Module 9: Unit A Flashcards
Itraconazole (Sporanox) indication
Broad-spectrum fungal infections
Itraconazole MOA
Inhibits ergosterol and inhibits Fungal CYP metabolism
Safety Itraconazole
Cardio suppression, Liver injury
Potent CYP inhibitor so many D2D interactions. (Warfarin, theophylline, macrolides, statins, CYP450 drugs).
Monitor LFTs and ECG.
BBW Itraconazole
Not for use with superficial dermatosis or onychomycosis.
Not for use in patients with heart failure or ventricular dysfunction
Fluconazole (Diflucan) indication
Systemic. Fungal infections of the skin, mouth, esophagus, vagina
MOA diflucan
Inhibits ergosterol and inhibits Fungal CYP metabolism
Safety Diflucan
Potent CYP inhibitor so many D2D interactions
Prolongs QT
AE: Nausea, HA, SJS
Griseofulvin (Gris-PEG) indication
Systemic antifungal. Superficial mycosis (not active against candida)
Safety Griseofulvin
Avoid alcohol.
Monitor LFTs
MOA Griseofulvin
Inhibits fungal mitosis
Nystatin (Mycostatin) indication and MOA
Oral or topical antifungal
Candidiasis Skin, mouth, esophagus, vagina
Polyene antibiotic
Antifungals-topical: Allylamines
(-FINE)
Naftifine (Naftin)
Terbinafine (Lamisil)
Butenafine (Lotrimin, Menax)
Naftifine (Naftin)
Terbinafine (Lamisil)
Butenafine (Lotrimin, Menax) indication
Local tinea
Antivirals used in the treatment of HSV and Varicella Zoster VZV
Acyclovir
Valcyclovir
(Prodrug of Acyclovir)
Famciclovir
(prodrug of penciclovir)
Acyclovir MOA
Inhibits viral replication by suppressing viral DNA.
Safety/Special Acyclovir
Best started at the onset of symptoms. Only decreases symptoms does not produce a cure.
Children 3 months and up
Valacyclovir indication
Herpes labialis
Varicella
Genital herpes
Herpes zoster
What age can you prescribe valcyclovir?
Approved for children two years of age
Famciclovir
(prodrug of penciclovir)
Indication
Herpes zoster (shingles)
Genital herpes
Provider applied wart treatment
Podophyllin (podophyllum resin)
Trichloroacetic acid (TCA)
BCA
Indication TCA and Podophyllin
Venereal warts
Common warts
MOA Podophyllin
Inhibits DNA synthesis and mitosis.
MOA TCA
Chemical coagulation
Safety podophyllin
Highly caustic- wash off with alcohol, soap, and water a few hours after application.
Limit treatment to small surfaces.
It can cause central and peripheral neuropathy, kidney damage, and blood dyscrasias.
Not for moles or birthmarks. Repeat tx q 4 weeks.
Not to be used in pregnancy or lactation
Safety TCA
Wash off after drying- Talc for neutralization
Repeated weekly.
Patient applied wart tx
Imiquimod (Aldara)
Sinecatechins (Veregen)
Imiquimod MOA
Apoptosis
Imiquimod does not have antiviral effects – it intensifies the immune response by stimulating the production of interferon-alpha, TNF, and several interleukins.
Safety Imiquimod
Imiquimod is approved for those 12 years and older.
It should be avoided in pregnancy.
What can treat Rosacea?
Flagyl
Salicylic acid (3-6%) indication
Acne, dandruff, seborrheic dermatitis, psoriasis
Safety salicylic acid
It is readily absorbed through the skin.
Can develop salicylism when high concentrations are used for prolonged time.
Benzoyl peroxide indication
Mild to moderate acne
Benzoyl peroxide MOA
Antibiotic and keratolytic. Suppresses P. acnes. DOES not promote resistance in P. Acnes.
Clindamycin, Erythromycin indication
Acne
Impetigo
MRSA
Cellulitis
Clindamycin, erythromycin MOA
Suppresses P. acnes. Decrease inflammation.
Safety with Clinda and Erythro
Monotherapy with either of these can promote resistance. Combine with Benzoyl peroxide.
Silver Sulfadiazine indication
Second and third-degree burns
MOA of silver sulfadiazine
Release of free silver-antibacterial
Safety Silver Sulfadizaine
*sulfa allergy
Not for use in pregnancy at term. It should not be used in patients with G6PD deficiency.
