Drugs for Cancer, Sunscreen, Lice

Question 1

Ovicidal lice drug

Answer 1

Malathion

Question 2

Malathion MOA

Answer 2

applied topically; organophosphate that is metabolized by the louse to malaoxon, inhibiting acetylcholinesterase causing neuronal hyperstimulation and paralysis

Question 3

Malathion Human Metabolism

Answer 3

rapidly converted to inactive metabolites and excreted by kidneys

Question 4

Malathion Adverse Effects

Answer 4

Not associated with many, but if accidentally ingested can cause cholinergic excess that can be treated with atropine and pralidoxime

Question 5

Permethrin MOA

Answer 5

cause hyperstimulation and paralysis by binding voltage-gated sodium channels within the louse

Question 6

Permethrin Adverse Effects

Answer 6

asthma exacerbation in patients allergic to ragweed; minimal percutaneous absoprtion with no interactions

Question 7

Permethrin Resistance

Answer 7

Knock down resistance (kdr) mutations of louse sodium channels

Question 8

Lindane Uses

Answer 8

louse treatment for people who cannot tolerate or have failed first line therapy; administered topically as shampoo or lotion

Question 9

Lindane Adverse Effects

Answer 9

Neurotoxicity - CNS stimulant promoting seizures, blockade of GABA action); black box - skin diseases, neonatal prematurity, people with uncontrolled seizure disorders

Question 10

Ivermectin MOA

Answer 10

causes louse hyperexcitability and paralysis by binding selectively and with high affinity to glutamate-gated chloride ion channels present in invertebrate nerve and muscle cells

Question 11

Ivermectin Adverse Effects

Answer 11

Elevated liver enzymes, cross BBB of children, worsen bronchial asthma

Question 12

Physical methods of removing lice

Answer 12

lice comb, benzyl alcohol, petroleum jelly

Question 13

Cinoxate

Answer 13

organic UV filter sunscreen that absorbs UV-B radiation

Question 14

Para-aminobenzoic acid (PABA)

Answer 14

organic UV filter sunscreen that absorbs UV-B radiation

Question 15

Trolamine

Answer 15

organic UV filter sunscreen that absorbs UV-B radiation

Question 16

Dioxybenzone, Oxybenzone

Answer 16

organic UV filter sunscreen that absorbs UV-B and UV-A2 radiation

Question 17

Avobenzone

Answer 17

Only FDA approved organic sunscreen that protects against UV-A1 radiation

Question 18

Titanium Dioxide and Zinc Oxide

Answer 18

sunscreens of inorganic compounds that function by reflecting and scattering UV radiation; provide UV-A and UV-B protection

Question 19

Microionized Titanium Dioxide Exception

Answer 19

Does not provide UV-A1 protection; nonionized form does

Question 20

SPF

Answer 20

the amount of UV radiation required to produce a sunburn on protected skin relative to that of unprotected skin; primarily a measure of UV-B exposure

Question 21

Targeted Drugs for Basal Cell Carcinoma

Answer 21

Imiquimod and Vismodegib

Question 22

Targeted Drugs for Melanoma

Answer 22

Aldesleukin, Interferon, Ipilimumab, Sorafenib, Trametinib, Vemurafenib

Question 23

Targeted Drugs for Actinic Keratosis

Answer 23

Diclofenac and Trichloroacetic Acid

Question 24

Targeted Drugs for Squamous Cell Carcinoma

Answer 24

None available

Question 25

Standard chemotherapuetics for BCC

Answer 25

5-Fluorouracil

Question 26

Imiquimod MOA

Answer 26

Topical immune response initiator through direct activation of TLR7/8, involves adenosine receptor blockage and activation of NFkB causing upregulation of cytokines like TNFa and interfleukins; also acts on GLI to repress HH signaling

Question 27

Imiquimod Uses

Answer 27

BCC, Actinic Keratosis, HPV

Question 28

Imiquimod Adverse Effects

Answer 28

Skin reactions, allergy, increased photosensitivity, compromise of condom/diaphragm

