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Pharm Flashcards

1
Q

Aluminum chloride

A

topical antiperspirant: occludes eccrine and apocrine gland ducts
combines with keratin to produce fibrillar contraction
Tx: FIRST LINE hyperhidrosis
AE: irritation to broken skin

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2
Q

Botulinum toxin

A

injection: muscular paralysis
prevents vesicular and cell membrane fusion: SNARE cleavage
drug endocytosed
heavy chain binds cell membrane, light chain cleaves SNAP25
blocks release of painneuropeptides
Tx: hyperhidrosis
SECOND line
sprouting occurs: renews coupling between nerve and muscle
AE: systemic: respiratory arrest and death, anticholinergic effects, allergy to albumin

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3
Q

Glycopyrrolate

A

systemic antimuscarinic
Tx: hyperhidrosis
doesn’t cross BBB
AE: constipation, urinary retention, mydriasis, blurred vision, bronchiole dilation, tachycardia, decrease glandular secretion, restless, confusion, delirium, hallucinations

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4
Q

Oxybutynin

A

systemic antimuscarinic
cross BBB
Tx: hyperhidrosis
AE: constipation, urinary retention, mydriasis, blurred vision, bronchiole dilation, tachycardia, decrease glandular secretion, restless, confusion, delirium, hallucinations, SEDATION, DELIRIUM

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5
Q

Propantheline

A

systemic antimuscarinic
Tx: hyperhidrosis
doesn’t cross BBB
AE: constipation, urinary retention, mydriasis, blurred vision, bronchiole dilation, tachycardia, decrease glandular secretion, restless, confusion, delirium, hallucinations, DELIRIUM, SEDATION

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6
Q

Propranolol

A

reduce sympathetic CNS stimulation

Tx: hyperhidrosis

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7
Q

Clonidine

A

reduce sympathetic CNS

Tx: hyperhidrosis

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8
Q

Diltiazem

A

Ca channel involved in secretion process

Tx: hyperhidrosis

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9
Q

aldesleukin

A

IV, SC
IL-2 receptor stimulator
Tx: melanoma
CI: BBW CNS, BBW CARDIAC, BBW PULMONARY, BBW RENAL (CAPILLARY LEAK syndrome), hepatic, organ transplant
monitor: xray, thallium stress test (cardiac and pulm function)

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10
Q

dabrafenib

A

kinase inhibitor: BRAF (WT, V600E/K/D)

Tx: melanoma

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11
Q

diclofenac

A 
topical
chemical peel
NSAIDs: PG inhibition
unknown mechanism for actinic keratosis
Tx: actinic keratosis
AE: local skin
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12
Q

imiquimod

A

topical
activates TLR7/8 (Th1 response), adenosine receptor inhibitor, NFkB activation, negative GLI modulation (repress HH signaling)
Tx: basal cell carcinoma, actinic keratosis, HPV
CI: weakens physical barrier contraception protection
AE: photosensitivity, skin irritation (benzoyl alcohol, paraben)

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13
Q

interferon-alpha

A

IV, SC
activate CD8, NK to lyse tumor (perforin, granzyme, FasL)
Tx: melanoma
Caution in BBW: AUTOIMMUNE, CARDIAC, DEPRESSION
AE: flu-like, PULMONARY, BLOOD DYSCRASIA
monitor: xray, LFT, CBC, ECG

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14
Q

ipilimumuab

A

checkpoint inhibitor
CTLA4 inhibitor
Tx: melanoma

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15
Q

nivolumab

A

checkpoint inhibitor
PD-1 inhibitor
Tx: melanoma

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16
Q

pemolizumab

A

checkpoint inhibitor
PD-2 inhibitor
Tx: melanoma

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17
Q

sorafenib

A

kinase inhibitor
Tx: melanoma
AE: HTN

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18
Q

trametinib

A

kinase inhibitor: MEK1/2

Tx: melanoma

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19
Q

trichloroacetic acid

A

chemical peel
Tx: actinic keratosis
AE: localized SKIN (brun, inflammation, tender)

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20
Q

vemurafenib

A

kinase inhibitor: BRAF (V600E)

Tx: melanoma

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21
Q

vismodegib

A

HH pathway: SMO inhibitor
Tx: basal cell carcinoma
AE: intrauterine fetal death, TERATOGEN, ALOPECIA, GI
need contraception

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22
Q

hedgehog inhibitors

A

TERATOGEN

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23
Q

What type of skin cancer has no targeted therapies?

