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Pharm Flashcards

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1
Q

Used for severe dermatoses over nonfacial areas like scalp, plan, or sole of feet?

A

Clobestalol (class 1)

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2
Q

Side affects of topical steroids

A 
Acne              
Striae 
skin atrophy 
steroid rosacea
Hyperpigmentation 
Telangiectasias
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3
Q

Systemic SE of steroids?

A

Hyperglycemia
Cushings
Hypertension

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4
Q

Topical med w/ antimicrobial and comedolytic properties

SE: bleaching hair + skin irritation

A

Benzyl peroxide

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5
Q

Retinoids?

A

Vitamin A derivatives

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6
Q

Used for acne+ photodamaged skin + hyperpigmenation?

A

Retinoids

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7
Q

SE of retinoids?

A 
Photosensitivity 
dryness
Pruritus 
erythema 
scaling
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8
Q

Retinoids CI w/?

A

Benzoyl peroxide–> oxidizes retinoin

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9
Q

SE of isotrentinoin?

A

Teratogenic
Elevated LFTs
Elevated TGs

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10
Q

Inhibits keratinocyte proliferation?

SE?

A

Calcipotriene

SE: skin irritation

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11
Q

Inhibits keratinocyte proliferation but stimulates differentiation+ inhibits T cell proliferation?

A

Calitriol

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12
Q

Topical retinoid used for Psoriasis & acne

SE: Teratogenic + photosensitivity

A

Tazorotene

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13
Q

Only drug used to treat Squamous cell carcinoma?

A

Cisplatin

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14
Q

Drugs used in treatment of Actinic keratosis?

A

Fluorouracil
Diclofenac
Imiquimod
Trichloroacetic acid

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15
Q

3 sites of Skin cancer metastasis?

A

Lung + intestines+ Brain

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16
Q

MOA: direct activator of TLR7/ TLR8–> initiates Th1 cell immune response
Blocks adenosine receptors

A

Imiquimod

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17
Q

Activation of NF-kappa B

A

Leads to upregulation of cytokines like TNFalpa and Interleukins

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18
Q

SE: allergy to its components
Skin rxn
Increased Photosensitivity
CAN compromise CONDOMS

A

Imiquimod

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19
Q

Hedgehog driven tumor?

A

Basal cell carcinoma

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20
Q

MOA for Imiquimod used to Tx basal cell carcinoma?

A

INHIBITS GLI-A–> Suppresses Hedgehog Receptor signaling independent of TLR

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21
Q

Abberant Hedgehog signaling leads to?

A

increased Bcl2(anti-apoptotic protein) + VEGF

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22
Q

SMO vs. PTCH1 inhibition in Hedgehog pathway?

A

SMO is downstream of PTCH1 so inhibiting PTCH1 without SMO is ineffective

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23
Q

Protein target in Hedgehog signaling inhibition?

A

SMO

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24
Q

SMO inhibitor?

A

Vismodegib

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25
Q

SE of Vismodegib?

A

Intrauterine is FATAL
Male mediated Teratogenicity
Pregnancy should be avoided: Teratogenic
Alopecia: most common

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26
Q

MOA: IL 2 receptor agonist-> induces proliferation and differentiation of B & T cells, monos, macs, and CTLs (NK cells)?

A

Aldesleukin

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27
Q

CI for Aldesleukin?

A

CNS, cardiac, pulmonary, hepatic, or renal Disease or Organ transplant= increases rejection

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28
Q

SE: capillary leakage syndrome and baseline and daily CXR recommended?

A

Aldesleukin

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29
Q

Immunomodulator administered IV or SC?

A

Inferferon alpha

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30
Q

SE of Interferon alpha?

A 
Autoimmune disease worsening 
Cardiac Disease 
Depression/ Suicidal 
elevated LFTs 
Pulmonary infiltrates: pneumonitis
most common: flu like symptoms+ neutropenia
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31
Q

Tests routinely taken for pt on Interferon alpha?

