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Exam 1 Flashcards

1
Q

Formulations that are drying and best for oozing/crusting presentations

A

Tinctures, wet dressings, and lotions

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2
Q

Formulations that are moisturizing and best suited to xerodermic conditions

A

Creams & ointments

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3
Q

Emulsion of water and fat; lipid is biggest component

A

Cream

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4
Q

Emulsion of fat and water but with more water, less fat

A

Lotion

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5
Q

Emulsion of petroleum jelly and water; very thick & messy

A

Ointment

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6
Q

lotion or gel that is aerosolized; beneficial for scalp conditions

A

Foam

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7
Q

Emulsion of water and a thickener (polymer or starch)

A

Gel

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8
Q

Mixing a powder with a liquid creates a

A

Paste

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9
Q

Dry, mostly w/ cornstarch as the base in the US

A

Powder

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10
Q

Aqueous base of water and drug

A

Solution

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11
Q

Solution that contains alcohol; used when drug isn’t water soluble

A

Tincture

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12
Q

Common reasons to use a TCS

A

Atopic and contact derm, psoriasis, localized urticaria/hives

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13
Q

Side effects of systemic steroids?

A

Hyperglycemia, HTN, iatrogenic Cushing’s, HPA-axis inhibition

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14
Q

Super/Very Potent TCS

A

Clobetasol propionate 0.05% cream/ointment
Brand: Temovate & Clobex

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15
Q

Potent TCS

A

Mometsone furoate 0.1% ointment (Elocon)
Betamethasone dipropionate 0.05% lotion (Diprolene)

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16
Q

Mild potency TCS

A

Triamcinolone acetonide 0.25% cream

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17
Q

Least potent TCS

A

Hydrocortisone acetate (1% or 2.5% cream or lotions)

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18
Q

MOA of tacrolimus (Protopic) and pimecrolimus (Elidel) - what type of drugs are these?

A

Topical immunosuppressants
Bind to and inhibit calcineurin; inhibits T-cell activation

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19
Q

Topical antipuritics

A

Pramoxine, Doxepin (zonalon as topical, Sinequan oral), Diphenhydramine (topical benadryl)

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20
Q

Topical antipuritic that is a tricyclic antidepressant; Plasma levels may be similar whether given oral or topical - anticholinergic effects, sedation, drug interactions

A

Doxepin (zonalon)

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21
Q

Antihistamine that is given as a topical antipuritic. Plasma levels may approach that of oral use if used chronically - anticholinergic effects, sedation

A

Diphenhydramine (Topical Benadryl)

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22
Q

Peptide abx available topically, covers G+ bacteria
Inhibits transporting NAG/NAM across cell membrane
Poorly absorbed, well tolerated

A

Bacitracin

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23
Q

Peptide abx available topically, covers G- bacteria
Binds LPS, disrupts cell membrane
Poorly absorbed, well tolerated

A

Polymyxin B

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24
Q

aminoglycosides available topically, covers G- bacteria
Binds to 30S ribosomal subunit
Poorly absorbed, may lead to sensitization

A

Neomycin, Gentamicin

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25
Q

What 3 antibiotics are in Neosporin?

A

Bacitracin, Polymyxin B, and Neomycin

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26
Q

Antibiotic active against G+ cocci (Strep, Staph, including MSSA and MRSA)
Inhibits isoleucyl-tRNA synthetase, inhibiting protein synthesis
Used for impetigo as well as other superficial infx caused by susceptible organisms

A

Mupirocin (Bactroban)

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27
Q

Topical antibiotic
Binds 50S ribosomal subunit
Similar in spectrum and use as mupirocin, but not specifically approved for MRSA

A

Retapamulin (Altabax)

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28
Q

Systemic antibiotics for skin infections

A

Penicillins (amoxi/clav, dicloxacillin)
Cephalosporins (cephalexin, cefprozil, cefuroxime, cefpodoxime, ceftriaxone)
Fluoroquinolones (ciprofoxacin, levofloxacin, moxifloxacin)
Others: clindamycin, daptomycin, linezolid, tigecycline, TMP/SMX, vancomycin