A

squamous cell

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24
Q

IL-2 receptor

A

differentiation and proliferation of T cells (b cells, monocytes, macrophages, CTLs)

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25
Q

CTLA4

A

negative regulator of T cell at initial T cell activation
binds CD80 and CD86 decreases the ability of CD80/86 to bind CD28
not on surface of: naive or memory T cells
maintains consistent level of T cells: after TCR encounters antigen CTLA is transported to surface (from vesicles): more stimulation means more CTLA4

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26
Q

PD-1/2

A

negative regulator of T cells: regulate inflammatory response by effector T cell
induces anergic state in T cells

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27
Q

Kinase inhibitors

A

oral
need genotype
potential teratogen
AE: SKIN, VASCULAR, HEART (QT prolongation), RENAL, EYE I
other: fatigue, GI, endocrine, heme, hepatic, cough, musculoskeletal, edema
avoid in PREGNANCY

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28
Q

MAPK/BRAF inhibitor resistance

A

different pathways
change in target
mutation downstream

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29
Q

cinoxate

A

sunscreen: chemical

UVB

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30
Q

Para-aminobenzoic acid (PABA)

A

sunscreen: chemical

UVB

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31
Q

trolamine

A

sunscreen: chemical

UVB

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32
Q

dioxybenzone

A

sunscreen: chemical

UVB, UVA2

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33
Q

oxybenzone

A

sunscreen: chemical

UVB, UVA2

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34
Q

avobenzone

A

sunscreen: chemical

all UVA

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35
Q

UVA

A 
320-400 nm
UVA1: 340-400
UVA2: 320-340
penetrates deep into skin to reach dermis
indirect damage:
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36
Q

UVB

A

290-320 nm
direct DNA damage by linking pyrimidine bases
indirect damage:

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37
Q

titanium dioxide

A

sunscreen: inorganic physical
all UVA, UVB
micronized: does not provide UVA1

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38
Q

zinc dioxide

A

sunscreen: inorganic physical

all UVA, UVB

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39
Q

SPF

A

ability of sunscreen to protect skin from sunburn (UVB exposure)
NOT related to duration of exposure
UVB protection is not linear
FDA max: 50+ SPF for sunscreen

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40
Q

Can sunscreen be labeled waterproof?

A

no

water resistant only (maintains protection after 40-80 min of water immersion)

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41
Q

broadspectrum sunscreen

A

UVA and UVB protection

long extension of wavelengths covered

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42
Q

acyclovir

A

guanosine analog: inhibits viral DNA polymerase
monophosphorylated by viral thymidine kinase; triphosphate by host
virus lacks: 3’ OH
Tx: VZV
AE: cross hypersensitivity, SEIZURES (neurotoxic)
renal elimination: adjust does in renal disease

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43
Q

ganciclovir

A

guanosine analog
monophosphorylated by viral thymidine kinase; triphosphate by host
virus does not lack 3’ OH
Tx: HHV-6/7/8; actual HHV infection
AE: cross hypersensitivity, BLOOD DYSCRASIA, TERATOGEN
renal elimination: adjust does in renal disease
CI: immunosuppression be careful

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44
Q

cidofovir

A

cytosine analog: DNA polymerase inhibitor
Tx: Pox, HHV-6/7/8 (in vitro)
AE: NEPHROTOXIC
monitor: creatinine, probenecid hypersensitivity (reduce renal toxicity)
renal elimination: adjust does in renal disease

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45
Q

valacyclovir

A

oral
prodrug for acyclovir
Tx: VZV, HHV-8 (in vitro)

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46
Q

famciclovir

A

guanosine analog: inhibits viral DNA polymerase
monophosphorylated by viral thymidine kinase; triphosphate by host
Tx: VZV, HHV-8 (in vitro)
AE: cross hypersensitivity, no significant issues
renal elimination: adjust does in renal disease

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47
Q

valganciclovir

A

oral
prodrug for ganciclovir
Tx: HHV-6/8 (actual HHV-8 infection)

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48
Q

foscarnet

A

pyrophosphate binding site
DNA polymerase inhibitor; blocks chain elongation
Tx: HHV-6
AE: electrolytes imbalance, chelates Ca ions
renal elimination: adjust does in renal disease

