Pharm Flashcards
Physical Sunscreens
Inorganics- titanium dioxide, zinc oxide
Chemical Sunscreens
cinoxate, para-aminobenzoic acid, trolamine, dioxybenzone, oxybenzone
Ustekinumab MOA
binds p40 subunit integral to IL12 and 23 activation. Tx psoriasis
AE of Ustekinumab
increased risk of infection and neoplasia, live virus vaccine contraindicated, test for TB before tx, anaphylaxis possible
BBW of infliximab
infection, neoplasia
Infliximab contraindications
heart failure, murine protein hypersensitivity
Etanercept contraindications
sepsis. BBW infections, neoplasia
Adalimumab BBW
infection, neoplasia
Target RAR
tretinoin, adapalene, tazarotene
Target RXR
bexarotene, alitretinoin
All oral retinoids are
potent teratogens
Calcipotriene MoA
topical, binds to Vit D receptor, RXRalpha - modulates epidermal differentiation and inflammation, improves psoriatic plaques
AE Calcipotriene
topical irritant, hypercalcemia, hypercalciuria, abdominal pain, constipation, depression, fatigue, HTN, anorexia, weight loss, muscle weakness, N/V, thirst, increased susceptibility to UV induced skin cancer
Benzoyl Peroxide
topical pro drug converted to benzoic acid in skin, free radicals kill nearby P. Acnes
AE Benzoyl Peroxide
dry skin, peeling, erythema, irritation, avoid mucous membrane contact, may bleach hair and clothing
Clindamycin MoA
Acne med. inhibits protein synthesis (50s). Lots of resistance within P. Acnes.
Basal Cell Tx
cisplatin, cyclophosphamide, doxorubicin, fluorouracil, MTX, vinblastine. Imiquimod, Vismodegib
SCC Tx
cisplatin
Melanom Tx
carmustine, dacarbazine, dactinomycin, docetaxel, lomustine, vinblastine. Aldesleukin, interferon, ipilimumab, sorafenib, trametinib, vemurafenib
Actinic keratosis Tx
fluorouracil, diclofenac, imiquimod, trichloroacetic acid
Imiquimod MoA
small molecule tumor directed immune response initiator, activates TLR7/8 and NFKB -> upreg of TNFalpha and interleukins. Prevents transcriptional upregulation of GL1
Imiquimod uses
BCC, Actinic keratosis, HPV
AE Imiquimod
allergies to benzyl alcohol and paraben components, skin rxns common (mild to mod), increased photosens, can compromise condoms and diaphragms
Aberrant SHH signaling implicated in
Basal Cell Carcinoma. Leads to upreg of anti apop Bcl2, VEGF, angiopoietins. Pathway seems to be ligand independent, so must block at SMO or lower
Vismodegib MoA
oral SMO inhibitor, lipophilic with extensive metabolism
BBW of Vismodegib
fetal death, male teratogenecity, verify pt is not pregnant!
AE of Vismodegib
Alopecia, GI toxicity (N/V/D) common, weight loss, fatigue + BBW
Imiquimod is Category
C
Methotrexate is Category
X
Aldesleukin MoA
binds to cell surface IL2 receptor induces prolif and differentiation of B and T cells, monos, macros, CTLS and NK cells
Aldesleukin administered
IV or SC
BBW of Aldesleukin
contraindicated in pts with CNS, cardiac, pulmonary disease. Capillary leak syndrome
Aldesleukin contraindicated in
pts with CNS, cardiac, pulm, renal, hepatic disease or organ transplant
AE Aldesleukin
hypotension, s-tach, peripheral vasodilation, SVT, diminished mental status, speech diff, cortical blindness, limb or gait ataxia, hallucinations, agitation, dyspnea, pulm congestion, rales, rhonchi, renal failure caused by cap leak syndrome
Aldesleukin uses
Melanoma
Interferon alpha 2b administered
IV or SC
Interferon alpha 2b
Immunomodulator
Interferon alpha 2b BBW
caution in autoimmune disease, cardiac disease, depression
AE Interferon alpha 2b AE
caution in autoimmu, cardiac, depression, infection. Flu like rxn, neutropenia, leukopenia, anemia, alopecia, elevated LFTs, cough, dyspnea, pulm infiltrates, pneumonitis
Monitor in Interferon alpha 2b use
CBC, LFT, CXR
Ipilimumab MoA
CTLA-4 recomb antibody (cytotoxic t lympho assoc antigen 4) Bolsters antitumor response of immune system
Ipilimumab BBW
adrenal insuff, diarrhea, Guillan Barre, hepatitis, hyperthyroid, hypothyroid, myastenia gravis, per neuropathy, pregnancy, serious rash
Ipilimumab AE
dermatitis including TEN (toxic epidermal necrolysis), tiredness, diarrhea, itching, rash + BBW
Ipilimumab used for
melanoma tx
Sorafenib MoA and use
oral multikinase inhibitor (VEGF, PDGFR, KIT, Raf kinase) Tx melanoma
AE Sorafenib
elevated LFTs, peripheral neuropathy, rash/desquam, anemia, bone marrow supp, neutropenia, Cat D, increased bleeding in GI system, respiratory system, brain
Trametinib MoA
oral reversible MEK inhibitor
Trametinib used in pts with
BRAF V600E/K mutations
Trametinib AE
skin toxicity, dermatitis, erythema, hand-foot, diarrhea, stomatitis, anemia, decreased ejection fraction, HTN, hemorrhage, rare cardiomyopathy, interstitial lung disease, retinal pigment epithelial detachment
Vemurafenib MoA
oral inhibitor of mutated BRAF, genotype required for mutation evaluation
AE Vemurafenib
PGP and CYP interactions possible, elevated serum creatinine, QT prolongation, photosens, cutaneous SCC in 1/4 pts, SJS possible, uveitis, iritis, retinal vein occlusion
Monitor in Vemurafenib use
LFT, skin, ECG and electrolytes, eyes
Vemurafenib is Category
D
Sorafenib is Category
D
Trametinib is Category
D
Ald, ipi, and interferon A are category
C
MC AE in Vemurafenib
arthralgia, fatigue, rash, photosens, alopecia, N/D
Diclofenac
tx actinic keratosis, PGE2 inhibitor. AE: rash, itch, dry skin, peeling, redness
Trichloroacetic acid
tx actinic keratosis. chemical peel. AE: burning, inflammation, local tenderness