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SBL > Dermatologic Pharmacology > Flashcards

Dermatologic Pharmacology Flashcards

1
Q

is alcohol-based hand disinfection effective against c. diff?

A

NO! must use soap and water to kill c. diff

alcohol-based is effective against gram(+), gram(-) and viral pathogens

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2
Q

this moisturizer component forms an oily layer on top of the skin, traps water

give examples

A

emollients

ex: petrolatum, lanolin, mineral oil, dimethicone

good for dry skin

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3
Q

this moisturizer component draws water into the outer layer of the skin

give examples

A

humectants

ex: glycerin, lecithin, propylene glycol

(osmotic)

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4
Q

this moisturizer component loosens the bonds b/w the top layer of cells and helps dead skin cells fall off; helps the skin retain water, gives smoother and softer feeling

give examples

A

horny substance (keratin) softener

ex: urea, a-hydroxy acids (lactic, citric, glycolic), allantoin

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5
Q

what moisturizer do you need for normal skin?

A

water-based

lightweight oils (cetyl alcohol) or silicone-derived (cyclomethicone)

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6
Q

what moisturizer do you need for dry skin?

A

heavier, oil-based w/ antioxidants
- grape seed oil or dimethicone also help hydrate

pretrolatum-based products for very dry/cracked skin
- prevent water from evaporating

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7
Q

what moisturizer do you need for oily skin?

A

water-based that is labeled “noncomedogenic” to provide moisture while limiting acne breakouts

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8
Q

what moisturizer do you need for sensitive skin?

A

one with soothing ingredients – chamomile, aloe

no potential allergens (fragrance, dyes) or acids

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9
Q

what moisturizer do you need for mature skin?

A

oil-based w/ petrolatum + antioxidants or a-hydroxy acids

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10
Q

what radiation causes most erythema/sunburn, skin aging, and photocarcinogens?

A

UVB

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11
Q

what radiation causes skin aging and cancer?

A

UVA

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12
Q

name the three chemical compounds of sunscreen that absorb UV light

A
  1. PABA - active in UVB
  2. benzophenones - in range of UVB and UVA, less effective than PABA
  3. dibenzoylmethanes - active in UVA, useful for drug-induced photosensitivity and cutaneous lupus erythematous
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13
Q

name the target and MOA of the antiseptic: glutaraldehyde

there are 2 for this one

A

target: cell envelope (cell wall, outer membrane)
MOA: cross-linking of proteins

target: cross-linking of macromolecules
MOA: cross-linking of proteins in cell envelope and elsewhere in cell

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14
Q

name the target and MOA of the antiseptic:

quaternary amines

A

target: cytoplasmic (inner) membrane

MOA: generalized membrane damage involving phospholipid bilayers

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15
Q

name the target and MOA of the antiseptic:

chlorhexidine

A

target: cytoplasmic (inner) membrane

MOA: low concentrations affect membrane integrity, high concentrations cause congealing of cytoplasm

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16
Q

name the target and MOA of the antiseptic:
halogens

(there are 2 for this one)

A

target: effects on DNA
MOA: inhibition of DNA synthesis

target: oxidizing agents
MOA: oxidation of thiol groups to disulfides, sulfoxides, or disulfoxides

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17
Q

name the target and MOA of the antiseptic:

peroxygens

A

target: oxidizing agents

MOA: hydrogen peroxide (formation of free radicals, oxidizes thiol groups in enzymes and proteins)

OR

peracetic acid (disruption of thiol groups in proteins)

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18
Q

broad-spectrum antimicrobial agent widely used in homes and hospitals due to general efficacy on skin (including oral mucosa) and low irritability

A

chlorhexidine

{prevents development of spores; mycobacteriostatic; active against yeast membranes and can cause intracellular coagulation; lipid enveloped viruses more sensitive}

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19
Q

name a gel that reduces bacterial load while providing a moist wound environment

A

cadexomer idodine

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20
Q

what is toxic to bacteria and widely used by clinicians to decrease bacterial surface contamination? is rate of wound healing improved?

A
  1. silver (silvadene)

2. no, rate of healing is not improved

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21
Q

what should you suspect in patients with chronic illnesses, inadequate societal support, multisystemic trauma, or GI or neurological problems?