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49
Q

amorolfine

A 
topical only
inhibits ergosterol synthesis
Tx: fungal
AE: hypersensitivity
CI: PREGNANCY
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50
Q

ciclopirox

A

topical only
blocks fungal transmembrane transport, depleting essential substrates: interferes with RNA and DNA synthesis
Tx: fungal
AE: hypersensitive

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51
Q

naftifine

A

squalene 2,3 epoxidase inhibitor
locally bactericidal
Tx: fungal
anti-inflammatory: inhibit PG, LT, histamin: vasoconstriction
don’t combine with azole: diminishes effect
AE: hypersensitivity

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52
Q

fluconazole

A

crosses BBB
renal elimination
Tx: fungal

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53
Q

posaconazole

A

Tx: fungal

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54
Q

griseofulvin

A 
oral, NO topical (can't penetrate)
interferes with microtubule function, disrupts mitosis
elimination: hepatic (also renal, sweat)
CYP3A4 inducer
Tx: fungal
CI: PENICILLIN allergy, PREGNANCY
AE: photosensitive, porphyria
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55
Q

terbinafine

A 
inhibits squalene epoxidase
hepatic metabolism/renal elimination 
Tx: fungal
monitor: CBC, LFT
can use in pregnancy
AE: blood dyscrasia
CI: immunosuppressed
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56
Q

itraconazole

A

Tx: fungal
AE: QT prolongation

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57
Q

voriconazole

A

Tx: fungal

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58
Q

imidazole class

A 
-AZOLE
inhibit 1,4-alpha-demethylase
CYP3A4 substrate, inhibits CYPs
hepatic elimination
Tx: fungal
CI: PREGNANCY
AE: hepatotoxic
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59
Q

cefazolin

A 
IV/IM
1st generation: beta lactamase resistant
binds PBP: block cell wall cross linking
Tx: uncomplicated skin infection
adjust in renal failure
AE: HYPERSENSITIVITY, SJS, eosinophilia
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60
Q

ceftaroline fosamil

A

5th generation
IV
binds PBPs
Tx: staph, strep; added Rx polymicrobial MRSA (when P. aeruginosa and anaerobic bacteria unlikely)
AE: constipation, hypokalemia, phlebitis, C. difficile, ELEVATED LFT, BLOOD DYSCRASIA
adjust in renal failure
monitor: CBC

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61
Q

cephalexin

A 
PO
1st generation: beta lactamase resistant
binds PBP: block cell wall cross linking
Tx: staph, strep
adjust in renal failure
AE: HYPERSENSITIVITY, SJS
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62
Q

clindamycin

A

IV, IM
50s ribosomal inhibitor
Tx: uncomplicated skin infection if PCN allergy, CA-MRSA
AE: C-difficile infection, jaundice, SJS

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63
Q

daptomycin

A

IV
depolarizes membrane: inhibits DNA/RNA/protein synthesis
Tx: serious MRSA
CI: lung infection (inactivated by surfactant)
AE: RHABDOMYOLYSIS, RENAL, throat pain
adjust in renal failure
monitor: serum CK

64
Q

dicloxacillin

A 
PO
binds PBP: block cell wall cross linking
beta lactamase resistant
Tx: uncomplicated skin infection
AE: HYPERSENSITIVITY, interstitial NEPHRITIS
65
Q

doxycycline

A

oral, IV
bind 30s ribosomal subunit: inhibit binding of aminoacyl-tRNA
Tx: staph, strep, CA-MRSA
AE: photosensitive, TERATOGEN, DISCOLORED TEETH, LIVER, ataxia, tinnitus, vertigo
adjust in renal failure

66
Q

imipenem

A

IV
binds PBP: cell wall synthesis inhibitor
Tx: added Rx polymicrobial MRSA
CILASTATIN (inhibits renal dihydropeptidase I: prevents metabolism)
AE: seizure
adjust in renal failure
monitor: BUN/Cr

67
Q

linezolid

A

PO, IV
binds 23s of 50s ribosomal sub-unit: prevent initiation complex
Tx: CA-MRSA (oral), serious MRSA, unknown skin infection
usually well tolerated
AE: PERIPHERAL and OPTIC NEUROPATHY (mitochondrial dysfunction), VISION LOSS (reversible), SEROTONIN SYNDROME, SEIZURES, SJS, HTN, MYELOSUPPRESSION, lactic acidosis
caution in renal failure

