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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
Q

Topical corticosteroids adverse effects

A

Cushing’s Syndrome, Dermal atrophy, Corticoid rasacea, steroid acne, hypopigmentation, hypertrichosis, increased intraocular pressure

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26
Q

Salicylic acid

A

causes desquamation of horny layer of skin; used for hyperkeratotic conditions and acne

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27
Q

Salicylic acid Adverse effects

A

contact irritation, renal or hepatic impairment, neonatal toxicity via contact or breast milk

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28
Q

Salicylate Intoxication

A

early indicators: dizziness and tinnitus; severe: multiple organ involvement, CNS failure, renal failure, organ edema

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29
Q

Innervation of Eccrine sweat glands

A

post-ganglionic sympathetic with Acetycholamine

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30
Q

Innervation of Apocrine sweat glands

A

post-ganglionic sympathetic with Catecholamines

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31
Q

Receptors for sweat glands

A

primarily M2, M3 but also alpha1 for localized effect; alpha1,2 also cause constriction of blood vessels which help with temp regulation

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32
Q

Cholinergic Excess symptoms

A

DUMBBELS: Diarrhea, Urination, Miosis/Muscle weakness, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Salivation/Sweating

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33
Q

Cholinergic agonists MOA

A

cause increased secretions by increasing intracellular Ca2+ levels thus activating water and chloride/potassium loss and resulting cell shrinkage

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34
Q

Hyperhidrosis treatment options in order of use

A

Antiperspirants, botulin toxin, then systemic anticholinergics

35
Q

Aluminum Chloride MOA

A

short-term occlusion of eccrine and apocrine sweat gland ducts; it combines with keratin to produce fibrillar contraction of duct

36
Q

Aluminum Chloride Pharm

A

minimal systemic absorption; renal elimination; infrequently may cause excessive irritation

37
Q

Botulinum toxin MOA

A

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
Q

Botulinum Toxin Activation

A

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
Q

Botulinum Toxin Adverse Effects

A

systemic botulism causing respiratory arrest and death; also other anticholinergic effects; albumin allergy

40
Q

Glycopyrrolate and Propatheline

A

nicotinic and muscarinic systemic agents that do not cross BBB

41
Q

Oxybutynin and Atropine

A

systemic antimuscarinic agents that cross BBB

42
Q

Diltiazem use in hyperhidrossis

A

blocks Ca2+ channels involved in secretion process

43
Q

Propranolol and clonidine use in hyperhidrossis

A

reduce sympathetic CNS stimulation, improving emotional stability for systemic antimuscarinic agents that cross BBB

44
Q

Dapsone Metabolite issues

A

methemoglobinemia, hemolysis; interactions with Rifampin, Cimetidine, Omeprazole (gastric hyeracidity drugs), Trimethoprim

45
Q

Dapsone Contraindications

A

Patients with G-6-PD deficiency

46
Q

Dapsone MOA

A

folate antagonist producing bacteriostatic effect; inhibitor of second messenger pathways involved in neutrophil chemotaxis

47
Q

Dapsone Sydrome (A.E.)

A

Hemolysis, Methemoglobinemia, Hepatitis (mono like), Cholestatic jaundice, peripheral neuropathy, severe hypoalbuminemia, psychosis, leukopenia, agranulocytosis

48
Q

Dapsone uses

A

Acne vulgaris, Dermatitis herpetiformis, leprosy

49
Q

Rifampin MOA

A

inhibits bacterial and mycobacterial RNA synthesis by binding the beta subunit of DNA dependent RNA polymerase, eukaryotic cells unaffected

50
Q

Rifampin distribution, metabolism, and elimination

A

Crosses inflamed meninges, placenta; eliminated in breast milk; hepatic metabolism and elimination; entero-hepatic recirculation; CYP inducer (1A2, 2B6, 2C19, 2C9, 3A)

51
Q

Rifampin Adverse Effects

A

transient increases in LFTs, sometimes fatal liver toxicity; makes management of DM more difficult; discolor bodily fluids (urine, saliva, tears, sputum; contact lenses)