A

malnutrition – these conditions may impair intake

must address protein-calorie malnutrition and deficiencies of vitamins and minerals; nutrition is imperative to wound healing

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22
Q

what is the usual reason for inadequate oxygenation?

A

local vasoconstriction due to sympathetic overactivity

common causes: blood volume deficit, unrelieved pain, hypothermia; oxygenation is imperative to wound healing

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23
Q

how does removing dead tissue and debris promote wound healing?

A

limits protease production and conserves local resources needed for healing

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24
Q

this should be routine; flushes bacteria and removes loose material

A

low-pressure irrigation w/ normal saline

*esp. for larger wounds

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25
Q

this is appropriate for removing large areas of necrotic/infected tissue

A

surgical debridement

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26
Q

what enzyme may promote endothelial cell and keratinocyte migration for angiogenesis and epithelialization?

A

collagenase (enzymatic debridement)

this has mixed results

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27
Q

this results in liquefaction of necrotic tissue while leaving healthy tissue intact

A

maggot therapy (biologic debridement)

{pressure ulcer healing time not consistently reduced}

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28
Q

platelet derived growth factor, promotes cel proliferation and angiogenesis

A

becaplermin

*only agent approved for the treatment of chronic diabetic foot ulcers; black box warning for malignancy (>3 tubes)

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29
Q

what is the only agent approved for treatment of chronic diabetic foot ulcers?

A

becaplermin

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30
Q

does epidermal growth factor significantly improve epithelialization?

A

no (“good distractor on exam because this is surprising”)

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31
Q

what comprises the fluid of wounds during healing?

A

metalloproteases, cytokines

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32
Q

name the agents for the

  1. debridement stage
  2. granulation stage
  3. epithelialization stage
A
  1. debridement stage – hydrogels
  2. granulation stage – foam and low-adherence dressings
  3. epithelialization stage – hydrocolloid and low-adherence dressings
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33
Q
  • peptide antibiotic, inhibits bacterial wall synthesis
  • active against gram(+), and others
  • often causes contact dermatitis; poorly absorbed through skin
A

bacitracin

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34
Q
  • aminoglycoside antibiotic, binds to 30S ribosomal subunit
  • active against gram(-)
  • often causes contact dermatitis; poorly absorbed through skin
A

neomycin

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35
Q
  • peptide antibiotic, binds to phophor-lipids to alter permeability and damage bacterial cytoplasmic membrane
  • effective against gram(-)
A

polymixin B

“detergent-like effect”

*active agains P. aeruginosa, E. coli, Enterobacter, Klebsiella

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36
Q

what is the most common cause of jock itch, athlete’s foot, and onychomycosis?

A

dermatophyte Trichophyton rubrum

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37
Q

as a class, these block ergosterol synthesis and have a wide range of activity against dermatophytes and yeasts (antifungals)

A

topical imidzaoles; usually apply 1-2x/day for 2-3 weeks, may cause stinging, pruritus, erythema, and local irritation

  • miconazole
  • clotrimazole
  • efinaconazole
  • ketoconazole
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38
Q

topical imidazole; vaginal cream or suppositories useful in vulvovaginal candidiasis

A

miconazole

clotrimazole also effective, tablet or cream

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39
Q

topical imidazole; onychomycosis treatment, given for 48 weeks (low complete cure rate)

A

efinaconazole

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40
Q

topical imidazole; cream for treatment of dermatophytosis and candidiasis, shampoo for seborrheic dermatitis

A

ketoconazole

inhibitor of CYP450

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41
Q

synthetic broad-spectrum topical antimycotic agent, disrupts macromolecular synthesis

what is it active against?
OTC or prescription?

A

ciclopirox

  • active against dermatophytes, Candida, and Malassezia; prescription
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42
Q

allylamine, selectively inhibits squalene epoxidase (key enzyme for synthesis of ergosterol)

what is it effective against?

A

terbinafine

  • highly active against dermatophytes, less active against yeasts; avoid contact w/ mucous membranes
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43
Q

synthetic antifungal compound, distorts hyphae/shunts mycelial growth

what is it effective against?
OTC or prescription?