A

CBC
EKG
LFTs
CXR

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32
Q

Ipilimumab MOA?

A

CTLA-4 recombinant antibody

Blocks Cytotoxic Tcells from interacting w/ CD80+ CD86

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33
Q

BBW SE for Ipilimumab?

A 
Adrenal insufficiency 
Guillain Barre 
Hepatitis 
SERIOUS RASH
Peripheral neuropathy 
Teratogenic
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34
Q

MOA: Inhibiting the negative regulator of CTLs (CTLA4) which increases T cell # and action

A

Ipilimumab

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35
Q

Sorafenib MOA?

A

Multi Kinase inhibitor (VEGF, PDGFR, KIT, RAF )

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36
Q

SE of Sorafenib?

A 
Hepatitis (elevated LFTs)
Hand and Foot syndrome 
Rash+ anemia 
Teratogenic 
FATAL GI or Brain or Respiratory Bleeding
Teratogenic
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37
Q

SE: Fatal bleeding?

A

Sorafenib (VEGF + PDGFR actions)

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38
Q

Oral Reversible MEK inhibitor?

A

Trametinib

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39
Q

Trametinib is a MEK inhibitor for pt w. what mutations?

A

BRAF V600E and V600K

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40
Q

SE of Trametinib?

A 
Skin toxic
Decreased LVEF
RENTINAL pigment epithelial detachment 
Cardiomyopathy 
Interstitial lung dz 
Hemorrhage
Teratogenic
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41
Q

Whats more downstream of RTK: BRAF or MEK?

A

RTK-> NRAS-> BRAF (vemurafinib)-> MEK (trametinib)-> ERK-> proliferation/ survival

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42
Q

Common SE of Sorafenib+ Trametinib + Vemurafenib?

A

RASH

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43
Q

SE: EYE and Secondary malignancies?

A

BRAF (vem) and MEK(tram) inhibitors

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44
Q

Oral inhibitor of mutated BRAF?

A

Vemurafenib

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45
Q

Genotype of Vemurafenib requirement?

A

BRAF mutation (V600E)

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46
Q

Resistance to BRAF / MED inhibitors?

A

Alternative pathway activation s

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47
Q

SE of Vemurafenib?

A 
QT prolongation 
Photosensitivity 
Cutaneous 2nd Squamous cell carcinoma 
SEVERE skin rxn
SEVERE eye issues: uveitis + iritis + retinal v occlusion 
Teratogenic
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48
Q

MOA of Carmustine?

A

alkylation + carbamoylation of amino acids

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49
Q

MOA of Decarbazine?

A

Pro-drug of active akylating moiety

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50
Q

Dactinomycin MOA?

A

DNA intercalator

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51
Q

Flourouracil MOA?

A

Thyidylate synthase inhibitor: interferes w/ RNA & RNA synthesis

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52
Q

Lomustine MOA?

A

Alkylator

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53
Q

Non-invasive lesion due to sun exposure-> epithelial transformation extremely unlikely to progress to SCC?

A

Actinic Keratosis

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54
Q

Topical Tx for Actinic Keratosis?

A

Fluorouracil + Imiquimod

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55
Q

Non topical Tx of actinic Keratosis>

A

NSAID diclofenac and Trichloroacetic acid

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56
Q

DIclofenac MOA?

A

Inhibitor of inflammatory mediators: PGs

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57
Q

SE of Diclofenac?

A

RASH and skin peeling

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58
Q

Trichloroacetic acid MOA?

A

chemical peel: rapidly penetrates and cauterizes (to burn) skin + keratin

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59
Q

SE of Trichloroacetic acid?

A

Burning
Inflammation
Tenderness

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60
Q

Tx of tuberculoid leprosy?

A

Dapsone + Rifampin for 12mo

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61
Q

Tx of Lepromatous leprosy?

A

Dapsone+ Rifampin + Clofazimine for 24 mo

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62
Q

What is Dapsone’s harmful metabolite via CYP 3A & 2C9?

