Dermatology Pharmacology and Prescribing Flashcards
Apply a stepwise approach to treating skin problems ensuring that exacerbating factors have been addressed.
a
Define ‘unlicensed medicines’.
Not approves for use in the UK.
Define ‘off label’.
A licensed medication that Is being used for an unlicensed indication.
Define ‘specials’.
- Unlicensed dermatological preparations
- Long history of use: no strong evidence base but clinically effective
Pharmacokinetics vs pharmacodynamics.
Pharmacokinetics = the effect of the body on the drug. Pharmacodynamics = the effect of the drug on the body.
List the factors associated with poor adherence.
- Psychiatric co-morbidities
- Slower acting agents
- Multiple applications per day
- Lack of patient education
- Cosmetic acceptability of treatments
- Unintentional non-adherence
Define ‘vehicle’.
Pharmacologically inert, physically and chemically stable substance that carries the active drug e.g. cream, gel, spray powder, etc.
List the factors that affect the absorption of a topical treatment.
- Concentration
- Vehicle
- Chemical properties of the drug
- Thickness and hydration of stratum corneum
- Temperature
- Skin site
Describe the effect of topical steroids on the body.
- Regulate pro-inflammatory cytokines
- Suppress fibroblasts, endothelial and leukocyte function
- Vasoconstriction
- Inhibit vascular permeability
List side effects of topical steroids.
- Thinning/atrophy
- Striae
- Bruising
- Hirsutism
- Telangiectasia
- Acne/rosacea/perioral dermatitis
- Glaucoma, cataracts
Describe retinoids.
Vitamin A analogues;
- Normalise keratinocyte function
- Anti-inflammatory and anti-cancer effects
Describe retinoids.
Vitamin A analogues;
- Normalise keratinocyte function
- Anti-inflammatory and anti-cancer effects
Describe the side effects of retinoids.
- Teratogenic
- Cheilitis, xerosis
- Increase in transaminases, triglycerides
- Rarely psychiatric, eye, bone side effects
Describe the side effects of retinoids.
- Teratogenic
- Cheilitis, xerosis
- Increase in transaminases, triglycerides
- Rarely psychiatric, eye, bone side effects
Describe retinoids and give examples.
- Treatment of inflammatory skin disorders
- Oral steroids
- Azathioprine
- Ciclosporin
- Methotrexate
- Mycophenolate mofetil
Describe the side effects of immunosupressants and how patients are monitored.
- Risk of malignancy and serious infection
Need regular blood test monitoring;
- FBC (esp. methotrexate and azathioprine)
- Renal function (esp. ciclosporin)
- Liver function (esp. methotrexate)
Describe biologics in dermatology.
The next generation in treatment of inflammatory conditions;
- Genetically engineered proteins derived from human genes
- Designed to inhibit specific components of the immune system
- Very effective, but expensive
Describe the name systems of biologics
- “-cept” - receptor fusion
- "-mab" - monoclonal antibodies Immediately preceding '-mab'; - zu: humanised - ix: chimeric - u: fully human - li/l: immunomodulator
Describe the side effects of biologics
Risk of infection;
- TB reactivation
- Serious infection
- Avoid live vaccines
Risk of malignancy;
- TNF inhibitors: risk of demyelination