52
Q

Clofazimine MOA

A

binds to mycobacterial guanine in DNA, causing progressive, dose-dependent anti-inflammatory and immunosuppressive effects

53
Q

Clofazimine Pharm

A

highly lipophilic (lasts for many months), hepatic elimination

54
Q

Clofazimine Adverse Effects

A

hepatitis, jaundice, staining of body and fluids, black/tarry feces, skin discoloration which may trigger depression

55
Q

What tests to run on patients undergoing leprosy treatment

A

CBC and platelets at every visit, AST/ALT every 3 months; first visit all labs

56
Q

Clarithromycin MOA

A

inhibits 50S ribosomal sub-unit; can be used in pregnancy

57
Q

Minocycline MOA

A

inhibits 30S ribosomal sub-unit; can be used in pregnancy

58
Q

Ofloxacin MOA

A

inhibits bacterial DNA gyrase; can be used in pregnancy

59
Q

Adverse Reactions to primary Leprosy treatment

A

type 1 red patchy skin lesions, erythema, swollen hands/feet, joint pain; type 2 sudden eruption of nodules, neuritis

60
Q

Thalidomide MOA

A

inhibits NFkB mediated transcriptional upregulation and TNFa production, blocking leukocyte migration

61
Q

Thalidomide Adverse Effects

A

Teratogen, increase in plasma HIV load, somnolence, rash, HA, peripheral neuropathy

62
Q

Lepromatous Treatment regimen

A

Dapsone, Rifampicin, Clofazimine daily for 24 months

63
Q

Leprosy treatment for those with adverse effects to initial treatment

A

Clarithromycin, Minocycline, Ofloxacin

64
Q

Leprosy treatment ofr patients who cannot tolerate Clofazimine

A

Corticosteroids and Thalidomide

65
Q

Trichogenic Agents

A

Minoxidil, Finasteride

66
Q

Antitrichogenic Agents

A

Eflornithine

67
Q

Pigmentation Therapies

A

Hyrdoquinone/Fluocinolone/Tretinoin; Methoxsalen

68
Q

Minoxidil Uses

A

topical agent for hair regrowth through unknown mechanism

69
Q

Minoxidil Pharm

A

topical use, poor percutaneous absorption; drug treatment must continue for effects to be maintained

70
Q

Finasteride MOA

A

oral drug that is a testosterone analog that blocks 5-alpha-reductase activity, decreasing scalp and serum DHT concentrations

71
Q

Finasteride Adverse Effects

A

Loss of libido, sexual dysfunction, feminization

72
Q

Finasteride Contraindications

A

do not use with Saw palmetto because they have similar pharmacologic MOA, which can cause exaggerated effects

73
Q

Eflornithina Uses

A

topical drug to reduce unwanted female facial hair

74
Q

Eflornithine MOA

A

decrease ornithine decarboxylase which decreases cell division and differentiation; also produces trypanostatic action, so used against sleeping sickness

75
Q

Eflornithine Pharm

A

limited percutaneous absorption, not a depilatory agent, used in facial and chin areas only

76
Q

Flucinolone MOA

A

anti-inflammatory corticosteroid

77
Q

Hydroquinone MOA

A

inhibits melanin formation, blocking melanocyte enzymatic oxidation of tyrosie to 3,4=dihydroxyphenylalanine

78
Q

Treinoin MOA

A

modulates skin growth and pigmentation; increased keratinocyte shedding from the retinoid treated epidermis results in decreased epidermal melanin content

79
Q

Flucinolone, Hyrodquinone, Tretinoin Combo Therapy

A

temporary relief of facial skin darkening by hormonal changes, pregnancy, OCs, or HRT; cause increased sensitivity to UV

80
Q

Methoxsalen MOA

A

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
Q

Methoxsalen Uses

A

oral and topical agent; used for Vitligo, symptomatic relief of psoriasis, cutaneous T cell lymphoma, alopecia areata, inflammatory dermatoses, eczema, lichen planus

82
Q

Chemotherapy induced Alopecia

A

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
Q

Reasons not to use scalp cooling

A

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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