A

Hydroxylamine

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63
Q

Potent oxidant–> causes Methemoglobinemia and Hemolysis?

A

Dapsone metabolite Hydroxylamine

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64
Q

Dapsone in CI in pts with… due to…?

A

G6PD deficiency causes Hemolysis

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65
Q

Drug interactions for Dapsone (hydroxyl amine)?

A

Rifampin-> increased toxicity
Trimethoprim-> increase Serum levels of Drugs
Cimetidine + omeprazole-> decrease toxicity

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66
Q

Elimination of Dapsone?

A

Renal Excretion

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67
Q

Dapsone MOA?

A

Folic acid derivative-> inhibits Thymidine and purine synthesis
*site of action btwn Sulfa and Trimethoprim

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68
Q

Inhibitors of second messenger pathway involved in PMNs chemotaxis?

A

Dapsone (folate antagonists)

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69
Q

SE of Dapsone?

A 
RASH (SJ syndrome) 
Hemolysis 
Methemoglobinemia 
Hepatitis 
Cholestatic jaundice 
Peripheral MOTOR neuropathy 
SEVERE hypoalbuminemia 
Leukopenia/ agranulocytosis
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70
Q

Labeled uses of Dapsone?

A

Acne vulgaris
Dermatitis Herpetiformis
LEPROSY (hansen’s disease)

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71
Q

Rifampin SE?

A 
Crosses inflamed Meninges + placenta + breast milk 
Hepatic Toxic/ metabolism 
CYP inducer
hematuria 
RED colored fluids
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72
Q

Common SE of Dapsone and Rifampin?

A

Hemolysis

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73
Q

Clofazimine MOA?

A

Binds to Mycobacterial Guanine (cystine) in DNA

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74
Q

SE of Clofazimine?

A 
Highly lipophilic-> Long T1/2 (months)
Hepatic Toxicity/ elimination 
Staining of Body+ bodily fluids + infants 
Skin discoloration 
Black Tarry feces
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75
Q

SE Clofazimine and Rifampin have in common?

A

Discolor Bodily fluids

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76
Q

SE include Black tarry feces + hepatitis+ skin discoloration?

A

Clofazimine

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77
Q

Test routinely ordered to monitor Leprosy pt drug toxicity?

A

CBC + platelet count
AST
ALT

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78
Q

Drugs used for patients who cannot tolerate Clofazimine>

A

Clarithromycin
Minocycline
Ofloxacin

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79
Q

Leprosy pt w/ sudden eruption of numerous, painful, nodules, neuritis?

A

Erythema nodosum leprosum

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80
Q

Tx of Erythema nodosum leprosum?

A

Corticosteroids
Clofazimine
Thalidomide

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81
Q

Inhibits Nf kappaB meidated transcription upregulation of TNF alpha production?

A

Thalidomide–> blocks leukocyte migration

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82
Q

Main SE of thalidomide?

A

Teratogenic
Increase in Plasma HIV viral load
Peripheral neuropathy

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83
Q

Thalidomide is used to Tx?

A

Side effects of Leprosy

Myeloma (anti-angiogenic activity)

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84
Q

Leprosy with:
Cell mediated response
Granuloma formation
Few organisms?

A

Tuberculoid Leprosy

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85
Q

Cytokines involved in Tuberculoid leprosy?

A 
IFN gamma
TNF
IL-2
IL-16
IL-12
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86
Q

Humeral repsonse
Foamy macrophages
Many organisms?

A

Lepromatous leprosy

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87
Q

Cytokines involved in Lepromatous leprosy?

A

Il-4

IL-10

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88
Q

Dx used to treat Tinea and Onchymycosis by Blocking transmembrane transport depleting essential substrates and interfering with RNA & DNA synthesis?

A

Ciclopirox

Does NOT inhibit synthesis or lyse fungal cell wall

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89
Q

MOA: Inhibit fungal ergosterol synthesis by inhibiting P-450 enzyme that converts lanosterol to Ergosterol?

