dermpharm Flashcards
antihistamines
H1 - sedation, anticholinergic effects (dry mouth, constipation, dysuria, blurred vision). includes diphenhydramine, hydroxyzine, promethazine, chlopheniramine, cyproheptadine (increased appetite)
H2- less sedating as they don’t cross blood brain barrier, lack anticholinergic effects. includes loratadine, desloratadine, cetirizine, levocitirizine, fexofenadine
- *note cetirizine is the MOST sedating of H2 blockers
- *use H1 blockers in preggo and lactating patients
retinoids
SE - triglyceridemia/HLD (> 800), elevated LFTs (> 3x upper limit of normal), hypothyroidism (bexarotene), agranulocytosis (bexarotene), teratogenicity (mental issues, spontaneous abortion, defects in craniofacial/heart/brain/thymus)
how to treat elevated TGs in these patients? fenofibrate
And if hyperlipidemia? atorvastatin/pravastatin
Bexarotene (topical/oral) is used to treat CTCL
Alitretinoin (topical) is used to treat KS
What can retinoids not be mixed with?
isotretinoin + doxy - NO, psuedotumor cerebri
Acitretin + ETOH - NO, turns into etretinate
Bexarotene + gemfibrozil - NO, severe hypertriglyceridemia
how much cortisol does our body normal secrete?
5-7.5 mg/day
Corticosteroids (glucortico>mineralcortico in derm)
high mineral, low gluco = cortisone, hydrocortisone
high gluco, low mineral = prednisone, prednisolone, methylprednisone, triamcinolone
high gluco, no mineral = betamethasone, dexamethasone
SE: leukopenia, osteoporosis, cataracts, poor wound healing, increased risk of infection, striae, atrophy, telangiectasia, growth impairment, hypertriglyceridemia
*greatest loss of bone density in first 6 months of prednisone. most affected group: young men
**most SE can be resolved with QOD dosing EXCEPT FOR osteoporosis + cataracts
apremilast (otezla)
PDE4 inhibitor (SE -diarrhea, nausea which tend to resolve within 4 weeks of use)
tofacitinib (xeljanz)
JAK 1 and 3 inhibitor, SE include URI, mild headaches, and nausea, hyperlipidemia, hypertriglyceridemia, elevated LFTs
ruxolitinib (jakafi)
JAK 1 and 2 inhibitor, local SEs
azathioprine (imuran)
inhibits purine metabolism
SE - myelosuppression, increased risk of SCC and lymphoma, infection, teratogenicity, nausea, vomiting, diarrhea
allopurinol, febuxostat, ACEI, sulfasalazine, and folate antagonists increase risk of myelosuppression when taken with azathioprine
cyclosporine
inhibits calcineurin by binding to cyclophilin
SE - nephrotoxicity, hypertension, increased risk of NMSC in psoriasis patients
If HTN develops, it is NOT a contraindication to discontinue therapy. HTN can be controlled with CCB
cyclophosphamide
an alkylating agent, nitrogen mustard derivative
SE - hemorrhagic cystitis, infertility, increased risk of transitional cell carcinoma of bladder, leukemia, NHL, and SCC, hyperpigmentation of skin and nails
**prevent hemorrhagic cystitis with MESNA
methotrexate
inhibits DHF
SE - nausea, vomiting, abdominal pain, LFT issues, pancytopenia, phototoxicity
If considering conception, women must be off medication for 1 ovulatory cycle and men must be off med for 3 months
- check CBC and CMP every 3-4 months
increased risk of myelosuppression if given along with trimethoprim, sulfonamides, dapsone, tetracyclines, phenytoin, phenothiazines, NSAIDs, salicylates
mycophenolate mofetil (cellcept)
binds and inhibits inosine monophosphate dehydrogenase
SE - increased risk of lymphoma, nausea, vomiting, diarrhea, abdominal pain
**cannot use with antacids and PPI as these decrease serum levels of medication
CBC and CMP every 2-3 months
hydroxyurea
inhibits ribonucleotide diphosphate reductase
SE - megaloblastic anemia , hyperpigmentation of skin and nails
chlorambucil
an alkylating agent
SE - epileptogenic/mood altering potential, nausea, vomiting, azoospermia, amenorrhea, pulmonary fibrosis, hepatotoxicity, bone marrow suppression, oral ulcers