68
Q

meropenem

A 
IV
binds PBP: cell wall synthesis inhibitor 
Tx: added Rx polymicrobial MRSA
AE: seizure
adjust in renal failure
monitor: BUN/Cr
69
Q

minocycline

A

PO, IV
FIRST LINE leprosy
inhibits 30s ribosomal sub-unit: inhibit binding of tRNA
Tx: staph and strep, leprosy, CA-MRSA (oral)
AE: photosensitive, TERATOGEN, DISCOLORED TEETH, LIVER, ataxia, tinnitus, vertigo
adjust dose in renal failure

70
Q

nafcillin

A 
IV
binds PBP: block cell wall cross linking
beta lactamase resistant
Tx: uncomplicated skin infection
AE: HYPERSENSITIVITY, interstitial NEPHRITIS, hypokalemia, elevated LFTs
adjust in renal and hepatic dysfunction
71
Q

oxacillin

A 
PO
binds PBP: block cell wall cross linking
beta lactamase resistant
Tx: uncomplicated skin infection
AE: HYPERSENSITIVITY, interstitial NEPHRITIS
72
Q

piperacillin

A

IV
binds PBP: cell wall synthesis inhibitor
Tx: added Rx polymicrobial MRSA
with TAZOBACTAM (Beta-lactamase inhibitor)
AE: HYPERSENSITIVITY, SJS, blood dyscrasia, C. difficile
monitor: BUN/Cr

73
Q

trimethoprim/sulfamethoxazole

A

PO/IV
synergistic folate inhibitors: no THF means no thymidine for nucleic acids
T: dihydrofolate reductase inhibitor
S: PABA analog, dihydropteroate synthase inhibitor
Tx: CA-MRSA (oral)
AE: photosensitive, TERATOGEN

74
Q

vancomycin

A

IV, oral only for GI
binds D-Ala-D-Ala: blocks cell wall synthesis
Tx: uncomplicated skin infection in PCN allergy, serious MRSA
AE: RED MAN SYNDROME: thrombophlebitis (histamine, hypotension), OTOTOXIC, NEPHROTOXIC
adjust dose in renal failure

75
Q

dapsone

A

FIRST LINE leprosy
folate inhibitor
inhibits neutrophil chemotaxis
toxic, inactive metabolites: hydroxylamine
Tx: leprosy, acne, dermatitis
AE: HEMOLYSIS, METHEMOGLOBINEMIA (blue lips and nails), LIVER, SJS, maculopapular rash: upper limbs/forehead, peripheral neuropathy, hypoalbuminemia, psychosis, leukopenia, agranulocytosis
CI: G-6-PD deficiency
DI effects on dapsone: rifampicin (increase toxicity), GI hyperacidity drugs (cimetidine, omeprazole; decreased toxicity decreased metabolic activity), trimethoprim (increase serum levels)
decreased renal function: leads to accumulation
probenecid decreases clearance

76
Q

rifampin

A

FIRST LINE
inhibits bacterial/mycobacterial DNA-dependent RNA polymerase
CYP INDUCER
AE: RED secretions, LIVER, difficult to manage DM, HEMOLYSIS
hepatic metabolism
crosses BBB, placenta, breast milk
Tx: leprosy

77
Q

clofazimine

A

binds mycobacterial guanine and cytosine (these are increased in mycobacteria vs. humans) in DNA
lipophilic: persist in fat
Tx: leprosy
AE: IMMUNOSUPPRESSION, RED to BROWN/BLACK skin (and in suckling infants)/fluids/feces (confused with GI bleed), dry skin, DEPRESSION (secondary to skin discoloration), LIVER
monitor: LFT

78
Q

thalidomide

A

inhbits NfkB mediated transcription and TNF-a production
blocks leukocyte migration
AE: TERATOGEN, increase HIV viral load, somnolence, rash, peripheral neuropathy
Tx: leprosy, myeloma

79
Q

acitretin

A

Tx: psoriasis

80
Q

tazorotene

A

retinoid

Tx: psoriasis, acne

81
Q

adalimumab

A 
biologic
SC: rotate injection site
TNF-a Ab
Tx: psoriasis
AE: malignancy, CHF, hypotension /angina/ arrhythmia, LUPUS
82
Q

alefacept

A

biologic
IM: rotate site
LFA-3/IgG1 fusion protein: binds CD2 and prevents T cell activation/ promotes apoptosis
Tx: psoriasis

