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
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
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
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
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
6
Q
Propranolol
A
reduce sympathetic CNS stimulation
Tx: hyperhidrosis
7
Q
Clonidine
A
reduce sympathetic CNS
Tx: hyperhidrosis
8
Q
Diltiazem
A
Ca channel involved in secretion process
Tx: hyperhidrosis
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)
10
Q
dabrafenib
A
kinase inhibitor: BRAF (WT, V600E/K/D)
Tx: melanoma
11
Q
diclofenac
A
topical chemical peel NSAIDs: PG inhibition unknown mechanism for actinic keratosis Tx: actinic keratosis AE: local skin
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)
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
14
Q
ipilimumuab
A
checkpoint inhibitor
CTLA4 inhibitor
Tx: melanoma
15
Q
nivolumab
A
checkpoint inhibitor
PD-1 inhibitor
Tx: melanoma
16
Q
pemolizumab
A
checkpoint inhibitor
PD-2 inhibitor
Tx: melanoma
17
Q
sorafenib
A
kinase inhibitor
Tx: melanoma
AE: HTN
18
Q
trametinib
A
kinase inhibitor: MEK1/2
Tx: melanoma
19
Q
trichloroacetic acid
A
chemical peel
Tx: actinic keratosis
AE: localized SKIN (brun, inflammation, tender)
20
Q
vemurafenib
A
kinase inhibitor: BRAF (V600E)
Tx: melanoma
21
Q
vismodegib
A
HH pathway: SMO inhibitor
Tx: basal cell carcinoma
AE: intrauterine fetal death, TERATOGEN, ALOPECIA, GI
need contraception
22
Q
hedgehog inhibitors
A
TERATOGEN
23
Q
What type of skin cancer has no targeted therapies?
A
squamous cell
24
Q
IL-2 receptor
A
differentiation and proliferation of T cells (b cells, monocytes, macrophages, CTLs)
25
CTLA4
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
26
PD-1/2
negative regulator of T cells: regulate inflammatory response by effector T cell
induces anergic state in T cells
27
Kinase inhibitors
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
28
MAPK/BRAF inhibitor resistance
different pathways
change in target
mutation downstream
29
cinoxate
sunscreen: chemical
| UVB
30
Para-aminobenzoic acid (PABA)
sunscreen: chemical
| UVB
31
trolamine
sunscreen: chemical
| UVB
32
dioxybenzone
sunscreen: chemical
| UVB, UVA2
33
oxybenzone
sunscreen: chemical
| UVB, UVA2
34
avobenzone
sunscreen: chemical
| all UVA
35
UVA
```
320-400 nm
UVA1: 340-400
UVA2: 320-340
penetrates deep into skin to reach dermis
indirect damage:
```
36
UVB
290-320 nm
direct DNA damage by linking pyrimidine bases
indirect damage:
37
titanium dioxide
sunscreen: inorganic physical
all UVA, UVB
micronized: does not provide UVA1
38
zinc dioxide
sunscreen: inorganic physical
| all UVA, UVB
39
SPF
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
40
Can sunscreen be labeled waterproof?
no
| water resistant only (maintains protection after 40-80 min of water immersion)
41
broadspectrum sunscreen
UVA and UVB protection
| long extension of wavelengths covered
42
acyclovir
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
43
ganciclovir
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
44
cidofovir
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
45
valacyclovir
oral
prodrug for acyclovir
Tx: VZV, HHV-8 (in vitro)
46
famciclovir
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
47
valganciclovir
oral
prodrug for ganciclovir
Tx: HHV-6/8 (actual HHV-8 infection)
48
foscarnet
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
49
amorolfine
```
topical only
inhibits ergosterol synthesis
Tx: fungal
AE: hypersensitivity
CI: PREGNANCY
```
50
ciclopirox
topical only
blocks fungal transmembrane transport, depleting essential substrates: interferes with RNA and DNA synthesis
Tx: fungal
AE: hypersensitive
51
naftifine
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
52
fluconazole
crosses BBB
renal elimination
Tx: fungal
53
posaconazole
Tx: fungal
54
griseofulvin
```
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
```
55
terbinafine
```
inhibits squalene epoxidase
hepatic metabolism/renal elimination
Tx: fungal
monitor: CBC, LFT
can use in pregnancy
AE: blood dyscrasia
CI: immunosuppressed
```
56
itraconazole
Tx: fungal
AE: QT prolongation
57
voriconazole
Tx: fungal
58
imidazole class
```
-AZOLE
inhibit 1,4-alpha-demethylase
CYP3A4 substrate, inhibits CYPs
hepatic elimination
Tx: fungal
CI: PREGNANCY
AE: hepatotoxic
```
59
cefazolin
```
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
```
60
ceftaroline fosamil
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
61
cephalexin
```
PO
