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Dermatological Block > Drugs for Psoriasis/Acne, Hyperhydrossis, leprosy, Misc. > Flashcards

Drugs for Psoriasis/Acne, Hyperhydrossis, leprosy, Misc. Flashcards

1
Q

Adalimumab

A

IgG1 monoclonal antibody that binds TNFa; administered SC; used for moderate to severe psoriasis and psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, Crohn’s disease

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2
Q

Etanercept

A

composed of p75 TNF receptor and Fc IgG1; binds to TNFa; administered SC; used for moderate to severe psoriasis and psoriatic arthritis, RA, ankylosing spondylitis

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3
Q

Infliximab

A

chimeric monoclonal antibody composed of variable region of mouse monoclonal AB on human IgG1; binds to TNFa; given IV; used for severe psoriasis and moderate-severe psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, and Crohn’s disease

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4
Q

Infliximab contraindications

A

Heart failure, murine protein hypersensitivity

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5
Q

Etanercept Contraindications

A

Sepsis

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6
Q

Infliximab, Etanercept, Adalimumab Black Box Warnings and List of Medications not to use with

A

Black Box: Infection, neoplasia, TB

Not with: Immunosuppressives or vaccinations

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7
Q

Ustekinumab MOA

A

binds to p40 subunit integral for IL-12, 23 activation, disrupting their signal transduction

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8
Q

Ustekinumab Adverse Effects

A

increased risk of infection, neoplasia; live virus vaccines contra; test for latent TB prior to treatment; anaphylaxis

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9
Q

Functions of Vitamin A

A

embryonic growth, morphogenesis, differentiation and maintenance of epithelial tissues, reproduction, visual functions

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10
Q

Retinoids MOA

A

topical application activates RAR/RXR causing activation of transcription factors -> activation of heparin binding epidermal growth factor (HB-EGF) and amphiregulin (AR) -> proliferation of basal keratinocytes, thickening the epidermis and causing flaking/peeling of the stratum corneum

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11
Q

RAR Targeting

A

affects cellular differentiation and proliferation

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12
Q

RXR Targeting

A

predominantly induces apoptosis

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13
Q

Retinoid Toxicities

A

dry skin, nosebleeds, conjunctivitis, reduced night vision, hair loss, serum lipid elevation, TERATOGEN

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14
Q

RAR selective Toxicities

A

mucocutaneous and musculoskeletal symptoms

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15
Q

RXR Selective Toxicities

A

physiochemical changes

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16
Q

Topical retinoids use

A

1st line for comedonal acne; also for reducing fine wrinkles and dyspigmentation associated with photoaging

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17
Q

Topical retinoid Adverse effects

A

erythema, desquamation, burning, and stinging; increased reactivity to UV radiation causing increased risk of severe sunburn

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18
Q

Calcipotriene

A

topical drug that binds to vitamin D receptor and associates with RXRa and binds DNA vit D response elements; used for plaque psoriasis

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19
Q

Calcipotriene Adverse Effects

A

topical irritation (reduced by steroids), hypercalcemia, hypercalciuria, increase susceptibility to UV-induced skin cancer

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20
Q

Calcitriol

A

hormonally active form of Vit D3; better tolerated in intertriginous and sensitive areas of the skin with comparable safety to calcipotriene; given topically

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21
Q

Benzoyl Peroxide

A

Topical prodrug of benzoic acid; free radical liberation is lethal for P. acnes; often formulated with ABX

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22
Q

Benzoyl Peroxide Adverse Effects

A

drying of skin, contact dermatitis, pruritus; avoid contact with eyes and mucous membranes; bleaches hair and fabric

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23
Q

Diseases that are highly responsive to steroids

A

Psoriasis (intertriginous), Atopic Dermatitis (kids), Seborrheic Dermatitis, Intertrigo

