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Module 4: Mali: Derm > pharm Derm chart > Flashcards

pharm Derm chart Flashcards

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1
Q

what is the drug class for bacitracin?

A

topical antibiotic

cell-wall inhibiting antibiotic

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2
Q

what is the MOA of bacitracin?

A

inhibits cell wall synthesis by interfering with the incorperation of peptidoglycan subunits in bacterial cell wall

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3
Q

what is the indication for bacitracin?

A

G+ skin or mucosal infections

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4
Q

does bacitracin have cross reactivity with other antibiotics?

A

nope!! lucky!!

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5
Q

what is bacitracin only used as a topical drug? what are the four locations it can be used in?

A

because it is NEPHROTOXIC SYSTEMICALLY….wayyyyy dangerous so can only be used on skin, mucous membrane, opthalic, and GI tract

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6
Q

what drug class is mupirocin [bactroban]?

A

topical antibiotic

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7
Q

what is the MOA of mupirocin [bactroban]?

A

reversibly binds to the tRNA synthase and inhibits bacterial protein synthesis

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8
Q

what are the indications for mupirocin [bactroban]? (3)

A

superficial G+ (including MRSA)
selected G-
impetigo

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9
Q

what type of veichle is mupirocin [bactroban]?

A

polyethylene glycol vechicle

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10
Q

where are the only two places you can use mupirocin [bactroban]

A

skin or nasal use

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11
Q

what are two reasons you wouldn’t use mupirocin [bactroban]?

A
  1. use on large areas of skin…don’t do it

2. renal failure pts because thats how it is cleared, so its toxic if the patient can’t clear it…duh

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12
Q

what is the drug class for polymixin B sulfate?

A

topical antibiotic

Polymixin antibiotic

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13
Q

what is the MOA for polymixin B sulfate?

A

interacts with the phospholipids and disrupts bacterial cell membrane

binds and inactivates endotoxins

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14
Q

what is the indication for polymixin B sulfate? what four bacteria does this target, which two are resistant?

A

superficial G- infections

  1. pseudomonas
  2. e. coli
  3. enterobacter
  4. klebsiella

Proteus and neisseria are resistance so you can’t use this to cover those!

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15
Q

what happens if polymixin B sulfate is systemically used?….even though it shouldn’t be because it says on the drug chart topical (5)

A

muscle weakness, apnea, parathesias, vertigo, slurred speech

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16
Q

what does polymixin B sulfate interact with?

A

aminoglycosides

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17
Q

what two body sytems is polymixin B sulfate toxic to?

A

neurotoxic and ototoxic if it is systemically absorbed

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18
Q

what is the max dose allowed daily for polymixin B sulfate?

A

200 mg in 24 hours…it causes a lot of toxicity so thats why you can’t use that much!

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19
Q

what drug class is nystatin?

A

oral/topical antifungal

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20
Q

what is the MOA of nystatin?

A

binds to sterols in the fungal cell membrane, increasing permability so it can be destroyed

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21
Q

what is the indication for nystatin?

A

topical skin and mucosal candida infections only

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22
Q

what are 3 side effects you worry about with nystatin?

A

bitter taste
contact dermatitis
sjs

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23
Q

what formulations does nystatin come in?

A 
tablets
suspension
cream
powder
troche formulations

minimal PO absorption

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24
Q

what is the drug class for ciclopirox olamine?

A

topical antifungal

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25
Q

what is the MOA of ciclopirox olamine?

A

inhibits the uptake of precursors of macromolecular synthesis inhibiting fungal cell membrane formations

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26
Q

what is the indication for ciclopirox olamine? (3)

A

dermaphytes
candida
p orbiculare

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27
Q

what are two SE of ciclopirox olamine?

A

headache

alopecia

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28
Q

what should you avoid when using ciclopirox olamine?

A

occlusive dressing

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29
Q

what are the two formulations of ciclopirox olamine and what do you use them for?

A
  1. 1% cream or lotion of dermatomycosis, candidiasis, tinea versicolor
  2. 8% solution (penlac nail lacquer) for onchymycosis
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30
Q

what is the drug class for fluconazole?

A

oral antifungal

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31
Q

what is the MOA of fluconazole?

A

alters permeability of fungal cell wall

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32
Q

what is the indication for fluconazole?

