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Derm > Medication pearls > Flashcards

Medication pearls Flashcards

What conditions do we treat with this medication Warnings and adverse effects (Most common and most serious) Contraindications (major) F/u Labs Key points

1
Q

What class(es) of drugs do we use to treat atopic dermatitis

A

Topical Corticosteroids, Calcineurin inhibitors, cyclosporine, dupilumab (biologic)

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2
Q

What class(es) of drugs do we use to treat psoriasis?

A

Topical corticosteroids
salicylic acid
Vit D analogs
Methotrexate, acitretin, cyclosporine, apremilast
TNFa inhibitors
IL-23 inhibitors
IL-17 inhibitors

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3
Q

What class(es) of drugs do we use to treat Acne Vulgaris

A

Topical retinoids
Oral isoretinoin
Oral ABx (doxy)
Topicals (Benzoyl peroxide, salicylic acid, clindamycin, azelaic acid)

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4
Q

What class(es) of drugs do we use to treat Rosacea

A

Azelaic acid, metronidazole gel

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5
Q

What class(es) of drugs do we use to treat Tinea

A

Butenafine, terbinafine, ketoconazole

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6
Q

What class(es) of drugs do we use to treat bacterial infections of the skin?

A

Mupirocin (bactroban)

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7
Q

What class(es) of drugs do we use to treat seborrheic dermatitis?

A

selenium sulfide

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8
Q

What class(es) of drugs do we use to treat oychomycosis?

A

oral terbinafine, topical ciclopirox

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9
Q

What class(es) of drugs do we use to treat pruritis?

A

diphenhydramine, hydroxyzine

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10
Q

What drugs are used to target increased follicle proliferation and abnormal desquamination in Acne Vulgaris?

A

Topical reinoids, isoretinoin, azelaic acid, azelaic acid

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11
Q

What drugs are used to target increased sebum production in Acne Vulgaris?

A

oral isoretinoin, OCP, spironolactone, clascoterone

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12
Q

What drugs are used to target cutibacterium acnes in Acne Vulgaris?

A

Benzoyl peroxide, topical ABx (clindamycin, minocycline), oral ABx (tetracyclines), azelaic acid

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13
Q

What drugs are used to target inflammation in Acne Vulgaris?

A

oral isoretinoin, oral ABx (tetracyclines), topical retinoids, azelaic acid, Dapsone

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14
Q

What is generally first line treatment in Acne vulgaris?

A

retinoids (+ benzoyl perozide w/ papulopustular)

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15
Q

What medications could you consider if first line Acne treatment doesn’t work?

A

OCP & Spironolactone (females only), isoretinoin, tetracyclines for 3 months (papulopustular)

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16
Q

What additional considerations should patients take in regards to oral hygiene with Acne vulgaris?

A

Use gentle cleansers/scrubbing
Noncomedogenic agents
no picking

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17
Q

What therapeutic targets does isoretinoin have?

A

Follicular proliferation, abnormal desquamination, sebum production, c. acne bacteria, inflammation

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18
Q

Isoretinoin contraindications

A
  • Pregnancy
  • Severe soy allergy
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19
Q

Isoretinoin adverse effects

A

Mucotaneous (dry skin/eyes), Hyperlipidemia, Psychiatric (depression/SR), IBD, Hepatotoxicity, IC HTN

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20
Q

What medications/treatments/procedures should a patient avoid who is on isoretinoin and why?

A

Tetracycline (IC HTN), Vitamin A supp, skin procedures, Excessive EtOH, nursing, blood donation

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21
Q

Isoretinoin screening (patient Hx)

A

Prior contraceptive failure
depression (uncontrolled)
hyperlipidemia or FHx of early
FHx IBD
Dry eyes
Heavy EtOH
Extreme physical activity (photosensitive?)

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22
Q

Isoretinoin monitoring

A

Need to wait 2-3 months to gauge improvement

Worsening of acne
depression sx
bowel sx
hyperlipidemia
dry eyes/vision changes
headaches (IC HTN)

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23
Q

What labs should you order for a patient starting isoretinoin?

A

Serum ALT
Triglyceride levels
urine or serum pregnancy testing

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24
Q

Adverse effects of high potency topical steroids

A

striae, irritation; d/c after 2 weeks.

