral or IV abx in tx of MRSA
-not effective against fungal or viral infx’s
MOA- inhibits bacterial protein synthesis
-cream or ointment usu dosed BID or TID
-applied to nares for tx of MRSA
SE- local irritation, burning, itching, localized pain/rash

Question 8

ketoconazole/ Nizarol

Answer 8

topical antifungal
for superficial fungal infx's(tinea's), superficial yeast infx, seborrheic derm
MOA- inhibits sterol synthesis
-lotion, ointment, shampoo
-may cause skin irritation

Question 9

use of glucocorticoids…

Answer 9

frequently scripted for immunosuppressive & anti-inflammatory properties
routes- intra-lesional injections, oral, IM, IV
-avoid topical use on abraided or damaged skin
common conditions- atopic derm, ca=ontact derm, psoriasis, eczema, bullous dz, SLE, granulomatous dz

Question 10

glucocorticoid classes

Answer 10

7 classes
class 1- most potent
class 7- least potent
halogenated corticosteroids are generally the most potent topical steroids- their use assoc w/inc local & systemic toxicity

Question 11

glucocorticoid side effects

Answer 11

local- skin atrophy(long term use), striae, telangiectasias, purpura, acneiform lesions, perioral dermatitis, fungal/bacterial skin overgrowth, hypopigmentation, rosacea

• potent doses can cause systemic toxicity- HPA supression, inc risk for hyperglycemia osteoporosis & osteonecrosis
• factors that inc systemic absorp.- ammount applied, extent of tx area, frequency, length of tx, potency, use of occlusive barrier
• injection sites may develop atrophy of underlying fat & muscle

Question 12

hydrocortisone/ cortef

Answer 12

MOA- antiinflammatory. affects gene transcription to stimulate or repress protein production
-topical cream- OTC 1%

Question 13

retinoids

Answer 13

vitamin A derivatives
affect cellular proliferation & differentiation, immune function, inflammation, sebum production
commonly tx’d dz’s- cycstic & papular acne, BCC, SCC, actinic keratosis, psoriasis, cutaneous aging

Question 14

drug tx for acne

Answer 14

topical salicylic acid, topical benzoyl peroxide, topical abx(erythromycin, clindamycin metrondiazole), retinoids
-if topical tx fails- oral abx(tetracycline), oral retinoids(accutane)

Question 15

tretinoin/ retin A

Answer 15

vitamin A derivative
for acne, tx of photo damaged skin
MOA- reduction of hyperkeratinization that leads to microcomedone formation- initial lesion of acne. inc epidermal thickness & inc dermal collagen synthesis
-topical, usu applied qh, max response may take months
-SE- erythema, peeling, burning, stinging, photosensitivity

Question 16

isoretinoin/ accutane

Answer 16

vitamin A derivative
for acne, acne rosacea, hidradenitis supperativa
MOA- red. of hyperkeratinizaiton, red of sebaceous gland # & sebum production. red of propionibacterium acne(organism that is believed to contribute to inflam)
-PO, 40% recurrence with cessation of the drug
-CAT X! 2 forms fo birth control required, no refills w/o checking in for BC use
-SE- “depression, psychosis, suicidal ideation or attempts”, HA, myalgias, arthralgias, hyperlipidema, fatty liver, hepatitis, pancreatitis

Question 17

PUVA- Psoralen Ultraviolet A

Answer 17

phototherapy for psoriasis
-pts are given psoralen which reacts to UV light, then are exposed to UVA light
-MOA not fully understood- anti-inflammatory effect through immunosuppression, inhibitory effect on DNA
-other dz’s tx’s- vitiligo, T-cell lymphomas, alopecia areata, urticaria pigmentosa
SE- nausea, painful erythema, blistering, marked advanced aging, actinic keratosis
- most serious SE- inc risk for skin CA