Medications Flashcards
What is the first line of treatment for pain management following skin surgery.
1 gram acetaminophen every eight hours
400mg of Ibuprofen every 4 hours
What is the maximum dose of oxycodone
5mg tablets dispense 10 for no longer than 36 hours.
5mg of oxycodone is equivalent to how much codeine?
18mg
5mg of oxycodone is equivalent to how much hydrocodone
10mg
5mg of oxycodone is equivalent to how much tramadol
25mg
5mg of oxycodone is equivalent to how much morphine
2mg
5mg of oxycodone is equivalent to how much oxymorphone
1.5 mg
5mg of oxycodone is equivalent to how much hydromorphone
.8mg
FDA standard for testing required how much sunscreen applied.
2gm per cm2
How much sunscreen for total body application
one ounce (a shot glass full)
what is uva testing based on.
MED minimal pigmenting dose
How is uva of sunscreen tested?
critical wavelength. wave length above 290 where 90% of cumulative absorption occurs.
how do chemical sunscreen work?
absorb UV and convert to heat.
what are the most common uva sunscreen blockers in the US
Benzophenones
how do inorganic sunscreens work?
reflect or scatter radiation.
Which of the inorganic sunscreens work better for UVB.
zinc best for UVB
Titanium for UVA
What percent of inorganic sunscreens penetrate the stratum corneum.
They don’t penetrate the stratum corneum.
5FU treatment reduces AKs and SCC by what percent in 1 year.
75%
5FU treatment reduces Bcc by what % in one year?
0%
what percent does oral acitretin lower SCC.
60% no effect on existing KAs
what is the dosage of acitretin?
20-30gm per day
What is Capecitabine?
5FU oral Pro Drug
Capecitabine is useful in SCC skin cancer chemoprevention for what reason?
Does not cause organ rejection.
What two things must you check for before starting Capecitabine?
- dihydropyrimidine dehydrogenase deficiency
2. renal function
how are all the amide anesthetics metabolized
CYP450 in the liver
how are all the ester anesthetics metabolized
Plasma Pseudocholinesterase
List the four ester anesthetics the others are all amides
Procaine (Novacaine) teeth
Chloroprocaine nerve
Cocaine nose
Tetracaine eyes
how long does lidocaine last
30 minutes to 2 hours
what is the ph of lidocaine
6
how do you neutralize the acid of lidocaine.
sodium bicarbonate 8.4% one ml per 10ml of 1% lidocaine.
what is the dose recommended for post op pain from complex skin surgery of oxycodone
5mg x 10 tablets
what are the current pain management guidelines for skin surgery
one gram of acetaminophen alternate Q 4hours with 400mg of Ibuprofen
what are the bioequivalence for 5mg oxycodone
75mg Tramadol
50mg codiene
7.5 mg morphine and hydrocodone
2.5 mg oxy and hydro morphone
what are the three subtypes of minocycline hyperpigmentation.
Type 1 in scars only
Type 2 Blue Gray discoloration arms and legs
Type 3 Muddy brown discoloration in sun exposed areas.
Does Cephalexin have good coverage for MRSA
No
Name 5 drug classes good for MRSA
Clindamycin,
Tetracycline classes,
trimethoprim/Sulfamethoxazole (Septra, Bactrim)
Linezolid (zyvox)
Vancomycin (given IV oral poor absorption)
what antibiotic do you use in a pt with a valve and you are operating on a mucosal surface.
amoxicillin 2gms 30-60 minutes prior to surgery
What is the 1/2 life of acitretin/ soriatane
48 hrs
Name a nib that is a tyrosine kinase inhibitor
Imatinib (Gleevec) used for DFSP and CML ALL
Why was Ingenol mebutate discontinued?
piccata was stopped due to increase risk of SCC
what has a mechanism of Toll like receptor agonist used to treat bccs and Aks
Imiquimod
what can treat superficial bcc and AK that works by blocking pyrimidine
5FU
What does neoadjuvant therapy mean?
administering the adjuvant therapy before the main treatment.
what are the two first choices for SCC mets
cemiplimab and pembrolizumab
What does CTLA4 do to the T cell
down regulates. Ipilimumab is a IgG1 antibody that attacks the protein stopping the downregulation of the T cell
Toll like receptor 7 & 8 is agonized by what drug
imiquimod
localized Kaposi’s scarcoma can be treated with what list 5
cryosurgery topical imiquimod PDT blue light Alitretinoin (topical) intralesional Vinblastine
What MEK inhibitor used in treatment of melanoma can reduce occurance of SCC
trametinib
does Vismodegib work with Gorlin syndrome?
yes
which of these proteins increase apoptosis and which decrease apoptosis
BID, BAD, BAK, BAX increase apoptosis
Bcl-2 & Bcl-xL decrease apoptosis
what is the mechanism of Imatinib in treatment of DFSP
tyrosine kinase inhibitor
side efffects of immunotherapy include rash/itch Diarrhea Liver toxcity Hypophysitis (inflammation of the pituitary gland what time frames do they occur
Rash 4 weeks
Diarrhea 6 weeks
Liver 6 weeks
Hypophysitis 4 months
If you have a BRAF - met melanoma at one site if you were to do a single drug tx which would it be
in order of success
Nivolumab
Pembrolizumab
Ipilimumab
what is a wild type BRAF melanoma
One that is BRAF -
Vismodegib inactivates what in the hedgehog pathway
SMO smoothened
what can selenium be used for in dermatology
binding arsenic or other heavy metals through chelation
what fatal side effect of alpha interferon is associated with the treatment of melanoma
Rhabdomyolysis
How long do you need to be off vismodegib before trying to conceive.