A

candida and dermophyte fungal infections

cyrptoccal meningitis

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33
Q

what are the SE of fluconazole?

A

seizures
increase cholesterol
chemical hepatitis
SJS

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34
Q

what drug does fluconazole interact with and what does this increase the risk for?

A
  1. HMG-CoA statins

increase risk for rhabdomyolysis

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35
Q

what is the halflife for fluconazole?

A

30 Hours

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36
Q

what fluconazole bound to? what percent?

A

10% protein bound

almost completely absorbed from the GI tract regardless of acidity or food

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37
Q

what is the fluconazole dose for candidal vaginitis?

A

150 mg dose

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38
Q

what is the drug class for terbinafine?

A

oral/topical antifungal

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39
Q

what is the MOA of terbinafine?

A

inhibits sterol synthesis and disrupts cell wall

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40
Q

what is the indication for oral and topical terbinafine?

A

oral: onchomycosis
topical: tinea pedis

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41
Q

what is the contraindications for terbinafine?

A

hepatic or renal dysfunction

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42
Q

what are the 3 drug interactions seen with terbinafine?

A

increases effects of tricyclic antidepressants (

decreases codeine effectiveness

cimetadine increases serum levels

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43
Q

what is the CrCl cut off for the use of oral terbinafine in patients?

A

don’t use if

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44
Q

how much of terbinafine is bioavaliable after the first pass effect?

A

40% after the first pass

so it basically loooses a ton because of the first pass

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45
Q

what percent of terbinafine is protein bound?

A

99%

so it accumulates in the skin, nails, and fat

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46
Q

what is the t1/2 for terbinafine

A

12 H but 200-400H with steady state levels

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47
Q

what is the drug class of acyclovir?

A

nucleoside anti viral

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48
Q

what is the MOA of acyclovir?

A

blocks herpes virus nucleic acid synthesis

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49
Q

what is the indication for acyclovir?

A 
HSV 1 +2
VZV
EMV
CMV
HHV
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50
Q

what are four side effects you are concerned about with acyclovir?

A
  1. nephritis
  2. temors,
  3. delerium
  4. seizures?
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51
Q

what drug interactions can you see with acyclovir? (3)

A

probenicid
cimetadine increase
decrease elimination of MTX

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52
Q

what does acyclovir only accumulate in virus infected cells?

A

requires viral kinase for activation so it can only accumulates in virus infected cells

40-100x higher concentration in virus infected cells than regular cells

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53
Q

how is acyclovir eliminated?

A

glomular and tubular elimination

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54
Q

how is acyclovir doses?

A

dependent on the individual virus

55
Q

what is the oral avaliability of acyclovir?

A

10-30% and decreases with increased dosing

56
Q

how long can you use acyclovir for to supress genial herpes?

A

10 years!

57
Q

how does acyclovir effect shedding and transmission?

A

90% decrease in shedding

50% decrease in transmission

58
Q

what is Valcyclovir?

A

is the the prodrug form of acyclovir, its more potent but more expensive

59
Q

what is the drug class for trentinoin?

A

Vitamin A or Retinoic Acid (topical agent)

60
Q

what is the MOA of trentinoin?

A

bind to RARs and RXRs to regulate gene expression and increase epidermal cell turnover

61
Q

what is the indication for trentinoin?

A

acne vulgaris

skin photoaging

62
Q

what is the SE of trentinoin?

A

pigmentation changes

potent teratogen

63
Q

what are the interactions with trentinoin?

A

astringents

abrasives

64
Q

what percent of topical trentinoin is absorbed systemically?

A

less than 10%

65
Q

what can trentinoin do in a patient with UV expsure?

A

cause tumors

66
Q

what should you advice a patient who is begining trentinoin?

A

it can make the acne look worse initially because of the increase in epidermal cell turnover and can take SEVERAL MONTHS TO GET DESIRED RESULTS

67
Q

what formulations does trentinoin come in?

A

topical solution
gel
cream
microsponge formulations

68
Q

what is the drug class for isotretinoin?

A

Retinoic acid (oral agent)

69
Q

what is the MOA of isotretinoin?

A

undefined to normalize keratinization sebaceous glands and inhibit sebaceous gland size and funtion

70
Q

what is the indication for isotretinoin?

