Dermatology Pharmacology and prescribing

Question 1

Who decides license?

Answer 1

European Medicines Ageney (EMA)
MHRA (Mediciens and Healthcare products Regulatory Agency)
SMC - Scottish Medicines Consortium

Question 2

“unlicensed drugs”

Answer 2

Not approved for use in the UK

Question 3

“Off label”

Answer 3

A drug prescribed for something that it wasn’t licensed for

Question 4

“Specials”

Answer 4

-Unlicensed dermatological preparations
- Long history of use, no strong evidence but clinically effective

Question 5

Pharacokinetics vs pharmacodeynamics

Answer 5

Pharmacokinetics - effect of the body on the drug (Ki - body on drug)
Pharmacodynamics - effect of the drug on the body

Question 6

ADME

Answer 6

Absorption, Distribution, Metabolism (esp in liver disesae), Excretion of drugs (esp in kidney disease)

Question 7

Whar type of delivery do wee ideally want i derm. WHy?

Answer 7

Topical, less side effects

Question 8

What are the key concepts of the vehicle

Answer 8

Pharmacologically inert, phsyically and chemically stable that carries meds to where we need it.

Question 9

Factors affecting topical absorption

Answer 9

Thickness and hydration of skin (Stratum corneum)
Conc.
Base/vehicle
Chemical properties of the drug
Temperature
Skin site
Occlusion (eg clingfilm/plaster over the top)

Question 10

What do topical steroids do?

Answer 10

Reduce inflammation and immunosuppressive:
-Regulate pro inflammatory cytokines
-Suppress fibroblast, endothelial, and leukocyte function
-Vasoconstriction
-Inhibit vascular permeability

Question 11

What would get worse with steroids?

Answer 11

Acne and rosacea

Question 12

What is a finger tip unit?

Answer 12

about 0.5g

Question 13

Side effect of topical steriods?

Answer 13

thinning of the skin
Striae
Bruising
Hirsutism (woans mustashe)
Telangiectasia (dilated/broken blood vessels in the skin)
Acne/rosacea/perioral dermatitis
Glaucoma
Systemic absorption
Cataracts

Question 14

How do retinoids work?

Answer 14

Vitamin A analogue:
-Normalise keratinocyte function
-Anti inflammatory and anti cancer effects

Question 15

Isotertinoin? WHo can prescribe?

Answer 15

Oral Retinoid, used in Acne (ISO - it is an ISOlating skin disorder)

Question 16

Acitretin?

Answer 16

Oral Retinoid used in Psoiasis

Question 17

Bexarotene?

Answer 17

Oral retinoid used for Cutaneous T cell lymphoma

Question 18

Alitretinoin?

Answer 18

Oral retinoid used in hand eczema (ALI - climbs - uses hands with chalk)

Question 19

Isses with REtinoids?

Answer 19

Esp oral ones.

TERATOGENIC

Dry skin and lips
increased transaminases and triglycerides ( Lipid levels must be controlled)
Rare - psychiatric/eye/bone effects

Question 20

Which immunosupporessants are uned?

Answer 20

Azathioprine
Ciclosporin
Methotrexate
Mycophenolate mofetil

Question 21

Issues with Methotrexate and azathioprine?

Answer 21

Can become neutropenic/lymphopenic (need to tet for FBC)

Question 22

Ciclosporin issues

Answer 22

RENAL!!

Question 23

Biologics name:
-mab means
-cept means

Answer 23

-mab = (M -AB = Monoclonal AntiBodies)
-cept = receptor fusion

Question 24

preceding mab:
–zu
-ix
-u
li-/-l-

Answer 24

• zu = humanised
  -ix = from mice/animals (chimeric)
  -u = Fully human
  li-/-l- = immunomodulator

Question 25

Ant TNF group contraindications (of biologics)

Answer 25

-Risk of infection:
TB reactivation
Serious infection
Avoid live vaccines

-Risk of malignancy

-TNF inhibitors – risk of demyelination

Question 26

Melanoma drugs, targeted tratments: BRAF 600
Imunotherapies

Answer 26

If BRAF 600 mutation:
Vemurafenib
Dabrafenib

Immunotherapies:
Ipilumumab
Pembrolizumab