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Yr 3 - Pharmacology > Drugs - Dermatology > Flashcards

Drugs - Dermatology Flashcards

1
Q

What class of drug are calcineurin inhibitors?

A

Immunomodulars

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2
Q

Mechanism of action of calcineurin inhibitors

A

Inhibit the chemical calcineurin which activates inflammation of the skin and causes redness and itching.

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3
Q

What are the 2 types of topical calcineurin inhibitors?

A
  1. Tacrolimus ointment
  2. Pimecrolimus cream (Eidel)
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4
Q

How are emollients effective in skin disorders?

A

To create an artificial barrier over the skin to compensate for a defective skin barrier. Help prevent patches of inflammation and flare ups.

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5
Q

Indications for emollients?

A

Topical treatment of dry or scaling skin disorders:

  • Eczema – used alone or in combination with topical corticosteroids
  • Psoriasis – can reduce dryness and cracking
  • Pruritus
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6
Q

Mechanism of emollients?

A
  • Replace water content in dry skin by creating barrier
  • Contain oils or paraffin-based products that help to soften the skin and can reduce water loss by protecting against evaporation from the skin surface
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7
Q

When should emollients be applied?

A

As often as possible - especially immediately after washing or bathing and before bed to maximise effect of skin hydration

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8
Q

Give some examples of thin emollient creams

A
  • E45
  • Aveeno cream
  • Diprobase cream
  • Oilatum crem
  • Epaderm cream
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9
Q

Give some examples of thick, greasy emollients

A
  • 50:50 ointment (50% liquid paraffin)
  • Hydromol ointment
  • Diprobase ointment
  • Epaderm ointment
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10
Q

What is the mani tolerability issue of emollients?

A

Main tolerability issue is that they cause greasiness of skin – but this is integral to their therapeutic effect

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11
Q

How can emollients affect pores and hair follicles?

A

Can block pores and hair follicles - can exacerbate acne vulgaris and folliculitis

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12
Q

How can the risk of folliculitis be reduced when applying emollients?

A

Apply in the direction of hair growth

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13
Q

What receptors do anabolic steroids bind to?

A

Androgen receptors

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14
Q

What do anabolic steroids mimic the effects of?

A

Testosterone

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15
Q

Mechanism of corticosteroids?

A

Bind to glucocorticoid receptors - activates a metabolic pathway that suppresses inflammation & immune responses

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16
Q

Indications for topical glucocorticoids?

A

Inflammatory skin conditions to treat disease flare or to control chronic disease where emollients alone are ineffective:

  • Eczema (atopic)
  • Contact dermatitis
  • Psoriasis
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17
Q

The general rule is to use the weakest steroid for the shortest period required in inflammatory skin conditions. Give an example of a mild topical corticosteroid

A

Hydrocortisone (0.5%, 1% and 2.5%)

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18
Q

Give an example of a potent topical glucocorticoid

A
  • Betamethasone 0.1% (Betnovate)
  • Beclomethasone
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19
Q

Side effects of topical steroid therapy?

A
  • Side effects of all topical therapies:
    • Local irritation
    • Contact allergy
    • Staining
  • Thinning of skin which can make skin more prone to:
    • Flares
    • Bruising
    • Tearing
    • Stretch marks
    • Enlarged blood vessels under surface of skin (telangiectasia)

Depending on location and strength of steroid, there may be some systemic absorption of the steroid

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20
Q

In which scenarios should topical steroids not be used?

A
  • Infection
  • Facial lesions in children
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21
Q

How should topical steroids be used in the treatment of facial lesions?

A

Avoid potent corticosteroids, only weak steroids used very cautiously should be applied to areas of thin skin such as the face, around the eyes and in the genital region

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22
Q

Topical steroid potencies:

A
  • Mild – Hydrocortisone 0.5%
  • Moderate – Eumovate
  • Potent – Betnovate
  • Very potent – Dermovate
23
Q

What are calcineurin inhibitors?

A

Calcineurin inhibitors are immunosuppressants used in the management of autoimmune conditions such as interstitial lung disease, atopic** **dermatitis etc

24
Q

What are the 2 types of topical calcineurin inhibitors?

A
  1. Tacrolimus ointment
  2. Pimecromilus cream (Elidel)
25
Q

Indications for topical calcineurin inhibitors?

A
  • Atopic eczema (management and prevention of flares)
  • Psoriasis (particularly on the face)
  • Seborrhoeic eczema
  • Lichen planus
  • Vitiligo
26
Q

Mechanism of calcineurin inhibitors?

A

Inhibits calcineurin – a chemical that activates inflammation in the skin, causing redness and itching.

27
Q

What is calcineurin?

A

a chemical that activates inflammation in the skin, causing redness and itching.

28
Q

Side effects of calcineurin inhibitors?

