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PHARM 307 > PHARM 307 Final - Drugs > Flashcards

PHARM 307 Final - Drugs Flashcards

1
Q

Permethrin 1%

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

Synthetic pyrethroid indicated for treatment of head and pubic lice

  • Schedule II
  • Contraindications: Not for children
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2
Q

Pyrethrin with Piperonyl Butoxide

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

Insecticide from chrysanthemum indicated for treatment of head and pubic lice

  • Schedule II
  • Contraindications: Allergies to chrysanthemum, ragweed, and petroleum
  • Directions for use: Apply 25mL to DRY hair, leave in for 10 minutes and rinse, repeat in 7-10 days
  • Side effects: Mild irritation, potential contact dermatitis
  • Efficacy: Fairly effective with some ovicidal activity but may have cross-resistance with permethrin
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3
Q

Isopropyl myristate 50% w/w cyclomethicone 50%

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

Non-insecticide indicated for treatment of head lice

  • Schedule II
  • No contraindications but should not be used in children
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4
Q

Dimeticone 50%

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

Non-insecticide indicated for the treatment of head lice

  • Schedule II
  • No contraindications but should not be used in children
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5
Q

Permethrin 5%

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

Indicated for treatment of scabies

  • Schedule II
  • Contraindications are allergy to ragweed and chrysanthemum; not for use in children
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6
Q

Crotamiton 10% and Sulfur 5-10%

Indication

A

Second-line treatment for scabies infection

Sulfur can be used to treat children

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7
Q

Benzoyl Peroxide

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

First-line treatment for mild to moderate acne

  • OTC 5% or with topical antibiotic included
  • No contraindications
  • Directions for use: Apply to entire affected area, can taper up dose to decrease irritation (will have initial clinical worsening)
  • Side effects: Drying, peeling, erythema, burning, bleaching, odorous
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8
Q

Salicylic Acid

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

Treatment for mild to moderate acne, may be more effective for non-inflammatory

  • OTC (0.5-3.5%)
  • No contraindications
  • Directions for use: Apply to entire affected area, not just spot treatment
  • Side effects: Drying, burning, stinging, erythema, pruritus
  • Well-tolerated but less potent than equal strength BPO
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9
Q

Glycolic Acid

Indication
Schedule
Directions for use
Side effects
Efficacy
A

Treatment for mild to moderate acne, mildly comedolytic

  • OTC (2-15%)
  • Directions for use: Apply to entire affected area
  • Side effects: Burning, stinging, erythema
  • Less effective than BPO and salicylic acid
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10
Q

Topical Retinoids

Examples ( + potency)
Indication
Schedule
Contraindications
Directions for use
Side effects
Counselling points
A

Adapalene

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11
Q

Isotretinoin

Indication
Schedule
Contraindications
Directions for use
Side effects
Efficacy
Counseling points
A

Systemic retinoid used for nodulystic acne, scarring, forms of acne unresponsive to other treatments, psychological distress

  • Schedule I
  • Contraindications: Pregnancy, lactation, soy allergy, non-compliance with contraceptives (all are absolute contraindications); dyslipidemia, liver and kidney disease are relative contraindications; DO NOT take with minocycline
  • Directions for use: Take 1-2x daily with a high fat meal
  • Side effects: Dry skin and mucous membranes, hair loss, minor aches, photosensitivity
  • Will flare after 2 months, but will improve in 3 months
  • Moisturize/hydrate, avoid other acne topicals, avoid intense sun, wear sunscreen, avoid waxing
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12
Q

Topical Clindamycin (1%)

Indication
Schedule
Directions for use
Side effects

A

Used to decrease skin colonization of P. acnes

  • Schedule I
  • Directions for use: Apply to affected area 1-2x daily (may have combination product with BPO)
  • Side effects: Erythema, itching, peeling, dryness, burning
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13
Q

Oral antibiotics for acne

Indication
Examples
Schedule
Contraindications
Directions for use
Side effects
Efficacy
A

Used to target P. acnes

  • Tetracycline, minocycline, doxycycline
  • Schedule I
  • Contraindications: Pregnancy
  • Directions for use: Take 2 hours after milk or multivitamins
  • Side-effects: Stomach upset, photosensitivity, bacterial resistance
  • Can combine with BPO
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14
Q

Combined oral contraceptives for acne

A

Anti-androgen effect suppresses sebaceous gland activity

  • May not be official indication
  • Non-combination pills are NOT effective
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15
Q

Topical Metronidazole

Indication
Schedule
Directions for use
Side effects
Counseling points
A

Imidazole antibiotic used to decrease papules, pustules, and some erythema in rosacea

  • Schedule I
  • Directions for use: Apply 1-2x daily
  • Side effects: Local irritation
  • Will take 3 months for improvement, need to continue using product indefinitely
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16
Q

What are three Health Canada approved medications to treat rosacea?

