Lectures 74,75,76 -- Drug Specifics

Question 1

topical corticosteroids

Answer 1

USE – dermatitis (acute and subacute), psoriasis
classified according to potency which corresponds to anti-inflammatory activity and vasoconstrictive potency

Question 2

topical CS SE

Answer 2

thinning of skin
dilated blood vessels
increased bruising
skin color changes
risk of HPA suppression with long term use of high potency agents
development of tolerance (tachyphylaxis)

Question 3

topical calcineurin inhibitors

Answer 3

pimecrolimus, tacrolimus
USES – subacute dermatitis, psoriasis
blocks pro-inflammatory cytokine genes; can be used on any area; considered 2nd line treatment for intermittent use only

Question 4

topical calcineurin inhibitor SE

Answer 4

few
burning
long term use –> risk of malignancies and risk of respiratory infections in children under 2yos

Question 5

phosphodiesterase 4 inhibitors

Answer 5

nonsteroidal
crisaborole 2% ointment
USE – subacute dermatitis
alternative to TCS or TCIs if having steroid phobia; use BID for 28 days; around $600-700

Question 6

JAK inhibitors

Answer 6

Ruxolitinib, Upadactinib
USE – mild to moderate atopic dermatitis (R), moderate to severe atopic dermatitis (U)
short term usage only; avoid in immunocompromised patients; mediates cytokine signaling
U caused major CV events/thrombosis

Question 7

IL-4 inhibitors

Answer 7

Dupilumab (Dupixent), Tralokinumab
USE – moderate to severe atopic dermatitis
biologic that is well tolerated; expensive

Question 8

retinoids

Answer 8

USES - acne
adapalene (differin)
tazorotene (tazorac)
trentinoin (retin-A)

Question 9

adapalene (Differin)

Answer 9

comes in gel, cream, and solution
MOA –> regulate epithelial cell growth
SE –> occasional scaling, burning, and flare
apply daily at night

Question 10

tazorotene (tazorac)

Answer 10

comes in cream or gel
SE –> often erythema; occasional scaling, burning, and flare
apply daily; start with lower strengths; very drying; category x

Question 11

trentinoin (retin-a)

Answer 11

comes in cream, gel, or solution
SE –> most often erythema and scaling, often burning and flame
daily at night; stinging and burning; dryness; photosensitivity; takes 4-6 weeks to see improvement

Question 12

azelaic acid (azelex)

Answer 12

comes in a cream
USE – adjunct therapy for acne; rosacea
SE –> often burning; occasional erythema and scaling
antibacterial agent; well tolerated; in rosacea, better absorbed than acne formulation due to less acidity

Question 13

Benzoyl Peroxide (Oxy-10)

Answer 13

BP
USE - acne
comes in cream, gel, and lotion
SE –> often erythema and scaling; occasional burning and flaring

Question 14

BP information

Answer 14

antibacterial agent, comedolytic, anti-inflammatory agent
dry skin/irritation
can bleach hair/skin
start with lower strength
avoid contact with clothing

Question 15

topical antibiotics

Answer 15

USE – acne, rosacea (metronidazole)
SE –> most often resistance, very occasional erythema, scaling, burning, and flare
drugs - clindamycin, erythromycin, clindamycin + BP, metronidazole

Question 16

clindamycin (cleocin-t)

Answer 16

comes in gel, solution, or lotion
use QD or BID to treat acne

Question 17

erythromycin (generic)

Answer 17

comes in gel or solution
use BID to treat acne
expires in 30 days

Question 18

clindamycin + BP (BenzaClin DAUAC)

Answer 18

comes in a cream
limits resistance
not usually covered by insurances but individual ingredients are
to treat acne

Question 19

metronidazole

Answer 19

comes in a cream, gel, and lotion
treatment of choice in rosacea
apply BID

Question 20

oral antibiotics

Answer 20

USE – acne
Drugs – minocycline, doxycycline, erythromycin, azithromycin, TMP-SMX
Decreases bacteria and inflammation; most effective when inflammation is present

Question 21

OA SE

Answer 21

risk of allergy
photosensitivty
GI upset
thrush
risk of resistance developing –> limit to 6-8 weeks

Question 22

anti-androgens

Answer 22

USE – acne
Drugs – oral (low dose OC/spironolactone) or topical (clascoterone)
SE – local erythema
ideal for females whose acne flares during menstrual cycle but clascoterone can be used in males

Question 23

Isotrentinoin (acutane)

Answer 23

USE – severe acne or acne in patients who have failed other treatments/relapses soon after d/c other treatments
vit A derivative
provides resolution in up to 80% of cases
acne will get worse before it gets better
if acne flares after 2 months of treatment, a second course may be used
effective increases with higher doses

Question 24

isotrentinoin SE

Answer 24

skin –> dry skin, dry eyes and nose, dry lips, hair shedding, peeling of palms and soles, photosensitivity
MSK –> back pain, arthralgia, myalgias, fatigue, risk of osteoporosis, delayed bone healing
labs –> elevated AST/ALT, elevated cholesterol and triglycerides
other –> category x, headache, mood changes, night blindness, depression and suicidal thoughts

Question 25

isotrentinoin counseling points

Answer 25

avoid in pregnancy and use contraceptives
adverse effects
do not take vit A supplement
use moisturizer, lip balm, and artificial tears
use with sunscreen
take with food

Question 26

class 1 TCS

Answer 26

very high potency
halobetasol propionate, clobetasone propionate, betamethasone dipropionate ointment
indications – very severe lesions; thickening skin when maximum penetration is needed
CI – face
avoid using for more than 2 weeks; limit to no more than 50g per week

Question 27

class 2 TCS

Answer 27

high potency
flucinolide cream, gel, ointment and betamethasone dipropionate cream
indications, CI, and comments same as class I

Question 28

classes 3-5

Answer 28

mid potency
betamethasone valerate, triamcinolone acetonide, mometasone furoate, and betamethasone dipropionate lotion
indications – most skin surfaces for exacerbations
comments – moderate anti-inflammatory effect; safer for longer usage than high potency

Question 29

classes 6-7

Answer 29

low potency
hydrocortisone (cortaid) and desonide (desonate)