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25
Q

Length of treatment for high and medium potency steroids

A

High: 2 weeks (taper)
Med: 3 months

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26
Q

Adverse effects/warnings of topical retinoids

A

Avoid in eyes
Avoid in pregnancy
Photosensitivity
No spot treatment

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27
Q

What topical retinoids are the most and least irritating?

A

Most: Tazarotene
least: Adapalene

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28
Q

What medications should you avoid when taking topical retinoids?

A

UV light & Benzoyl peroxide b/c it can deactivate it.

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29
Q

Adverse effects of Benzoyl peroxide

A

drying or peeling of the skin

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30
Q

Adverse effects of salicylic acid

A

drying or peeling of the skin

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31
Q

Adverse effects of azelaic acid

A

burning/tingling

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32
Q

What conditions can be treated with salicylic acid

A

Acne
Psoriasis

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33
Q

MOA for calcineurin inhibitors

A

suppress cellular (T Cell) immunity

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34
Q

Calcineurin inhibitors are indicated for what disease(s)?

A

Atopic dermatitis. Can apply to face and intertriginous areas.

Can also be used for vitiligo, mucosal lichen planus, graft vs host disease, allergic contact dermatitis, and rosacea

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35
Q

Calcineurin inhibitor adverse effects/warnings

A
  • Transient erythema, burning, pruritis
  • Rare: systemic immune-related effects (Tacro > Pimecro)
  • Black Box warning: malignancy
  • Avoid long-term continuous use
  • Avoid in Netherton Syndrome
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36
Q

Which calcineurin inhibitor has fewer adverse effects?

A

Pimecromilus

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37
Q

What diseas(s) are Vitamin D analogs used to treat?

A

Psoriasis

38
Q

Name 2 Vitamin D analogs

A

Calcipotriene, Calcitrol

39
Q

Vitamin D analog MOAs

A

binds Vit D receptors and inhibits keratinocyte proliferation while enhancing keratinocyte differentiation

40
Q

Vit D analogs Adverse effects

A

Hypercalcemia and Hypercalciuria possible if exceeding recommended weekly dosage limit (100g Calcipotriene; 100g calcitrol (2-7yrs), 200g calcitrol (7+ yrs)

Irritation
Mild photosensitive

41
Q

what treatment can be used with Vit D analogs to produce synergistic effect?

A

Topical corticosteroids
Will also reduce irritation

42
Q

Things to avoid with Vit D analogs

A

Vitamins/Calcium supplements
Occlusive dressings
sunlight/UV exposure

43
Q

Indications for Clindamycin topical gel

A

Acne (inhibits growth of Cutibacterium acnes)

44
Q

Adverse effects of Clindamycin topical gel

A

Erythema, burning, itching, peeling, oiliness. Can also cause D. diff associated diarrhea. Avoid eyes

45
Q

When in an acne treatment should you consider clindamycin gel?

A

After 3 mo of mild papulopustular acne that has failed to improve with Benzoyl peroxide and topical retinoids.

46
Q

Mupirocin indications

A

Impetigo, MRSA derm infection

47
Q

Mupirocin adverse effects

A

Dryness, burning, erythema, stinging, tenderness.

Allergies! Angioedema, anaphylaxis, generalized rash

48
Q

Metronidazole gel indications

A

Rosacea

49
Q

Length of treatment for Mupirocin ointment

A

TID 3-5 days

50
Q

Warnings and adverse effects of metronidazole gel

A

do not use vaginal prep on face. Can also cause dizziness, HA, N/V, diarrhea

51
Q

When should you see improvement in rosacea with metronidazole gel?

A

within 3 weeks, continuing improvement through 9 weeks.

52
Q

oral tetracyclines dermatological indications

A

Acne

53
Q

Adverse effects of tetracyclines

A

Esophagitis (take with glass of water)
Photosensitivity/skin discoloration
idiopathic IC HTN
Gi issues

No pregnancy and children <8. retards skeletal development

Don’t take with calcium + minerals (chelation)

54
Q

When in an acne treatment plan should you consider Tetracyclines?

A

Mod/severe papulopustular acne. Concomitant use with topical retinoids and Benzoyl peroxide.