3months
How long do you need to be off vismodegib before trying to conceive for men and for women.
3months men 24months women.
the combined treatment for AKs with 5FU and calcipotriol is twice daily for how long?
4days
Imiquimod may be associated with what type of growths as a side effect.
milia and epithelial cysts
if a person has a grade 3 to 4 toxicity to Ipilimumab how long should it be discontinued.
Permanently
toll like 7 receptors bind to what when treatment with aldara
single strand RNA
what does sonidegib inhibit.
smoothened the same as vismodegib
what is the mechanism of action for 5FU
inhibits Thymidylate synthase enzyme
when treating a KA with intralesional 5FU how many weekly injections is typical.
6 to 8
What injectable works just as well as 5FU in treating KAs
Bleomycin
what is the response rate to vismodegib in met BCC
30%
superficial BCCs are treatable by imiquimod 83% and 80% 5FU what has a 98% cure rate
excision with 4mm margins
What is the response rate of Vismodegib with metastatic BCC and the duration?
30% 7 months
what are ester anesthesia agents metabolized by?
Metabolized by pseudocholinesterase and excreted through the kidney.
how are the amide anesthetics metabolized
cytochrome p450 in the liver
What is the active metabolite of azathioprine an immunosuppressant that is steroid sparing and increases risk of SCC but not BCC
6-thioguanine
What is the brand name of Retapamulin
Altabax binds to the L3 protein on the 50s subunit of the ribosome
Isopropyl alcohol works by what mechanism of action?
denatures protein and DNA
Povido-Iodine works by what mechanism
halogenates proteins making salts
Chlorhexidine mechanism of action is what?
It is a + charged molecule interacts with - charged membrane enters cells and causes precipitation of proteins.
Is Hexachlorophene used in derm surgery
Not often
In order which of these has the broadest antimicrobial spectrum Isopropyl alcohol, Povidone Iodine, Chlorhexidine
Povidone Iodine( best) Chlorhexidine (2n best) Isopropyl Alcohol (not great for spores)
What is the mechanism of action of aspirin and its half life?
COX inhibitor half-life 20 minute but platelets can’t make more COX and they last 10 days.
what is the mechanism of action of Clopidogrel
inhibits binding of ADP to platelets 1/2 life 6 hrs
what it the temp of LN2 in C and F
-196C -320F
What class of drug can increase lidocaine toxicity by inhibition of CYP 450 and decrease liver perfusion
Calcium channel blockers (verapamil, nifedipine, diltiazem)
which of these antiseptics may cause neurotoxicity
Chlorhexidine, Hexachlorophene, Isopropyl Alcohol, Povidone Iodine
Hexachlorophene
name an immunosuppressive drug that in a kidney transplant patient that may reduce the risk of SCCs
Sirolimus
what is the dose for chemoprevention of SCC with acitretin?
.2mg /Kg
What is the half-life of acitretin? Soriatane
2days (48 hrs)
alcohol can metabolize acitretin into etretinate which has a half life of what?
120 days
How long should one wait to get pregnant when on acitretin?
3 years
Penicillin has what mechanism of action
bactericidal by inhibiting bacterial cell wall formation
What % of people have hypersensitivity rxns to PCN
10-15%
what kidney problems can PCN cause.
acute interstitial nephritis
What % of people have true allergy to PCN that report an allergy.
10-15%
Can PCN cause a delayed hypersensitivity rxn.
yes, fever, eosinophilia and serum sickness like rxn.
Why was Ingenol Mebutate (picato) taken from the market
increased risk for SCC
What is the mechanism of action of methotrexate
In the S phase of the cell cycle it inhibits dihydrofolate reductase.
This is not how it works in autoimmune disorders.
What are the three most common side effects for vismodegib
Dysgeusia #1
Muscle Spasm #2
Alopecia #3
what is the best topical antibiotic to use in pregnant women.
Mupirocin (class B)
What is the mechanism of action for Mupirocin
binds tRNA synthetase
What is the other topical antibiotic that can be used in pregnancy besides Mupirocin
Polymyxin B (but only has gram - coverage
how does Polymyxin work
detergent like activity disrupts the cell membrane
How does Neomycin work
binds 30s subunit of ribosome (screws up protein synthesis)
how does Silver Sulfadiazine work
Binds bacterial DNA directly
How does Retapamulin work
binds 50s subunit of ribosome (screws with protein synthesis)
How does Bacitracin works
destroys cell wall by binding C55 phenol pyrophosphatase
Which is the most toxic of the topical antibiotics
Neomycin (an aminoglycoside) can cause ototoxicity and nephrotoxicity