A

tolnaftate

  • effective against dermatophytes, Malessezia; NOT Candida; OTC
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44
Q

binds to fungal sterols, alters membrane permeability

limited to topical treatment of cutaneous and mucosal candida infections

A

nystatin

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45
Q

binds to fungal sterols, alters membrane permeability

limited to topical treatment of cutaneous candida infections, may cause temporary yellow staining of skin

A

amphotericin B

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46
Q

synthetic guanine analog w/ inhibitory activity against HSV 1 and 2

A

acyclovir

  • used for recurrent orolabial HSV infection in immunocompetent adults; administered as ointment, cream or buccal tablet
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47
Q

pruritus without primary rash, due to compression or degeneration of nerves in the skin, en route to the spine or in the spine itself is known as…

what may provide relief?

A

…neuropathic localized pruritus

  • anticonvulsants gabapentin and pregabalin may provide relief
48
Q

topical therapy particularly useful for anogenital pruritus, may experience transient burning and stinging

A

topical calcineurin inhibitors

dose: tacrolimus (ointment); pimecrolimus (cream)

49
Q

topical therapy for pruritus; H1 antagonist

avoid in children, 20-25% risk of sedation

A

doxepin

50
Q

topical therapy for pruritus; TRPM8 antagonist

useful for patients who report cooling as an alleviating factor

A

menthol

51
Q

topical therapy for pruritus; TRPV1 agonist

useful for neuropathic itch, may experience initial transient burning

A

capsaicin

52
Q

topical therapy for pruritus; COX inhibitor and keratolytic

useful in lichen simplex chronicus; acne and dandruff; avoid in acute inflammatory dermatoses and children

A

salicyclic acid

also antibacterial – can open clogged pores

53
Q

where do you use class 7 topical steroids?

A

face, genitals, skin-folds

hydrocorticosterone, prednisolone

54
Q

describe the MOA of capsacin

A
  1. activate transient TRPV1 (ion channel in cutaneous nerve fibers)
  2. neurons release and eventually deplete certain neuropeptides (substance P)
  • can also induce lasting desensitization of neurons to variety of stimuli
55
Q

describe the keratolytic effects of salicylic acid

A

dissolves the intercellular cement, causes epidermal cells to shed more rapidly

56
Q

this systemic pruritic medication is only effective for utricaria

A

antihistamines

57
Q

systemic therapy for nocturnal pruritus

A

mirtazapine

antidepressant; NaSSA (a2-agonist)

58
Q

systemic therapy for cholestatic pruritus

A

sertraline

antidepressant; SSRI

59
Q

systemic therapy for cholestatic and CKD-associated pruritis

A

naltrexone

u-opioid receptor antagonist

60
Q

systemic therapy for nocturnal and intractable pruritus

A

butorphanol

k-opioid receptor agonist/u-opioid receptor antagonist

61
Q

systemic therapy for neuropathic pruritus

A

gabapentin, pregabalin

anticonvulsants

62
Q

has shown benefits for patients with intractable pruritus, typically used for N/V from chemo

A

aprepitant

substance P antagonist

63
Q

a2-adrenergic agonist applied as topical gel for rosacea; vasocontricts

A

brimonidine

stimulates post-synaptic vascular a2-receptors

64
Q

a1A/a2-adrenergic agonist applied as a topical cream for rosacea; vasoconstricts

A

oxymetazoline

65
Q

name the four adrenergic receptor agonists for red eyes

A
  1. tetrahydrozoline (visine)
  2. naphazoline
  3. phenylepherine
  4. oxymetazoline
66
Q

topical agent, organophosphate cholinesterase inhibitor

[for ectoparasites]

A

malathion

67
Q

topical agent, binds to Na channels and blocks membrane repolarization

[for ectoparasites]

A

permethrin

  • synthetic insecticide, similar to chyrsanthemums
68
Q

administered orally, binds to glutamate-gated Cl channels and hyperpolarizes nerve and muscle cells

[for ectoparasites]

A

ivermectin

69
Q

topical agent, toxicity means used only after all other agents fail; disrupts GABAergic transmission in insects

[for ectoparasites]

A

lindane

70
Q

what is the first choice of treatment for mild comedonal acne?

