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Systems: Dermatology AB > Dermatology Pharmacology > Flashcards

Dermatology Pharmacology Flashcards

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Dermatology Board Prep flashcards
1
Q

Licensed medication

A

Approved for use in UK either by

  • MHRA – Medicines and Healthcare Products Regulatory Agency
  • EMA – European Medicines Agency
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2
Q

Unlicensed medication

A

Not approved for use in the UK

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3
Q

Off-label medication

A

A licensed medication that is being used for unlicensed indication

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4
Q

Specials medication

A
  • Unlicensed dermatological preparations

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

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5
Q

What are the main causes of prescription errors?

A
  • 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
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6
Q

Pharmacology

A

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

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7
Q

Pharmacokinetics

A

The effect of the body on the drug

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8
Q

Pharmacodynamics

A

The effect of the drug on the body

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9
Q

Distribution

A

Where the drug goes

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10
Q

When is metabolism of a drug a particular concern?

A

In liver disease

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11
Q

When is excretion of a drug a particular concern?

A

In renal disease

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12
Q

What is the preferred route of administration in dermatology?

A

Topical

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13
Q

What is important to think about in pharmacodynamics?

A
  • Age of patient
  • Pregnancy risk
  • Drug interactions
  • Pharmacogenetics
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14
Q

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

A
  • Female
  • Married
  • Employed
  • Not paying for their prescriptions
  • Increasing age
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15
Q

What factors are associated with poor adherence?

A
  • Psychiatric co-morbidities
  • Slower acting agents
  • Multiple applications per day
  • Lack of patient education
  • Cosmetic acceptability of treatments
  • Unintentional non-adherence
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16
Q

How is topical medication administered?

A

Applied to the skin

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17
Q

What are the 2 components of topical medications?

A
  • Vehicle

- Active drug

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18
Q

Vehicle

A

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

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19
Q

What factors can affect absorption of medications?

A

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

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20
Q

Give examples of vehicles.

A
  • Solution
  • Paste
  • Cream
  • Spray powder
  • Lotion
  • Shampoo
  • Gel
  • Ointment
  • Foam
  • Paint
  • Tape
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21
Q

Give examples of drugs that can be used topically

A
  • Corticosteroid
  • Chemotherapy
  • Antibiotic
  • Parasiticidals
  • Antiviral -Coal Tar
  • Dithranol
  • Anti-inflammatory
  • Vitamin analogues
  • Salicylic acid
  • The next generation (topical immunomodulators)
22
Q

What properties do topical steroids have?

A

Anti-inflammatory and immunosuppressive properties

23
Q

What do topical steroids do?

A
  • Regulate pro inflammatory cytokines
  • Suppress fibroblast, endothelial, and leukocyte function
  • Vasoconstriction
  • Inhibit vascular permeability
24
Q

How can topical steroids vary in strength?

A

Range of potencies

25
Q

When are topical steroids very safe?

A

When used appropriately

26
Q

How much is a finger top unit?

A

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

27
Q

What are the possible side effects of topical steroids?

A
  • Thinning /atrophy
  • Striae
  • Bruising
  • Hirsutism
  • Telangiectasia
  • Acne/rosacea/perioral dermatitis
  • Glaucoma
  • Systemic absorption
  • Cataracts
28
Q

Give examples of systemic treatments in dermatology

A
  • Retinoids
  • Traditional immunosuppressants
  • Biologics (also immunosuppressive)
29
Q

What are retinoids?

A

Vitamin A analogues

30
Q

What do retinoids do?

A
  • Normalise keratinocytes

- Anti-inflammatory and anti-cancer effects

31
Q

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

A
  • Isotretinoin for acne
  • Acitretin for psoriasis
  • Bexarotene fro cutaneous T cell lymphoma
  • Alitretinoin for hand eczema
32
Q

Why is careful patient selection important with retinoids?

A

They are teratogenic

33
Q

What are the possible side effects of retinoids?

A
  • Chelitis (dry lips) and xerosis (dry skin)
  • Increase in transaminases and triglycerides
  • Rarely psychiatric, eye, bone side effects
34
Q

What are immunosuppressant’s used in the treatment of?

A

Inflammatory skin disorders

35
Q

Give examples of immunosuppressant’s.

A
  • Oral steroids
  • Azthioprine
  • Ciclosporin
  • Methtrexate
  • Myconphenolate mofetil
36
Q

What is there risk of with immunosuppressants?

A
  • Malignancy

- Serious infection

37
Q

What regular blood test monitoring is required while on immunosuppressants?

A
  • FBC (esp in methotrexate and azathioprine)
  • Renal function (esp ciclosporin)
  • Liver function (esp methotrexate)
38
Q

What are biologics?

A
  • The next generation in treatment of inflammatory conditions
  • Genetically engineered proteins derived from human genes
  • Designed to inhibit specific components of the immune system
39
Q

Biologics names: What does cept mean?

A

It is a receptor fusion protein

40
Q

Biologics names: What does mab mean?

A

It is a monoclonal antibody

41
Q

Biologics names: What does zu mean?

A

Humanised

42
Q

Biologics names: What does ix mean?

A

Chimeric

43
Q

Biologics names: What does u mean?

A

Fully human

44
Q

Biologics names: What does li/l mean?

A

Immunomodulator

45
Q

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

A
  • Etanercept
  • Infliximab
  • Adalimumab
  • Ustekinumab
  • Secukinumab
46
Q

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

A

Hidredenitis suppurativa

47
Q

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

A

Omalizumab

48
Q

What risk are there with biologics?

A 
Risk of infection
   -TB reactivation
   -Serious infection
   -Avoid live vaccines
Risk of malignancy
Risk of demyelination (TNF inhibitors)
49
Q

How effective are biologics in the treatment of melanoma?

A

A revolution in treatment options for advanced melanoma

~20% 5 year survival in stage 4 disease

50
Q

How are biologics used in targeted treatment of melanoma?

A

If BRAF 600 mutation

  • Vemurafenib
  • Dabrafenib

Immunotherapies

  • Ipilumumab
  • Pembrolizumab

Systems: Dermatology AB (11 decks)

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