83
Q

efalizumab

A

Tx: psoriasis

84
Q

etanercept

A 
biologic
SC: rotate site
false TNF-a receptor linked to IgG Fc
Tx: psoriasis
AE: malignancy, LUPUS
85
Q

infliximab

A 
biologic
IV
TNF-a Ab
Tx: psoriasis
AE: malignancy, CHF, hypotension /angina/ arrhythmia, LUPUS
CI: HEART FAILURE
86
Q

ustekinumab

A

biologic
IL-12, IL-23 Ab
Tx: psoriasis

87
Q

calcipotriene

A

topical
binds Vit. D receptor: associates with RXR-a and binds DNA Vit. D response elements
Tx: psoriasis
AE: skin irritation (Tx with steroids), HYPERCALCEMIA, HYPERCALCIURIA, increased susceptibility to UV induced SKIN CA

88
Q

calcitriol

A

active form of Vit. D3
similar to calcipotriene
Tx: psoriasis in sensitive areas of skin

89
Q

adapalene

A

retinoid

Tx: acne

90
Q

isotretinoin

A

retinoid
decrease sebaceous gland size
Tx: acne
AE: DEPRESSION

91
Q

tretinoin, ATRA for acne

A

retinoid

Tx: acne

92
Q

benzoyl peroxide

A

topical
free radicals: kill P. acnes, reduce lipids; keratolytic (drying and desquamation)
epithelial cell proliferation, production of granulation tissue
Tx: acne, decubitus ulcers
can be formulated with clindamycin/erythromycin/adapalene
AE: dry skin, contact dermatitis (Tx with steroid or cool compress)
BLEACH hair/clothes
avoid mucous membranes/eyes

93
Q

salicylic acid

A

topical
keratolytic: desquamation of horny layer
Tx: acne, warts, psoriasis, callus, corn
AE: irritation, if systemic: salicylism in people with renal/hepatic dysfunction, neonatal toxicity via breast milk if applied to chest

94
Q

hydrocortisone

A

mild corticosteroid

Tx: acne

95
Q

betamethasone valerate

A

moderate corticosteroid

Tx: acne

96
Q

budesonide

A

potent corticosteroid

Tx: acne

97
Q

clobetasol proprionate

A

very potent corticosteroid

Tx: acne

98
Q

malathion

A

topical: 8-12 hr
acetylcholinesterase inhibition
chemical insecticide: hyperstimulation and paralysis
Tx: lice
AE if ingested: diarrhea, cramps, rinorrhea, wheeze, bradycardia, hypotension, confusion/convulsions
Tx ingestion: atropine/2-PAM

99
Q

permethrin

A 
topical: 10 min
inhibits voltage gated Na channels
chemical insecticide: hyperstimulation and paralysis
Tx: lice, ticks/fleas on dogs
toxic to cats and aquatic life
100
Q

ivermectin

A

topical: 10 min, oral for Onchocerca volvulus
binds glutamate receptors gating chloride
Tx: lice
chemical insecticide: hyper stimulation and paralysis
GABA agonist

101
Q

dimethicone

A

mechanical insecticide: lubricate hair to remove nits and lice and physically occlude respiratory system
Tx: lice
less toxic and less resistance

102
Q

eflornithine

A

topical
takes 6-8 weeks to see results
ornithine decarboxylase inhibitor: decreases cell differentiation and division
hair remover
Tx: unwanted female facial hair, African sleeping sickness (trypanostatic)
do not apply around eyes or mucous membranes

103
Q

minoxidil

A 
topical
unknown mechanism
potent oral vasodilator: Tx HTN
hair growth: must continue for maintenance
Tx: baldness
AE only in compromised skin integrity
104
Q

finasteride

A 
oral
5-alpha-reductase inhibitor: inhibits 5alpha-dihydro-testosterone production
hair growth
Tx: baldness, BPH
CI: caution with Sa Palmetto (for BPH)
AE: sexual dysfunction, infertility
105
Q

hydroquinone

A

melanin synthesis inhibitor
inhibits oxidation of tyrosine to DOPA
Tx:relief of skin darkening

106
Q

fluocinolone

A

corticosteroid
melanin synthesis inhibitor
Tx: relief of skin darkening

107
Q

tretinoin for skin color

A

melanin synthesis inhibitor: increased keratinocyte shedding decreases epidermal melanin content
Tx: relief of skin darkening
AE: photosensitive

