Dermatological Agents 2

Question 1

MOA of benzoyl peroxide

Answer 1

Powerful oxidising agent
Highly lipophilic
Rapidly degraded to benzoic acid and hydrogen peroxide, generating oxidative free radicals after reaching pilosebaceous follicles

• antibacterial
• anti-inflammatory
• keratolytic (same as SA)

Question 2

adverse effects of benzoyl peroxide

Answer 2

• can bleach hair, clothes
• <1% of patients develop contact dermatitis
• increases sensitivity to the sun - sunscreen use during treatment
• irritation and sensitising properties

Question 3

What are first generation retinoids

Answer 3

• retinol (vitamin A)
• tretinoin (all trans retinoic acid (vitamin a acid))
• isotretinoin
• alitretinoin

Question 4

What are second generation retinoids?

Answer 4

also known as aromatic retinoids
- acitretin - psoriasis
- etretinate

Question 5

What are third generation retinoids

Answer 5

created after the discovery of specific retinoid receptors and have diverse structures designed to optimise receptor - selective binding
- tazarotene
- bexarotene
- adapalene

Question 6

What are nevi

Answer 6

moles

Question 7

what is the ABCDE of melanoma

Answer 7

Asymmetry
Border
Colour
Diameter (should be <1/4 inch)
Evolving

Question 8

What is Dacarbazine

Answer 8

Chemotherapy for melanoma
Methylates guanosine residues, making them stick together.
This makes cell division impossible.

Question 9

Name 3 biological therapies used to treat Melanoma

Answer 9

• Ipilimumab
• Nivolumab
• Pembrolizumab

Question 10

MOA of Ipilimumab

Answer 10

Binds to CTLA-4 on T cells, blocking the inhibitory signal from DCs (dendritic cells)

Question 11

Pembrolizumab MOA

Answer 11

Blocks the protein PD-1 on t cells

Question 12

Name 3 targeted therapies used to target specific mutations in cancer cells

Answer 12

Vemurafenib
Dabrafenib
Trametinib

Question 13

What do Vemurafenib and Dabrafenib inhibit?

Answer 13

b-RAF Kinase
They can be used to treat the BRAFV600E mutation

Question 14

What does Trametinib inhibit?

Answer 14

MEK1 and MEK2

Question 15

Which mutations are common in melanoma and which pathway do they activate?

Answer 15

Mutations in BRAF, NRAS, MEK1, MEK2
These activate the MAPK/ Extracellular signal-regulated kinase (ERK) pathway

Question 16

Mutations in which gene including the V600E mutation are the most frequently identified cancer causing mutations in melanoma?

Answer 16

B-Raf

Question 17

is BCC or SCC more serious?

Answer 17

SCC
BCC almost never metastasizes although it shouldn’t be taken lightly as it can disfigure if not treated promptly

Question 18

What does Imiquimod treat?

Answer 18

Small, superficial BCCs, also for actinic keratosis and warts

Question 19

What does Fluorouracil treat?

Answer 19

Superficial, pre-malignant and malignant skin lesions, superficial BCCs

Question 20

What treats advanced and metastatic BCC

Answer 20

Vismodegib

Question 21

What is involved in photo-dynamic therapy for SCC

Answer 21

Topical methyl-aminolevulinate (approved)
or
Topical 5-aminolevulinic acid (off label)
Activation by red light 3 hours later

Question 22

What is the brand name of Nivolumab

Answer 22

OPDIVO

Question 23

What is the brand name of Pembrolizumab

Answer 23

KEYTRUDA

Question 24

MOA of Nivolumab and Pembrolizumab

Answer 24

Block PD-1 on T cells
By blocking interaction of PD-1 with PD-L1 and PD-L2, this helps to restore T cell response and immune response

Question 25

Which phase are scalp hairs usually in?

Answer 25

The anagen phase

Question 26

What is chemotherapy induced alopecia called?

Answer 26

Anagen effluvium

Question 27

What can help to reverse anagen effluvium?

Answer 27

Scalp cooling during chemotherapy Minoxidil

Question 28

What is alopecia characterised by diffuse hair shedding called?

Answer 28

Telogen effluvium

Question 29

What are the steps in the cycle of hair growth?

Answer 29

Anagen Catagen Telogen Early-to-mid anagen Anagen

Question 30

What 2 treatments can be used for androgenic alopecia?

Answer 30

- Minoxidil - Finasteride

Question 31

MOA of minoxidil

Answer 31

Enhances follicular size, resulting in longer and thicker hair shafts Stimulates/ prolongs the anagen phase of the hair cycle

Question 32

Adverse effects of Minoxidil

Answer 32

Contact dermatitis Care should be taken when applying it as it can cause unwanted hair growth in certain areas

Question 33

MOA of Finasteride for androgenic alopecia

Answer 33

Androgenic alopecia is caused by a buildup of dihydrotestosterone Finasteride inhibits type 2 5-alpha reductase which converts t to dht in hair follicles

Question 34

Adverse effects of Finasteride

Answer 34

Mood disturbances Sexual dysfunction Increased risk of prostate cancer

Question 34

What is hyperhidrosis

Answer 34

Excessive sweating

Question 35

What is alopecia areata?

Answer 35

Spot baldness - an autoimmune disease in which hair is lost from one or all of the areas in the body topical corticosteroids are the treatment

Question 35

What is the treatment for eyelash hypotrichosis

Answer 35

Bimatoprost ophthalmic solution This is a prostamide F2a-analog which is indicated for the treatment of ocular hypertension or glaucoma

Question 36

Why does hyperhidrosis occur in areas such as the palm of your hand, soles and axillae?

Answer 36

there is a higher concentration of eccrine glands there

Question 37

What are the most widely used active ingredients in antiperspirants?

Answer 37

Metallic salts Aluminium chloride hexahydrate is used in higher strengths for excessive sweating of underarms For managing sweaty hands or sweaty feet, higher concentrations are used

Question 38

Name the 4 types of BoNTs licensed by the FDA

Answer 38

Onabotulinum Toxin A (Botox) Incobotulinum Toxin A (Xeomin) Abobotulinum Toxin A (Dysport) RimabotulinumtoxinB (Myobloc)