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Pharm > Dermatologic Pharm > Flashcards

Dermatologic Pharm Flashcards

1
Q

Topical Corticosteroids

A
  • produce anti-inflammatory response in skin
  • used to systematic relief of itching
  • classified based on potency
  • used for eczema and psoriasis
  • low potency on thin skin
  • high potency on thick skin
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2
Q

Adverse effects of topical steroids

A
  • high potency steroids increase chance of systemic effect and can permanently thin skin
  • local effects are more often seen in topical applications (atrophy, steroid acne,hypopigmentation, hypertrichosis, allergic contact dermatitis)
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3
Q

Imiquimod (Aldara)

A

-topical steroid
-immunomodulator
MOA: stimulates immune system to make interferon and interleukin to get rid of skin lesion
Spectrum: genital/perianal warts, actinic keratoses on face and scalp, superficial basal cell of trunk, neck, and extremities
Adverse effects: local itching and redness

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4
Q

Tacrolimus (Protopic) and Pimecrolimus (Elidel)

A

-topical steroid
-immunomodulator
MOA: T-cell activation leads to activation of calcineurin. Calcineurin activates gene prodcution to produce IL-2 activating immune response
-Calcineurin inhibitor
-used for moderate to severe atopic dermatitis
-short term or intermittent tx
-not for continuous long term use
-not for kids under 2 years old
-Adverse effects: burning, itching, redness.
-BBW: skin cancer and lymphomas

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5
Q

Ectoparasiticides

A
  • topical steroid
  • kill parasites
  • Permethrin (Elimite)
  • Ivermectin (SKLice)
  • Malathion (Ovide)
  • Lindane (Kwell)
  • Crotamiton (Eurax)
  • typically have to treat more than once (7-10 days after original tx)
  • Concern is drug systemically absorbed
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6
Q

Permethrin (Elimite & Nix)

A
  • topical steroid
  • Ectoparasiticides
  • spectrum: pediculus humanus (lice), pthirus pubis (crabs), sarcoptes scabiei (scabies)
  • lice/crabs: apply and leave on for 10 minutes
  • scabies: hleave on for 8-14 hours
  • Adverse effects: burning, pruritis
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7
Q

Ivermectin (Sklice)

A
  • topical steroid
  • Ectoparasiticides
  • used in pt over 6 months of age for head lice
  • scabies
  • apply to dry hair and rinse off after 10 minutes
  • adverse reactions: conjunctivitis, eye irritation, dandruff, dry skin, skin burning sensation
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8
Q

Malathion (Ovide)

A
  • topical steroid
  • tx of pediculus humanus capitis (head lice and their ova)
  • mildly effective for scabies
  • thoroughly cover and moisten hair, allow it to dry (8-12 hr)
  • repeat in 7-9 days
  • adverse effects: irritation of scalp and skin
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9
Q

Lindane (Kwell)

A
  • topical steroid
  • kills lice (shampoo)
  • Important difference: more systemic absorption, concentrates in brain, increased risk of neurotoxicity (seizures and death)
  • okay for small area (lice tx), but not okay for larger area (scabies)
  • BBW: do not give to infants, children, and pregnant women
  • Adverse effect: skin irritation
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10
Q

Topical Immunomodulators

A
  • modify the immune system in the skin
  • not systemic so less adverse reactions
  • Imiquidmod and Tacrolimus/Pimecroliumu
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11
Q

Crotamiton (Eurax)

A
  • topical steroid
  • used for scabies
  • apply to the neck down once daily and repeat next day
  • repeat this cycle again in 1 week if needed
  • adverse effect: skin irritation
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12
Q

Topical Acne drugs

A
  • retinoids (tretinoin, adapalene, tazarotene)
  • benzoyl peroxice
  • azelaic acid (Finacea)
  • salicylic acid
  • topical antibiotics (erythromycin, clindamycin, gentamicin, sodium sulfacetamide)
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13
Q