108
Q

methoxsalen

A

oral, topical
melanocyte repopulization in epidermis from hair follicle
pigementing agent
requires UV activation: DNA cross-linking and cell death
Tx: vitiligo, psoriasis, cutaneous T cell lymphoma, alopecia areta, inflammatory dermatoses, eczema, lichen planus

109
Q

hedgehog signaling

A

basal cell carcinoma, medulloblastomas, rhabdomyosarcomas
Hh - PTCH1 - SMO - sufu -gli
inhibitors must act at or below SMO (smoothened)
blocking PTCH1 is ineffective: too high up

110
Q

basal cell carcinoma Tx

A

localized: topical 5-FU and imiquimod

advanced, metastatic: no standard, vismodegib

111
Q

squamous cell carcinoma Tx

A

initial: surgery, radiation, no drugs
metastatic: no standard, cisplatin

112
Q

melanoma Tx

A

immunotherapy: aldesleukin, IFNa, ipilimumab, nivolumab, pembrolizumab
TKIs: dabrafenib, sorafenib, trametinib, vemurafenib
chemo: dacarbazine, lomustine, carmustine (platinum, vincas, taxanes)

113
Q

checkpoint inhibitor AE

A

DERMATITIS: toxic epidermal necrolysis
BBW: endocrinopathies, diarrhea, peripheral neuropathy, rash
CI in PREGNANCY
CTLA-4 inhibitor highest frequency of events

114
Q

actinic keratosis Tx

A 
topicals
5-FU
imiquimod
diclofenac
trichloroacetic acid
115
Q

FDA regulations on sunscreen

A
  1. max SPF: 50+
  2. UVB, UVA: broad spectrum
  3. broadspecturm SPF at least 15: can say reduce risk of skin aging and CA if used as directed and with other sun protection
  4. bans use of: sunblock, waterproof, sweat proof, instant protection, claim that they can go more than 2 hours without reapplication
116
Q

eccrine sweat glands

A

post ganglionic sympathetic
ACh on muscarinic M2, generalized effect
feet, forehead, palms cheeks

117
Q

atropine

A

cross BBB

Tx: hyperhidrosis

118
Q

scalp cooling

A

vasoconstriction leading to decreased drug delivery to scalp
AE: preservation of scalp micr-metastases
Tx: alopecia following chemo

119
Q

cream

A

oil in water

less greasy, less effective

120
Q

gel

A

solid until agitated

can act as reservoirs

121
Q

lotion

A

diluted cream

122
Q

ointment

A

best drug delivery

provides barrier

123
Q

solution

A

typically alcoholic

don’t coat hair

124
Q

lacquer

A

finger/toe nails and adjacent skin

125
Q

foam

A

quickly dissolves with minimal residue

126
Q

powder

A

easy to use
less effective
use for prophylaxis

127
Q

ketoconazole

A

Tx: fungal, prostate CA
higher doses: inhibits aldosterone, cortisol, testosterone
AE: impotence, menstrual irregularity, gynecomastia, hot flashes, QT prolongation

128
Q

flucytosine

A

inhibits nucleic acid synthesis

Tx: fungal infection

129
Q

air alle

A

hair dryer for lice

dehydrate lice

130
Q

apocrine sweat glands

A

post ganglionic sympathetic
alpha-1 localized effect
catecholamines
axilla, groin

131
Q

How do cholinergics increase secretion?

A

increase intracellular Ca levels activating water and chloride/potassium loss and cell shrinks

132
Q

clarithromycin

A

inhibit 50s ribosomal sub-unit
Tx: leprosy
CI: pregnancy

133
Q

ofloxacin

A

inhibits bacterial DNA gyrase
Tx: leprosy
CI: pregnancy

134
Q

corticosteroids

A

Tx: leprosy

135
Q

leprosy Tx

A

treatment is prolonged (1-2 years; MB greater duration than PB) and requires more than one drug

136
Q

fluoroquinolones and MRSA

A

don’t use to treat MRSA

resistance common and increasing in both nosocomial and CA

137
Q

MMR vaccine

A
  1. hypersensitivity more likely in combined formulation
  2. won’t work in immunosuppressed
  3. TB skin test problems with people that just got it (suppresses response)
  4. NO AUTISM (probably)
138
Q

Tri-luma

A

combines flucinolone, hydroquinone, and tretinoin
Tx: relief of skin darkening
AE: photosensitive

139
Q

Location of hair stem cells

A

bulge

not affected by chemotherapy

140
Q

chemotherapy induced alopecia

A

Bcl-2, Bax, p53 mediated
depends on drug, dose, intensity, route
complete within 2-3 months

141
Q

What should be monitored in a patient being treated for leprosy?