A

Azoles

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90
Q

What is the enzyme blocked by Azoles?

A

14-alpha demethylase

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91
Q

SE: inhibits testosterone synthesis/ adrenal dysfunction?

A

Ketoconazole

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92
Q

Major inhibitor of CYP 2C19?

A

Voriconazole

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93
Q

Significant inter-patient variability of CYP 2C19 affects the serum levels of?

A

Voriconazole

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94
Q

Itraconazole is an inhibitor and substrate for?

A

CYP 3A4

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95
Q

Posaconazole inhibits CYP?

A

CYP 3A4 + P-gp

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96
Q

Fluconazole inhibits CYP?

A

CYP 2C9 + 3A4

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97
Q

Azoles acting on CYP 2B6 + 2C19?

A

Voriconazole

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98
Q

Azoles acting on CYP 2C9?

A

Fluconazole + Voriconazole

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99
Q

Azole with RENAL elimination?

A

Fluconazole

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100
Q

Azoles able to enter CSF?

A

Fluconazole [HIGH]

Voriconazole [low]

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101
Q

Azoles that does NOT cause QT prolongation?

A

Itraconazole

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102
Q

SE: photosensitivity + Optic Neuritis + SCC and Melanoma cases?

A

Voriconazole

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103
Q

Which azole must be taken with food for Proper Bioavailability?

A

Posaconazole

104
Q

MOA for Griseofulvin?

A

interferes w/ microtubule function: disrupts mitosis + Deposits in Keratin tissue (Nails)

105
Q

Metabolism and elimination of Griseofulvin?

A

hepatic metabolism

eliminated via Liver/ kidney/ Perspiration

106
Q

SE of Griseofulvin?

A 
CYP 3A4 INDUCER 
Teratogenic
Hepatotoxic 
Interferes w/ Porphyrin metabolism= confusion + headaches 
Penicillium hypersensitivity 
Photosensitivity
107
Q

SE: CYP 3A4 inducer + causes porphyria?

A

Griseofulvin

108
Q

Inhibits Fungal squalene epoxide?

A

Terbinafine

109
Q

Terbinafine metabolism and Elimination?

A

Hepatic metabolism

RENAL elimination

110
Q

SE: transient Lymphopenia & neutrooenia + Abnormal LFTs + visual disturbances + teratogenic?

A

Terbinafine

111
Q

MOA: Squalene epoxide inhibitor + anti-inflammatory by inhibiting PGs + LTs + Histamins causing vasoconstriction?

A

Naftifine

112
Q

Naftifine SE + CI?

A

Hypersensativity
Teratogenic
CI: Do NOT use w/ AZOLES

113
Q

why are Naftifnine and Azoles CI in concurrent use?

A

Both inhibit Ergosterol synthesis but Naftifine @ earlier stage thus diminishes Azoles actions

114
Q

Cilopriox MOA?

A

Topical ONLY

Blocks Fungal transmembrane transport (DNA + RNA synthesis?

115
Q

SE for Ciclopirox?

A

Hypersensitivity

Skin irritation

116
Q

Amorolfine MOA?

A

TOPICAL only: Inhibits ergosterol synthesis

117
Q

SE of Amorolfine?

A

Hypersensitivity

118
Q

Acyclovir is used to Treat?

A

VZV and HSV

119
Q

Anti-virals used to treat Varicella Zoster?

A

Acyclovir + Famciclovir + Valacyclovir

120
Q

What two antivirals are PRO_ DRUGS?

A

Valacyclovir + Valganciclovir

121
Q

Metabolized to its active product Penciclovir?

A

Famciclovir–> used to Treat Recurrent Herpes Labialis

122
Q

MOA: competitively inhibit viral DNA pol. Compete w/ Deoxyguanosine triphosphate for incorporation into Viral DNA?

A 
Acyclovir 
Famciclovir 
Ganciclovir
Valacyclovir
Valganciclovir
123
Q

Mode of resistance is mutated Viral Thymidine kinsae?

