Pharm: Derm Flashcards
bacitracin
- antibacterial agent
MOA: inhibits cell wall synthesis
tx: gram positive organism a - i.e. strep and staph, and some anaerobes
mupirocin
- antibacterial agent
MOA: inhibits protein synthesis
tx: gram positive bacteria including MRSA
** tx for impetigo caused by S. aureus and B-hemolytic strep
polymyxin B sulfate
- antibacterial agent
MOA: binds phsopholipids and increases permeability of cell wall
** a main ingredient in neosporin
tx: gram negative organisms
Neomycin
- antibacterial agent
MOA: binds 30s
tx: gram negative organisms
gentamicin
- antibacterial agent
MOA: binds 30s
tx: gram negative
Clindamycin
- antibacterial agent for acne
MOA: binds to 50s
Note: activitity against P. acnes
Erythromycin
- antibacterial agent for acne
MOA: binds 50s
Metronidazole
- antibacterial agent for acne
MOA: interacts with DNA causing srang breakage
tx: acne roscea
NOTE: CI during pregnancy
Acyclovir/penciclovir
topical antiviral
MOA: converted to pharmacologically active triphosphate metabolites, inhibit DNA synthesis and viral replication
Topical – modest benefit for herpes labialis
Also used systemically for HSV and VZV infections
docosanol
topical antiviral
MOA: inhibits fusion between the plasma membrane and the HSV envelope, thereby preventing viral entry and replication
When applied within 12 hours of the onset of prodromal symptoms, five times daily, median healing time was shortened by 18 hours compared with placebo in recurrent orolabial herpes
ciclopirox olamine
Topical antifungal
MOA: inhibits uptake of precursors of macromolecule synthesis
Uses: topical dermatomycosis, candidiasis, tinea versicolor, mild-to-moderate onychomycosis
Allylamine - terbinafine
Topical antifungal
MOA: inhibits squalene epoxidase
Uses: tinea corporis, tinea cruris, and tinea pedis
butenafine
Topical antifungal
MOA: inhibits squalene epoxidase
Uses: tinea corporis, tinea cruris, and tinea pedis
nystatin
Topical antifungal
MOA: binds ergosterol in fungal cell membrane altering permeability
Nystatin limited to topical cutaneous and mucosal uses = Thrush
amphotericin B
Topical antifungal
MOA: binds ergosterol in fungal cell membrane altering permeability
Amphotericin B broad antifungal spectrum but rarely used topically
= Cumulative organ toxicity (ampho-terrible)
imiquimod
imunomodulator
MOA: may be related to stimulation of peripheral mononuclear cells to release interferon-α and macrophage stimulation to produce interleukins-1, -6, -8, and TNF-α
Uses: external genital and perianal warts in adults, actinic keratoses on the face and scalp, biopsy-proven primary basal cell carcinomas on the trunk, neck, and extremities (< 2 cm diameter)
ADRs: local inflammation, pruritus, erythema, superficial erosion
tacrolimus/pimecrolimus
imunomodulator
MOA: inhibit T-lymphocyte activation and prevent release of inflammatory cytokines and mediators from mast cells
Uses: treatment of atopic dermatitis and psoriasis
**traditionally used to prevent heart, liver, and kidney allograft rejection due to potent immunosuppressive activity (oral forms)
Topical ADRs: transient erythema, burning, and pruritus
retinoic acid, tretinoin
topical acne prep
= acid form of Vitamin A
MOA: may decrease cohesion b/w epidermal cells and increase cell turnover
AE: erythema, mild peeling, dryness, increased photosensitivity
adapalene
acne: topical retinoic acid derivative
MOA: may decrease cohesion b/w epidermal cells and increase cell turnover
- photochemically more stable and less irritating than tretinoin
used to tx mild-moderate acne vulgaris
tazarotene
acne: topical retinoic acid derivative
MOA: may decrease cohesion b/w epidermal cells and increase cell turnover
approved for psoriasis, acne and photoaging
NOTE: CI for pregnant women!
Isotretinoin
= accutane: oral retinoid
MOA: reduces sebacerous gland size, reduces sebum production
tx: severe cystic acne!
PK: t1/2 10-20 hours; hepatic metabolism; highly protein bound (99-100%)
ADRs: resemble hypervitaminosis A (dryness and itching)
DONT USE DURING PREGNANCY!
benzoyl peroxide
acne preparation
MOA: releases free-radical oxygen and oxidizes bacterial proteins in the sebaveous follicles
tx: p. acnes
acitretin
systemic psoriasis tx - retinoic acid derivative
* not as effective as other systemic therapies
tx: severe psoriasis
SE: similar to isotretinoin
CI: pregnant women
tazarotene
psoriasis tx
topical retinoid - extended response
calcipotriene
psoriasis tx
MOA: synthetic vitamin D3 analog
– as effective as topical glucocorticoids but slower onset; no long-term glucocorticoid adverse effects
cyclosporine
tx psoriasis
MOA: inhibits calcineurin and thus IL-2, IL-2 and blocks T cell activation
tx for psoriasis, RA, and transplants
ADRs: nephrotoxicity, hypertension, hepatotoxicity, gingival hyperplasia, and hirsutism
Used in extensive disease in patients who are unresponsive to other agents
TB must be ruled out prior !!
etanercept
TNF inhibitor: tx psoriasis
MOA: prevents TNF mediated immune responses
ADRs: risk of serious life-threatening infections (sepsis, pneumonia), exacerbation of congestive heart failure, and cause demyelinating disease in predisposed patients
TB must be ruled out prior !!
infliximab
TNF inhibitor: tx psoriasis
MOA: prevents TNF mediated immune responses
ADRs: risk of serious life-threatening infections (sepsis, pneumonia), exacerbation of congestive heart failure, and cause demyelinating disease in predisposed patients
TB must be ruled out prior !!
