Eye, Skin, Glaucoma

Question 1

tacrolimus

Answer 1

Pharmacologic Class: **calcineurin inhibitors **
Examples: tacrolimus and pimecrolimus
Indication: dermatitis when other topicals have failed

Important:
* can give to pts** over 2 y.o**.
* BLACK BOX WARNING: don’t give long-term due to increase risk of skin cancer

Bonus:
* may be used overall skin surfaces (including face and neck) because they ahve fewer adverse effects than the topical corticosteroids
* Adverse effects include burning nad stinging on broken skin

Adams, p. 803

Question 2

psoriasis treatment

Answer 2

• primary initial tx - topical corticosteroids (if high-potency formulation, should not be used on face and genital areas)
• methotrexate - severe psoriasis when topical treatment fails; also used to tx some cancers
• cyclosporine - severe psoriasis in adults when topical treatment fails - immunosupressant used in transplant patients

Question 3

methotrexate

Answer 3

Uses: severe psoriasis when topical treatment fails; also used to tx some cancers

blocks synthesis of folic acid
monitor for deficiency of folic acid
monitor for bleeding
monitor for pulmonary toxicity (avoid inhaling drug particles)

decreased **immune system **
photosensitivity - avoid skin to sun exposure; use sunscreen?

Question 4

cyclosporine

Answer 4

Uses: severe psoriasis in adults - when topical therapies have failed; also used in pts transplant

immunosuppressant

make sure they aren’t immunocompromised
monitor for WBC - low wbc increased risk of infection

s/s of infection:
fever, temperature, chills,
clammy, sweaty
tachy

hepatotoxic and nephrotoxic

Question 5

permethrin

Answer 5

permethrin (NIX)
* available in cream, lotion, or shampoo
* kills head and crab lice, and mites
* treatment of choice for lice and scabies
* for lice 1% shampoo or lotion
* can get OTC
* for scabies 5% lotion

Bonus: remain on hair and scalp 10 minutes before removal
*successful elmination should include removaing nits iwth nit comb, washing bedding, cleaning or removing objects in contact with head or hair
local reactions may occur: itching, rash, transient tinglign, burning, stinging, erythema, and edema of affected area

Contraindications: lactating women

Question 6

Acne Vulgaris

Answer 6

Acne Vulgaris
disorder of hair and sebaceous glands
affects 80% of adolescents

Pharmacotherapy
benzoyl peroxide - OTC
tretinoin, isotretinoin
oral contraceptives
antibiotics

Question 7

benzoyl peroxide and salicylic acid

Answer 7

benzoyl peroxide and salicylic acid
suppress sebum production
1st line drug therapy for mild to moderate acne; most common
adr
minimal adverse effects
anaphylaxis; very rare but can cause facial swelling, tongue, eyes, throat…difficulty breathing

Question 8

isotretinoin

Answer 8

isotretinoin (Accutane)
Pharmacologic Class: Retinoids

oral vitamin A metabolite

**pregnancy category X ** - req. two negative pregnancy tests

hepatotoxicity
* jaundice - yellowing of eyes, skin
* abdominal pain, esp. on right side

Question 9

latanoprost

Answer 9

prostaglandin analogs - latanoprost
open-angle glaucoma
maintenance of visual fields, vision, & IOP below 21 mmHg
**peak effect in about 12 hrs
*****
side effect:
lengthening of eyelashes
change in pigmentation of iris (e.g., might turn blue iris to brown color)
tearing, dryness, burning or pain or irritation of eye

Question 10

timolol

Answer 10

beta-adrenergic antagonist - timolol

eye drops:
open-angle glaucoma
has no effects on visual acuity
may take 2 - 4 wks for therapeutic effect
if we administer in way where pt can have systemic absorption can have systemic effects (hypotension, bronchospasms, etc.)