Pharm 27 Objectives Flashcards by Vanessa Amabile

What are some general principles of topical drug therapy?

Avoids systemic absorption of agents
Use an appropriate vehicle
Apply a WET dressing with evaporate to an oozing/weeping lesion to dry it
To moisturize a dry lesion, trap moisture with occlusive agents

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What are some general principles of transdermal drug therapy?

Achievement of systemic concentrations due to controlled delivery of drug

Avoids “first pass” effect from the liver

Best for small, highly lipid-soluble molecules

Dose of drug is determined by surface are covered

Delay between start and stop of dosing

Types of patches differ

Patches can have 10-95% of drug left inside after removal

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What vehicle do you select that are drying and will enhance evaporation from the skin?

Solutions (wet dressing and suspensions)
Sprays (aerosols and aqueous sprays)
Lotions
Gels
Powders

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What vehicle do you select that are moisturizing and will trap water in the stratum corneum

Creams
Ointments
Ointment bases

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What is the rank of vehicles from most moisturizing to least moisturizing?

Occlusive dressing
Ointment
Cream
Lotion
Gel
Spray
Solution

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What will occur if you select the wrong vehicle (wetting vs non-wetting dressing)?

It can hamper wound healing

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What is an example of low potency topical corticosteroid medication?

Hydrocortisone (1% or 2.5%)

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What is an example of medium potency topical corticosteroid medication?

Triamcinolone (0.1%)

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What is an example of high potency topical corticosteroid medication?

Flucinonide (0.05%)

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What is an example of very high potency topical corticosteroid medication?

Clobetasol (0.05%)

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Why can Tiamcinolone be in the medium and high potency class?

Different % of the drug (0.025%, 0.1% and 0.5%)

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What are the therapeutic uses for topical corticosteroids?

Relieves inflammation and itching

Contact dermatitis
Eczema
Psoriasis

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What are some ASEs of topical corticosteroids?

Atrophy/thinning of skin

Telangiectasias

Striae (striped skin)

HPA axis suppression from systemic absorption

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What is Telangiectasia which are an ASEs to topical corticosteroids?

Dilated capillaries, red, elevated, wart-like spots

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How does HPA axis suppression occur with the use of topical corticosteroids?

Applying high potency agents over time

Applying moderate-high potency agents over broken skin

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What are contraindications of topical corticosteroids?

Skin infections

Applying to broken skin (causes systemic absorption)

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What is the therapeutic use of Nystatin?

Yeast infections

- diaper dermatitis

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What is the therapeutic use of Clotrimazole?

Tinea versicolor

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What is the therapeutic use of Terbinafine?

Tinea Pedis

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MOA of benzoyl peroxide?

Drying and may increase cell turnover

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ASEs of benzoyl peroxide?

Local irritations and bleaches clothing/bed sheets

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How do you reduce irritation caused by benzoyl peroxide?

Start by diluting it with water, then work up to full strength

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Clinical use of benzoyl peroxide?

Acne

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MOA of salicylic acid?

Desquamates stratum corneum by dissolving cement holding epithelial cells together
-Softens and discourages growth of calluses

