PHARM 307 Final - Drugs Flashcards
Permethrin 1%
Indication Schedule Contraindications Directions for use Side effects Efficacy
Synthetic pyrethroid indicated for treatment of head and pubic lice
- Schedule II
- Contraindications: Not for children
Pyrethrin with Piperonyl Butoxide
Indication Schedule Contraindications Directions for use Side effects Efficacy
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
Isopropyl myristate 50% w/w cyclomethicone 50%
Indication Schedule Contraindications Directions for use Side effects Efficacy
Non-insecticide indicated for treatment of head lice
- Schedule II
- No contraindications but should not be used in children
Dimeticone 50%
Indication Schedule Contraindications Directions for use Side effects Efficacy
Non-insecticide indicated for the treatment of head lice
- Schedule II
- No contraindications but should not be used in children
Permethrin 5%
Indication Schedule Contraindications Directions for use Side effects Efficacy
Indicated for treatment of scabies
- Schedule II
- Contraindications are allergy to ragweed and chrysanthemum; not for use in children
Crotamiton 10% and Sulfur 5-10%
Indication
Second-line treatment for scabies infection
Sulfur can be used to treat children
Benzoyl Peroxide
Indication Schedule Contraindications Directions for use Side effects Efficacy
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
Salicylic Acid
Indication Schedule Contraindications Directions for use Side effects Efficacy
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
Glycolic Acid
Indication Schedule Directions for use Side effects Efficacy
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
Topical Retinoids
Examples ( + potency) Indication Schedule Contraindications Directions for use Side effects Counselling points
Adapalene
Isotretinoin
Indication Schedule Contraindications Directions for use Side effects Efficacy Counseling points
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
Topical Clindamycin (1%)
Indication
Schedule
Directions for use
Side effects
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
Oral antibiotics for acne
Indication Examples Schedule Contraindications Directions for use Side effects Efficacy
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
Combined oral contraceptives for acne
Anti-androgen effect suppresses sebaceous gland activity
- May not be official indication
- Non-combination pills are NOT effective
Topical Metronidazole
Indication Schedule Directions for use Side effects Counseling points
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
What are three Health Canada approved medications to treat rosacea?
Azelaic acid
Brimonidine (for rosacea without pustules and papules)
Ivermectin cream 1% (anti-parasitic - no risk of resistance)
What are four off-label use drugs to treat rosacea? (Topical and systemic)
Clindamycin 1% + BPO 5%
Topical retinoids
Topical calcineurin inhibitors
Isotretinoin
Systemic antibiotics for rosacea
Modulate inflammatory response
- Tetracycline, doxycycline, minocycline
- Use in mild to moderate rosacea that does not respond to other treatments or severe/recurrent rosacea
Zinc and antioxidant supplements
Used to delay progression in age-related macular degeneration
- Need to be used in combination to be effective
Ranibizumab, Bevacizumab, Aflibercept
Indication
Mechanism of Action
Treatment for wet macular degeneration
- Directly injected into the eye to stop blood vessel growth
- Bind and inhibit VEGF
- Antibody therapy
Verteporfin
Indication
Contraindications
Use
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)
Beta-adrenergic antagonists
Indication
Use/dosing
Contraindications
Side effects
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
Prostaglandin analogues
Indication
Use/dosing
Side effects
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
Adrenergic agonists
Indication
Dosing
Side effects
Interactions
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)
Carbonic anhydrase inhibitors (CAI)
Indication
Dose
Side effects
Used in treatment of POAG
- Dose BID
- Side effects: Burning, stinging, transient bitter taste
Cholinergic agents
Indication
Dose
Side effects
Used in treatment of POAG
- Dose BID-QID; pilocarpine gel QHS (may need to increase concentration with dark eyes)
- Side effects: Headache, myopia
Cannabinoids
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
How is acute angle closure glaucoma treated?
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
What sort of moisturizers should be used in xerosis?
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
Give an example of an ultra-high potency topical corticosteroid
Betamethasone dipropionate glycol
Give an example of a high potency topical corticosteroid
Amcinonide, betamethasone dipropionate
Give an example of a medium potency topical corticosteroid
Betamethasone valerate
Give an example of a low potency topical corticosteroid
Hydrocortisone
Ketoconazole 2%
Indication
Use/dose
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
Selenium sulfide
Used for seborrheic dermatitis or dandruff
Zinc pyrithione
Used in treatment of seborrheic dermatitis and dandruff
Role of keratolytics in treatment of dandruff and seborrheid dermatitis (plus examples)
Remove scale associated with condition
- Salicylic acid, lactic acid, urea, propylene glycol
Role of topical corticosteroids in seborrhea and alternatives to long term use of topical corticosteroids
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
What medications are used in severe psoriasis?
Infliximab, adalimunab, etanercept, ustekinumab, secukinumab (+/- mild to moderate treatment options)
What medications are used in moderate psoriasis?
Phototherapy, methotrexate, cyclosporine, acitretin, apremilast (+/- mild treatment options)
What medications are used in mild psoriasis?
Emollients, corticosteroids, vitamin D analogues, calcineurin inhibitors, retinoids, other (SA, coal tar, anthralin)
What medications are known to cause flares in psoriasis?
Lithium Beta-blockers Anti-malarials Interferon Indomethacin Rapid tapering of CS
Corticosteroids in the treatment of psoriasis
Dose/schedule
Side effects
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
Topical calcineurin inhibitor in psoriasis
Use/mechanism of action
Black box warning
Dose
Side effects
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
Calcipotriol
Indication
Mechanism of action
Side effects
*Contraindications
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
Methotrexate
Indication
Mechanism of action
Route
Side effects and how to manage
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
Cyclosporine
Indication Mechanism of action Route Side effects WHO warning
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)
Apremilast
Indication
Mechanism of action
Route
Side effects
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)
nbUVB 311nm
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
Etanercept
Indication Mechanism of action Route of administration and dosing schedule Side effects Monitoring
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
Infliximab
Indication Mechanism of action Route of administration and dosing schedule Side effects Monitoring
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
Adalinumab
Indication Mechanism of action Route of administration and dosing schedule Side effects Monitoring
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
Ustekinumab
Indication Mechanism of action Route of administration and dosing schedule Side effects Monitoring
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
Sekukinumab
Indication Mechanism of action Route of administration and dosing schedule Side effects Monitoring
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
Minoxidil 2%, 5%
Indication
Mechanism of action
Dose
Side effects
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)
Finasteride
Indication Mechanism of action Contraindications Route of administration Side Effects
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
What are the pharmacological options for scarring alopecia?
- Topical/injectable steroids
- Antibiotics
- Antimalarials
- Systemic retinoids
- Systemic immunosuppressants
What prescription treatments can be used for hyperhidrosis?
Anticholinergics and botulinum toxin
What non-prescription treatments can be used for hyperhidrosis?
Antiperspirants (aluminum salts - e.g., aluminum chloride)
Deodorants (aluminum, zinc, potassium/aluminum alum)
Treatment for impetigo
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
Treatment for corns and calluses
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)
Treatment for plantar warts (non-prescription)
Salicylic acid, lactic acid
What are prescription treatment options for plantar warts?
- Oral cimetidine
- Imiquimod (topical)
- Podophyllin (topical)
- Diphenylcyclopropenone (topical)
- Cantharone (topical)