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29
Q

MOA, common/serious SE, coverage of Penicillins

A

Binds to and inhibits PBP, inhibiting peptidoglycan synthesis
SE: hypersensitivity MC, rash, serum sickness, SJS, renal toxicity, diarrhea
Amoxi/Clav covers B-lactamase + organisms, G+ staph and strep, Haemophilis, Listeria, E. coli, Shigella, Salmonella
Dicloxacillin covers B-lactamase + organisms and staph

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30
Q

MOA, common/serious SE, coverage of Cephalosporins

A

MOA: PBP inhibition (same as pcn)
SE: hypersensitivity (MC), bleeding (MTT side chain in Cefotetan), N/V/D, obstructive biliary toxicity w/ Ceftriaxone, C. diff, Disulfiram-like rxn
Coverage: higher gen = broader spectrum; don’t cover LAME,
Cephalexin - staph/strep
Cefprozil, Cefuroxime - Enterobacteria (E. coli, Klebsiella) and Bacteroides fragilis
Ceftriaxone, Cefpodoxime - Gram - rods, pcn-resistant Strep pneumo

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31
Q

MOA, common/serious SE, coverage of Fluoroquinolones

A

MOA: targets DNA gyrase in G- and Topoisomerase IV in G+
SE: QT interval, insulin resistance, CNS - myasthenia gravis, N/V/D, cartilage toxicity in pregnancy and children, drug interactions w/ cations, CYP1A2 inhibition
Covers Gram- such as Enterbacteriaceae, Haemophilus, Moraxella, and Pseudomonas
Cipro and moxifloxacin can cover G+ and anaerobes

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32
Q

Not as broad spectrum, significantly inhibit p450 enzymes, almost totally regulated to topical treatment (*1 exception)

A

Imidazoles (Ketoconazole*, clotrimazole, econazole, miconazole, oxiconazole, sertaconazole, sulconazole)

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33
Q

Tend to be broader spectrum with less drug interactions; almost all used systemically

A

Triazoles (*Efinaconazole, *terconazole, fluconazole, itraconazole, posaconazole, voriconazole)

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34
Q

MOA of Azole-antifungals

A

Inhibits lanosterol-14a-demethylase (needed to convert lanosterol to ergosterol)

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35
Q

Toxicity of systemic azole-antifungals

A

Nausea, abdominal discomfort, hepatotoxicity, drug interactions, avoid in pregnancy

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36
Q

Orally (Nizoral)
Foam for Seb derm (Extina)
Shampoo for dandruff (Nizoral AD)
Topical use well tolerated

A

Ketoconazole

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37
Q

Side effects of systemic ketoconazole

A

Hepatotoxicity common, strong p450 inhibition (drug interactions), inhibits synthesis of androgens, estrogens, progestins, cortisol, and aldosterone

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38
Q

Clotrimazole, Butoconazole, Econazole, Luliconazole, Miconazole, Oxiconazole, Sertaconazole, Sulconazole, Tioconazole

A

Imidazole Antifungals

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39
Q

Used topically for tineas and vaginal candidiasis

A

Imidazole antifungals

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40
Q

Used orally for tinea, onychomycosis, or serious systemic infections
Negative inotrope - avoid in heart failure

A

Itraconazole (Sporanox)

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41
Q

Used orally or IV. Less drug interactions than itraconazole. Used for candidiasis (thrush, vulvovaginal, or systemic) or other systemic fungal infx, including fungal meningitis

A

Fluconazole (Diflucan)

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42
Q

Used orally or parenterally; similar # of drug interactions as fluconazole; Often chosen as prophylaxis against fungal infx in high-risk patients; Used for oropharyngeal and esophageal candidiasis in AIDS patients

A

Posaconazole (Noxafil)

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43
Q

Used for vaginal candidiasis

A

Terconazole (Terazol) or Fluconazole (Diflucan)

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44
Q

Used topically for onychomycosis (only indication); used daily for a year & cures 15% of cases

A

Efinaconazole (Jublia)

