Dermatology pharmacology and prescribing Flashcards
What is licenced medication?
○ Approved for use in the UK
- MHRA: Medicine and healthcare products regulatory agency
- EMA: European medicines agency
○ High standards of safety and quality
○ Trial evidence to show positive effect
○ SMC submission: Scottish medicines consortium
What are medications without licence?
○ Unlicensed
- Not approved for use in the UK
○ Off label
- A licenced medication that is being used for an unlicensed indication
○ Specials
- Unlicensed dermatological preparations
- Long history of use, no strong evidence base but clinically effective
- It has been used longer than regulations but it is effective so it’s OK
What are retinoids?
• Vitamin A analogues
□ Normalise keratinocyte function
□ Anti-inflammatory and anticancer effects
• Four different molecules used orally in dermatology
What are traditional immunosuppressants?
• Treatment of inflammatory skin disorders
- Oral steroids
- Azathioprine
- Ciclosporin
- Methotrexate
- Mycophenolate mofetil
• Risk of malignancy and serious infection
• Need regular blood test monitoring
- FBC (especially methotrexate and azathioprine)
- Renal function test (especially ciclosporin)
- Liver function test (especially methotrexate)
What are biologics?
• The next generation of treatment of inflammatory conditions
- Genetically engineered proteins derived from human genes
- Designed to inhibit specific components of the immune system
- Very effective but expensive
- Risks
□ Infection
□ TB reactivation
□ Serious infection
□ Avoid line vaccines
□ Risk of malignancy
□ TNF inhibitors: risk of demyelination
What are retinoids effective in?
- Acne (isotretinoin)
- Psoriasis (acitretin)
- Cutaneous T cell lymphoma (bexarotene)
- Hand eczema (alitretinoin)
What are the side effects of retinoids?
- Teratogenic: careful patient selection
- Cheilitis (dry lips) and xerosis (dry skin)
- Increased transaminases
- Increased triglycerides
- Rarely psychiatric, eye or bone side effects
