Dermatologic Pharmacology Flashcards
routes of medication delivery for the skin? which cause systemic effects?
topical
transdermal
oral
transdermal and oral can cause systemic effects
what are some factors that affect drug permeation?
age condition regional skin sites skin hydration skin metabolism blood flow to the area
what are some dermatological agents we are going to talk about?
antibacterials antifungals antivirals glucocorticoids retinoids psoralens for PUVA therapy sunscreens keratolytic agents
what class is neosporin (bacitracin-neomycin-polymyxin B combo)?
topical antimicrobial
indications for neosporin?
superficial bacterial skin infxns, eyes and external ear infxn
used prophylactically against bac contamination of abrasions, burns, skin grafts or incisions
MOA of neosporin? when should it not be used?
polymyxin disrupts the structure of the bacterial cell membrane by interacting w/phospholipids; bacitracin interferes w/peptidoglycans of the bacterial cell wall
do not use if allergic ot systemic aminoglycosides
drug of choice for impetigo? benefits of using this drug?
if limited # of lesions can use mupirocin/bactroban
benefits: limited systemic absorption, lower risk of bacterial resistance
class of mupirocin/bactroban? MOA? how can it be used against MRSA? SEs?
class: topical antibiotic
MOA: inhibits bacterial protein synthesis
use in MRSA colonization: should be applied to the nares to eradicate nasal carriage of the infxn
SEs: local irritation
drug of choice for tinea infxns?
ketoconazole/nizoral
class of ketoconazole/nizoral? indication? MOA? SEs?
topical antifungal
indication: superficial fungal infxn such as tinea pedis, tinea cruris, tinea corporis
MOA: inhibits sterol synthesis, component of fungal cell membranes
SEs: skin irritation
what two other sxs do we tend to see w/atopic dermatitis/eczema?
allergic rhinitis and asthma
non-pharm interventions for atopic derm/eczema?
avoid triggers such as harsh chemicals, drying soaps, extreme temps
maintain skin patency: keep moist and hydrated, apply ointment, cream or lotion right after cleansing, air and pat dry
use cotton sheets and pajamas
what conditions are topical corticosteroids typically used in?
atopic derm/eczema
contact/allergic derm
psoriasis
classes of topical corticosteroids?
Class I= very high potency
Class II-III= high potency
Class IV-V= medium potency
Class VI-VII= low potency
characteristics of class II-III topical corticosteroids?
use for less than 3 weeks
good for lichenified lesions
do not use on face, mucous membranes, eyelids, skin folds
when are Class IV-V topical corticosteroids used?
chronic dz
when are class VI-VII topical corticosteroids used?
in children
characteristics of class I (very high potency) topical corticosteroids?
should not be discont abruptly, switch to lower potency as opposed to quitting abruptly
should not exceed 2-4 wks
what do you need to avoid when using class II-III topical corticosteroids?
avoid occlusive dressings (esp w/betamethasone and dipropionate)
when would it be indicated to use a low potency (class VI-VII) topical corticosteroids?
with children, PG women, elderly and pts w/large areas to be treated
preferred for face, groin, armpits or skin folds
cutaneous adverse reactions that can come with topical corticosteroids?
skin atrophy telangiectasia hypopigmentation steroid acne increased hair growth
which classes of topical corticosteroids can be systemically absorbed? what are the systemic SEs?
class I (very high potency) class II-III (high potency) systemic SEs: insomnia, hyperglycemia, osteoporosis, impaired wound healing
what is another tx option aside from corticosteroids for atopic dermatitis/eczema?
topical calcineurin inhibitors
when would you use topical calcineurin inhibitors?
as a last line therapy to tx atopic dermatitis/eczema
tx options for pruritis/hives?
what is NOT recommended as a tx option?
systemic antihistamines (loratadine, cetrizine) DO NOT recommend topical antihistamines b/c ineffective, can carry risk of contact dermatitis and cutaneous sensitization
non-pharm tx options of acne?
cleansing (no more than 2x daily)
comedone extraction using specialized tools
avoid oil-based skin products
diet changes
pharm tx options of acne?
salicylic acid
benzoyl peroxide
topical retinoids
antibacterial agents (erythromycin, clindamycin, azelaic acid, dapsone)
antisebum agents (BC, spironolactone, isotretinoin)
class of isotretinoin/accutane? indications? MOA? main concern w/using this as tx?
vit A derivative
indications: acne, acne rosacea, hidradentitis supperativa
MOA: reduction of hyperkeratinization, reduction in # of sebaceous glands and sebum production and reduction of p. acne
teratogenicity is the main concern with this tx (1st 3 wks of PG)
additional SEs: depression, psychosis, myalgias, hyperlipidemia
what is the iPLEDGE program?
risk evaluation and mitigation strategies for use of prescribing isotretinoin/accutane
goal is to not have any female starting the tx if PG and to not get PG while on tx
requires females of child bearing age to have a PG test 7 d before getting rx refilled
tx options for psoriasis?
topical corticosteroids topical vit D analog topical vit A analog/retinoid phototherapy systemic tx including oral steroids, chemotherapy agents and TNF-a inhibitors
what class is calcipotriene/covonex? used to tx what? MOA? SEs? potentially more effective when used with what?
vit D analog
used to tx plaque psoriasis, scalp psoriasis
MOA: inhibits epidermal proliferation and stimulation of differentiation
effective as topical corticosteroids but more frequent ADRs
SEs: photosensitivity, hypercalcemia, may potentially worsen psoriasis, skin irritation
potentially more effective when used with betamethasone
class of tazarotene/tazorac? indication? SEs?
topical retinoid
use for plaque psoriasis, also used in acne
recommended to use w/topical corticosteroids for improved efficacy and tolerability
SEs: skin burning, irritation, stinging
alternative tx of psoriasis?
phototherapy of UVA/UVB rays
photochemotherapy- psoralen drug added to the tx
what does PUVA stand for?
psoralen and ultraviolet therapy in which the pt first given a psoralen then exposed to UVA light
MOA of PUVA tx?
not fully understood, however has been proven effective in tx of psoriasis
SEs of PUVA tx?
nausea, painful erythema, blistering, chronic use associated w/increased risk of skin CA