A

topical retinoid

71
Q

what is the first choice of treatment for mild mixed and papular/pustular acne?

A

topical retinoid + topical antimicrobial

72
Q

what is the first choice of treatment for moderate mixed and papular/pustular acne?

A

oral antibiotic + topical retinoid +/- BPO

73
Q

what is the first choice of treatment for moderate nodular acne?

A

oral antibiotic + topical retinoid + BPO

74
Q

what is the first choice of treatment for severe nodular/conglobate acne?

A

oral isotretinoin

75
Q

topical retinoid taken once daily before bed; alters gene expression to normalize keratinization, decreases keratinocyte cohesiveness and decreases microcomedone formation

A

tretinoin

  • may cause local skin irritation, dryness, flaking
  • Atralin contains soluble fish proteins
76
Q

topical antimicrobial; twice daily; gels, lotions, creams, pads, masks, cleansers

A

benzoyl peroxide

may cause local skin irritation, may bleach hair or clothing

77
Q

topical antimicrobial; twice daily or once daily as foam

A

clindamycin

  • rare risk of pseudomembranous colitis (C. diff)
  • works similar to macrolides; kills anaerobes and useful for range of infections (acne, osteomyelitis)
78
Q

topical antimicrobial; twice daily; gel, solution, pledget

oral antibiotic; may cause GI distress; well-known CYP450 inhibitor

A

erythromycin

79
Q

this medication kills acne bacteria (p. acne) and decreases the production of keratin; it is a dicarboxylic acid and is involved in the plant defense to infection

used to treat mild to moderate acne, post-inflammatory hyperpigmentation

A

azaleic acid

20% cream, 15% gel

may cause local skin irritation

80
Q

oral antibiotic; may cause photosensitivity, GI distress; contraindicated in pregnancy and young children (grey teeth); twice daily

A

tetracycline

81
Q

oral antibiotic; may cause photosensitivity, GI distress; contraindicated in pregnancy and young children; can be once or twice daily

A

doxycycline

82
Q

oral antibiotic; may cause dizziness, drug-induced lupus, skin (dark pigmentation) or sclera (blue) discoloration; contraindicated in pregnancy and young children

A

minocycline

83
Q

oral antibiotic; may cause GI distress; intermittent dosing due to long drug half-life; unusual because it is taken up by phagocytes and released at the site of infection

A

azithromycin

does not inhibit CPY450

84
Q

oral antibiotic; may cause SJS, TEN

A

trimethoprim-sulfamethoxazole

85
Q

hormonal agent that is partial adrenergic agonist; especially useful for women w/ menstrual-cycle related breakouts of acne; contraindicated in pregnancy

A

spironolactone

  • K-sparing diuretic
  • can be used for male pattern baldness in women
86
Q

oral retinoid; teratogenic (absolute contraindication in pregnancy); increases risk of suicidal ideation

A

oral isotetinoin

for very severe acne; iPledge program

87
Q

what enzymes convert Vitamin A (retinol) to retinal?

A

alcohol dehydrogenase/retinol dehydrogenase

88
Q

what enzyme converts retinal to all-trans-RA

A

retinal dehydrogenase

89
Q

what are the topical treatment options for mild to moderate psoriasis?

A

emollients, corticosteroids

90
Q

which topical therapy for psoriasis reduces keratinocyte production?

A

topical vitamin D analogs

calcipotriene, calcitriol

91
Q

what is a topical retinoid gel used for psoriasis?

A

tazarotene

92
Q

what topical therapy for psoriasis blocks the lymphocytic burst in trans.?

A

calcineurin inhibitors

93
Q

what topical therapy for psoriasis has anti-inflammatory effects?

A

anthralin

94
Q

what are the initial treatment choices for moderate-severe psoriasis?

A

UVB and PUVA

*PUVA increases risk of melanoma, must be protected in the sun

95
Q

what will patients ingest prior to PUVA treatment?

