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MSK Exam 1 Spring 2015 > Dermatologic Pharmacology > Flashcards

Dermatologic Pharmacology Flashcards

1
Q

rate limiting step drug absorption

A

stratum corneum

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2
Q

vehicle reservoir

A

to extend the release of dermatologic agent

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3
Q

routes of drug absorption

A

through stratum corneum
sweat ducts
sebaceous follicles

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4
Q

percutaneous absorption

A

concentration gradient estabilished

partition coefficient - drug ability to leave vehicle

diffusion coefficient

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5
Q

wet lesion

A

wet dressings

pulls moisture out as evaporates

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6
Q

ointments

A

most able to stop evaporation

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7
Q

dry skin

A

use cream or ointment

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8
Q

wet skin

A

use gel or lotion

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9
Q

transdermal patch

A

constant drug delivery

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10
Q

10yo M mountain bike wreck, abraded areas

A

tx approach - clean with soap and water

use of topical antibiotic debated - promote resistance

clean wound and remove debris**

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11
Q

MOA of neosporin

A

bacitracin - inhibit cell wall synthesis
polymyxin B - increases permeability of cell wall
neomycin - bind and inhibit 30S ribosomal subunit

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12
Q

bacitracin

A

gram positive

anaerobic cocci

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13
Q

polymyxin B and neomycin

A

gram negative coverage

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14
Q

5yo F, red sores around mouth, suspect impetigo

what antibiotic cover group A beta-hemolytic strep and staph aureus (including MRSA)

A

mupirocin

retapamulin

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15
Q

group A beta-hemolytic strep

A

strep pyogenes

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16
Q

tx of impetigo

A

non-bullous - topical therapy - mupirocin or retapamulin for 5 days

bullous - oral antimicrobial for 7 days

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17
Q

benefits of topical tx

A

fewer side effect

low risk of bacterial resistance

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18
Q

adverse of bacitracin and neomycin

A

contact dermatitis

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19
Q

acne

A

topical antibiotics
-less effective than benzylperoxide

clindamycin, erythromycin, metrondiazole, sodium sulfacetamide

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20
Q

MOA clindamycin

A

macrolide - inhibits 50S

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21
Q

MOA erythromycin

A

macrolide - inhibit 50S

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22
Q

MOA metrondiazole

A

damages DNA

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23
Q

MOA sodium sulfacetamide

A

sulfonamide - inhibit folic acid synthesis

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24
Q

organism in acne

A

proprionibacterium acnes

gram positive rod**

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25
Q

35yo M construction worker, itching of both feet, dermatophyte infection
-athletes foot tx?

A

azole
allylamine
butenafide
toinaftate

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26
Q

MOA azole

A

inhibit synthesis of ergosterol
-inhibits lanosterol 14-a-demethylase

for ring worm, athletes foot, etc.

also cutaneous candidiasis - vaginal yeast infection

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27
Q

MOA ciclopirox alamine

A

inhibit uptake of precursors of macromolecule synthesis

topical detmatomycosis, candidiasis, tinea versicolor

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28
Q

MOA allylamines

A

inhibit squalene epoxidase

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29
Q

terbinafine and naftifine

A

allylamines

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30
Q

MOA toinaftate

A

unknown

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31
Q

use of nystatin

A

cutaneous and mucous candida infection - thrush

swish and spit

32
Q

amphotericin B

A

for systemic infection - broad antifungal coverage

33
Q

fever, chills, hypotension, kidney dysfunction, liver, anemia

A

side effects of amphotericin B

also - long half life - lots of organ toxicity

34
Q

esophageal candida

A

use azoles

35
Q

MOA griseofulvin

A

inhibit fungal cell mitosis at metaphase

in dermatophyte infection

induces CYP enzymes

36
Q

azoles

A

lots of drug rxns

37
Q

terbinafine

A

high first pass metabolism

-accumulate in skin, nails, fat

38
Q

tinea

A

dermatophyte function

capitis - scalp - oral
pedis - feet - topical
cruris - groin - topical
corporis - body - topical

39
Q

candida infections

A

thrush - oropharyngeal - oral
esophageal - systemic
vulvovaginitis - topical - fluconazole
invasive - systemic antifungal

40
Q

40yo M frequent cold sores

-organism is what?