1st generation: beta lactamase resistant
binds PBP: block cell wall cross linking
Tx: staph, strep
adjust in renal failure
AE: HYPERSENSITIVITY, SJS
```
62
clindamycin
IV, IM
50s ribosomal inhibitor
Tx: uncomplicated skin infection if PCN allergy, CA-MRSA
AE: C-difficile infection, jaundice, SJS
63
daptomycin
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
dicloxacillin
```
PO
binds PBP: block cell wall cross linking
beta lactamase resistant
Tx: uncomplicated skin infection
AE: HYPERSENSITIVITY, interstitial NEPHRITIS
```
65
doxycycline
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
imipenem
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
linezolid
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
meropenem
```
IV
binds PBP: cell wall synthesis inhibitor
Tx: added Rx polymicrobial MRSA
AE: seizure
adjust in renal failure
monitor: BUN/Cr
```
69
minocycline
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
nafcillin
```
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
oxacillin
```
PO
binds PBP: block cell wall cross linking
beta lactamase resistant
Tx: uncomplicated skin infection
AE: HYPERSENSITIVITY, interstitial NEPHRITIS
```
72
piperacillin
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
trimethoprim/sulfamethoxazole
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
vancomycin
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
dapsone
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
rifampin
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
clofazimine
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
thalidomide
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
acitretin
Tx: psoriasis
80
tazorotene
retinoid
| Tx: psoriasis, acne
81
adalimumab
```
biologic
SC: rotate injection site
TNF-a Ab
Tx: psoriasis
AE: malignancy, CHF, hypotension /angina/ arrhythmia, LUPUS
```
82
alefacept
biologic
IM: rotate site
LFA-3/IgG1 fusion protein: binds CD2 and prevents T cell activation/ promotes apoptosis
Tx: psoriasis
83
efalizumab
Tx: psoriasis
84
etanercept
```
biologic
SC: rotate site
false TNF-a receptor linked to IgG Fc
Tx: psoriasis
AE: malignancy, LUPUS
```
85
infliximab
```
biologic
IV
TNF-a Ab
Tx: psoriasis
AE: malignancy, CHF, hypotension /angina/ arrhythmia, LUPUS
CI: HEART FAILURE
```
86
ustekinumab
biologic
IL-12, IL-23 Ab
Tx: psoriasis
87
calcipotriene
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
calcitriol
active form of Vit. D3
similar to calcipotriene
Tx: psoriasis in sensitive areas of skin
89
adapalene
retinoid
| Tx: acne
90
isotretinoin
retinoid
decrease sebaceous gland size
Tx: acne
AE: DEPRESSION
91
tretinoin, ATRA for acne
retinoid
| Tx: acne
92
benzoyl peroxide
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
salicylic acid
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
hydrocortisone
mild corticosteroid
| Tx: acne
95
betamethasone valerate
moderate corticosteroid
| Tx: acne
96
budesonide
potent corticosteroid
| Tx: acne
97
clobetasol proprionate
very potent corticosteroid
| Tx: acne
98
malathion
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
permethrin
```
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
ivermectin
topical: 10 min, oral for Onchocerca volvulus
binds glutamate receptors gating chloride
Tx: lice
chemical insecticide: hyper stimulation and paralysis
GABA agonist
101
dimethicone
mechanical insecticide: lubricate hair to remove nits and lice and physically occlude respiratory system
Tx: lice
less toxic and less resistance
102
eflornithine
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
minoxidil
```
topical
unknown mechanism
potent oral vasodilator: Tx HTN
hair growth: must continue for maintenance
Tx: baldness
AE only in compromised skin integrity
```
104
finasteride
```
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
hydroquinone
melanin synthesis inhibitor
inhibits oxidation of tyrosine to DOPA
Tx:relief of skin darkening
106
fluocinolone
corticosteroid
melanin synthesis inhibitor
Tx: relief of skin darkening
107
tretinoin for skin color
melanin synthesis inhibitor: increased keratinocyte shedding decreases epidermal melanin content
Tx: relief of skin darkening
AE: photosensitive
108
methoxsalen
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
hedgehog signaling
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
basal cell carcinoma Tx
localized: topical 5-FU and imiquimod
| advanced, metastatic: no standard, vismodegib
111
squamous cell carcinoma Tx
initial: surgery, radiation, no drugs
metastatic: no standard, cisplatin