A

photosenitizer psoralen

96
Q

inhibits PDE4 and increases cAMP

for moderate-severe plaque psoriasis, active psoriatic arthritis

oral administration (expensive)

may cause NVD, HA; mood changes/suicidal ideation possible

A

apremilast

decreases NO synthase, TNF-a and IL-23; increases IL-10

97
Q

PDE4 inhibitor recently approved as topical therapy for dermatitis

A

crisaborole

98
Q

hmAb, targets proinflammatory cytokines: IL-12, IL-23

treatment for plaque psoriasis, psoriatic arthritis, Crohn disease

subQ at 8-12 week intervals, expensive

increases risk of infection, possible increase risk SCC

A

ustekinumab

(blunted cytokine effects include: decreased NK activation; decreased CD4 differentiation and activation; decreased MCP-1, TNF-a, CXCL-10 and IL-8 expression)

99
Q

hmAb, targets proinflammatory cytokine: IL-17A

treatment for ankylosing spondylitis, plaque psoriasis, psoriatic arthritis

subQ for weeks 0-4, then e/ 4 weeks; expensive

increased risk of infection; IBD exacerbation

A

secukinumab

(blunted cytokine effects include: decreased IL-6, GC-CSF, IL-1B, TGF-B, TNF-a; decreased IL-8, GRO-a, NCP-1; decreased prostaglandins)

100
Q

hmAb against iIL-17A

A

ixekuzumab

101
Q

topical immune response modifier that stimulates local cytokine induction (via TLRs?); effective for actinic keratosis

A

imiquimod

also useful for genital warts, SCC

102
Q

treatment for actinic keratosis

  1. disrupts cell plasma membranes and mitos –> cell necrosis (chemoablation)
  2. neutrophil-mediated Ab-dependent cellular toxicity eliminates remaining tumor cells
A

ingenol mebutate

derived from sap of Euphorbia peplus plant

103
Q

treatment for actinic keratosis

NSAID

A

topical diclofenac

benefits suggest PGs may be important for skin carcinogenesis

104
Q

treatment for actinic keratosis

inhibits thymidylate synthetase

A

topical 5-fluorouracil

4-6 weeks skin progresses: erythema –> blistering –> necrosis w/ erosion –> re-epithelialization

105
Q

what are the two topical medications for BCC and SCC? (not for advanced)

A

imiquimod (esp. spuamous) and 5-FU

106
Q

what are the two medications for advanced BCC? describe MOA

A

vismodegib, sonidegib

oral hedgehog signaling pathway inhibitors

107
Q

describe the treatment of melanoma

A
  1. surgical excision – 1-2 cm margins, sentinel node bx
  2. conventional chemo – dacarbazine +/- carmustin and tamoxifen OR cisplatin and vinblastine
  3. MAP kinase inhibitors – vemurafenib if V600D gene mutation (~60%), results in apoptosis
108
Q

what is the chemo drug for melanoma?

A

dacarbazine

+/- carmustin and tamoxifen OR cisplatin and vinblastine

109
Q

if a patient with melanoma has V600D mutation, what drug is apropriate?

A

vemurafenib

MAP kinase inhibitor

110
Q

this treatment for male pattern baldness vasodilates d/t K-channel opening (hyperpolarization)

promotes hair growth by increasing anagen (growth) phase and decreasing telogen (rest) phase, and enlarging miniaturized follicles

A

minoxidil

aka rogane

111
Q

this treatment for male pattern baldness is an oral inhibitor of DHT production

A

finasteride

first line treatment, can cause ED

112
Q

what is the first line treatment for female pattern hair loss (androgenetic alopecia)?

A

minoxidil

113
Q

what are the second-line treatments for female pattern hair loss (androgenetic alopecia)?

A
  1. spironolactone (androgen partial agonist)
  2. finasteride (blocks DHT synthesis)
  3. flutamide (protypical non-steroid androgen antagonist; can be used for prostate cancer)
114
Q

this is a chronic, relapsing immune-mediated (auto-Abs) inflammatory disorder affecting hair follicles and resulting in non-scarring hair loss

A

alopecia areata

115
Q

name the treatment options for alopecia aerata

A
  • intralesional or topical corticosteroids

- topical immunotherapy – DPCP (diphenylcyclopropenone); induces contact dermatitis which causes hair growth

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