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24
Q

Fluorinated steroids adverse effects

A

perioral dermatitis; should not be applied to face

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25
Topical corticosteroids adverse effects
Cushing's Syndrome, Dermal atrophy, Corticoid rasacea, steroid acne, hypopigmentation, hypertrichosis, increased intraocular pressure
26
Salicylic acid
causes desquamation of horny layer of skin; used for hyperkeratotic conditions and acne
27
Salicylic acid Adverse effects
contact irritation, renal or hepatic impairment, neonatal toxicity via contact or breast milk
28
Salicylate Intoxication
early indicators: dizziness and tinnitus; severe: multiple organ involvement, CNS failure, renal failure, organ edema
29
Innervation of Eccrine sweat glands
post-ganglionic sympathetic with Acetycholamine
30
Innervation of Apocrine sweat glands
post-ganglionic sympathetic with Catecholamines
31
Receptors for sweat glands
primarily M2, M3 but also alpha1 for localized effect; alpha1,2 also cause constriction of blood vessels which help with temp regulation
32
Cholinergic Excess symptoms
DUMBBELS: Diarrhea, Urination, Miosis/Muscle weakness, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Salivation/Sweating
33
Cholinergic agonists MOA
cause increased secretions by increasing intracellular Ca2+ levels thus activating water and chloride/potassium loss and resulting cell shrinkage
34
Hyperhidrosis treatment options in order of use
Antiperspirants, botulin toxin, then systemic anticholinergics
35
Aluminum Chloride MOA
short-term occlusion of eccrine and apocrine sweat gland ducts; it combines with keratin to produce fibrillar contraction of duct
36
Aluminum Chloride Pharm
minimal systemic absorption; renal elimination; infrequently may cause excessive irritation
37
Botulinum toxin MOA
blocks the release of Ach from vesicles by cleaving SNARE proteins, so that the vesicles cannot attach to the surface; blocks both muscarinic and nicotinic receptors
38
Botulinum Toxin Activation
heavy chain portion binds to cell membrane, then is endocytosed, then the light chain (active form) cleaves SNAPs; new nerve endings eventyally sprout and reconnect the muscles.
39
Botulinum Toxin Adverse Effects
systemic botulism causing respiratory arrest and death; also other anticholinergic effects; albumin allergy
40
Glycopyrrolate and Propatheline
nicotinic and muscarinic systemic agents that do not cross BBB
41
Oxybutynin and Atropine
systemic antimuscarinic agents that cross BBB
42
Diltiazem use in hyperhidrossis
blocks Ca2+ channels involved in secretion process
43
Propranolol and clonidine use in hyperhidrossis
reduce sympathetic CNS stimulation, improving emotional stability for systemic antimuscarinic agents that cross BBB
44
Dapsone Metabolite issues
methemoglobinemia, hemolysis; interactions with Rifampin, Cimetidine, Omeprazole (gastric hyeracidity drugs), Trimethoprim
45
Dapsone Contraindications
Patients with G-6-PD deficiency
46
Dapsone MOA
folate antagonist producing bacteriostatic effect; inhibitor of second messenger pathways involved in neutrophil chemotaxis
47
Dapsone Sydrome (A.E.)
Hemolysis, Methemoglobinemia, Hepatitis (mono like), Cholestatic jaundice, peripheral neuropathy, severe hypoalbuminemia, psychosis, leukopenia, agranulocytosis
48
Dapsone uses
Acne vulgaris, Dermatitis herpetiformis, leprosy
49
Rifampin MOA
inhibits bacterial and mycobacterial RNA synthesis by binding the beta subunit of DNA dependent RNA polymerase, eukaryotic cells unaffected
50
Rifampin distribution, metabolism, and elimination
Crosses inflamed meninges, placenta; eliminated in breast milk; hepatic metabolism and elimination; entero-hepatic recirculation; CYP inducer (1A2, 2B6, 2C19, 2C9, 3A)
51
Rifampin Adverse Effects
transient increases in LFTs, sometimes fatal liver toxicity; makes management of DM more difficult; discolor bodily fluids (urine, saliva, tears, sputum; contact lenses)