A

herpes simplex type 1

41
Q

tx for herpes simplex type 1

A

acyclovir, penciclovir, docosanil - modest benefit

docosanil is OTC

42
Q

chronic suppression of HSV1

A

acyclovir valacyclovir

43
Q

MOA cyclovirs

A

converted to pharmacologically active triphosphate metabolites - inhibit DNA synthesis and viral replication

44
Q

MOA docosanol

A

inhibit fusion between plasma membrane and HSV envelope

-prevent viral entry and replication

45
Q

immunomodulators

A

imiquimod - external genital warts

tacrolimus - atopic dermatitis - inhibit T lymphocyte activation - in transplant patients

46
Q

oral for transplant rejection

A

tacrolimus

47
Q

14yo F acne treatment
-benzoyl peroxide dries out skin

other options

A

topical retinoids

  • tretinoin
  • adapalene
  • tazarotene

MOA - decrease cohesion epidermal cells - increased epidermal turnover

48
Q

MOA benzoyl peroxide

A

releases free radical oxygen species - oxidize bacterial proteins - activity against P. acnes

no resistance occurs**

49
Q

CI of retinoids

A

pregnant women

50
Q

isotretinoin

A

oral retinoid

reduces sebaceous gland size

51
Q

CI for isotretinoin

A

pregnancy**

need 2 forms of birth control
and monthly preg test
and cannot donate blood

iPLEDGE program

52
Q

few lesions, little or no inflammation

A

mild acne

53
Q

many lesions, significant inflammation

A

moderate acne

54
Q

numerous lesions, extreme inflammation, significant scarring

A

severe acne

55
Q

acne tx approach

A

1 - topical retinoid
2 - topical retinoid and antimicrobial
3 - topical retinoid, antibiotic, benzyl peroxide
4 - oral isotretinoin

56
Q

<5% psoriasis on body

A

use topical

57
Q

topical glucocorticoids

A

for psoriasis - don’t use for long term

58
Q

coal tar

A

for psoriasis

-historical agent - older

59
Q

calcipotriene

A

vit D3 analog

-up and coming mild to moderate psoriasis - <5% body - slow onset - no long term effects

60
Q

tazarotene

A

topical retinoid

-for psoriasis

61
Q

systemic psoriasis tx

A

if >5% body covered

methotrexate
acitretin
cyclosporine

62
Q

not in pregnancy or alcohol

A

acitretin

63
Q

not in kidney or liver dysfunction

A

methotrexate

64
Q

not in kidney dysfunction or HTN

A

cyclosporine

65
Q

methotrexate and phototherapy

A

systemic tx psoriasis

66
Q

MOA methotrexate

A

inhibit dihydrofolate reductase - folic acid analog

with phototherapy for tx of psoriasis

67
Q

TNF inhibitors

A

new psoriasis drugs

etanercept
infliximab
adalimuab

rule out TB**

68
Q

cannot use with TB

A

TNF inhibitors

69
Q

topical steroids

A

immunosuppressive and anti-inflammatory

grouped based on potency

70
Q

low potency corticosteroids

A

hydrocortisone

71
Q

high potency corticosteroid

A

betamethasone

clobetasol

72
Q

keratolytic agent

A

salicylic acid

causes softening and dissolution of peeling of stratum corneum

73
Q

pruritis and itching

A

antihistamines - can cause allergic dermatitis

also topical anesthetics

74
Q

H1 antagonists

A

effective and treatment for itching

diphenhydramine and promethiaizine**

75
Q

agents for hair growth

A

trichogenic agent

minoxidil - unknown MOA
finasteride

76
Q

finasteride MOA

A

competitive selective inhibitor of 5-a reductase
-blocks T > DHT conversion

adverse - decreased libido, erectile dysfunction

77
Q

pregnant women

A

should not handle finasteride

MSK Exam 1 Spring 2015 (21 decks)

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