A

Acyclovir

124
Q

Anti-virals that require inracellular kinase-dependent phosphorylation for activity?

A 
Acyclovir 
Famciclovir 
Ganciclovir 
Valacyclovir 
Valganciclovir
125
Q

Anti-virals that DO NOT require intracellular phosphorylation?

A

Cidofovir

Forscarnet

126
Q

SE of acyclovir + Valacylovir?

A

neurotoxic/ Seizures

127
Q

Anti-viral with no Significant SE?

A

Famciclovir

128
Q

SE for Cidofovir?

A

Nephrotoxic

Hypersensitivity

129
Q

Management of Cidofovir Nephrotoxicity?

A

Co-adminstration w/ Probenecid and IV saline

130
Q

SE: electrolyte imbalance - chelates Ca2+ & Nephrotoxicity?

A

Forscarnet

131
Q

MOA: Viral DNA pol inhibitor by binding to Pyrophosphate-binding site–> Blocks chain elongation?

A

Forscarnet

132
Q

MOA: inhibits DNA pol by competing w/ deoxycytosine triphosphate for incorporation into Viral DNA?

A

Cidofovir

133
Q

SE: Pancytopenia, thrombocytopenia + Teratogenic+ Renal toxic?

A

Ganciclovir + Valganciclovir

134
Q

Which of the anti-virals DO NOT have Cross hypersensitivity?

A

Cidofovir

Forscarnet

135
Q

MOA of Minoxidil?

A

Potent vasodilator (artery>vein)–> HTN

  • *Activates hair follicle directly or stimulates follicular microcirculation
  • *Alter local androgen metabolism
136
Q

SE of minoxidil?

A

Poor skin absorption-> little systemic SE

Skin irritations

137
Q

MOA: Testosterone analog-> blocks 5-alpha-reductase activity to decrease scalp and serum DHT concentration?

A

Finasteride

138
Q

SE of Finasteride?

A

Loss of libido
**Sexual dysfunction
Feminization

139
Q

Finasteride is CI w/ concurrent use of?

A

Saw palmetto–> similar MOA

140
Q

Main SE Male sexual dysfunction?

A

Finasteride

141
Q

MOA; decrease Ornithine decarboxylase-> decrease cell division & differentiation
USED to reduce Unwanted female facial hair

A

Eflornithine

142
Q

MOA: produces trypanostatic action–> USED against Sleeping Sickness?

A

Eflornithine

143
Q

SE of Eflornithine?

A

Not for eyes of mucus membranes

Rare skin adverse rxns

144
Q

Tri-Luma USE and makeup?

A

TRI= Fluocinolone + Hydroquinone + Tretinoin

USE: Decrease Skin Darkening

145
Q

Fluocinoolone MOA?

A

Anti-inflammatory corticosteroid

146
Q

Hydrquinone MOA?

A

Inhibits melanin formation by blocking Melanocyte enzymatic oxidation of tyrosine to 3,4-DOPA.

147
Q

MOA of Tretinoin?

A

Modulates skin growth and pigmentation

**Increased Keratinocyte shedding from Retinoid treatment

148
Q

SE TRI-LUMA?

A

Increased sensitivity to UV

149
Q

Oral topical pigment agent activated by UVA 9320-400nm Exposure?

A

Methoxsalen

150
Q

SE of Methoxsalen?

A

Delayed erythema

increased epidermal melanization> thicken Conrneum

151
Q

Uses of Methoxsalen?

A

Vitiligo
Psoriasis
cutaneous T-cell Lymphoma (mycosis fungoides)
Alopecia

152
Q

Apoptosis involves what proteins?

A

Decreased Bcl-2

Increased Bax & p53

153
Q

source of stem cell for hair regrowth>

A

Bulge

154
Q

MOA of Melathion?

A

Topical Organophosphate-> metabolized in louse to malaoxon–> inhibits acetyl-cholinesterase

155
Q

Outcome of Melathion in Human body?