52
Clofazimine MOA
binds to mycobacterial guanine in DNA, causing progressive, dose-dependent anti-inflammatory and immunosuppressive effects
53
Clofazimine Pharm
highly lipophilic (lasts for many months), hepatic elimination
54
Clofazimine Adverse Effects
hepatitis, jaundice, staining of body and fluids, black/tarry feces, skin discoloration which may trigger depression
55
What tests to run on patients undergoing leprosy treatment
CBC and platelets at every visit, AST/ALT every 3 months; first visit all labs
56
Clarithromycin MOA
inhibits 50S ribosomal sub-unit; can be used in pregnancy
57
Minocycline MOA
inhibits 30S ribosomal sub-unit; can be used in pregnancy
58
Ofloxacin MOA
inhibits bacterial DNA gyrase; can be used in pregnancy
59
Adverse Reactions to primary Leprosy treatment
type 1 red patchy skin lesions, erythema, swollen hands/feet, joint pain; type 2 sudden eruption of nodules, neuritis
60
Thalidomide MOA
inhibits NFkB mediated transcriptional upregulation and TNFa production, blocking leukocyte migration
61
Thalidomide Adverse Effects
Teratogen, increase in plasma HIV load, somnolence, rash, HA, peripheral neuropathy
62
Lepromatous Treatment regimen
Dapsone, Rifampicin, Clofazimine daily for 24 months
63
Leprosy treatment for those with adverse effects to initial treatment
Clarithromycin, Minocycline, Ofloxacin
64
Leprosy treatment ofr patients who cannot tolerate Clofazimine
Corticosteroids and Thalidomide
65
Trichogenic Agents
Minoxidil, Finasteride
66
Antitrichogenic Agents
Eflornithine
67
Pigmentation Therapies
Hyrdoquinone/Fluocinolone/Tretinoin; Methoxsalen
68
Minoxidil Uses
topical agent for hair regrowth through unknown mechanism
69
Minoxidil Pharm
topical use, poor percutaneous absorption; drug treatment must continue for effects to be maintained
70
Finasteride MOA
oral drug that is a testosterone analog that blocks 5-alpha-reductase activity, decreasing scalp and serum DHT concentrations
71
Finasteride Adverse Effects
Loss of libido, sexual dysfunction, feminization
72
Finasteride Contraindications
do not use with Saw palmetto because they have similar pharmacologic MOA, which can cause exaggerated effects
73
Eflornithina Uses
topical drug to reduce unwanted female facial hair
74
Eflornithine MOA
decrease ornithine decarboxylase which decreases cell division and differentiation; also produces trypanostatic action, so used against sleeping sickness
75
Eflornithine Pharm
limited percutaneous absorption, not a depilatory agent, used in facial and chin areas only
76
Flucinolone MOA
anti-inflammatory corticosteroid
77
Hydroquinone MOA
inhibits melanin formation, blocking melanocyte enzymatic oxidation of tyrosie to 3,4=dihydroxyphenylalanine
78
Treinoin MOA
modulates skin growth and pigmentation; increased keratinocyte shedding from the retinoid treated epidermis results in decreased epidermal melanin content
79
Flucinolone, Hyrodquinone, Tretinoin Combo Therapy
temporary relief of facial skin darkening by hormonal changes, pregnancy, OCs, or HRT; cause increased sensitivity to UV
80
Methoxsalen MOA
activated by exposure to UVA, causing conjugation and ccross-linking of DNA leading to cell death; causes delayed erythema followed by increased epidermal melanization and thickening of stratum corneum
81
Methoxsalen Uses
oral and topical agent; used for Vitligo, symptomatic relief of psoriasis, cutaneous T cell lymphoma, alopecia areata, inflammatory dermatoses, eczema, lichen planus
82
Chemotherapy induced Alopecia
usually does not affect bulge (hair stem cells), but increases apoptotic cell death via decreased Bcl-2 and increased Bax and p53; it is dose, drug, intensity, and route dependent
83
Reasons not to use scalp cooling
potential for scalp micro-metastases experiencing sublethal exposure and questionable efficacy in patients with slower drug clearance

Dermatological Block (6 decks)

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