A

Azelaic acid
Brimonidine (for rosacea without pustules and papules)
Ivermectin cream 1% (anti-parasitic - no risk of resistance)

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17
Q

What are four off-label use drugs to treat rosacea? (Topical and systemic)

A

Clindamycin 1% + BPO 5%
Topical retinoids
Topical calcineurin inhibitors
Isotretinoin

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18
Q

Systemic antibiotics for rosacea

A

Modulate inflammatory response

  • Tetracycline, doxycycline, minocycline
  • Use in mild to moderate rosacea that does not respond to other treatments or severe/recurrent rosacea
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19
Q

Zinc and antioxidant supplements

A

Used to delay progression in age-related macular degeneration
- Need to be used in combination to be effective

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20
Q

Ranibizumab, Bevacizumab, Aflibercept

Indication
Mechanism of Action

A

Treatment for wet macular degeneration

  • Directly injected into the eye to stop blood vessel growth
  • Bind and inhibit VEGF
  • Antibody therapy
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21
Q

Verteporfin

Indication
Contraindications
Use

A

Photosensitizer that accumulates in abnormal blood vessels, closing them when activated with non-thermal laser light

  • IV injection followed by irradiation with diode laser
  • Contraindications: Photosensitizing drugs; sunlight exposure (absolutely none)
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22
Q

Beta-adrenergic antagonists

Indication
Use/dosing
Contraindications
Side effects

A

Used in the treatment of POAG

  • Gold standard for POAG treatment, decrease aqueous humour production
  • BID dosing, or extended release
  • Contraindications: Interact with cardiac medications; not for use in asthma
  • Side effects: Decrease heart rate and blood pressure, bronchospasm
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23
Q

Prostaglandin analogues

Indication
Use/dosing
Side effects

A

Used in treatment of POAG

  • Increase aqueous humour outflow
  • Dose QHS
  • Side effects: FBS, burning, stinging, blurring; can change iris in green-brown/blue-brown eyes; can cause thickening of eyelashes
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24
Q

Adrenergic agonists

Indication
Dosing
Side effects
Interactions

A

Used in treatment of POAG

  • Increase outflow of aqueous humour and decrease production
  • Dose BID
  • Side effects: Mydriasis (pupil dilation), decrease blood pressure and heart rate, lethargy
  • Interactions with MAOI and alpha-2 selective drugs (CNS depressants, anti-HTN)
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25
Q

Carbonic anhydrase inhibitors (CAI)

Indication
Dose
Side effects

A

Used in treatment of POAG

  • Dose BID
  • Side effects: Burning, stinging, transient bitter taste
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26
Q

Cholinergic agents

Indication
Dose
Side effects

A

Used in treatment of POAG

  • Dose BID-QID; pilocarpine gel QHS (may need to increase concentration with dark eyes)
  • Side effects: Headache, myopia
27
Q

Cannabinoids

A

Should not be used in the treatment of POAG as they decrease perfusion to the optic disc and the patient remains at risk for losing vision

28
Q

How is acute angle closure glaucoma treated?

A

1) Pilocarpine 1-4% qtts q5mins 4-6 doses
2) Acetazolamide (250/500 PO or injectable)
3) Osmotic agents to rapidly decrease IOP and shift fluid
4) Surgery

29
Q

What sort of moisturizers should be used in xerosis?

A

Thick, bland moisturizers

  • Can use moisturizers with humectants (e.g., glycerin, urea, lactate, PG) as these can put water back into the skin
  • Lanolin-based creams are good moisturizers and emulsifiers
30
Q

Give an example of an ultra-high potency topical corticosteroid

A

Betamethasone dipropionate glycol

31
Q

Give an example of a high potency topical corticosteroid

A

Amcinonide, betamethasone dipropionate

32
Q

Give an example of a medium potency topical corticosteroid

A

Betamethasone valerate

33
Q

Give an example of a low potency topical corticosteroid

A

Hydrocortisone

34
Q

Ketoconazole 2%

Indication
Use/dose

A

Used for seborrheic dermatitis or dandruff

  • Apply to scalp and leave on for 5-10 minutes, rinse, and repeat if desired
  • Repeat at least 2x a week
35
Q

Selenium sulfide

A

Used for seborrheic dermatitis or dandruff

36
Q

Zinc pyrithione

A

Used in treatment of seborrheic dermatitis and dandruff

37
Q

Role of keratolytics in treatment of dandruff and seborrheid dermatitis (plus examples)

A

Remove scale associated with condition

- Salicylic acid, lactic acid, urea, propylene glycol

38
Q

Role of topical corticosteroids in seborrhea and alternatives to long term use of topical corticosteroids

A

Decrease acute flare inflammation, but should not be used for more than 1-3 weeks
- Can use topical calcineurin inhibitors (e.g., pinecrolimus, tacrolimus) for longer term therapy if topical CS are needed often

39
Q

What medications are used in severe psoriasis?