adalimumab
TNF inhibitor: tx psoriasis
MOA: prevents TNF mediated immune responses
ADRs: risk of serious life-threatening infections (sepsis, pneumonia), exacerbation of congestive heart failure, and cause demyelinating disease in predisposed patients
hydrocortisone
anti-inflamm: topical corticosteroid
tx: psoriasis, dermatitis
Low to medium efficacy produce remission in disorders responsive to corticosteroids: seborrheic dermatitis, psoriasis of genitalia and face
ADRs: suppression of pituitary-adrenal axis
Atrophy, steroid rosacea, steroid acne, allergic contact dermatitis
triamcinolone
anti-inflamm: topical corticosteroid
tx: psoriasis, dermatitis
ADRs: suppression of pituitary-adrenal axis
Atrophy, steroid rosacea, steroid acne, allergic contact dermatitis
acetonide
anti-inflamm: topical corticosteroid
tx: psoriasis, dermatitis
ADRs: suppression of pituitary-adrenal axis
Atrophy, steroid rosacea, steroid acne, allergic contact dermatitis
betamethasone
anti-inflamm: topical corticosteroid
tx: psoriasis, dermatitis
low efficacy : (betamethasone valerate)= produce remission in disorders responsive to corticosteroids: seborrheic dermatitis, psoriasis of genitalia and face
high efficacy: betamethasone dipropionate: useful in disorder less responsive to corticosteroids: psoriasis of palms and soles, sarcoidosis
ADRs: suppression of pituitary-adrenal axis
Atrophy, steroid rosacea, steroid acne, allergic contact dermatitis
salicyclic acid
keratolytic/ peeling agent
Uses: acne, seborrheic dermatitis, psoriasis, hyperkeratosis (corns, plantar warts, calluses); in combination with antifungal sodium thiosulfate for tinea versicolor
NOTE: can be destructive to tissues at concentrations greater than 6%
Salicylate toxicity can occur (nausea, vomiting, dizziness, loss of hearing, tinnitus, lethargy, diarrhea, psychic disturbances)
lower dose: used for acne
higher dose: used for warts
antihistamine
antipruritic agent
First generation H1-receptor antagonists
Diphenhydramine, promethazine
- Some anticholinergic activity, sedating, useful in nocturnal pruritus
Second generation H1-receptor antagonists
Cetirizine, loratadine, desloratadine, fexofenadine
- Do no cross blood-brain barrier, lack anticholinergic side effects, non-sedating
mioxidil
= rogaine: promotes hair growth
MOA: unknown
Originally developed as an antihypertensive (PO dosing)
Percutaneous absorption minimal but systemic effects on BP should be monitored in those with cardiac disease
finasteride
= propecia : promotes hair growth
- tx. alopecia and BPH
MOA: competitive and selective inhibitor of steroid 5α-reductase; blocks the conversion of testosterone to dihydrotestosterone (DHT)
ADRs: decreased libido, ejaculation disorders, erectile dysfunction
Pregnant women should not handle drug
rate of absorption
- concnetration gradient (c)
- partition coefficient (Km)
- diffusion through skin (d)
rate is indirectly proportional to the thickness of stratum cornea
J = C x Km x D/x
what do you use for acute inflammation with oozing, vesiculation and crusting?
tinctures, wet dressings, and lotions - these evaporate and take off the fluid
what to use for chronic inflamm. with xerosis, scaling and lichenification?
cremes and ointments
drying –> lubricating preparations
tinctures < wet dressings < lotions < gels < aerosols < powders < pastes < creams < ointments
what makes up neosporin?
bacitracin, polymyxin B, neomycin
tx approach for impetigo?
nonbullous impetigo: topical mupirocin therapy for 5 days
extensive impetigo with bullous formation: oral antimicrobials
-azoles
topical antigungal
MOA: inhibits synthesis of ergosterol (an essential component of fungal membranes)
Uses: tinea corporis (ring worm), tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea versicolor, and cutaneous candidiasis, such as vaginal yeast infections, infections of the skin, diaper rash, and thrush (candidiasis of the oral mucosa and tongue, and sometimes the palate, gingivae, and floor of the mouth)
tolnaftate
antifungal agent
MOA: unknown
Uses: tinea pedis, tinea cruris, and tinea corporis
tx of tinea capitis
itraconazole
tx of tinea pedis, cruris, corporis?
topical antifungals
tx of thrush?
oral nystatin, clomitazoe, or fluconazole
tx of esophageal candidiasis?
systemic antifungal
tx of vuvovaginalis?
topical antifungla, oral fluconazole
acne treatment approach?
Comedonal (non-inflammatory) acne:
- Topical retinoid
- Alternatives: azelaic acid, salicylic acid
Mild papulopustular and mixed acne:
- Topical retinoid AND topical antimicrobial (BPO alone or BPO +/- topical antibiotic)
Moderate papulopustular and mixed acne
- Topical retinoid AND oral antibiotic AND topical BPO
Moderate nodular acne
- Topical retinoid AND oral antibiotic AND topical BPO
Severe nodular/conglobate acne
- Oral isotretinoin
topical therapy for psoriasis?
Emollients – used as basic adjunct; reduces scaling, itching, and related discomfort
Keratolytics – reduce hyperkeratosis; enable other topical drugs to penetrate
Topical glucocorticoids – rapid response; control inflammation and itching; mainstay of topical treatment
Anthralin – used for widespread, refractory plaques
Calcipotriene – as effective as topical glucocorticoids but slower onset; no long-term glucocorticoid adverse effects
Tazarotene – extended response; maintenance therapy
