Pharm: Dermatologic Pharmacology Flashcards
What are 2 benefits of using ointment vs. cream dermatologic drugs?
- Provide for more complete absorption of the active ingredient
- Are less likely to cause an allergic rxn than creams, which contain preservatives
Which is better for using on oozing/”wet” skin conditions, creams or ointments?
Creams
What is better for using on large areas, creams or ointments?
Creams: spread easily, are well-absorbed, and wash off with water
Refers to agents such as glycerin, lecithin and propylene glycol found in moisturizers to draw water into the outer layer of skin
Humectants
Broad-spectrum antimicrobial agent widely used in homes and hospitals due to efficacy on skin and oral mucosa with low irritability.
Chlorhexidine
Platelet-derived growth factor that promotes the cell proliferation and angiogenesis needed for diabetic ulcer repair; why must it be used cautiously?
- Becaplermin
- Use of >3 tubes ↑↑↑ risk of malignancy
To heal best, wounds should be kept clean and ____
Moist
Antifungal applied topically that penetrates into nails to treat fungal infection?
Efinaconazole
Active ingredient of vulvovaginal medications for candidiasis:
Clotrimazole or Miconazole
Refers to substances in moisturizers that form an oily layer to trap water in the skin; petrolatum, lanolin and mineral oil are among common examples.
Emollients
Name of the agents found in moisturizers that loosen bonds btw top layer of cells helping dead skin cells fall off, leaving skin feeling softer and smoother; common example?
- Horny substance (keratin) softners
- Urea, alpha hydroxy acids, and allantoin
Which type of radiation is the cause of skin aging and cancer?
UVA
Which chemical compound in sunscreen is active in UVA range and is particularly useful for conditions like drug-induced photosensitivity?
Dibenzoylmethanes
Control that is now considered a priority for optimal wound closure.
Glycemic control
Local vasoconstriction due to blood volume deficit, unrelieved pain, hypothermia, etc., can impair wound healing due to an inadequate amount of this in the tissue:
Oxygenation
Important component of wound healing, it conserves the local resources by limiting the need to synthesize proteases; stage when hydrogels are good wound covering.
Debridement
Which wound coverings are best for debridement, granulation, and epithelialization stages of wound healing?
- Hydrogels for debridement stage
- Foam and low-adherence dressings for granulation stage
- Hydrocolloid and low-adherence dressings for epithelialization stage
Aminoglycoside antibiotic of Neosporin with activity against gram-negative bacteria:
Neomycin
Peptide antibiotic with efficacy against gram-negative bacteria including pseudomonas has a detergent-like effect that damages the bacterial cell membrane:
Polymixin B
Peptide antibiotic with activity against gram-positive organisms and some anaerobes; only applied topically to limit systemic toxicity, often causes contact dermatitis:
Bacitracin
Imidazole antifungal drug applied topically for tx of dermatophytosis, candidiasis, and as shampoo for seborrheic dermatitis; also noteworthy as a classic inhibitor of cytochrome P450:
Ketoconazole
Class of antifungal drugs with a wide range of activity, blocks ergosterol synthesis.
Imidazoles
Prescription synthetic topical antimycotic agent with broad spectrum of activity against fungal skin infections such as ringworm, athlete’s foot, tinea versicolor, dandruff:
Ciclopirox
What is the MOA of Terbinafine and what is it used for?
- Allylmaine, selectively inhibits squalene epoxidase, a key enzyme for synthesis of ergosterol
- Highly active against dermatophytes; can be used topically or given orally for tx of onychomycosis
Which synthetic antifungal distorts hyphae/stunts mycelial growth and is effective topicaly against various dermatophyt and malessezie infection, but not candida?
Tolnaftate
When used to treat thrush, it is held in the mouth before swallowing (has negligible GI absorption)
Nystatin
What is the MOA of both Nystatin and Amphotericin B?
Binds fungal sterols, alters membrane permeability
Antifungal agent with topical effects limited to candida infections, may temporarily stain the skin yellow (also administered IV, etc., for other fungal infections as well including aspergillus and endemic mycosis)
Amphotericin B
Which 2 systemic imidazole drugs can be used to treat tinea versicolor?
Fluconazole and itraconazole
Can be administered systemically to treat tinea capitis (ringworm in scalp) and non-hairy skin caused by epidermophyton, microsporum and trichophyton.
Griseofulvin
Which topical therapy is particularly useful in anogenital pruritus?
Calcineurin inhibitors: Tacrolimus
Can be useful therapies for pruritus on face associated with CKD and in neuropathic pruritus?
Local Anesthetics
On which areas of skin should you start with low-potency vs. high-potency glucocorticoids?
- Low-potency on face, genitals, skin fold
- Elsewhere, generally start high-potency and then titrate downward
μ-opioid receptor antagonist that can treat the pruritus associated with CKD and cholestasis.
Naltrexone
Which k-opioid receptor antagonist/μ-opioid receptor antagonist is useful in tx nocturnal and intractable pruritus; administered how?
