[PHARM] Dermatologic Pharmacology [Wollff]

Question 1

What are 2 benefits of using ointment vs. cream dermatologic drugs?

Answer 1

• Provide for more complete absorption of the active ingredient
• Are less likely to cause an allergic rxn than creams, which contain preservatives

Question 2

Which is better for using on oozing/”wet” skin conditions, creams or ointments?

Answer 2

Creams

Question 3

What is better for using on large areas, creams or ointments?

Answer 3

Creams: spread easily, are well-absorbed, and wash off with water

Question 4

Refers to agents such as glycerin, lecithin and propylene glycol found in moisturizers to draw water into the outer layer of skin

Answer 4

Humectants

Question 5

Broad-spectrum antimicrobial agent widely used in homes and hospitals due to efficacy on skin and oral mucosa with low irritability.

Answer 5

Chlorhexidine

Question 6

Platelet-derived growth factor that promotes the cell proliferation and angiogenesis needed for diabetic ulcer repair; why must it be used cautiously?

Answer 6

• Becaplermin
• Use of >3 tubes ↑↑↑ risk of malignancy

Question 7

To heal best, wounds should be kept clean and ____

Answer 7

Moist

Question 8

Antifungal applied topically that penetrates into nails to treat fungal infection?

Answer 8

Efinaconazole

Question 9

Active ingredient of vulvovaginal medications for candidiasis:

Answer 9

Clotrimazole or Miconazole

Question 10

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.

Answer 10

Emollients

Question 11

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?

Answer 11

• Horny substance (keratin) softners
• Urea, alpha hydroxy acids, and allantoin

Question 12

Which type of radiation is the cause of skin aging and cancer?

Answer 12

UVA

Question 13

Which chemical compound in sunscreen is active in UVA range and is particularly useful for conditions like drug-induced photosensitivity?

Answer 13

Dibenzoylmethanes

Question 14

Control that is now considered a priority for optimal wound closure.

Answer 14

Glycemic control

Question 15

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:

Answer 15

Oxygenation

Question 16

Important component of wound healing, it conserves the local resources by limiting the need to synthesize proteases; stage when hydrogels are good wound covering.

Answer 16

Debridement

Question 17

Which wound coverings are best for debridement, granulation, and epithelialization stages of wound healing?

Answer 17

• Hydrogels for debridement stage
• Foam and low-adherence dressings for granulation stage
• Hydrocolloid and low-adherence dressings for epithelialization stage

Question 18

Aminoglycoside antibiotic of Neosporin with activity against gram-negative bacteria:

Answer 18

Neomycin

Question 19

Peptide antibiotic with efficacy against gram-negative bacteria including pseudomonas has a detergent-like effect that damages the bacterial cell membrane:

Answer 19

Polymixin B

Question 20

Peptide antibiotic with activity against gram-positive organisms and some anaerobes; only applied topically to limit systemic toxicity, often causes contact dermatitis:

Answer 20

Bacitracin

Question 21

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:

Answer 21

Ketoconazole

Question 22

Class of antifungal drugs with a wide range of activity, blocks ergosterol synthesis.

Answer 22

Imidazoles

Question 23

Prescription synthetic topical antimycotic agent with broad spectrum of activity against fungal skin infections such as ringworm, athlete’s foot, tinea versicolor, dandruff:

Answer 23

Ciclopirox

Question 24

What is the MOA of Terbinafine and what is it used for?

Answer 24

• 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

Question 25

Which synthetic antifungal distorts hyphae/stunts mycelial growth and is effective topicaly against various dermatophyt and malessezie infection, but not candida?

Answer 25

**Tolnaftate**

Question 26

When used to treat thrush, it is held in the mouth before swallowing (has negligible GI absorption)

Answer 26

**Nystatin**

Question 27

What is the MOA of both Nystatin and Amphotericin B?

Answer 27

Binds fungal sterols, **alters membrane permeability**

Question 28

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)

Answer 28

Amphotericin B

Question 29

Which 2 systemic imidazole drugs can be used to treat tinea versicolor?

Answer 29

**Fluconazole** and **itraconazole**

Question 30

Can be administered systemically to treat tinea capitis (ringworm in scalp) and non-hairy skin caused by epidermophyton, microsporum and trichophyton.

Answer 30

**Griseofulvin**

Question 31

Which topical therapy is particularly useful in anogenital pruritus?

Answer 31

**Calcineurin inhibitors**: Tacrolimus

Question 32

Can be useful therapies for pruritus on face associated with CKD and in neuropathic pruritus?

Answer 32

**Local Anesthetics**

Question 33

On which areas of skin should you start with low-potency vs. high-potency glucocorticoids?

Answer 33

- **Low-potency** on **face, genitals, skin fold** - **Elsewhere**, generally start **high-potency** and then **titrate downward**

Question 34

μ-opioid receptor antagonist that can treat the pruritus associated with CKD and cholestasis.

Answer 34

**Naltrexone**

Question 35

Which k-opioid receptor antagonist/μ-opioid receptor antagonist is useful in tx nocturnal and intractable pruritus; administered how?

