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year 2 dermatology > Dermatology Pharmacology and Prescribing > Flashcards

Dermatology Pharmacology and Prescribing Flashcards

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Dermatology Board Prep flashcards
1
Q

are adverse drug reactions common and ar ethey preventable?

A

3-6% of hospital admissions are due to adverse drug reactions - Half are preventable

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2
Q

What is a difficulty when prescribing in dermatology?

A

Difficulty in dermatology with rarity of some skin conditions and lack of evidence behind treatments

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3
Q

how is medication licensed in the uk?

A

• Approved for use in UK either by:

  • MHRA – Medicines 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
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4
Q

what are different names for medication wihtout a licence?

A

Unlicensed

‘Off label’

‘Specials’

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5
Q

what is unlicensed medication?

A

Not approved for use in the UK

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6
Q

What is ‘Off label’ medication?

A

A licensed medication that is being used for an unlicensed indication

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7
Q

what are ‘Specials’ medication without a licence?

A

unlicensed dermatological preparations

Long history of use, no strong evidence base but clinically effective

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8
Q

what are the causes of prescription errors?

A
  • Lack of knowledge - About the patient, the medication, allergies
  • Mistake writing/generating the prescription
  • Poor communication
  • No local or national guidelines
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9
Q

what can be used to help prevent prescribing errors?

A

Pharmacy/medicine info service

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10
Q

what is pharmacology?

A

The branch of medicine concerned with the uses, effects, and modes of action of drugs

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11
Q

what is the definition of Pharmacokinetics?

A

The effect of the body on the drug

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12
Q

what is the defnition of Pharmacodynamics?

A

The effect of the drug on the body

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13
Q

what different things come under and need to be thought baout in relation to Pharmacokinetics?

A

• Need to think about route of administration

  • topically where possible
  • If oral, optimal absorption important
  • Distribution – where the drug goes
  • Metabolism – especially in liver disease
  • Excretion – especially in renal disease
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14
Q

what things need to be thought about in relation to Pharmacodynamics?

A
  • Individual variation in response
  • Think about:
  • Age of patient
  • Pregnancy risk
  • Drug interactions
  • Pharmacogenetics
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15
Q

Influences on adherence - in a psoriasis study, Which patients stuck to treatment plan?

A

Female

Married

Employed

Not paying for their prescriptions

Increasing age

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16
Q

what are factors associated with poor adherence?

A
  • Psychiatric co-morbidities
  • Slower acting agents
  • Multiple applications per day
  • Lack of patient education
  • Cosmetic acceptability of treatments
  • Unintentional non-adherence
  • The NHS spends £100 million annually on unused medicine
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17
Q

what is topical therapy?

A

Medication applied to the skin

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18
Q

what are the 2 components that make up topical therapy?

A

Vehicle + active drug

Vehicle: pharmacologically inert, physically and chemically stable substance that carries the active drug

19
Q

what are factors that affect absorption?

A
  • Concentration
  • Base/vehicle
  • Chemical properties of the drug
  • Thickness and hydration of stratum corneum
  • Temperature
  • Skin site
  • Occlusion
20
Q

what are the different vehicles that may be used for topical therapy?

A

Solution

Cream

Lotion

Gel

Foam

Tape

Paste

Spray powder

Shampoo

Ointment

Paint

21
Q

what are examples of drugs that are used tropically?

A

Corticosteroid

Antibiotic

Antiviral

Dithranol

Vitamin analogues

Chemotherapy

Parasiticidals

Anti-inflammatory

Coal Tar

Salicylic acid

The next generation – topical immunomodulators

22
Q

what is the function of topical steroids?

A

• Anti-inflammatory and immunosuppressive properties

23
Q

What are the anti-inflammatory and immunosuppressive properties of topical steroids?

A
  • Regulate pro inflammatory cytokines
  • Suppress fibroblast, endothelial, and leukocyte function
  • Vasoconstriction
  • Inhibit vascular permeability
24
Q

what is the strength of topical steroids like?

A

Range of potencies

Mild, moderate, potent, super potent

25
Q

are topical steroids safe?