A

refractory, severe cystic acne

71
Q

what are the SE of isotretinoin?

A

LITERALLY EVERYTHING

corneal opacitiies
arthalgia
lipid increase
abnormal menses
IBS
permature epiphyseal closure plus litterally every other complication known to man
72
Q

what is the drug class for adapaline?

A

retinoid-ike anti acne agent

73
Q

what is the MOA of adapaline?

A

retinoid like compound

modulator of cellular differentiation, keratinization, and inflammatory process

these are all part of the pathology of acne vulgaris so it interferes with al these

74
Q

what is the indication for adapaline?

A

mild to moderate acne

75
Q

what is the SE of adapaline?

A

sun exspsure, irritation of the skin

76
Q

what type of skin should you not used adapaline on?

A

broken, abraded, suburned skin

dermatitic skin

77
Q

what are the drug interaction of adapaline?

A

vitamins A, D, E, K can AMPLIFY photosensitization effect

78
Q

what can you combine adapaline with to make it more effective?

A

use topically alone or can combine with benzyl peroxide

79
Q

what is the drug class for benzyl peroixide?

A

Benzoic Acid, Topical agent

80
Q

what is the MOA of benzyl peroxide?

A

undefined but may be antimicrobial activity against P acnes

can cause peeing and comedolytic activity

81
Q

what is the indication for benzyl peroxide?

A

acne vulgaris

82
Q

what is a SE of benzyl peroxide?

A

oxidant, can bleach hair and fabrics)

83
Q

what percent of benzyl peroxide is absorbed topically?

A
84
Q

what should be your starting concentration of benzyl peroixide?

A

2.5% starting and escalate if helpful!!!

Dont get it in your eyes or mucous membranes it will STING SO BAD!!!

85
Q

what are the efficacy for the TOPICAL STEROIDS:

triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

A

triamcinolone acetonide .25%=INTERMEDIATE
triamcinolone acetonide .50%=HIGH
colbetasol proprionate=HIGHEST

86
Q

what are the MOA of
triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

A

Attaches to the GR receptor and inhibits protein synthesis

87
Q

triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

what do you use steroids for?

A

antiinflammatory

duh, since they are all steroids

88
Q

what are the SE of the topical steroids:
triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

8 THINGS!!

A 
striae
fat distribution
skin atrophy
hyperglycemia
HTZ
myopathy
cataracts
behavioral disturbances

AKA PRETTY MUCH EVERYTHING.

89
Q

triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

what two conditions should you avoid using these in?

A

don’t use if the patient has gastric ulcers or osteoporosis

just don’t do it

90
Q

what are the two drugs that the topical steroids can interact with:
triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

A

NSAIDS
immunosuppressants

think about it, the topical steroids make a person more apt to get an infection, so you def don’t wanna give it to them if they are already on immunosuppressants.

91
Q

what are the four things you want to monitor with long term use of topical steroids:
triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

A

lipid levels
glucose
CrCL
and the response….duh, is it working?

92
Q

how are the topical steroids metabolized and excreted:
triamcinolone acetonide .25%
triamcinolone acetonide .50%
colbetasol proprionate

A

hepatic metabolism

renally excreted

93
Q

what do you not want to use the two stronger topical steroids with?
triamcinolone acetonide .50%
colbetasol proprionate

A

an occlusive dressing!!…make the likely hood you will have side effects worse and with all the side effects of steroids…YOU DON’T WANT THIS!!

94
Q

what is the drug class for calcipotriene?

A

psoriasis drug, topical vitamin D

95
Q

what is the MOA of calcipotriene?

A

regulates skin cell production/proliferation

96
Q

what is the indications for calcipotriene?

A

moderately severe plaque psoriasis

97
Q

what are two things caused by calcipotriene?

A

hyperpigmentation, hypercalcemia

98
Q

what are contras for calcipotriene?

A

hypercalcemia (this drug makes it worse)

Vit D toxicity (since this is vitamin D, duh)

99
Q

when should you expect to see improvement when using calcipotriene? when is the max improvement seen?

A

2 weeks=see improvement

8 weeks=max improvement

100
Q

what percent of patients see local clearing when using calcipotriene?