A

dapsone, rifampin, clofazimine
monitor: CBC, LFT, platelets
others on first visit: Ca, BUN, creatinine, bilirubin, G6PD

142
Q

Type 1 reaction to TB therapy

A

red patchy skin lesions, erythema, swollen hands/feet, joint pain
Tx: corticosteroids

143
Q

Type 2 reaction to TB therapy

A

sudden eruption of numerous, painful nodules; neuritis

Tx: steroids, clofazimine, thalidomide

144
Q

Tx of uncomplicated non-MRSA for soft tissue infections

A

dicloxacillin, cephalexin, cefazolin, nafcillin, oxacillin, clindamycin, vancomycin

145
Q

Tx of CA-MRSA for soft tissue infection

A 
trimethoprim/ sulfamethoxazole
minocycline
doxycycline
clindamyacin
linezolid
146
Q

Tx of serious MRSA for soft tissue infection

A

vancomycin
linezolid
daptomycin

147
Q

Tx of polymicrobial infections (possibly involving MRSA) for soft tissue infection

A 
add MRSA drug to broad spectrum drug
piperacillin/tazobactam
imipenem-cilastatin
meropenem
ceftaroline fosamil
148
Q

PCN allergy

A

R1 side chain
IgE mediated: urticaria, angioedema, bronchospasm, anaphylaxis
includes: 1st and 2nd gen. cephalosporins

149
Q

serotonin syndrome

A

linezolid, psychotropic drugs, St. Johns Wort, Ginseng

mental status change, autonomic hyperactivity, NM abnormalities

150
Q

apremilast

A

biologic
PO
PDE4 inhibitor: increases cAMP
Tx: psoriasis

151
Q

biological agents for psoriasis

A

AE: IMMUNOSUPPRESSION: infections, MALIGNANCY
CI: INFECTION, live vaccines

152
Q

retinoids

A

related to Vit. A
act on nuclear receptors affecting transcription: RXR/RAR: activates HB-EGF (heparin binding) and AR (amphiregulin)
modulate epithelial cell populations: proliferation of keratinocytes with flaking of stratum corneum, reduce sebum
Tx: psoriasis, acne, photoaging, pro-myelocytic leukemia
AE: TERATOGEN, Vit. A type toxicity: DRY skin/mucous membranes (nosebleed), conjunctivitis, reduced night vision, hair loss
monitor: serum lipids, transaminoases, CBC

153
Q

When do you want retinoids to target RAR vs. RXR?

A

RAR: skin (psoriasis, acne); mucocutaneous and musculoskeletal
RXR: mycosis fungoides, Kaposi sarcoma; physiochemical changes

154
Q

topical retinoids

A

FIRST LINE: comedonal acne
correct abnormal keratinization, reduce P. acnes and inflammation
Tx: acne, photoaging (inhibit MMPs in response to UV)
AE: erythema, desquamation, burning, stinging, SUNBURN

155
Q

topical corticosteroids

A

histone acetylation; binds GR and inhibits NFkB
anti-inflammatory, antipruritic, vasoconstriction
potency based on ability to produce cutaneous blanching
Tx: psoriasis, atopic dermatitis, seborrheic dermatitis, intertrigo
Tx of skin conditions varies by condition and location
penetration: genital > head > palm > forearm > sole
also have intralesional injection depot
AE: if become systemic: Cushing, growth retardation; do NOT apply fluorinated (increases potency) steroids to face: DERMATITIS (rosacea); DERMAL ATROPHY (cigarette paper), acne, alteration of cutaneous infection, hypo pigmentation, hypertrichosis, increased intraocular pressure, allergic contact dermatitis

156
Q

salicylate intoxication

A

tachycardia, TINNITUS, N/V, vasodilation, hyperventilation, dizzy, headache
severe: seizure, delirium, lethargy, resp. alkalosis, metabolic acidosis, GI bleed, hypotension, pulm/cardio edema, hypoglycemia, hyperpyrexia, RENAL and LIVER failure

Skin (8 decks)

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