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dermatology > Dermatology Pharmacology and Prescribing > Flashcards

Dermatology Pharmacology and Prescribing Flashcards

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1
Q

Who must medication be approved by to be licensed in the UK for dermatology?

A

MHRA (Medicines and Healthcare Products Regulatory Agency)

EMA (European Medicines Agency)

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2
Q

What are the different kinds of medicines without liscence?

A
  • Unlicensed
    • Not approved for use in UK
  • ‘Off label’
    • Licensed medication that is being used for an unlicensed indication
  • ‘Specials’
    • Unlicensed dermatological preparations
    • No strong evidence base but clinically effective
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3
Q

What does ‘off label’ medication mean?

A

Licensed medicatio that is being used for an unlicensed indication

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4
Q

What are some causes of prescription error?

A
  • Lack of knowledge
    • About the patient, medication or allergies
  • Mistake writing/generating prescription
  • Poor communication
  • No local or national guidelines
  • Pharmacy/medicine info service
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5
Q

What is pharmacology?

A

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

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6
Q

What is pharmacokinetics?

A

Effect of the body on the drug

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7
Q

What is pharmacodynamics?

A

Effect of the drug on the body

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8
Q

What are the 4 things that should be considered in relation to pharmacokinetics?

A

Absorption

Distribution

Metabolism

Excretion

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9
Q

What are some different kinds of routes of administration for dermatology medications?

A

Topical

Oral

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10
Q

What is meant by pharmacodynamics being the effect of the drug on the body?

A

Individual variation in response

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11
Q

What needs to be considered when thinking about the pharmacodynamics of a drug?

A
  • Age of patient
  • Pregnancy risk
  • Drug interactions
  • Pharmacogenetics
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12
Q

What are some factors associated with poor aherence to taking medication?

A
  • Psychiatric co-morbidities
  • Slower acting agents
  • Multiple applications per day
  • Lack of patient education
  • Cosmetic acceptability of treatments
  • Unintentional non-adherence
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13
Q

What is topical therapy?

A

Medication applied to the skin

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14
Q

What does topical medication contain?

A

Vehicle and active drug

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15
Q

What is a vehicle in topical medication?

A

Pharamcological inert, physically and chemically stable substance that carries the active drug

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16
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
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17
Q

What are some different kinds of vehicles?

A
  • Solution
  • Cream
  • Lotion
  • Gel
  • Foam
  • Tape
  • Paste
  • Spray powder
  • Shampoo
  • Ointment
  • Paint
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18
Q

What are some examples of drugs that can be used topically?

A
  • Corticosteroid
  • Antibiotic
  • Antiviral
  • Dithranol
  • Vitamin analogues
  • Chemotherapy
  • Parasiticidals
  • Coal Tar
  • Anti-inflammatory
  • Salicylic acid
  • Topical immunomodulators
    • Next generation drug
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19
Q

What properties do topical steroids have?

A

Anti-inflammatory and immunosuppressive properties:

  • Regulate pro inflammatory cytokines
  • Suppress fibroblast, endothelial and leukocyte function
  • Vasoconstriction
  • Inhibit vascular permeability
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20
Q

What can be refered to for guidance on how much of a drug to prescribe?

A

BNF (British National Formulary)

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21
Q

What is a ‘finger tip’ unit?

A

About 0.5g

Should be used to treat an area the size of one hand

Useful in young children

22
Q

What are some possible side effects of topical steroids?

A
  • Thinning/atrophy
  • Striae
  • Bruising
  • Hirsutism
  • Telangiectasia
  • Acne/rosacea/perioral dermatitis
  • Glaucoma
  • Systemic absorption
  • Cataracts
23
Q

What are some systemic treatments used in dermatology?

A
  • Retinoids
  • Traditional immunosuppressants
  • Biologics (also immunosuppressive)
24
Q

What are retinoids?

A

These are vitamin A analogues:

  • Normalise keratinocyte function
  • Anti-inflammatory and anti-cancer effects
25
Q

What effects do retinoids have?

A
  • Normalise keratinocyte function
  • Anti-inflammatory and anti-cancer effects
26
Q

What are retinoids useful to treat?

A
  • Acne
    • Isotretinoin
  • Psoriasis
    • Acitretin
  • Cutaneous T cell lymphoma
    • Bexarotene
  • Hand eczema
    • Alitretinoin
27
Q

Why must patients be selective careful for retinoids?

A

They are teratogenic

28
Q

What are some possible side effects of retinoids?

A
  • Cheilitis (dry lips) and xerosis (dry skin)
  • Increases transaminases and triglycerides
  • Rarely psychiatric, eye and bone side effects
29
Q

What is the medical term for dry lips?

A

Cheilitis

30
Q

What is the medical term for dry skin?

A

Xerosis

31
Q

What are immunosuppressants used to treat?

A

Inflammatory skin disorders

32
Q

What are some examples of immunosuppressants?

A
  • Oral steroids
  • Azathioprine
  • Ciclosporin
  • Methotrexate
  • Mycophenolate mofetil
33
Q

What are the risks of taking immunosuppressants?

A

Malignancy and serious infection

34
Q

What must be done regulatory when taking immunosuppressants?

A

Need regular blood test monitoring, in particular:

  • FBC (especially in methotrexate and azathioprine)
  • Renal function (especially ciclosporin)
  • Liver function (especially methotrexate)
35
Q

What are biologics?

A

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
36
Q

What do biologics do?

A

Inhibit specific components of the immune system

37
Q

What are the 2 suffixes of biologics?

A
  • cept
  • mab
38
Q

What does the suffix -cept indicate?

A

It is a receptor fusion

39
Q

What does the suffix -mab indicate?

A

Monoclonal antibodies

40
Q

What are some infixes of biologics that immediately preced -mab?

A
  • –zu (humanised)
  • –ix (chimeric)
  • –u (fully human)
  • –li-/-l- (immunomodulatory)
41
Q

What does the infix -zu indicate in biologics?

A

Humaised

42
Q

What does the infix -ix indicate in biologics?

A

Chimeric

43
Q

What does the infix -u indicate in biologics?

A

Fully human

44
Q

What does the infix -li-/-l- inficate in biologics?

A

Immunomodulatory

45
Q

What are some currently licenced biologics for plaque psoriasis in the UK?

A
46
Q

What is a licenced biologic for chronic spontaneous urticarial?

A

Omalizumab

47
Q

What is a licenced biologic for eczema?

A

Dupilumab

48
Q

When taking biologics, what are you at risk of?

A

Risk of infection:

  • TB reactivation
  • Serious infection
  • Avoid live vaccines

Risk of malignancy

TNF inhibitors cause risk of demyelination

49
Q

What is a revolutionary treatment option for advanced melanoma?

A

Biologics

20% 5 year survival in stage 4 disease

50
Q

What are some targeted treatments (biologics) for advanced melanoma?

A
  • If BRAF 600 mutation
    • Vemurafenib
    • Dabrafenib
  • Immunotherapies
    • Ipilumamab
    • Pembrolizumab
    • Nivolumab
51
Q

Where can reliable information about drugs be found?

A
  • SPC
  • SMC
  • BNF

dermatology (11 decks)

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