A

Infliximab, adalimunab, etanercept, ustekinumab, secukinumab (+/- mild to moderate treatment options)

40
Q

What medications are used in moderate psoriasis?

A

Phototherapy, methotrexate, cyclosporine, acitretin, apremilast (+/- mild treatment options)

41
Q

What medications are used in mild psoriasis?

A

Emollients, corticosteroids, vitamin D analogues, calcineurin inhibitors, retinoids, other (SA, coal tar, anthralin)

42
Q

What medications are known to cause flares in psoriasis?

A 
Lithium
Beta-blockers
Anti-malarials
Interferon
Indomethacin
Rapid tapering of CS
43
Q

Corticosteroids in the treatment of psoriasis

Dose/schedule
Side effects

A

Use lowest effective potency

  • QD is as good as BID
  • 2-3 weeks on, 1 week off
  • Side effects: Skin thinning, glaucoma with use around eye, secondary adrenal suppression
44
Q

Topical calcineurin inhibitor in psoriasis

Use/mechanism of action
Black box warning
Dose
Side effects

A

Topical calcineurin is a topical immunomodulator used when skin thinning with corticosteroids is an issue or when psoriasis is unresponsive to first line therapy

  • Prevents dephosphorylation of IL-2 genes which prevents production of IL-2 in T cells and decreases inflammation and T-cell activation
  • Black box warning: Potential risk of lymphoma, but there is very minimal evidence for this
  • Dose: Tacrolimus 0.03% >2 years, 0.1% > 16 years; pinecrolimus 1% >2 years
  • Mild side effects: Irritation, potential for secondary infection
45
Q

Calcipotriol

Indication
Mechanism of action
Side effects
*Contraindications

A

Vitamin D3 analogue used in the treatment of psoriasis

  • Topical
  • Effects differentiation of keratinocytes and immune system
  • Side effects: Irritation, hypercalcemia
  • *Contraindications: Pregnancy, lactation, kidney dysfunction, calcium metabolism abnormalities
  • May interfere with UV therapy therefore should not apply 2 hours before or immediately after
46
Q

Methotrexate

Indication
Mechanism of action
Route
Side effects and how to manage

A

Used in treatment of psoriasis

  • Inhibits dihydrofolate and ultimately works on DNA synthesis to decrease inflammatory T cell numbers
  • Oral or subcutaneous
  • Need folic acid supplements as these help manage side effects
  • Side effects: Dirty drug: Hepatotoxicity, pulmonary fibrosis, GI, pancytopenia, teratogenic, renal toxicity, etc.
  • Lots of drug interactions
  • Need to monitor blood work closely
47
Q

Cyclosporine

Indication
Mechanism of action
Route
Side effects
WHO warning
A

Used in treatment of psoriasis - can help bridge patients onto different medications as it helps in rapid clearance of acute flares

  • Inhibits calcineurin and therefore NFAT-1, leading to a decrease in IL-2 and therefore a decrease in T-cell proliferation
  • Oral
  • Side effects: Renal, HTN, tremor, paresthesia, hypertrichosis, myalgia, lethargy, etc.
  • Not for use longer than cumulative year due to renal toxicity (WHO)
48
Q

Apremilast

Indication
Mechanism of action
Route
Side effects

A

Used in treatment of psoriasis, cost effective

  • PDE4 inhibtor that prevents degradation of cAMP leading to promotion of cell differentiation and inhibition of proliferation of skin keratinocytes
  • Oral
  • Side effects: Nausea, vomiting, headache, weight loss, arrhythmia, possible depression (may need to weigh risks and benefits or use in certain populations, including pregnant)
49
Q

nbUVB 311nm

A

Used in treatment of psoriasis

  • Effective at clearing lesions, no increase in risk of carcinogenesis
  • Usually have 2-3 treatments/week, with maintenance thereafter on a q1-2 week basis
50
Q

Etanercept

Indication
Mechanism of action
Route of administration and dosing schedule
Side effects
Monitoring
A