Retinol-A:
Tretinoin (Retin-A, Atralin, Avita)
Tretinoin (Refissa, Renova)
Indication
Tretinoin (Retin-A, Atralin, Avita) (marketed for acne)
Tretinoin (Refissa, Renova) (marketed for wrinkles)
MOA of Tretinoin (Retin-A, Atralin, Avita) (marketed for acne)
Tretinoin (Refissa, Renova) (marketed for wrinkles)
Derivative of vitamin A. Can unplug comedones. Prevent new ones and reduce inflammation.
May suppress the gene code for the breakdown of collagen.
Safety
Tretinoin (Retin-A, Atralin, Avita)
Tretinoin (Refissa, Renova)
Contraindicated in pregnancy and lactation.
6 weeks to work.
Adapalene (Differin) indication
mild to moderate acne
wrinkles
MOA differin
Modulates inflammation, epithelial keratinization
Onset and special with Differin
8-12 weeks, may seem worse before it gets better.
Tazarotene (Tazorac) indcation
Acne, wrinkles,
and psoriasis
Tazarotene (Tazorac) MOA safety
Same as other Retinoids (Modulates inflammation, epithelial keratinization)
Pregnancy category X.
Isotretinoin (Accutane) indication
Severe nodular cystic acne
Accutane MOA
Decreases sebum, sebaceous gland size, inflammation, and keratinization. (Also lowers skin P. acnes).
Accutane safety
Contraindicated in pregnancy. Avoid in breastfeeding
Must be on TWO effect forms of birth control throughout and one month after.
Participate in iPLEDGE
BBW accutane
Isotretinoin carries a high risk of severe structural and cognitive defects in the developing fetus—increased risk for spontaneous abortion.
Hormonal agents for acne
Birth control (YAZ, Estrostep, Ortho Tri-cyclen)
Spironolactone (Aldactone)
Birth control MOA with acne and length of tx
Decrease androgen activity, and decrease production of sebum.
Takes 4-6 months to see effect.
MOA spiralactone
Blocks steroid receptors including aldosterone and sex hormones).
Safety spiralactone
hyperkalemia
Taken after BC not effective.
Fluorouracil (Efudex) indication
Actinic or solar keratosis
Basal cell carcinoma,
MOA fluorouracil
pyrimidine antimetabolite that interferes with DNA synthesis
Safety fluorouracil
If applied with a fingertip, wash hands immediately after application. Do not cover the area with an occlusive dressing. Topical preparations are for external use only, not for ophthalmic, oral, mucous membrane, or intravaginal use.
Use is contraindicated in patients who are pregnant.
Adverse effects, including ventricular septal defect and miscarriage, have been reported following topical application of fluorouracil products to mucous membranes in pregnant patients
Topical Immune-suppressants: Tacrolimus (Protopic) indication
Moderate to severe atopic dermatitis
Safety with fluorouracil
*May pose a risk for cancer.
Children 2-16 use 0.03% adults may use either 0.1% or 0.03%.
Treatment should be intermittent or short-term.
Pimecrolimus cream (Elidel) indication
Mild to moderate atopic dermatitis.
Safety Pimecrolimus cream
Treatment should be intermittent or short-term.
Cisaborole ointment (Eucrisa) indication
atopic dermititis
Eucrisa MOA
Inhibits PDE4 – reduction in cytokines and inflammation.
Hydrocortisone
Betamethasone
Clobetasol propionate (Clobex)
indication
Relieve and itching associated with insect bites inflammation, dermatitis, psoriasis, eczema, and pemphigus)
MOA topical corticosteroids
Anti-inflammatory/
immunosuppressant
Safety topical corticosteroids
Infection and irritation are potential side effects.
Atrophy of the skin, striae, acne, and adrenal suppression are all potential side effects.
Prednisone indication
Severe disease:
Pemphigus, psoriasis, seborrheic dermatitis, contact dermatitis, exfoliative dermatitis.
Saety prednisone
Osteoporosis, infection, impaired wound healing, hyperglycemia, myopathy, electrolyte imbalance, growth delay, psyc disturbances, cataracts, glaucoma, peptic ulcer disease, iatrogenic Cushing’s, adrenal suppression.
Drug-to-drug interactions with NSAIDS- GI bleed., insulin or oral hypoglycemics., Vaccines.