55
Q

Methotrexate indications

A

psoriasis, sarcoidosis, RA, oncology (high dose)

56
Q

MTX MOA

A

Folate antagonist/antimetabolite. Targets cells during DNA synthesis and reduces hyperproliferation

57
Q

MTX contraindications

A

Pregnancy/nursing
Liver issues (chronic disease, EtOH liver disease)
Immunodeficiency syndromes
Preexisting blood dyscrasias

58
Q

Warnings/cautions for MTX

A

Black box: toxicity, teratogenicity
Abnormalities in renal function
Abnormalities in liver function
Active infections
Many drug interactions

59
Q

MTX adverse effects (low dose)

A

GI issues
Hepatoxicity
CNS effects
Rash
Pancytopenia

60
Q

What medication should you supplement with MTX?

A

Folic Acid 1mg

61
Q

Baseline labs for MTX

A

Pregnancy
CBC with diff
BUN and serum creatinine (kidney function)

Liver tests:
LFTs
Serum albumin
Noninvasive liver fibrosis assessment
Hep B&C screening

Latent TB testing
CXR (some providers for pulm tox)

62
Q

Ongoing labs for MTX monitoring

A

CBC

Liver tests: LFTs, serum albumin, serum creatinine (3-6 mo)
FIB-4, Fibrosure, Fibrometer, Hepascore (annual)

After 3.5-4.0 cumulative dose-> GI consult

63
Q

Apremilast indication, warnings, and notes

A

Psoriasis, GI effects, titrate

64
Q

butenafine indication

A

Tinea

65
Q

Butenafine Hydrochloride warnings/AE

A

Dermatitis, burning, worsening of condition.

66
Q

Considerations to make when using butenafine HCL

A

if not improvement in 4 weeks, reconsider Dx

67
Q

Ketoconazole indications

A

Tinea, seborrheic derm, dandruff

68
Q

Ketoconazole AEs/warnings

A

burning, stinging, irritation, erythema.
Allergic: angioedema

69
Q

Ketoconazole considerations

A

Shampoo–sit for 5 mins before rinsing

70
Q

Terbinafine indications

A

Tinea

71
Q

Terbinafine considerations

A

Not indicated for Tinea unguium

Improvement usually in 3-4 days, but continue for 1-4 weeks

72
Q

Ciclopirox indications

A

Onychomycosis

73
Q

Ciclopirox warnings/AEs

A

pruritis, erythema, burning

74
Q

Ciclopirox considerations

A

Trim nails closesly
not as effective as oral Tx

75
Q

Selenium sulfide indications

A

Seborrheic dermatitis, tinea versicolor

76
Q

Selenium sulfide warnings/AEs

A

dryness or oiliness of skin

77
Q

Topical Antifungal medications

A

Butenafine HCL, Ketoconazole, Terbinafine, Ciclopirox, Selenium Sulfide

78
Q

Acitretin indication

A

Psoriasis

79
Q

Acitretin warnings

A

Hepatotixicity
Elevated lipid levels

No blood donation during and 3 years post Tx

80
Q

Acitretin contraindications

A

Avoid in pregnancy (and for 3 years post-Tx)
No EtOH (and 2mo Post Tx)

81
Q

Terbinafine indications

A

onychomycosis

82
Q

Medications that treat onychomycosis

A

Terbinafine (oral AF), Ciclopirox (topical AF)

83
Q

Terbinafine warnings/AEs

A

Hepatotoxicity, Steven’s Johnson Syndrome, TEN, N/V/Rash

84
Q

Terbinafine C/Is

A

Liver Disease
Severe Renal Disease

85
Q

Terbinafine baseline labs

A

LFTs
Nail Bx

86
Q

Diphenhydramine indications

A

Pruritis

87
Q

Hydroxyzine indications

A

Pruritis

88
Q

oral Antihistamines indicated for pruritis

A

Diphenhydramine, Hydroxyzine

89
Q

oral Antihistamines warnings/AEs

A

Anticholinergic drowsiness, sedation, dry mouth

90
Q

Oral antihistamines C/Is

A

NA Glc, BPH, bladder obstruction

91
Q

Oral antihistamine considerations

A

Don’t use to treat URI
Don’t use in older adults

Derm (13 decks)

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