A

Rapidly converted to inactive metabolites and Excreted by the KIDNEY

156
Q

SE of oral/pulmonary ingested Malathion?

A 
Increased GI peristalsis 
decreased Ocular accommodation 
Bradycardia
Confusion 
Hypotension
157
Q

Tx for Malathion toxicity?

A

Atropine or pralidoxime

158
Q

What is the ONLY ovicidal therapy available for treating lice?

A

Malathion

159
Q

MOA of Permethrin?

A

Bind to voltage gated Na channels–> cause hyperexcitability and paralysis

160
Q

SE of Permethrin?

A

Asthma exacerbation–> ragweed allergy

But drug reaching systemic circulation is rapidly inactivated by ester hydrolysis

161
Q

Resistance to Permethrin?

A

Knock-down resistance mutation (kdr) of louse Na channels

162
Q

Lindane MOA?

A

GABA blockade

Only used in pts who CANNOT tolerate or have failed 1st line treatment

163
Q

SE of Lindane?

A

BBW: Skin dz + Neonatal prem + CNS stimulant causes SEIZURES

164
Q

Lindane CI w/ ?

A

Py w. seizures due to its GABA blockade-> promotes seizures

165
Q

Disfavored due to Neurotoxicity and persistence in the environment?

A

Lindane

166
Q

Ivermectin MOA?

A

Selectively binds to Glutamate-gated Cl- channel present in Invertebrate nerves and muscle cells.

167
Q

Disfavored in younger pts do its tendency to CROSS the BBB + elevates LFTs + worsens Bronchial Asthma?

A

Ivermectin

168
Q

Physical methods of controlling Lice?

A

Benzyl alcohol
Cetaphil
Petroleum Jelly–> Shown to have OVICIDAL efficacy

169
Q

Before prescribing Isotrention to a young women what tests should be done?

A

Pregnancy test (Serum beta HCG levels)

170
Q

Pathogenesis: 5 alpha reductase + androgenic effects of dihydrotestosterone actions?

A

Male pattern baldness

171
Q

Calcipoteiene MOA?

A

activates Nuclear transcription factor (vitamin D receptor) inhibits keratinocyte proliferation and induces differentiation

172
Q

Before prescribing Isotrention to a young women what tests should be done?

A

Pregnancy test (Serum beta HCG levels)

173
Q

Pathogenesis: 5 alpha reductase + androgenic effects of dihydrotestosterone actions?

A

Male pattern baldness

174
Q

Calcipoteiene MOA?

A

activates Nuclear transcription factor (vitamin D receptor) inhibits keratinocyte proliferation and induces differentiation

175
Q

Pg: Antigen presents and T cells release cytokines (TNF and IFN) inducing keratinocyte and endothelial cell proliferation?

A

Psoriasis

176
Q

Numerous lesions on the trunk caused by FGF receptor 3 mutation causing monotonous proliferation of basal cells?

A

Seborrheic Keratosis

177
Q

Thickened stratum corneum with retained nuclei?

A

parakeratosis

178
Q

<1cm lesion showing cytologic atypia precursor to SCC caused by TP53 mutations?

A

Actinic keratosis

179
Q

Round, coin like lesion with a “stuck on” appearance?

A

Soborrheic keratosis

180
Q

Impairs antigen presentation by Langerhan cells causing immunosuppression?

A

UVB

181
Q

Most common UV induced mutation in SCC?

A

TP53

182
Q

Likelihood of SCC to metastasize is related to?

A

Thickness and degree of invasion into Subcutis

183
Q

SCC located in _____ are generally much more aggressive?

A

Mucosal SSC

184
Q

Which skin cancer is associated with dysregulation of Hedgehog signaling pathway?

A

Basal cell carcinoma

185
Q

Mutation in what gene in most associated w/ familial basal cell carcinoma?

A

PTCH gene

186
Q

“Pearly” papules with prominent subepidermal blood vessel dilations (telangiectasia)?

