Dermatology Pharmacology and Prescribing Flashcards
What is meant by an unlicensed medicine?
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
What is meant by an off label medication?
A licensed medication being used for an unlicensed indication
->e.g. immunosuppressants being used in eczema treatment
What are meant by ‘specials’ medications?
Group of unlicensed dermatological preparations
Long history of use, no strong evidence but clinically effective
List some of the factors associated with poor adherence to medication in dermatology.
Psychiatric co-morbidities
Slower acting agents
Multiple applications per day
Lack of patient education
Cosmetic acceptability of treatment
Unintentional non-adherence
RECAP- pharmacokinetics?
Effect of body on drug
RECAP- pharmocodynamics?
Effect of drug on body
List some factors which affect topical absorption.
Concentration
Base/vehicle
Chemical properties
Thickness and hydration of stratum corneum
Temperature
Skin site
Occlusion
List some vehicles of topical medications.
Shampoo
Solution
Cream
Lotion
Gel
Foam
Paste
Spray powder
Which topical drug is a main treatment in dermatology?
Topical steroids
What properties do topical steroids have which make them good for derm?
Anti-inflammatory properties
Immunosuppressive properties
Which dermatological conditions get worse with steroids?
Acne
Rosacea
What are some of the side effects of topical steroids?
Thinning/atrophy
Striae
Bruising
Hirsutism
Telangiectasia- red spidery appearance on skin
Ace/rosacea/perioral dermatitis
Systemic absorption
Cataracts
List three systemic treatments used in dermatology.
Retinoids
Traditional immunosuppressants
Biologics- also immunosuppressive
What are retinoids?
Vitamin A analogues which work on the epidermis and normalise keratinocyte functions
What derm conditions can retinoids be used it?
Acne
Psoriasis
Cutaneous T cell lymphoma
Hand eczema
What is a contraindication for retinoids?
They are teratogenic so must be avoided in pregnancy
What are some side effects pf retinoids?
Cheilitis- dry lips
Xerosis- dry skin
Deranged LFT’s so need blood monitoring
Sometimes psychiatric, eye and bone side effects
When are immunosuppressants used in derm?
For inflammatory skin disorders
What risks are associated with immunosuppressants?
Risk of malignancy and serious infection
Those on immunosuppressants require regular blood test monitoring. What needs to be looked at in particular?
FSC
Renal function
Liver function
What are biologics?
Genetically engineered proteins derived from human genes which inhibit specific components of the immune system
What is the main pro and con of biologics?
Very effective but expensive
Any drug ending in ‘mab’ is a what?
Monoclonal antibody
What are the risks of using biologics?
Risk of infection- TB reactivation
Risk of malignancy
TNF inhibition- risk of demyelination
Those on biologics need to avoid what?
Live vaccines