A
  • Local irritation or a burning or itching sensation (should settle within a week)
  • Redness
  • Tingling, feeling of warmth
  • Folliculitis
  • Skin more sensitive to sunlight
  • Small risk of developing cold sores (HSV) on treated skin during first weeks of treatment
29
Q

Calcineurin inhibitors vs topical steroids for the face?

A

Do NOT cause skin atrophy, telangiectasia or glaucoma (like topical steroids) so are particularly useful on the face

30
Q

Calcineurin inhibitors vs topical steroids in treating severe flares?

A

Topical calcineurin inhibitors should NOT be used when atopic dermatitis is at its most severe, but can be gradually introduced as severity reduces → topical corticosteroids are more ideal at treating severe flares

31
Q

What are the most common topical retinoids prescribed for acne?

A
  1. Adapalene
  2. Tretinoin
  3. Tazarotene
32
Q

What are the ingredients in epiduo?

A

Benzoyl peroxide + adapalene

33
Q

Side effects of topical retinoids?

A
  • Irritation
  • Photosensitivity
  • Teratogenic
34
Q

What class of drug is fusidic acid?

A

Topical antibiotic

35
Q

indications for fusidic acid?

A

Fusidic acid is prescribed for skin infections caused by germs called staphylococcal bacteria e.g. impetigo, infected cuts and grazes, and infected dermatitis.

36
Q

What are the ingredients in Duac?

A

Benzoyl peroxide + clindamycin

37
Q

Indication for coal tar?

A
  1. Psoriasis
  2. Seborrheic dermatitis
38
Q

What is coal tar frequently combined with?

A

Keratolytics (e.g. SA)

39
Q

What class of drug is calcitriol?

A

Vitamin D analogue

40
Q

Indication for calcitriol? Why?

A

Psoriasis → Has antiproliferative effect on keratinocytes

41
Q

What 2 immunosuppressants are used in inflammatory conditions?

A
  1. Methotrexate (typically 1st line)
  2. Ciclosporin (typically 2nd line)
42
Q

Give some inflammatory conditions where methotrexate may be used

A
  • Psoriasis
  • Psoriatic arthritis
  • Various forms of eczema
  • Sarcoidosis
  • Rheumatoid arthritis
  • Crohn’s disease
43
Q

Contraindications for methotrexate?

A
  • Hypersensitivity
  • Pregnancy and breastfeeding
  • Severe liver, kidney or blood disease
  • Infection
  • Ulcers (mouth, peptic)
  • Due to have a ‘live’ vaccine
44
Q

What are you likely to take alongside methotrexate to reduce side effects?

A

Folic acid

45
Q

Why are blood tests regularly required during methotrexate treatment?

A

Potential to cause bone marrow suppression

46
Q

Side effects of methotrexate?

A
  • Likely to take folic acid alongside to reduce side effects
  • Loss of appetite
  • Diarrhoea
  • N&V
  • Headaches
  • Fatigue
  • Hair loss
  • Mouth ulcers
  • Infections (due to bone marrow suppression)
  • RED FLAGS:
    • Sore throat, fever, or any signs of infection
    • Mouth ulcers
    • Unexplained bruising or bleeding from hums
    • N&V, abdo pain or dark urine
    • Breathlessness or cough
47
Q

Side effects of ciclosporin?

A
  • Can be remembered by the 5 H’s:
    • Hypertension
    • Hypertrophy of the gums
    • Hypertrichosis (excessive hair growth)
    • Hyperkalaemia
    • Hyperglycaemia (diabetes)
  • Reduced function of kidneys
  • Reduced resistance to severe infections (e.g. TB, hepatitis, chickenpox)
  • Increased risk of cancer (breast, bowel, skin, cervical)
  • Increased skin sensitivity to sun
48
Q

What is the most commonly used oral retinoid in the management of psoriasis?

A

Acitretin

49
Q

What is the most commonly used oral retinoid in the management of acne?

A

Isotretinoin (roaccutane)

50
Q

Mechanism of isotretinoin?

A

Targets different factors that cause acne including the production of sebum and production of keratin (outer scales of skin) that block the pores of the hair follicle.

51
Q

Contraindications for isotretinoin?

A
  • Pregnancy & breastfeeding (teratogenic) – all women of childbearing age must be put on the Pregnancy Prevention Programme
  • Soya allergy (or peanut allergy)
  • Mental health
52
Q

Which 3 main medications should be avoided when taking isotretinoin?

A
  • Tetracycline antibiotics
  • Methotrexate
  • Vitamin A supplements (including multivitamins containing vitamin A)
53
Q

What must all women taking acitretin (oral retinoid for psoriasis)?

A
  • Must wait at least 3 years after stopping acitretin to get pregnancy
  • Rarely given to women of childbearing age
  • Contraception!

Yr 3 - Pharmacology (18 decks)

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