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45
Q

MOA of Allylamines & Tolnaftate

A

Inhibits squalene epoxidase (enzyme involved in ergosterol synthesis); ergosterol decreases, squalene increases, which is likely toxic

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46
Q

Orally for onychomycosis and other dermatophyte infx - most effective for onychomycosis
Topically for minor tineas
Toxicity (Systemic): GI, increased liver enzymes, hepatotoxicity

A

Terbinafine (Lamisil)

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47
Q

Allylamines & Use

A

Naftifine (Naftin), Butenafine (Mentax), Tolnaftate (Tinactin), Terbinafine (Lamisil)

Have good activity against dermatophytes and Candida

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48
Q

MOA of Griseofulvin (Gris-PEG)

A

Deposits into keratin (skin & nails), binds to fungal microtubules and inhibits mitosis

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49
Q

Use of Griseofulvin

A

Orally for dermatophyte type infections; Not considered first-line - usually requires months of tx and high relapse rates

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50
Q

Poorly absorbed from gut; high fat meals improves absorption

A

Griseofulvin

51
Q

DOC for cutaneous kerion

A

Griseofulvin - inflammatory reaction against canine dermatophyte species

52
Q

Toxicity of Griseofulvin

A

GI, hepatotoxic, AVOID w/ OCP, AVOID in patients w/ porphyria (increases synthesis of heme)

53
Q

Available topically as cream, gel, shampoo
Used for tinea versicolor, seb derm, onychomycosis

A

Ciclopirox (Loprox)

54
Q

MOA of Ciclopirox

A

speculative - chelates iron; iron-dependent enzymes (catalases and peroxidases) fail to function

55
Q

MOA of Tavaborole (Kerydin)

A

Inhibits leucyl-tRNA synthetase; decreases leucine-charged tRNA pool

56
Q

Available topically for onychomycosis - cure rate 6.5% after 48wks

A

Tavaborole (Kerydin)

57
Q

Topical Meds for Herpetic Lesions

A

Acyclovir (Zovirax) & Penciclovir (Denavir)
Docosanol (Abreva) OTC

58
Q

Topicals for Papillomatous disease

A

Salicylic acid (Compound W, others)
Podophyllum resin (Podofilm) & Podofilox (Condylox)

59
Q

Structural analogs of DNA bases; Prodrugs converted by viral thymidine kinase to monophosphate form & converted by host enzymes to triphosphate form
Triphosphate form inhibits viral DNA synthase

A

Acyclovir & Penciclovir

60
Q

Inhibits fusion of viral coat to cell membrane

A

Docosanol (Abreva)

61
Q

Keratolytic agent; may cause skin irritation or skin damage if used too aggressively; may cause hypersensitivity reaction to pts sensitive to salicylates (including aspirin)

A

Salicylic acid (Compound W)

62
Q

Derived from Mayapple plant; mechanism likely due to inhibition of topoisomerase II (inhibiting DNA synthesis); may cause skin irritation; AVOID in pregnancy

A

Podophyllum & podofilox

63
Q

MOA of Clindamycin

A

binds to 50S ribosomal subunit preventing translocation down mRNA

64
Q

Coverage & SE of Clindamycin

A

Broad spectrum & covers anaerobes
SE: High risk of C. diff; hepatotoxicity, hypotension, EKG changes may occur but rare

65
Q

Daptomycin MOA, Coverage, SE

A

Forms a pore in cell membrane
Covers Gram + bacteria (including VRSA)
SE: N/V, myopathy, rhabdomyolysis, peripheral neuropathy and paresthesia

66
Q

Linezolid MOA, coverage, SE

A

Binds to 23S site on 50S subunit
Covers G+ resistance to other drugs (MRSA, VRSA, VRE, nosocomial pneumonia)
SE: N/V/D, bone marrow suppression, acts as MAOI w/ similar drug interactions, mitochondrial toxicity (lactic acidosis, peripheral & optic neuropathy)

67
Q

Tigecycline MOA, coverage, SE

A

Binds to 30S ribosomal subunit preventing tRNA from entering A site
Covers G+, G-, and atypicals + MRSA/VRSA
SE: N/V/D, C.diff, photodermatitis, reduces enterohepatic circulation