Question 29

Vismodegib MOA

Answer 29

oral SMO inhibitor; lipophilic agent with extensive metabolism

Question 30

Vismodegib Adverse Effects

Answer 30

Black Box: intrauterine fetal death, M/F Teratogenicity, | Others: alopecia, GI issues, weight loss, fatigue

Question 31

Treatment of SCC

Answer 31

No standard regimens, but usually Cisplatin based therapy

Question 32

Aldesleukin MOA

Answer 32

binds to cell surface IL-2 receptor, inducing proliferation and differentiation of B and T cells, monocytes, macrophages, and CTLs; given IV or SC

Question 33

Aldesleukin Contraindications

Answer 33

Significant CNS, Cardiac, Pulmonary, renal, or hepatic disease; organ transplant recipient

Question 34

Aldesleukin Adverse Effects

Answer 34

Capillary leak syndrome; CNS, Cardiac, Pulm issues; all organ systems affected

Question 35

Interferon alpha 2b

Answer 35

IV or SC administered immunomodulator

Question 36

Interferon Adverse Effects

Answer 36

AI disease, Cardiac disease, depression, flu like symtoms, neutropenia, leukopenia, anemia, alopecia, elevated hepatic enzymes, cough, dyspnrea, pulmonary infiltrates, pneumonitis, pneumonia

Question 37

Routine tests run while on Interferon

Answer 37

CBC, pulmonary X-ray, ECG, LFTs

Question 38

Ipilimumab MOA

Answer 38

CTLA4 recombinant antibody that bolsters antitumor response of immune system by blocking the interaction of CTLA4 with CD80/86 on T cells thus increasing activation and proliferation

Question 39

Ipilimumab Adverse Effects

Answer 39

severe and fatal immune reactions; dematitis, toxic epidermal necrolysis; adrenal insufficiency, diarrhea, Gullain-Barre, hepatitis, hyper/hypothyroidism, myasthenia gravis, peripheral neuropathy, pregnancy, rash

Question 40

Sorafenib MOA

Answer 40

oral multi-kinase inhibitor - VEGF, PDGFR, KIT, Raf kinase; hepatic metabolism

Question 41

Sorafenib Adverse Effects

Answer 41

Hand and foot syndrome, rash/desquamation, anemia, bone marrow suppression, neutropenia, increased bleeding in GI, Resp, and brain, Hepatitis, teratogen

Question 42

Trametinib MOA

Answer 42

oral reversible MEK inhibitor for patients with BRAF V600E/K mutations

Question 43

Trametinib Adverse Effects

Answer 43

rapid onset of skin toxicity, GI toxicity, decreased LVEF, HTN, hemorrhage, cardiomyopathy, interstitial lung disease, retinal pigment epithelial detachment, teratogen

Question 44

Vemurafenib MOA

Answer 44

oral inhibitor of mutated BRAF, including V600E; resistance is via alternative pathway activation;

Question 45

Vemurafenib Pharm

Answer 45

Hepatic metabolism with potential PGP and CYP interactions

Question 46

Vemurafenib Adverse Effects

Answer 46

Elevated serum creatinine, QT prolongation and TP, increased photosensitivity, cutaneous SCC, SJS, opthalmologic issues (uveitis, iritis, retinal vein occlusion), teratogen

Question 47

Tests to run on Pt receiving Vemurafenib

Answer 47

LFTs, ECG, electrolyte monitoring, derm exams

Question 48

BRAF/MEK inhibitors common toxicities

Answer 48

Liver, Heart, Eye, possible secondary malignancies, skin issues (SJS)

Question 49

Diclofenac MOA

Answer 49

used for Actinic Keratosis; inhibitor of inflammatory mediators including PGE2

Question 50

Diclofenac Adverse Effects

Answer 50

itchy rash, dry skin, skin peeling, and redness

Question 51

Trichloroacetic Acid MOA

Answer 51

used for actinic keratosis; chemical peel - rapidly penetrates and cauterizes skin, keratin, and other tissues

Question 52

Trichloroacetic Acid Adverse Effects

Answer 52

Burning, inflammation, localized tenderness

Question 53

Standard Chemo for Melanoma

Answer 53

Dacarbazine, Lomustine, Carmustine Platinums, Vincas, Taxanes