A

BCC

187
Q

Palisading alignment of tumor cells in the outermost layer separating from stroma?

A

BCC

188
Q

Can arise from chemical exposure, thermal burn sites, or HPV infection in immunosuppression?

A

SCC

189
Q

Superficial lesions in which cells produce melanin and grow in nests along dermoepidermal junction is associated w/ what mutation?

A

Activating BRAF mutations (melanocytic nevi)

190
Q

The most important signs of early manifestation of Melanoma?

A

Evolution (Change in color or size)

191
Q

Progenitor cells for BCC?

A

Hair follicles/ Germinative keratinocytes (basal layer)

192
Q

Progenitor cells for SCC?

A

Epidermal keratinocytes (spinous layer)

193
Q

Whats the most common invasive neoplasm in US?

A

Basal Cell Carcinoma

194
Q

What gene mutation is associated w/ sporadic BCC?

What is the role of that gene?

A

PTCH mutation

Hedgehog signaling pathway–> regulator of basal epidermal cell proliferation

195
Q

Risk factors for BCC?

A

UV exposure
Sunburns (esp blistering)
FHx of BCC
Immunosuppression

196
Q

Most common mutation in SCC?

A

TP53

197
Q

“pearly” nodule w/ telangactasias?

A

BCC

198
Q

Which type of neoplasm requires the Stroma for metastasis?

A

BCC

199
Q

AD mutation in PTCH causing increased risk of neoplasms, MSK defects, and Jaw cysts?

A

Grolin syndrome (Basal cell nevus syndrome)

200
Q

What is the action of PTCH?

A

It suppresses the SMO protein which activates teh Hedgehog signaling pathway

201
Q

what drug inhibits SMO?

A

Vismodegib

202
Q

Progression of SCC?

A

Minimal atypia (Actinic keratosis)
Full thickness epidermal atypia confined abouve basement membrane (SCC in situ)
Invasive SCC

203
Q

Erythroplasia of Queyrat?

A

SCC of glans penis

204
Q

Risk factors for developing SCC?

A 
UV
HPV
Immunosuppression 
Chronic inflammation
Scars (burns)
Chemical exposure (arsenic)
205
Q

Risk of metastasis of cutaneous SCC is related to?

A

SIze >2cm
Depth into dermis >4mm
Anatomic site (mucosal membranes)
Host immune status

206
Q

Keratinocyte neoplasm rapidly growing 2-6 wks, Painful and may involute spontaneously?

A

Keratoacanthoma

207
Q

An ulcerated invasive SCC arising on background of chronic inflammation, scarring, radiation, and trauma?

A

Marjolin’s Ulcer

208
Q

Whats the most common type of cancer in 25-29 yo?

A

Melanoma

209
Q

Mature melanocytes with descent into dermis and no melanocytes above basal layer?

A

Nevi

210
Q

Melanocytes do not mature w/ descent and located above basal layer?

A

Melanoma

211
Q

What mutation is common to both Nevi and Melanoma?

A

BRAF

212
Q

> 50 moles increases risk for?

A

melanoma

213
Q

Melanoma risk factors?

A

> 50 nevi
H/o blistering sunburns
immune dysfunction

214
Q

Acral Lentiginous melanoma?

A

Melanoma on palms and soles of feet

215
Q

Melanocytes are derived from what embryonic cells?

A

Neural crest cells

216
Q

1 organ site for metastasis of Melanoma?

A

SKIN

217
Q

Most common cause of death for pt w. melanoma?

A

CNS involvement

218
Q

Single most important prognostic factor for melanoma?

A

Lymph node involvement

219
Q

Most important histological prognostic factors for Melanoma?

A

Breslow thickness + ulcerations

220
Q

breslow’s thickness?

A

Distance involved from the stratum granulosum to the deepest tumor cell

221
Q

MOA for Vemurafenib?

A

Inhibits BRAF (approved for metastatic melanoma)

222
Q

Combination therapy of Vemurafenib and ipilimumab shows great improvement.
MOA of Ipilimumab?