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Clinical uses of salicylic acid?

``` Acne Seborrheic derm Psoriasis of body and scalp Dandruff Wart removal Hyperkeratotic skin disorders ```

ASEs of salicylic acid?

Skin peeling

Contraindications of salicylic acid?

Avoid using on irritated, broken or infected skin, use appropriate product (use only as concentrated as necessary)

MOA of topical retinoids (adapalene, tretinoin, etc)?

Modulator of cellular differentiation, keratinization, and inflammatory processes

Clinical use of topical retinoids (adapalene, tretinoin, etc)?

Acne

ASEs of topical retinoids (adapalene, tretinoin, etc)?

Very irritating (adapalene is less irritating) Photosensitivity

What are some special monitoring parameters of topical retinoids (adapalene, tretinoin, etc)?

Can be used with topical antibiotics, but need to watch for irritation Use sunscreen when using retinoids

Clinical use of azelaic acid?

Inflammatory acne (BID up to 6 mos or longer) Inflammatory lesions of rosacea

ASEs of azelaic acid?

Skin irritation Lightening of skin

MOA of Isotretinoin (oral agent)

Reduce oil output to skin

Clinical use of Isotretinoin (oral agent)?

Severe or cystic acne

Contraindications of Isotretinoin (oral agent)?

Pregnancy- teratogenic

Special monitoring parameters for Isotretinoin (oral agent)?

iPLEDGE program ---> 2 forms of birth control at all times. | Depression screening

What bugs do topical antibiotics target?

Staph and strep

What topical agents are used for a pt with mild to moderate psoriasis?

Topical corticosteroids Emollients Salicylic acid Calcipotriene ( Synthetic Vitamin D derivative) Tazarotene Coal tar

What topical agents are used for a pt with moderate to severe psoriasis?

Acitretin Calcitriol Entanercept

What is the concentration dependent therapeutic use of salicylic acid?

Low concentrations can correct abnormal keratinization 1% concentrations cause skin peeling 20% concentration has caustic effects on the skin

What 2 drugs are used to stimulate hair growth?

Finasteride Topical minoxidil

What is the MOA of Finasteride?

Inhibits conversion of testosterone to dihydrotestosterone (DHT)

What are advantages of Finasteride?

First line for hair growth, may be slightly more effective than topical minoxidil

What are disadvantages of Finasteride?

Length of time to wait to see response, potential for chronic sexual dysfunction, pregnant women should avoid skin exposure

What is the MOA of Topical minoxidil (Rogaine®)?

Stimulates follicles and follicle cycling, induces vascular endothelial growth factor (VEGF)

What is an advantage of Topical minoxidil (Rogaine®)?

No prescription needed

What is a disadvantage of Topical minoxidil (Rogaine®)?

5% more effective but more irritating

What medication is used for unwanted hair growth?

Eflornithine

What is the MOA of Eflornithine?

Inhibits enzyme which blocks cell division of hair cells, slowing growth

What is an advantage of Eflornithine?

Can use with other methods of hair removal

What is a disadvantage of Eflornithine?

Prescription required and $$$

What are the medications used as the first line treatments for head lice?

Permethrin Pyrethrins + piperonyl butoxid

Does Permethrin kill both live lice and eggs?

Only kills live lice, has no effect on eggs

What are some dosing guidelines for Permethrin?

May require repeat dose in 7-9 days Stays on the hair for 14 days Saturate hair and scalp; wash out after 10 minutes

Pyrethrins + piperonyl butoxide is both a shampoo and?

Spray for furniture and toys

What is a dosing guideline for Pyrethrins + piperonyl butoxide?

Apply shampoo to hair and scalp; wash out in 10 min; reapply in 5-10 days prn

What are the 2nd line medications for head lice?

Ivermectin lotion ( >6 mo) Malathion lotion ( >6 yrs) Spinosad 0.9% ( >6 mo) Lindane lotion and shampoo (>2 yrs) Ivermectin (oral)

What head lice medication is no longer recommended in pediatric pts and why?

Lindane lotion and shampoo Due to CNS toxicity

What are the medications use tx scabies?

Topical permethrin 5% (1st choice) Crotamiton Lindan lotion (avoid in preg and peds)

What are the medications used to tx genital warts (condyloma accuminatum)?

Podophyllum Resin (25% of podophyllotoxin) Podoflox (0.5% of podophyllotoxin) Imiquimod (Aldara® cream)

How is Podophyllum Resin applied?

Only applied by clinician due to toxicity

What are ASEs of Podophyllum Resin?

Can lead to cell death (nectoris)

What are contraindications of Podophyllum Resin?

NEVER apply Podophyllum Resin to cervix or vaginal epithelium!!! - Chemical burns Teratogenic- avoid in pregnancy Not for mucosal use (external use only) - cause skin irritation up to ulceration

What are some ASEs of Imiquimod?

Mild to moderate local redness

How does changes in skin structure in older pts result in drug toxicity?

Older pts are more prone to dry skin, itching, and cracking which means using topical drugs on damaged skin may lead to potential for systemic absorption leading to toxicity.

What is the dose of topical cream/ointment for face and neck, one arm, and hands and feet BID x 1 week?

15 gm

What is the dose of topical cream/ointment for face and neck, one arm, and hands and feet TID x 2 week?

45 gm

What is the dose of topical cream/ointment for face and neck, one arm, and hands and feet BID x 4 week?

60 gm

What is the dose of topical cream/ointment for trunk BID x 1 week?

60 gm

What is the dose of topical cream/ointment for trunk TID x 2 week?

180 gm

What is the dose of topical cream/ointment for trunk BID x 4 week ?

240 gm

What is the dose of topical cream/ointment for one leg BID x 1 week?

30 gm

What is the dose of topical cream/ointment for one leg TID x 2 week?

90 gm

What is the dose of topical cream/ointment for one leg BID x 4 week?

120 gm

What is the dose of topical cream/ointment for the body BID x 1 week?

180 gm

What is the dose of topical cream/ointment for the body TID x 2 week?

454 gm

What is the dose of topical cream/ointment for the body BID x 4 week?

454 gm

Clinical use of Entanercept?

Psoriasis and psoriatic arthritis

MOA of Entanercept?

TNF-alpha blocking agent

MOA of misc. anti-pruritic topical drug: Pramoxine?

Antagonizes histamine-triggered itching

Topical antibiotic: Bacitracin is used for gram - or +?

Gram +

Topical antibiotic: Gentamicin, neomycin, polymixin is used for gram - or +?

Gram -

Topical antibiotic: Silver sulfadizazine is used for gram - or +?

Gram + and Gram -