68
Q

Vancomycin MOA, coverage, SE

A

Binds D-ala-D-ala preventing PBP from binding
Covers G+ and MRSA
SE: Nephrotoxicity, ototoxicity, histamine release (Red-man syndrome)

69
Q

TMP/SMX MOA, coverage, SE

A

SMX blocks first step in folate synthesis, TMP blocks last step in folate synthesis (DHFR)
Covers staph (MRSA), strep, E.coli, Salmonella, Shigella
SE: folate deficiency, N/V/D, myelosuppression, Hemolysis in G6PD def, avoid in late pregnancy, allergy, drug interactions

70
Q

First-line treatment of AOM

A

Amoxicillin (Amoxil)

71
Q

MC Side Effects of Amoxicillin

72
Q

Tx of AOM if pt doesn’t respond to Amoxil or if pt has had antibiotics in the previous month

A

Amoxicillin/Clavulanic Acid (Augmentin)

73
Q

Treatment for AOM if pt is allergic to PCN or if Augmentin has failed

A

Ceftriaxone (Rocephin) or other 3rd gen. Ceph (Cefdinir)

74
Q

MC Side Effects of Ceftriaxone & Cefdinir

75
Q

Alternative tx for AOM if pt is allergic to PCN and/or cephalosporins

A

Clindamycin (Cleocin)

76
Q

Side effects of clindamycin

A

N/V/D are MC; C. diff overgrowth may occur

77
Q

Tx primarily used for Acute Otitis Externa

A

Otic formulations of antibiotics with or without corticosteroids
Ofloxacin (Floxin) or Ciprofloxacin (cetraxal or Otiprio)

78
Q

What meds can be used for AOE regardless if the TM is intact or not?

A

Ofloxacin & ciprofloxacin

79
Q

What meds can be used for AOE only if the TM is INTACT?

A

Neomycin, polymyxin B, and HCT (cortisporin)

80
Q

Antihistamines

A

Azelastine intranasal (Astelin)
Second gen orals: Loratadine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra)
First gen: Diphenhydramine (Benadryl), Chlorpheniramine (Chlor-Trimeton)

81
Q

Nasal Corticosteroids

A

Triamcinolone (Nasocort), Fluticasone (Flonase), Mometasone (Nasonex), Ciclesonide (Omnaris)

82
Q

First Generation Antihistamines are (Drowsy or Non-Drowsy)

A

Drowsy - Diphenhydramine & Chlorpheniramine

83
Q

Second generation antihistamines are (drowsy or non-drowsy)

A

Non-drowsy - Loratadine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra)

84
Q

MOA of decongestants

A

Alpha-1 agonists

85
Q

OTC decongestants

A

Phenylephrine (Sudafed-PE, oral) & Oxymetazoline (Afrin, intranasal)

86
Q

BTC decongestant

A

Pseudoephedrine (Sudafed, oral)

87
Q

Side effects of decongestants

A

Systemic exposure may increase BP and worsen Benign Prostatic Hypertrophy (BPH); Rebound hyperemia may occur after long-term or high-dose use

88
Q

MOA of Montelukast (Singulair)

A

Leukotriene receptor antagonist

89
Q

MOA of Cromolyn nasal (NasalCrom)

A

mast-cell degranulation inhibitor; available OTC

90
Q

What type of sinusitis has symptoms < 10 days with no or low grade fever?

A

Viral Sinusitis

91
Q

What type of sinusitis has symptoms > 10 days, high fever, and purulent drainage?