Systemic acne drugs

A

Istretinoin (acutane)

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14
Q

Oral antibiotics for acne

A
  • tetracycline
  • minocycline
  • doxycycline
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15
Q

Tretinoin

A
  • topical tx for acne
  • topical form of vitamin A
  • cream and gel form
  • MOA: decreases cohesion between epidermal cells and comedones and stimulates turnover of follicular epithelial cells (cells shed more easily from the dermis)
  • adverse effects: skin irritation (worse over first 4-6 weeks)
  • don’t use around eyes, nose, and mouth
  • try cream before gel
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16
Q

Retinoids

A
  • topical acne tx
  • promotes dermal collagen synthesis, new blood vessel formation, and thickening of epidermis (decreased wrinkles)
  • derivatives: Adapalene (Differin) and Tazarotene (Tazorac)
  • Adapalene is less irritating then tretinoin
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17
Q

Benzoyl Peroxide

A
  • topical acne tx
  • MOA: antibacterial and comedolytic properities and generates free radicles that oxidize proteins in Cuitbacterium ances cell wall
  • adverse effects: bleaching of hair and skin irritation
  • synergistic with clindamycin or erythromycin
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18
Q

Azelaic acid (Azelex or Finacea)

A
  • same drug, but different brand names
  • Azelex marketed for acne vulgaris
  • Finacea marketed for rosacea
  • MOA: not know, but possess antimicrobial activity
  • mild to moderate acne
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19
Q

Topical Antibotics

A
  • Clindamycin, Erythromycin, Sodium Sulfacetamide
  • MOA: reduces number of Cutibacterium acnes
  • combining with retinoids or benzyol peroxice increase efficacy (work in different ways)
  • combining also decreases antibiotic resistance
  • Adverse effects: drying and stinging of skin
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20
Q

Clindamycin, erythromycin, and sodium sulfacetamide MOA

A

-inhibit protein synthesis at 50s subunit

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21
Q

Isotretinoin (Accutane)

A
  • systemic acne tx
  • vitamin A derivatives (like retinoids, but PO)
  • MOA: reduces sebaceous gland size and reduces sebum production
  • Adverse reactions: hypervitaminosis A, dryness and itching of mucous membranes, depression
  • Teratogen
  • only prescribed by dermatologist
  • severe cystic acne
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22
Q

systemic antibiotic acne tx

A
  • reduces number of cutibacterium acnes
  • combining with benzoyl peroxide increases efficacy
  • can be more effective, but has more side effects
  • Tetracycline, erythromycin, minocycline, and doxycycline (mino and doxy most common)
  • Clindamycin uses topically, but not orally due to c.diff risk
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23
Q

Minocycline and Doxycycline MOA

A

Inhibit protein synthesis at 30s subunit

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24
Q

Acne pharmacology

A
  • takes 6-8 weeks to work
  • most tx irritates skin
  • need to be careful with sun exposure
  • want drying effect so use lotions or gels and maybe some creams
  • avoid ointments
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25
Q

Mild acne

A

benzoyl peroxide or topical retinoid

26
Q

Moderate acne

A

combination of benzoyl peroxide + topical retinoid/topcial antibiotics

27
Q

Severe acne

A

combination therapy with oral antibiotics, topical retinoid, and benzoyl peroxide/topical antibotics

28
Q

Tazarotene (Tazorac)

A
  • topical drug for psoriasis
  • retinoid (vitamin A derivative)
  • can be teratogen
  • MOA: binds to retinoic acid receptor to reduce keratinocyte proliferation rate
  • helps normalize cell differentiation, prohibits formation of cornified envelope
  • ADR: irritates skin, phytosensitivity
29
Q

Calcipotriene (Dovonex)

A
  • topical drug for psoriasis
  • Vitamin D derivative
  • increased vitamin D receptors and inhibit epidermal proliferation and stimulation
30
Q

Calcipotriene/betamethasone (Taclonex)

