Dermatology Pharmacology

Question 1

Licensed medication

Answer 1

Approved for use in UK either by

• MHRA – Medicines and Healthcare Products Regulatory Agency
• EMA – European Medicines Agency

Question 2

Unlicensed medication

Answer 2

Not approved for use in the UK

Question 3

Off-label medication

Answer 3

A licensed medication that is being used for unlicensed indication

Question 4

Specials medication

Answer 4

• Unlicensed dermatological preparations

- Long history of use, no strong evidence base but clinically effective.

Question 5

What are the main causes of prescription errors?

Answer 5

• Lack of knowledge (About the patient, the medication, allergies)
• Mistake writing/generating the prescription
• Poor communication
• No local or national guidelines
• Pharmacy/medicine info service

Question 6

Pharmacology

Answer 6

The branch of medicine concerned with uses, effects and modes of action of drugs

Question 7

Pharmacokinetics

Answer 7

The effect of the body on the drug

Question 8

Pharmacodynamics

Answer 8

The effect of the drug on the body

Question 9

Distribution

Answer 9

Where the drug goes

Question 10

When is metabolism of a drug a particular concern?

Answer 10

In liver disease

Question 11

When is excretion of a drug a particular concern?

Answer 11

In renal disease

Question 12

What is the preferred route of administration in dermatology?

Answer 12

Topical

Question 13

What is important to think about in pharmacodynamics?

Answer 13

• Age of patient
• Pregnancy risk
• Drug interactions
• Pharmacogenetics

Question 14

What patients have been shown to be more likely to stick to a treatment plan?

Answer 14

• Female
• Married
• Employed
• Not paying for their prescriptions
• Increasing age

Question 15

What factors are associated with poor adherence?

Answer 15

• Psychiatric co-morbidities
• Slower acting agents
• Multiple applications per day
• Lack of patient education
• Cosmetic acceptability of treatments
• Unintentional non-adherence

Question 16

How is topical medication administered?

Answer 16

Applied to the skin

Question 17

What are the 2 components of topical medications?

Answer 17

• Vehicle

- Active drug

Question 18

Vehicle

Answer 18

Pharmacologically inert, physically and chemically stable substance that carries the active drug

Question 19

What factors can affect absorption of medications?

Answer 19

-Concentration
-Base/vehicle
-Chemical properties of the drug
-Thickness and hydration of stratum corneum
-Temperature
-Skin site
Occlusion

Question 20

Give examples of vehicles.

Answer 20

• Solution
• Paste
• Cream
• Spray powder
• Lotion
• Shampoo
• Gel
• Ointment
• Foam
• Paint
• Tape

Question 21

Give examples of drugs that can be used topically

Answer 21

• Corticosteroid
• Chemotherapy
• Antibiotic
• Parasiticidals
• Antiviral -Coal Tar
• Dithranol
• Anti-inflammatory
• Vitamin analogues
• Salicylic acid
• The next generation (topical immunomodulators)

Question 22

What properties do topical steroids have?

Answer 22

Anti-inflammatory and immunosuppressive properties

Question 23

What do topical steroids do?

Answer 23

• Regulate pro inflammatory cytokines
• Suppress fibroblast, endothelial, and leukocyte function
• Vasoconstriction
• Inhibit vascular permeability

Question 24

How can topical steroids vary in strength?

Answer 24

Range of potencies

Question 25

When are topical steroids very safe?

Answer 25

When used appropriately

Question 26

How much is a finger top unit?

Answer 26

-About 0.5g which should treat area double that of 1 hand

Question 27

What are the possible side effects of topical steroids?

Answer 27

- Thinning /atrophy - Striae - Bruising - Hirsutism - Telangiectasia - Acne/rosacea/perioral dermatitis - Glaucoma - Systemic absorption - Cataracts

Question 28

Give examples of systemic treatments in dermatology

Answer 28

- Retinoids - Traditional immunosuppressants - Biologics (also immunosuppressive)

Question 29

What are retinoids?

Answer 29

Vitamin A analogues

Question 30

What do retinoids do?

Answer 30

- Normalise keratinocytes | - Anti-inflammatory and anti-cancer effects

Question 31

What are the 4 different retinoid molecules used orally in dermatology and what for?

Answer 31

- Isotretinoin for acne - Acitretin for psoriasis - Bexarotene fro cutaneous T cell lymphoma - Alitretinoin for hand eczema

Question 32

Why is careful patient selection important with retinoids?

Answer 32

They are teratogenic

Question 33

What are the possible side effects of retinoids?

Answer 33

- Chelitis (dry lips) and xerosis (dry skin) - Increase in transaminases and triglycerides - Rarely psychiatric, eye, bone side effects

Question 34

What are immunosuppressant's used in the treatment of?

Answer 34

Inflammatory skin disorders

Question 35

Give examples of immunosuppressant's.

Answer 35

- Oral steroids - Azthioprine - Ciclosporin - Methtrexate - Myconphenolate mofetil

Question 36

What is there risk of with immunosuppressants?

Answer 36

- Malignancy | - Serious infection

Question 37

What regular blood test monitoring is required while on immunosuppressants?

Answer 37

- FBC (esp in methotrexate and azathioprine) - Renal function (esp ciclosporin) - Liver function (esp methotrexate)

Question 38

What are biologics?

Answer 38

- The next generation in treatment of inflammatory conditions - Genetically engineered proteins derived from human genes - Designed to inhibit specific components of the immune system

Question 39

Biologics names: What does cept mean?

Answer 39

It is a receptor fusion protein

Question 40

Biologics names: What does mab mean?

Answer 40

It is a monoclonal antibody

Question 41

Biologics names: What does zu mean?

Answer 41

Humanised

Question 42

Biologics names: What does ix mean?

Answer 42

Chimeric

Question 43

Biologics names: What does u mean?

Answer 43

Fully human

Question 44

Biologics names: What does li/l mean?

Answer 44

Immunomodulator

Question 45

What biologics are currently licensed for plaque psoriasis in the UK?

Answer 45

- Etanercept - Infliximab - Adalimumab - Ustekinumab - Secukinumab

Question 46

Other than plaque psoriasis, what is adalimumab licensed for in the UK?

Answer 46

Hidredenitis suppurativa

Question 47

What biologic is used in the treatment of chronic spontaneous urticaria?

Answer 47

Omalizumab

Question 48

What risk are there with biologics?

Answer 48

``` Risk of infection -TB reactivation -Serious infection -Avoid live vaccines Risk of malignancy Risk of demyelination (TNF inhibitors) ```

Question 49

How effective are biologics in the treatment of melanoma?

Answer 49

A revolution in treatment options for advanced melanoma | ~20% 5 year survival in stage 4 disease

Question 50

How are biologics used in targeted treatment of melanoma?

Answer 50

If BRAF 600 mutation - Vemurafenib - Dabrafenib Immunotherapies - Ipilumumab - Pembrolizumab