A

Bacterial Sinusitis

92
Q

Treatment for viral sinusitis

A

Supportive - acetaminophen or NSAIDS, nasal irrigation, decongestants, or nasal glucocorticoids

93
Q

DOC for bacterial sinusitis

A

Amoxicillin + Clavulanic acid (Augmentin)

94
Q

Alternative treatments for bacterial sinusitis

A

Levofloxacin (Levaquin) - don’t use during pregnancy or in children
Ceftriaxone or clindamycin
Macrolides - Clarithromycin or Azithromycin (may be resistant)

95
Q

Centor criteria for Group A Strep

A

+1 for swelling/exudate on tonsils, swollen anterior cervical LN, Fever >100, absent cough
Age 3-14 +1
Age 15-44 0
Age > 44 -1
Score 4-5 = Treat w/ antibiotics
Score 2-3 = RADT
Score 0-1 = very unlikely strep

96
Q

First-line treatment of strep throat

A

Penicillin or Amoxicillin

97
Q

Alternative treatment for strep throat

A

Macrolides (Clarithromycin, Azithromycin)
Clindamycin

98
Q

Treatments for Thrush

A

Nystatin (swish & swallow), Clotrimazole (troche), Miconazole (buccal tab), Fluconazole (oral)

99
Q

MOA of Nystatin

A

Polyene antifungal: binds ergosterol and polymerizes in cell membrane

100
Q

MOA of azole antifungals

A

Inhibits lanosterol-14a-demethylase - needed to convert lanosterol into ergosterol

101
Q

Treatment of aphthous ulcers

A

Triamcinolone oral paste or fluocinonide oral gel

102
Q

Treatment of Pulpitis

A

Amoxicillin/clavulanic acid (Augmentin) or Clindamycin (Cleocin)

103
Q

What is pulpitis?

A

an infection inside of the tooth

104
Q

Oral retinoid used for more severe cases of Psoriasis that has similar SE & toxicity to Isotretinoin

A

Acitretin (Soriatane)

105
Q

How long after treatment is Acitretin (Soriatane) contraindicated in pregnancy?

106
Q

Oral PDE4 inhibitor used in the treatment of psoriasis

A

Apremilast (Otezla)

107
Q

Systemic med for psoriasis that inhibits calcineurin

A

Cyclosporine A (Sandimmune)

108
Q

SE of Cyclosporine A (Sandimmune)

A

Diarrhea/vomiting, HTN, paresthesia, gingival hyperplasia, renal vasoconstriction –> kidney failure, HTN, gout

109
Q

What types of medications should you avoid taking with Cyclosporine A (Sandimmune)?

A

potent p450 inhibitors/inducers

110
Q

Systemic medication for psoriasis that inhibits DHFR and folate activation

A

Methotrexate

111
Q

SE of Methotrexate

A

bone marrow suppression, alopecia, diarrhea, mucositis, hepatitis (all similar to cancer chemo)

112
Q

Etanercept (Enbrel), Infliximab (Remicade), Adalimumab (Humira), Golimumab (Simponi)

A

TNF inhibitors used to treat psoriasis

113
Q

SE of TNF inhibitors

A

avoid during infx or those susceptible to infx, avoid w/ live attenuated vaccines, avoid in those at risk of TB as it may increase risk of lymphoma and other cancers

114
Q

MOA of Ustekinumab (Stelara)

A

antibody against IL 12 & 23; involved in T-cell activation

115
Q

MOA of Alefacept (Amevive)

A

reduces T-cell activation & reduces CD2+ cell counts

116
Q

MOA of Efalizumab (Raptiva)

A

decreases activation & migration of T cells

117
Q

What do you monitor in patient’s taking Efalizumab (Raptiva)?

A

Platelet counts

118
Q

MOA of Secukinumab (Cosentyx) & Ixekizumab (Taltz)

A

Antibodies against IL 17

119
Q

Treatments for Scabies

A

Permetrin (Elimite cream), Lindane, Crotamiton (Eurax)

120
Q

MOA of Permethrin

A

Pyrethroid-type insecticide - causes neuronal depolarization via VGNaCs

121
Q

MOA of Malathion (Ovide)

A

acetylcholinesterase inhibitor

122
Q

MOA of Lindane

A

organochlorine insecticide: interferes w/ GABA-A chloride channel

123
Q

Which ectoparasitic tx should be avoided in young children and pregnant women?

124
Q

Medications activated by UVA for vitiligo

A

Trioxsalen or Methoxsalen

Pharm II (5 decks)

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