Pharm Derm part I Flashcards
what are the topical antibiotics used for acne
clindamycin
erythromycin
metronidazole
what are the topical antifungals
azoles ciclopirox olamine allylamines- terbinagine (lamisil) butenafine folnaftate nystatin and amphotericin B
what are the oral antifungals
azoles- ketoconazole, itraconazole, fluconazole, voriconazole
what are the topical antiviral agents
acyclovir, penciclovir, docosanol
what are the immunomodulators used for derm
imiquimod
tacrolimus and pimecrolimus
what are the specific acne preparations
retinoic acid and derivatives: retinoic acid, adapalene, tazarotene
isotretinoion (accutane)
benzoyls peroxide
what are the drugs used for psoriasis
acitretin, tazarotene, calcipotriene, cyclosprine
TNF inhbitors: etanercept, infliximab, adalimumab
what are the anti inflammatory agents used for derm
topical steroids: hydrocortisone, hydrocortisone valerate, triamcinolone, acetonide, betamethasone, others
what are the keratolytic and destructive agents used in derm
salicylic acid
fluorouracil
what drugs do we use for antipruritic
antihistamine
what drugs do we use for trichogenic and antitrichogenic
minoxidil(rogaine)
finasteride (propecia)
which layer of skin limits diffusion of compunds
stratum corneum
what areas of body are more permeable than the forearm
scrotum, face, axilla and scalp
what factor helps increase the amount of drug transfered through skin
increased [ ] will increase the [ ] gradient so more transferred
what allows for the once daily application of topical drugs
skin acts as reservoir for many drugs
what is an occlusive dressing
application of plastic wrap– holds drug in close contact with skin
3 routes which molecules can penetrate skin
intact stratum corneum (rate limit is percutaneous absorption)
sweat ducts
sebaceous follicles
steps for percutaneous absorption
make [ ] gradient (force for drug movement across skin)
partition coefficient: release of drug from vehicle
diffusion coefficient: drug diffusion across layers of skin
what are factors for rate of absorption
[ ] drug in vehicle, partition coefficient, diffusion coefficient, thickness of stratum corneum
preferable characteristics of topical drugs
low molecular mass
adequate solubility in oils/lipids and water
high lipid: water partition coefficient
what particles do not cross stratum corneum
water soluble ions and polar molecules
what are the vehicles used for topical medications in order of most to least ability to retard evaporation from surface skin
ointments, creams, paste, powders, aerosols, gels, lotions, wet dressings, tinctures
best vehicle for acute inflammation with oozing, vesiculation and crusting
drying preparations: tinctures, wet dressings and lotions
best vehicle for chronic inflammation with xerosis, scaling and lichenification
creams and ointments
transdermal patches are used for what
contraception, smoking cessation, hormone therapy, osteoporosis, hypogonadism, pain relief, motion sickness, local anesthesia and angina pectoris
methods to hydrate skin so drug absorbed more
occlusion with impermeable film, application of lipophilic occlusive vehicles like ointments and soaking dry skin before occlusion
difference of age when giving topical medications
children have greater SA than to mass ratio. so more systemic effects. decrease dose
what is intralesional administration and what is main reason not to use it
direct contact of drug with underlying pathologic process. eliminates first pass
watch out for systemic absorption
when do you use systemic administration of derm agents
systemic infections, yeast, fungus, bacteria or severe dermatological illness
MOA bactitracin and gramicidin
inhibit cell wall synthesis, bind phospholipids and increase permeability of cell wall
spectrum bacitracin and gramicidin
gram + and anaerobic cocci: neisseria, tetanus bacilli and diphteria bacilli
MOA mupirocin
inhbiits protein synthesis
spectrum mupirocin
gram + aerobic bacteria and MRSA
allowed for Tx impetigo
MOA polymyxin B sulfate
binds phospholipids and increases permeability of cell wall membrane
spectrum polymyxin B sulfate
gram - organisms: P aeruginosa, E coli, Enterobacter, Klebsiella
Polymyxin B sulfate toxicity
neurotoxicity and nephrotoxicity
MOA neomycin and gentamicin
irreversibly binds 30S subunit and inhibits protein synthesis
spectrum neomycin and genta
gram -
E coli, Enterobacter, Klebsiella, Proteus,
genta:
P aeruginosa, staphylococcie, group A beta-hemolytic strep
toxicity with neomycin and gentamicin
nephrotoxicity, neurotoxicity and ototoxicity if have renal failure since excreted primarily in urine
MOA clindamycin
inhibits protein synthesis binds 50S
works against P acnes
MOA erythromycin
inhibits protein synthesis. binds 50S
complications of using erythromycin for acne
R to staphylococci, need to discontinue and start systemic
MOA metronidazole
interacts with DNA resulting in strand breakage, anti inglammatory effects
uses of metronidazole for acne
acne rosacea
CI to metronidazole use for acne
during pregnancy or nursing because carcinogenic nature
MOA Na sulfacetamide
inhibit P acnes thorugh competetive inhibition and inhibits bacterial folic acid synthesis
CI Na sulfacetamide for acne
sensitivity to sulfonamides