A

Ab against CTLA4= inhibiting this receptor leads to increase in Tcell actions= increased immune response to tumor

223
Q

UVB form what in DNA?

A

Thymine dimers

224
Q

MOA of Etanercept?

A

TNF alpha receptor Antagonist (Antibody fusion protein)

225
Q

MOA of Adalimumab?

A

Human Ab against TNF alpha (Components: igG1)

226
Q

Components of Etanercept>

A

p75 + TNF receptor and Fc igG1

227
Q

MOA of Infliximab?

A

Chimeric mouse Ab against TNF alpha

228
Q

CI w/ heart failure and causes Hypersensitivity?

A

Infliximab

229
Q

Etanercept is CI w/ what condition?>

A

Sepsis

230
Q

What are the BBW for Adalimumab + etanercept + infliximan?

A

Infections: Fungal/ myco / viral
Neoplasia
TB

231
Q

CI use concurrently with Immunosuppressives or vaccinations?

A

Infliximab
Adalimumab
Etanercept

232
Q

MOA of Ustekinumab?

A

Binds p40= disrupts IL-12 + IL-23 signaling

suppresses Formation of inflammatory cytokines by Th1 and Th17 cells

233
Q

SE of Ustekinumab?

A

Increase risk of infection and Neoplasia

Anaphylaxis

234
Q

Ustekinumab is CI w/ what and what tests should be done prior to treatment?

A

CI w/ LIVE virus vaccines

Test for TB

235
Q

Functions of Vitamin A (retinoids)?

A

Embryonic growth
Reproduction
Vision

236
Q

Effects of Retinoids?

A

Modulates prolif + diff of keratinocytes
Inhibits keratinization
induces apoptosis
Immunologic/ anti-inflammatory

237
Q

Targeting RAR predominately affects?

A

Cellular differentiation and proliferation

238
Q

Targeting RXR induces?

A

Apoptosis

239
Q

SE of Retinoids?

A 
acutely: conjunctivitis + reduced night vision 
Teratogenic
Suicidal ideas 
TGs and ALT level checks 
Increase risk for SUNBURNS
240
Q

RARs vs. RXR selective retinoids SE?

A

RAR:Mucocutaneous + musculoskeletal
RXR: Phsiochemical

241
Q

MOA for Topical retinoids against acne?

A

Correct abnormal keratinization
reduce P acnes
reduce inflammation

242
Q

MOA of retinoids against Photoaging?

A

inhibits MMPs in response to UV

243
Q

MOA of calcipotriene?

A

Binds to vitamin D receptor;

RXR and binds DNA vit D elements to reduce inflammation

244
Q

SE of Calcipotriene?

A

Hypercalcemia + hypercalciuria

Increased UV skin cancer risk

245
Q

MOA of Calcitriol?

A

Hormonally active form of vit D3

246
Q

MOA of benzoyl peroxide?

A

PRO-drug converted in skin to benzoic acid

**Liberates free radical to kill P acnes

247
Q

MOA for Clindamycin?

A 
Inhibits 50s (static)
*P acnes have resistance
248
Q

Name mild Corticosteroid?

A

Hydrocortisone

Methylprednisolone

249
Q

Name moderate CS?

A

Betamethasone valerate

250
Q

Name Potent CS?

A

Fluocinonide

251
Q

Name very Potent CS?

A

Clobetasol propionate

Bethamethasone dipropionate

252
Q

Fluorinated Topical steroids should not BE?

A

applied to the FACE-> causes perioral dermatitis

253
Q

SE of topical CS?

A

Iatrogenic cushings
dermal atrophy
Rosacea (persistent erythema)
Steroid acne

254
Q

Salicylic acid is CI in?

A

Renal or hepatic impairment

Pregnancy-> neonatal toxicity when applied to chest

255
Q

SE of salicylic acid intoxication?

A

Dizziness
Tinnitus
seizures
Renal and Liver failure

Dermatology (4 decks)

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