A

10% see local clearing

101
Q

what is the drug class of sulfasalazine?

A

Sulfonamide (Folate antagonist)

102
Q

what is the MOA of sulfasalazine?

A

undefined local impact and systemic impact of decreasing prostaglandin and other cytokines

103
Q

what is the indications for sulfasalazine? (5)

A
  1. psoriasis
  2. psoriatic arthritis
  3. RA
  4. ulcerative colitis
  5. chrohns disease
104
Q

what are the contraindications for sulfasalazine? (2)

A

hepatic imparitment!!

if in the sun it can cause hemolytic anemia!!! woah

105
Q

when should you not take sulfasalazine?

A

if you gave had the varicella vaccine, these increase the concentration of sulfasalazine

106
Q

how is sulfasalazine metabolized and excreted?

A

hepatic metab and renal elimination

107
Q

what is the drug class for methotrexate?

A

psoriasis drug oral Folate Antagonist

108
Q

what is the MOA of methotrexate?

A

DHFR inhibitior which inhibits proliferation and induces apoptosis of immune inflammatory cells

109
Q

what is the indication for methotrexate?

A

RA and psoriasis

110
Q

what is are the SE seen with methotrexate?

A 
vasculitis
alopecia
hepatic fibrosis
bone marrow suppression
pulmonary fibrosis!
111
Q

what patients do you not use methotrexate in?

A
  1. other folate drugs
  2. renal or hepatic impairment
  3. alcoholic cirrohsis
112
Q

what drugs should you not take with methotrexate?

A

anti folate drugs

113
Q

what does methotrexate do at protein binding sites?

A

it competes at the protein binding sites and can increases MTX serum concentration with bone marrow suppression

114
Q

methotrexate is a …….

A

tetragen, don’t use in PG or nursing!!

115
Q

what drug class is hydroxyurea?

A

psoriasis drug, antimetabolite

116
Q

what is the MOA of hydroxyurea?

A

undefined interference with DNA synthesis

117
Q

what is the indication for hydroxyurea?

A

psoriasis

118
Q

what are the side effects of hydroxyurea? (5)

A
  1. drowsiness
  2. vasculitis
  3. hepatotoxicity
  4. periphreal neuropathy
  5. PULMONARY FIBROSIS
119
Q

what do you not want to use hydroxyurea in?

A

hyperuricemia

hepatic or renal impairment

120
Q

when do you not want to take hydroxyurea?

A

IF YOU HAVE HAD A VACCINE….just like methotrexate

121
Q

hydroxyurea is a ……..

A

TETRAGEN…..therefore you don’t use it in nursing or pregnancy….just like methotrexate

122
Q

what is the drug class for etanercept?

A

psoriasis drug
Biological response modifier
TNF alpha, beta blocker

123
Q

what is the MOA of etanercept?

A

blocks TNF alpha receptor

binding thereby inhibiting TH1 activity

124
Q

what is the indication for etanercept? (3)

A

refractory psoriasis unresponsive to all other modalities

psoriatic arthritis

ankolosing spondylitis

125
Q

what are the SE of etanercept? (4)

A

URIs
reduced ability to fight off infection
CHF exacerbation
DEMYLINATING DISORDERS

126
Q

what are the contraindications for etanercept? (4 thingssssss)

A
  1. TB
  2. HIV
  3. Hepatitis B
  4. CHF
127
Q

what do you want to monitor for someone who is on etanercept? (2)

A

IPPD

LFTS

128
Q

what is an important thin you need to do before prescribing someone etanercept?

A

PRETEST FOR TB, HIV, HEPATITIS, and CHF

need to know this because if you give them this drug, it can allow these to flurish and you can get exacerbation…then you can be sued. oh joy. DONT DO IT

129
Q

how is etanercept administered?

A

SQ 1-2x a week

130
Q

what is the drug class for permethrin?

A

antiparasitic agent

131
Q

what is the indications for permethrin?

A

5% cream: SCABIES

1% cream rinse: LICE

132
Q

what is the MOA of permethrin?

A

inhibits NA channel in parasitic cell membrane disrupting nerve transmission causing paralysis and death

133
Q

what does the permethrin cream contain?

A

formaldehyde!!!! CRAZY

Module 4: Mali: Derm (3 decks)

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