Pharm Flashcards
What is first line for scalp and nail fungal infections? 2nd line?
First line scalp: griseofulvin, 2nd line is terbinafine(lamisil)
nails 1st line: lamisil (terbinafine), 2nd line is itraconazole (sporanox)
Griseofulvin:
- MOA
- administration directions
- what are the two formulations?
- CI
- Adverse rxns
- drug interactions
MOA: inhibits fungal cell division
Admin: take with fatty meal to increase absorption
Two formulations:
- microsize
- ultramicrosize
- the smaller the particle size the greater the bioavailability*
CI:
- liver failure
- porphyria
- pregnancy cat X
- Caution: PCN allergy andd breast feeding.
Rxnns:
-skin: photosensitivity, SJS, toxic epidermal necrolysis, erythema multiforme
- liver: jaundice, elevated LFT
- BM: granulocytopenia
- Neuro: dizziness, HA, fatigue
- GI: N/V
- drug induced lupus like syndrome
Drug interactions:
-beware of warfarin, oral contraceptives, alcohol, barbiturates, cyclosporine
Lamisil (Terbinafine)
- MOA
- SE
- formulations
- indications
MOA: creates ergesterol deficiency within the fungal cell wall leading to cell death
SE:
- HA, diarrhea, elevated LFTs
- smell/taste disturbances leading to wt loss
formulations:
- granules(sprinkle on food) and tablets
Indications:
- tinea capitis
- oncychomycosis
Itraconazole (Sporanox)
- indication
- BBW
- CI
- drug interactions
- Adverse effects
- dosing
indication: onychomycosis
BBW: negative inotropic effects have been observed following IV infusion. D/C if signs and sx of heart failure occur.
CI:
- ventricular dysfunction
- pregnancy
- CHF
Drug interactions:
- PPI
- anxiolytics
- pain meds
- basically there are a lot.
Adverse SE:
- Nausea, diarrhea
- edema
- HA, Rash
- abnormal LFTs
- heart failure
- arrhythmia
- hearing loss
Dosing:
-fixed dosage
-pulse therapy (
Take it for a week, off for 3 wks, then take for another week, then you’re done.)
5-alpha-reductase inhibitor
- drugs
- indications
- MOA
- how does this affect PSA?
- efficacy
- SE
- CI
Drug: Finasteride (Propecia)
*same as proscar but lower dose.
Indications:
-1st line for andogrenic alopecia in men.
MOA: inhibits conversion of testosterone to dihydrotestosterone
PSA: reduces this by 50%.
*if PSA did not change after 6mo of therapy then it may indicated increased risk of prostate CA.
Efficacy: after 2 years of therapy hair counts may be increased by 25%
SE:
- sexual dysfunction (decreased libido, ejaculatory/erectile dysfunction)
- gynecomastia
- orthostatic hypotension
- weakness
CI:
-women should avoid contact with crushed or broken tablets; teratogenic
What are the common abx used in derm?
Cephalexin (keflex)
Mupirocin (Bactroban)
Doxycycline, Minocycline(Minocin)
Clindamycin
Cephalexin:
- drug class
- bugs it covers
- MOA
- pregnancy cat
- use
Drug class: 1st gen cephalosporin, beta lactam abx
Bugs: staph and strep
MOA: inhibits bacterial cell wall synthesis
Pregnancy B
Use: skin and skin structure infections
Mupirocin (Bactroban)
- indications
- formulations
- MOA
indication: IMPETIGO!!! d/t S. aureus, and S. pyogenes, also secondarily infected skin lesions d/t staph or strep
Formulations: intranasal, topical cream or ointment
MOA: inhibit protein synthesis by binding to isoleucyl transfer-RNA synthetase
Tetracyclines:
- drugs
- MOA
- SE
- Preg Cat
drugs: doxy and minocycline
MOA: inhibit protein synthesis by binding with 30S subunit
SE: photosensitivity
pregnancy cat D
Doxycycline:
- formulations
- SE
- indications
formulations: oral tablets, capsules, delayed release capsules and suspension
- IV
SE:
- nausea on empty stomach
- esophagitis if not taken with fluids
indications:
- tickborn rickettsial infection
- acne
- rosacea
- 2nd line for animal/human bites, MRSA cellulitis, skin and soft tissue infections
Minocycline (Minocin)
- indications
- formulations
- SE
indications: acne, off-label for MRSA cellulitis
Formulation:
-capsule, tablet, IV
SE: vertigo, esophagitis if not taken with water, GI upset if taken on empty stomach
When treating acne what can we do to decrease abx resistance?
before abx therapy give benzoyl peroxide for 5day and continue during abx. If benzoyl peroxide is not an option can use topical retinoid.
Limit abx to 12-18wks
dont change therapy too quickly
dont give topical plus the same oral abx
Clindamycin
- formulations
- indications
- at risk of developing what?
formulations:
- oral
- topical: gel, lotion, foam, swabs
Indications: acne and rosacea
avoid oral tx for acne d/t risk of C diff.
Retinoic Acid Derivative:
- drugs
- indications
- MOA
Drugs: Isotrentioin aka:
- accutane
- amnesteem
- absorica
- myorisan
- zenatane
- claravis
Indications:
- severe recalcitrant, nodular acne
- acne with many inflamm nodules (greater than 5mm) that is unresponsive to conventional therapy
MOA:
- shrinks sebaceous glands
- decreases sebum production
- only acne medication that can permanently alter the natural course of the disorder.
Accutane:
- high risk of what? prevention?
- SE
- monitoring
High risk of birth defects
–prevention: 2 forms of birth control required to have started at least 1 mo prior to rx. 2 negative pregnancy tests prior to initial rx. Pregnancy test counseling once monthly
SE:
- Cheilitis (dry lips)
- dry skin/mucous membranes
- epistaxis
- desquamation
- photosensitivity
- pruiritus
- corneal abrasion
- cutaneous staphylococcal infections
- temporary alopecia or nail brittleness.
- depression
- hypertriglyceridemia
- elevated LDL and total cholesterol
Monitoring:
-CBC, fasting lipid profile, LFT, pregnancy test monthly