A

-ADR: hypercalcemia, irritates skin

31
Q

Topical tx for psoriasis

A
  • Tazarotene (Tazorac)
  • Calcipotriene (Dovonex)
  • Calcipotriene/betamethasone (Taclonex)
  • topical steroids: betamethasone, desoximetasone, flucinolone, halboetasol
32
Q

Systemic tx for psoriasis

A
  • Methotrexate

- Acitretin (Soritane)

33
Q

Methotrexate

A
  • systemic tx for psoriasis
  • used for symptomatic control of psoriasis that is unresponsive to other therapies
  • MOA: interferes with DNA synthesis, repair, and cellular replication
34
Q

Acitretin (Soritane)

A
  • systemic tx for severe psoriasis
  • dermatologist prescribed
  • MOA: blocks retinoid receptors to inhibit IL-6 resulting in anti-inflammatory, anti-proliferative, and keratinocyte differentiation in epithelium
35
Q

ending mab

A
  • monoclonal antibody
  • biologics
  • systemic tx for psoriasis
36
Q

Occlusion

A
  • prevents the evaporation of water from the skin to increase the moisture level of the skin
  • wrapping area in plastic, vehicle of the drug (most common way), patches
37
Q

Types of vehicles

A
  • Tinctures: drug dispersed in alcohol based liquid
  • lotions: drug suspended in liquid, need to shake to disperse drug
  • gels: semisolid system, drug evenly dispersed
  • creams: drug evenly dispersed in a semisolid base that spreads easily
  • ointments: drug evenly dispersed in semisolid base that is less easy to spread
  • most to least drying: tinctures, gels, lotions, creams, ointments
38
Q

Transdermal delivery drugs

A
  • applied for a systemic effect
  • generally not for disease of skin
  • Pros: delivered reliably, relatively pain free, avoid first pass effect (good bioavailability), maintenace drugs due to increased pt compliance
  • Cons: takes several days to see effect, difficult to titrate dose
39
Q

Transdermal patches info

A
  • don’t cut patch as it destroys delivery system
  • when removed there is still drug in the patch - don’t touch surface
  • keep out of reach of children as they think they are stickers
40
Q

Clinical uses of topical antibiotics

A
  • prevention
  • treatment: mild active skin infection in early stage only
  • decreasing nasal carriage of stap (MRSA)
  • Acne
41
Q

Topical antibiotics

A

-OTC combinations: Neosportin (bacitracin, polymyxin B, neomycin) and polysporin (bactracin, polymyxin B)

42
Q

Bacitracin

A
  • topical antibiotic
  • MOA: inhibits peptidoglycan chain synthesis for bacterial cell wall synthesis
  • useful for G+ staph infections
43
Q

Polymyxin B

A
  • topical antibiotic
  • MOA: increasing bacterial cell membrane permeability leading to death of the cell (cell lysis)
  • useful for G-
44
Q

Neomycin

A
  • topical antibiotic
  • aminoglycoside
  • MOA: inhibits protein synthesis at 30s ribosomal subunit
  • Usual for G-
45
Q

Topical antibiotics tx

A
  • tx for mild active skin infection in early stage only
  • Standard of care for an active skin infection is oral antibiotics
  • Can combine with Retapamulin and Mupriocin for cases such as Impetigo
46
Q

Retapamulin (Altabax)

A
  • used with topical antibiotics
  • MOA: inhibit protein sysnthsis at 50s subunit
  • kills strep and staph but NOT MRSA
  • only use if methicillin-susceptible strains only
47
Q

Mupirocin (bactroban)

A
  • MOA: inhibits bacterial protein and RNA synthesis
  • Kills MRSA
  • decreases nasal carriage of MRSA
48
Q

Antifungals

A
  • takes 2-3 weeks for full effect
  • apply once or twice a day
  • 3 types: dermatophates, candida, malassezia furfur
49
Q