A

When used appropriately – very safe

26
Q

what do you need to do when prescribing topical steroids?

A

• Prescribe enough!

  • See BNF guide for adults
  • Can use finger-tip units
27
Q

what is a finger tip unit?

A
  • About 0.5 g
  • Should treat area double the size of one hand
  • Useful in young children
  • Charts available for age
28
Q

what are some side effects of topical steroids?

A
  • Thinning/atrophy
  • Striae
  • Bruising
  • Hirsutism
  • Telangiectasia
  • Acne/rosacea/perioral dermatitis
  • Glaucoma
  • Systemic absorption
  • Cataracts

(picture showing typical reaction from someone who has used to much steroid)

29
Q

what are Systemic Treatments in Dermatology?

A
  • Retinoids (found use in medicine where they regulate epithelial cell growth)
  • Traditional immunosuppressants
  • Biologics (also immunosuppressive)
30
Q

what are retinoids? and what effects do they have?

A

• Vitamin A analogues

  • Normalise keratinocyte function (an epidermal cell which produces keratin)
  • Anti inflammatory and anti cancer effects
31
Q

what are the 4 different retinoids used in dermatology and what for?

A
  • Four different molecules used orally in dermatology
  • Effective in:

Acne - isotretinoin

Psoriasis - acitretin

Cutaneous T cell lymphoma - bexarotene

Hand eczema - alitretinoin

32
Q

who are retinoids harmful to?

A

Teratogenic - Careful patient selection

A teratogen is an agent that can disturb the development of the embryo or fetus. Teratogens halt the pregnancy or produce a congenital malformation (a birth defect)

33
Q

what are the side effects of retinoids?

A

Cheilitis (dry lips) and xerosis (dry skin)

↑ transaminases, ↑ triglycerides

Rarely psychiatric, eye, bone side effects

34
Q

what are immunosuppressants used for?

A

Treatment of inflammatory skin disorders

Effective at suppressing T cell responses

35
Q

what are different kinds of immunosuppressents?

A

Oral steroids

Azathioprine

Ciclosporin

Methotrexate

Mycophenolate mofetil

36
Q

what is the risk of taking immunosuppressents?

A

Risk of malignancy and serious infection

37
Q

when on immunosuppressents, regular blood test monitoring is required, in particular what?

A

FBC (esp in methotrexate and azathioprine)

Renal function (esp ciclosporin)

Liver function (esp methotrexate)

38
Q

biologics are the next generation in treatment of inflammatory conditions

what are they?

A

Genetically engineered proteins derived from human genes

designed to inhibit specific components of the immune system

Very effective, but expensive

39
Q

what does the suffix ‘-cept’ indicate? (in biologics)

A

• Suffix ‘-cept’ indicates that it is a it is a Receptor fusion

Etanercept - genetically engineered fusion protein

40
Q

what does the suffix “-mab” mean?

A

• Suffix “-mab” is used to denote monoclonal antibodies

41
Q

what are some series of infixes which immediately precede –mab?

A

zu - humanised

ix - chimeric

u - fully human

li-/-l- - immunomodulator

  • E.g. adalimumab = immunomodulator fully human monoclonal antibodies
  • Infliximab = immunomodulator chimeric monoclonal antibodies
42
Q

How many currently licensed biologics are there for each dermatology condition?

A

Psoriasis – nine

Hidradenitis suppurativa – one

Chronic spontaneous urticarial – one

Atopic eczema – one

Pemphigus – one

43
Q

what are the risks of biologics?

A

• Risk of infection

  • TB reactivation
  • Serious infection
  • Avoid live vaccines
  • Risk of malignancy
  • TNF inhibitors – risk of demyelination
44
Q

how are biologics being used in melanoma?

A
  • A revolution in treatment options for advanced melanoma - ~20% 5 year survival in stage 4 disease
  • Targeted treatment:
  • If BRAF 600 mutation
  • Vemurafenib
  • Dabrafenib
  • Immunotherapies
  • Ipilumumab
  • Pembrolizumab

year 2 dermatology (11 decks)

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