112
melanoma Tx
immunotherapy: aldesleukin, IFNa, ipilimumab, nivolumab, pembrolizumab
TKIs: dabrafenib, sorafenib, trametinib, vemurafenib
chemo: dacarbazine, lomustine, carmustine (platinum, vincas, taxanes)
113
checkpoint inhibitor AE
DERMATITIS: toxic epidermal necrolysis
BBW: endocrinopathies, diarrhea, peripheral neuropathy, rash
CI in PREGNANCY
CTLA-4 inhibitor highest frequency of events
114
actinic keratosis Tx
```
topicals
5-FU
imiquimod
diclofenac
trichloroacetic acid
```
115
FDA regulations on sunscreen
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
eccrine sweat glands
post ganglionic sympathetic
ACh on muscarinic M2, generalized effect
feet, forehead, palms cheeks
117
atropine
cross BBB
| Tx: hyperhidrosis
118
scalp cooling
vasoconstriction leading to decreased drug delivery to scalp
AE: preservation of scalp micr-metastases
Tx: alopecia following chemo
119
cream
oil in water
| less greasy, less effective
120
gel
solid until agitated
| can act as reservoirs
121
lotion
diluted cream
122
ointment
best drug delivery
| provides barrier
123
solution
typically alcoholic
| don't coat hair
124
lacquer
finger/toe nails and adjacent skin
125
foam
quickly dissolves with minimal residue
126
powder
easy to use
less effective
use for prophylaxis
127
ketoconazole
Tx: fungal, prostate CA
higher doses: inhibits aldosterone, cortisol, testosterone
AE: impotence, menstrual irregularity, gynecomastia, hot flashes, QT prolongation
128
flucytosine
inhibits nucleic acid synthesis
| Tx: fungal infection
129
air alle
hair dryer for lice
| dehydrate lice
130
apocrine sweat glands
post ganglionic sympathetic
alpha-1 localized effect
catecholamines
axilla, groin
131
How do cholinergics increase secretion?
increase intracellular Ca levels activating water and chloride/potassium loss and cell shrinks
132
clarithromycin
inhibit 50s ribosomal sub-unit
Tx: leprosy
CI: pregnancy
133
ofloxacin
inhibits bacterial DNA gyrase
Tx: leprosy
CI: pregnancy
134
corticosteroids
Tx: leprosy
135
leprosy Tx
treatment is prolonged (1-2 years; MB greater duration than PB) and requires more than one drug
136
fluoroquinolones and MRSA
don't use to treat MRSA
| resistance common and increasing in both nosocomial and CA
137
MMR vaccine
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
Tri-luma
combines flucinolone, hydroquinone, and tretinoin
Tx: relief of skin darkening
AE: photosensitive
139
Location of hair stem cells
bulge
| not affected by chemotherapy
140
chemotherapy induced alopecia
Bcl-2, Bax, p53 mediated
depends on drug, dose, intensity, route
complete within 2-3 months
141
What should be monitored in a patient being treated for leprosy?
dapsone, rifampin, clofazimine
monitor: CBC, LFT, platelets
others on first visit: Ca, BUN, creatinine, bilirubin, G6PD
142
Type 1 reaction to TB therapy
red patchy skin lesions, erythema, swollen hands/feet, joint pain
Tx: corticosteroids
143
Type 2 reaction to TB therapy
sudden eruption of numerous, painful nodules; neuritis
| Tx: steroids, clofazimine, thalidomide
144
Tx of uncomplicated non-MRSA for soft tissue infections
dicloxacillin, cephalexin, cefazolin, nafcillin, oxacillin, clindamycin, vancomycin
145
Tx of CA-MRSA for soft tissue infection
```
trimethoprim/ sulfamethoxazole
minocycline
doxycycline
clindamyacin
linezolid
```
146
Tx of serious MRSA for soft tissue infection
vancomycin
linezolid
daptomycin
147
Tx of polymicrobial infections (possibly involving MRSA) for soft tissue infection
```
add MRSA drug to broad spectrum drug
piperacillin/tazobactam
imipenem-cilastatin
meropenem
ceftaroline fosamil
```
148
PCN allergy
R1 side chain
IgE mediated: urticaria, angioedema, bronchospasm, anaphylaxis
includes: 1st and 2nd gen. cephalosporins
149
serotonin syndrome
linezolid, psychotropic drugs, St. Johns Wort, Ginseng
| mental status change, autonomic hyperactivity, NM abnormalities
150
apremilast
biologic
PO
PDE4 inhibitor: increases cAMP
Tx: psoriasis
151
biological agents for psoriasis
AE: IMMUNOSUPPRESSION: infections, MALIGNANCY
CI: INFECTION, live vaccines
152
retinoids
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
When do you want retinoids to target RAR vs. RXR?
RAR: skin (psoriasis, acne); mucocutaneous and musculoskeletal
RXR: mycosis fungoides, Kaposi sarcoma; physiochemical changes
154
topical retinoids
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
topical corticosteroids
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
salicylate intoxication
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