Common fungal infections

A
  • onchomycosis: toe/finger nail
  • Tinea Pedis: feet
  • Tinea Cruris: jock itch
  • Tinea Corporis: ringworm
  • Tina Capitis: fungal scalp infection
50
Q

Topical Antifungals

A
  • Azoles
  • Ciclopirox (Penlac)
  • Tolnaftate (Tinactin)
  • Naftifine (Naftin)
  • Terbinafine (Lamisil)
  • Nystatin
51
Q

Topical Azoles (Imidazoles)

A
  • Efinaconazole (Jublia) - nail lacquer
  • Ketoconazole - cream, gel, shampoo
  • Econazole - cream, foam
  • Itraconazole (Sporonox): capsule
  • Fluconazole (Diflucan): tablet, suspension, IV
  • Miconazole (Lotrimin, Monistate): cream, powder, ointment
  • good at killing a 3 fungus
  • often found in combination with corticosteroids
  • ADR: itching, redness, stinging
52
Q

Ciclopriox (Loprox)

A
  • topical fungal that kills dermatophytes, candida, and malassezia furfur
  • MOA: inhibits transport of essential elements of fungal cells, disrupt DNA, RNA, and protein synethesis
  • Indications: onychomycosis, seborrheic dermatitis of scalp, tindea pedis, cruris, corporis
  • ADR: application site reaction (erythema, pruritus, burning)
53
Q

Tolnaftate (Tinactin)

A
  • topical fungal (cream or powder)
  • kills dermatophytes, but no candida
  • ADR: pruritus (rarely)
  • recurrenes can occur more often
  • doesn’t work on palms or soles of feel as well as azoles
54
Q

Naftifine (Naftin) and Terbinafine (Lamisil)

A
  • grouped together as they are allylamines
  • topical fungal (cream/powder)
  • MOA: inhibits squalene epoxidase (enzyme necessary for fungi biosythesis) which leads to deficiency in ergosterol and subsequent fungal death
  • good for dermatophytes (tineas)
  • no candida coverage
  • ADR: dry skin, erythema, pruritus, burning
55
Q

Nystatin

A
  • topical fungal (cream, ointment, powder, suspension)
  • kills candida, but not dermatophytes
  • MOA: binds to sterols in fungal cell membrane leading to leakage of cellular contents and cell death (tears holes in cell membrane)
  • well tolerated
56
Q

Oral antifungal groups

A
  • Oral azoles
  • Terbinafine
  • Griseofulvin
57
Q

Oral Azoles

A
  • antifungal
  • Fluconazole (Diflucan) and itraconazole (Sporanox)
  • effective for skin, less so for nails
  • do not give with statins, midazolam, or triazolam
  • 34A inhibitor
58
Q

Fluconazole (Diflucan)

A
  • oral azole
  • very long half life
  • can give every day or every other day
  • used for dermatophytes and candidia (espeially vaginal yeast infections)
59
Q

Itraconazole (Sporanox)

A
  • oral azole
  • last long time in skin and nails
  • can be used for nail infection, but has a lot of ADR including liver dysfunction
  • can give for 3 months which is a relatively short course of therapy
  • Monitor AST/ALT - hepatotoxic
  • avoid in heart failure -excarbates
60
Q

Terbinafine (Lamisil)

A
  • oral antifungal is effective, but can give topically
  • answer for nail infections
  • not to be used for a long time
  • 6 weeks for fingernails and 12 weeks for toenails
  • Need to check liver function tests periodically
  • ADR: headache, n/v, taste disturbances, increased liver enzymes
61
Q

Griseofulvin

A
  • oral antifungal
  • tx of dermatophyte infections not adequately treated by topical therapy
  • MOA: interferes with microtubule function - disrupting mitosis
  • uses: infection of hair/scalp (4-6 weeks), skin infection (3-4 weeks), nails (6-18 months)
  • ADR: teratogenic, headache, nausea, diarrhea, photosensivity, leukopenia, hepatotoxicity, may get reaction if allergic of pcn
  • not used much in US

Pharm (7 decks)

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