Answer 35

**Butorphanol**; administerd **intranasally**

Question 36

Which antiepileptic drug is useful in tx neuropathic pain and itching; what are 2 AE's?

Answer 36

- **Gabapentin** - May cause **drowsiness** and **weight gain**

Question 37

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)?

Answer 37

**Aprepitant**

Question 38

α2-agonist administered topically as a gel to treat rosacea

Answer 38

**Brimonidine**

Question 39

α-adrenergic agonist in Visine known for its ability to "get the red out":

Answer 39

**Tetrahydrozoline**

Question 40

Organophosphate anticholinesterase insecticide kills ectoparasites

Answer 40

**Malathion**

Question 41

Synthetic insecticide similar to that of chrysanthemums, ectoparasite therapy (Nix) that binds to insect Na+ channels and prevents membrane repolarization

Answer 41

**Permethrin**

Question 42

Orally administered insecticide to treat ectoparasites, binds glutamate-activated Cl- channels in invertebrates, hyperpolarizes the nerve and muscle cells

Answer 42

**Ivermectin**

Question 43

Late choice for treating ectoparasites, topical agent works by disrupting GABAergic transmission in insects

Answer 43

**Lindane**

Question 44

Topical retinoid administered for the treatment of acne, alters gene expression to normalize keratinization, decrease keratinocyte cohesiveness and reduce microcomedone formation

Answer 44

**Tretinoin**

Question 45

Topical antimicrobial agent commonly used to treat acne; local skin irritant and may bleach hair or clothing

Answer 45

**Benzoyl Peroxide**

Question 46

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

Answer 46

**Clindamycin**

Question 47

Macrolide antibiotic, among uses is for topical or systemic treatment of acne; among the well-known cytochrome P450 inhibitors to remember.

Answer 47

**Erythromycin**

Question 48

Component of plant defenses against bacteria, active against P. acne and also treats post-inflammatory hyperpigmentation

Answer 48

**Azelaic acid**

Question 49

Tetracycline used to treat acne, noteworthy for its ability to cause dark pigmentation in skin and sclera

Answer 49

**Minocycline**

Question 50

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**

Answer 50

**Spironolactone**

Question 51

What are some of the AE's of spironolactone and who is is contraindicated for?

Answer 51

- **Contraindicated** in **pregnancy** - Menstrual irregularity + breast tenderness - Minor GI sx's - **Orthostatic hypotension** - **Hyper**kalemia + dizziness + HA's + fatigue

Question 52

Retinoid administered orally for treatment of severe acne, powerful teratogen that mandates participation by young females in the iPledge program

Answer 52

Oral **isotretinoin**

Question 53

Photosensitizer administered in conjunction with UVA treatment of psoriasis

Answer 53

**Psoralen**

Question 54

Orally active PDE4 inhibitor, used in moderate-to- severe plaque psoriasis and psoriatic arthritis

Answer 54

**Apremilast**

Question 55

What are the downstream effects of the orally active PDE4 inhibitor, Apremilast?

Answer 55

- ↓ **nitric oxide synthase**, **TNF-**α, **IL-23** - ↑ **IL-10**

Question 56

What is the most common AE associated with the PDE4 inhibitor, Apremilast, used for moderate to severe plaque psoriasis?

Answer 56

**Severe diarrhea**

Question 57

Monoclonal antibody against IL-12 and IL-23, a biologic agent used to treat plaque psoriasis, psoriatic arthritis, and Chron disease

Answer 57

**Ustekinumab**

Question 58

Ustekinumab is generally well-tolerated but carries what risk?

Answer 58

- ↑ risk for **infections** - May ↑ risk for SCC's

Question 59

Biologic DMARD directed against IL-17a, used to treat psoriasis and psoriatic arthritis and, for some, works much better than anti-TNF therapies

Answer 59

**Secukinumab**

Question 60

Topical immune response modifier used to treat actinic keratoses and basal or squamous cell carcinomas; also used to treat genital warts

Answer 60

**Imiquimod**

Question 61

Treatment for actinic keratoses derived from Euphorbia peplus sap, causes chemoablation with neutrophil-mediated antibody dependent cellular cytotoxicity eliminating remaining tumor cells

Answer 61

**Ingenol Mebutate**

Question 62

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

Answer 62

**5-fluorouracil**

Question 63

What are 2 oral hedgehog signaling pathway inhibitor used to treat advanced basal cell carcinoma

Answer 63

**Vismodegib** or **Sonidegib**

Question 64

FDA-approved conventional therapy for melanoma:

Answer 64

**Dacarbazine**

Question 65

Inhibits the mutated BRAF V600D MAP kinase found in ~60% of melanomas resulting in apoptosis

Answer 65

**Vemurafenib**

Question 66

What is the MOA of Minoxidil and what is it used for?

Answer 66

- 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**

Question 67

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

Answer 67

**Finasteride**

Question 68

Treatment for alopecia, it is a contact allergen applied to cause dermatitis, which can be followed by hair growth

Answer 68

**DPCP**