Drugs Week 3 Flashcards
Corticosteroids
Action: Anti-inflammatory, immunosuppressive, anti-proliferative, vasoconstriction.
Uses: Eczema, contact dermatitis, psoriasis, itch, lichen planus…
Adverse effects: SKIN ATROPHY, striae, acne, suppression of the HPA axis.
Strength is categorized based on a standardized laboratory vasoconstriction assay. (graded from 7 - hydrocortisone (lowest) to 1 (highest) - prednisone 2) Use stronger grades on tougher skin like hands and feat. Use weaker grades on kids, babies, face.
Retinoids (tretinoin, tazarotene, adapalene
Vitamin A analogs which work through nuclear receptors on DNA causing alteration of gene transcrition.
Action: Regulates cell growth, inhibit carcinogensis, alter enzymes involved with cellular differentiation.
Uses: acne, psoriasis, cosmetic skin improvement
Adverse effects: dryness, irritation, and sun sensitivity
Calcipotriene
Mech of Action: Vitamin D analog that acts through DNA receptors to alter skin differentation
Uses: Psoriasis, eczema
Adverse effects: irritation, increased serum calcium
Topical Calcieurin Inhibitors (TCIs) “NSAIDs”
Tacrolimus, and Pimicrolimus
Work through calcineurin to alter T-cell activation
Uses: Eczema (especially near the eyes), dermatitis,
Adverse effects: limited. Local irritation or burning.
Other notes: Use them strictly as directed.
Sunscreens
UVM (290-320) and UVA (320-400)
Newer ones with Avobenzone/Heliplex/Mexoryl are better vs. UVA
SPF = Sun Protection Factor.
SPF 15 blocks 93%, SPF 30 blocks 97% Use SPF 15 or greater.
Imiquimod: Aldara cream
An immune response modifier whose mode of action is not well understood. Increases local immune activity through TLRs.
Uses: Condyloma, AK, and BCC, common warts, molluscum, in situ carcinoma.
Topical 5-fluorouracil
MOA: Inhibits thymidylate synthase resulting in reduced DNA synthesis. Acts selectively in actinic damaged skin cells.
Uses: Imiquimod and 5-FU used for AK
Isotretinoin and acitretin
Another subset? of Retinoids. Vitamin A analogs that bind to nuclear receptors to alter cell differentiation.
Uses: Acne, psoriasis, ichtyosis, Darier’s disease, chemoprophylaxis of skin cancer in transplant patients (repair disordered keratinizaiton)
Adverse Effects: dryness, hyperlipidemia, TERATOGENIC, hepatitis, arthralgias, and hair loss.
Labs: lipids, LFT, and HCG (pregnancy)
Dapsone
A sulfone. Action: inhibits myeloperoxidases in polymorphic neutrophils.
Use: Leprosy, dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet’s syndrome, spider bite (neutrophilic skin dz)
Adverse effects: Hemolysis(G6PD deficiency), Methemaglobinemia, Motor neuropathy
Labs: G6PD, CBC
Methotrexate
Action: DHFR Inhibitor that disrupts DNA synthesis to block cell division. Immunosupprssive.
Uses: psoriasis, CTCL, lupus
A.E. :hepatoxicity, myelosuppression, pneumonitis
Lab: CBC, LFT, Liver Biopsy
Bilogical Therapy
Newest generation of systemic therapy for psoriasis, psoriatic arthiritis, and RA. Biogenetically engineered proteins which disrupt/inhibit focused portions of the immune system involved in psoriasis.
Appear to be safe in long term control w/o organ toxicity.
A.E. Injection site irritation, Risk of infection, Exacerbate CHF, Reactivate TB, Risk for Cancer
Ultraviolet Light Therapy
UVB, Narrow band UVB, PUVA, . Forms pyrmidine dimers in DNA and reduces langerhans cell and leukocytes
Actions: anti-inflammatory, and immunosuppression
Uses: psoriasis, pruritis, eczema, CTCL
A.E. burns, carcinogenic, photoaging
Minoxidil (Rogaine)
Action: vasodilation adn direct stimulation of hair shaft growth. Only hair that would come back anywway.
Uses: Alopecia
Finasteride (propecia)
Action: Blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testerone to dihydotestosterone.
Uses: Androgenic alopecia
Liquid Nitrogen
Action: Freezes tissues (-196 C)
Uses: Warts, AK, skin cancer
