Dermatology Pharmacology and Prescribing

Question 1

What is meant by an unlicensed medicine?

Answer 1

Medicine which is not approved for use in the UK

->may be approved in Europe or other places. Important to note that this doesn’t mean that we cannot use the medication, just have to go through a lot of rigorous protocols

Question 2

What is meant by an off label medication?

Answer 2

A licensed medication being used for an unlicensed indication

->e.g. immunosuppressants being used in eczema treatment

Question 3

What are meant by ‘specials’ medications?

Answer 3

Group of unlicensed dermatological preparations
Long history of use, no strong evidence but clinically effective

Question 4

List some of the factors associated with poor adherence to medication in dermatology.

Answer 4

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

Question 5

RECAP- pharmacokinetics?

Answer 5

Effect of body on drug

Question 6

RECAP- pharmocodynamics?

Answer 6

Effect of drug on body

Question 7

List some factors which affect topical absorption.

Answer 7

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

Question 8

List some vehicles of topical medications.

Answer 8

Shampoo
Solution
Cream
Lotion
Gel
Foam
Paste
Spray powder

Question 9

Which topical drug is a main treatment in dermatology?

Answer 9

Topical steroids

Question 10

What properties do topical steroids have which make them good for derm?

Answer 10

Anti-inflammatory properties
Immunosuppressive properties

Question 11

Which dermatological conditions get worse with steroids?

Answer 11

Acne
Rosacea

Question 12

What are some of the side effects of topical steroids?

Answer 12

Thinning/atrophy
Striae
Bruising
Hirsutism
Telangiectasia- red spidery appearance on skin
Ace/rosacea/perioral dermatitis
Systemic absorption
Cataracts

Question 13

List three systemic treatments used in dermatology.

Answer 13

Retinoids
Traditional immunosuppressants
Biologics- also immunosuppressive

Question 14

What are retinoids?

Answer 14

Vitamin A analogues which work on the epidermis and normalise keratinocyte functions

Question 15

What derm conditions can retinoids be used it?

Answer 15

Acne
Psoriasis
Cutaneous T cell lymphoma
Hand eczema

Question 16

What is a contraindication for retinoids?

Answer 16

They are teratogenic so must be avoided in pregnancy

Question 17

What are some side effects pf retinoids?

Answer 17

Cheilitis- dry lips
Xerosis- dry skin
Deranged LFT’s so need blood monitoring
Sometimes psychiatric, eye and bone side effects

Question 18

When are immunosuppressants used in derm?

Answer 18

For inflammatory skin disorders

Question 19

What risks are associated with immunosuppressants?

Answer 19

Risk of malignancy and serious infection

Question 20

Those on immunosuppressants require regular blood test monitoring. What needs to be looked at in particular?

Answer 20

FSC
Renal function
Liver function

Question 21

What are biologics?

Answer 21

Genetically engineered proteins derived from human genes which inhibit specific components of the immune system

Question 22

What is the main pro and con of biologics?

Answer 22

Very effective but expensive

Question 23

Any drug ending in ‘mab’ is a what?

Answer 23

Monoclonal antibody

Question 24

What are the risks of using biologics?

Answer 24

Risk of infection- TB reactivation
Risk of malignancy
TNF inhibition- risk of demyelination

Question 25

Those on biologics need to avoid what?

Answer 25

Live vaccines