Used in the treatment of moderate to severe psoriasis, psoriatic arthritis

  • Binds soluble TNF-alpha (key regulatory cytokine in Th1 response in psoriasis)
  • Subcutaneous injection 2x weekly for 3 months, then down to once weekly
  • Side effects: Allergy, onset of demyelinating disorders, lymphoma risk
  • Monitor and screen for TB
51
Q

Infliximab

Indication
Mechanism of action
Route of administration and dosing schedule
Side effects
Monitoring
A

Used in treatment of moderate to severe psoriasis, psoriatic arthritis

  • Binds to soluble and bound TNF-alpha
  • IV dose at week 0, 2, 6, followed by maintenance infusions every 8 weeks
  • Side effects: Hypersensitivity, infusion reaction, worsening CHF, infection, TB
  • Screen for TB
52
Q

Adalinumab

Indication
Mechanism of action
Route of administration and dosing schedule
Side effects
Monitoring
A

Used in treatment of psoriasis and psoriatic arthritis

  • Binds TNF and blocks its interaction with cell surface receptors
  • Subcutaneous injection every 2 weeks (decrease dose for maintenance therapy)
  • Side effects: Hypersensitivity, confusion, MS, parasthesia, infection, TB, malignancy
  • Screen for TB, CBCD, chemistry, anti-ds-DNA
53
Q

Ustekinumab

Indication
Mechanism of action
Route of administration and dosing schedule
Side effects
Monitoring
A

Used in treatment of psoriasis and psoriatic arthritis

  • Inhibits cytokines and body’s inflammatory response that leads to hyperproliferation
  • Dose at week 0 and 4, then once every 3 months
  • Side effects: Lymphopenia, malignancies, infection, allergy, lymphoma risk, demyelinating disorders
  • Screen for TB
54
Q

Sekukinumab

Indication
Mechanism of action
Route of administration and dosing schedule
Side effects
Monitoring
A

Used in treatment of psoriasis and psoriatic arthritis

  • Binds and inhibits IL-17A which is seen in increased levels in psoriatic plaques
  • Subcutaneous injection given at weeks 0, 1, 2, 3, 4; maintenance dose monthly thereafter (starting at week 8)
  • Side effects: Increase in infections, exacerbations of Crohn’s, hypersensitivity, decreased white blood cell count, diarrhea
  • Screen for TB
55
Q

Minoxidil 2%, 5%

Indication
Mechanism of action
Dose
Side effects

A

For use in non-scarring alopecia, mainly AGA

  • Foam spray used to increase the duration of anagen phase and enlarge follicles to terminal hairs
  • Apply 1mL to scalp BID and avoid shampoo for 4 hours after, will take several months to see an effect
  • Side effects: Irritant/allergic dermatitis, hypertrichosis, theoretical systemic absorption can cause tachycardia and heart palpitations (use caution and monitor BP and tachycardia)
56
Q

Finasteride

Indication
Mechanism of action
Contraindications
Route of administration
Side Effects
A

For use in non-scarring alopecia

  • Inhibits 5-alpha-reductase and therefore decreases DHT and hair loss
  • Pregnancy category X, very rarely recommended for use in women
  • Oral drug
  • Side effects: Decreased libido, decreased semen volume, erectile dysfunction
57
Q

What are the pharmacological options for scarring alopecia?

A
  • Topical/injectable steroids
  • Antibiotics
  • Antimalarials
  • Systemic retinoids
  • Systemic immunosuppressants
58
Q

What prescription treatments can be used for hyperhidrosis?

A

Anticholinergics and botulinum toxin

59
Q

What non-prescription treatments can be used for hyperhidrosis?

A

Antiperspirants (aluminum salts - e.g., aluminum chloride)

Deodorants (aluminum, zinc, potassium/aluminum alum)

60
Q

Treatment for impetigo

A

Topical antibiotics
Non-prescription = Polymixin B +/- Bacitracin +/- Gramicidin
(Mupirocin 2% or Fusidic acid 2%)
Prescription will be more effective
Use a warm compress to remove crusts and then apply 2-3x daily for 7-10 days

61
Q

Treatment for corns and calluses

A

Moisturize skin on feet - can use urea agents to remove dead skin cells
Salicylic acid 12-40% (soak foot, file away skin, apply treatment; repeat every 1-2 days)

62
Q

Treatment for plantar warts (non-prescription)

A

Salicylic acid, lactic acid

63
Q

What are prescription treatment options for plantar warts?

A
  • Oral cimetidine
  • Imiquimod (topical)
  • Podophyllin (topical)
  • Diphenylcyclopropenone (topical)
  • Cantharone (topical)

PHARM 307 (15 decks)

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