Butorphanol; administerd intranasally
Which antiepileptic drug is useful in tx neuropathic pain and itching; what are 2 AE’s?
- Gabapentin
- May cause drowsiness and weight gain
Which substance P antagonist is used to control N/V of chemotherapy, but has show benefits in pt’s with intractabl pruritus (i.e., Sezary syndrome)?
Aprepitant
α2-agonist administered topically as a gel to treat rosacea
Brimonidine
α-adrenergic agonist in Visine known for its ability to “get the red out”:
Tetrahydrozoline
Organophosphate anticholinesterase insecticide kills ectoparasites
Malathion
Synthetic insecticide similar to that of chrysanthemums, ectoparasite therapy (Nix) that binds to insect Na+ channels and prevents membrane repolarization
Permethrin
Orally administered insecticide to treat ectoparasites, binds glutamate-activated Cl- channels in invertebrates, hyperpolarizes the nerve and muscle cells
Ivermectin
Late choice for treating ectoparasites, topical agent works by disrupting GABAergic transmission in insects
Lindane
Topical retinoid administered for the treatment of acne, alters gene expression to normalize keratinization, decrease keratinocyte cohesiveness and reduce microcomedone formation
Tretinoin
Topical antimicrobial agent commonly used to treat acne; local skin irritant and may bleach hair or clothing
Benzoyl Peroxide
Antibiotic that works similar to macrolides kills anaerobes, useful for range of infections including topical treatment of acne and for osteomyelitis; associated with increased risk of C. difficile
Clindamycin
Macrolide antibiotic, among uses is for topical or systemic treatment of acne; among the well-known cytochrome P450 inhibitors to remember.
Erythromycin
Component of plant defenses against bacteria, active against P. acne and also treats post-inflammatory hyperpigmentation
Azelaic acid
Tetracycline used to treat acne, noteworthy for its ability to cause dark pigmentation in skin and sclera
Minocycline
K+-sparing diuretic with partial agonist properties at androgen receptors that can make it useful for treating menstrual cycle linked acne or male pattern baldness in adult women
Spironolactone
What are some of the AE’s of spironolactone and who is is contraindicated for?
- Contraindicated in pregnancy
- Menstrual irregularity + breast tenderness
- Minor GI sx’s
- Orthostatic hypotension
- Hyperkalemia + dizziness + HA’s + fatigue
Retinoid administered orally for treatment of severe acne, powerful teratogen that mandates participation by young females in the iPledge program
Oral isotretinoin
Photosensitizer administered in conjunction with UVA treatment of psoriasis
Psoralen
Orally active PDE4 inhibitor, used in moderate-to- severe plaque psoriasis and psoriatic arthritis
Apremilast
What are the downstream effects of the orally active PDE4 inhibitor, Apremilast?
- ↓ nitric oxide synthase, TNF-α, IL-23
- ↑ IL-10
What is the most common AE associated with the PDE4 inhibitor, Apremilast, used for moderate to severe plaque psoriasis?
Severe diarrhea
Monoclonal antibody against IL-12 and IL-23, a biologic agent used to treat plaque psoriasis, psoriatic arthritis, and Chron disease
Ustekinumab
Ustekinumab is generally well-tolerated but carries what risk?
- ↑ risk for infections
- May ↑ risk for SCC’s
Biologic DMARD directed against IL-17a, used to treat psoriasis and psoriatic arthritis and, for some, works much better than anti-TNF therapies
Secukinumab
Topical immune response modifier used to treat actinic keratoses and basal or squamous cell carcinomas; also used to treat genital warts
Imiquimod
Treatment for actinic keratoses derived from Euphorbia peplus sap, causes chemoablation with neutrophil-mediated antibody dependent cellular cytotoxicity eliminating remaining tumor cells
Ingenol Mebutate
Effective topical therapy for actinic keratoses, causes fast- proliferating dysplastic cells to die a thymidine-less death; necrosis/erosion gives way to re-epithelialization over several weeks
5-fluorouracil
What are 2 oral hedgehog signaling pathway inhibitor used to treat advanced basal cell carcinoma
Vismodegib or Sonidegib
FDA-approved conventional therapy for melanoma:
Dacarbazine
Inhibits the mutated BRAF V600D MAP kinase found in ~60% of melanomas resulting in apoptosis
Vemurafenib
What is the MOA of Minoxidil and what is it used for?
- Potent vasodilator due to hyperpolarization via activation of K+ channels
- Promotes hair growth by increasing the duration of anagen (growth phase), shortening telogen (rest phase), and enlarging miniaturized follicles
- 1st-line for female pattern hair loss and also used for male pattern baldness
Blocks the conversion of testosterone to more potent androgen dihydrotestosterone, among its uses is to treat male pattern baldness in men and second-line agent for this in women
Finasteride
Treatment for alopecia, it is a contact allergen applied to cause dermatitis, which can be followed by hair growth
DPCP
