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Skin > Pharmacokogical Principles in Dermatology > Flashcards

Pharmacokogical Principles in Dermatology Flashcards

1
Q

Steps of drug delivery to the skin:

A

Absorption, distribution, metabolism, and elimination

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2
Q

____ drug delivery is applied right to the target area. No need to worry about bioavailability or first pass. There is less systemic ____ of the drug

A

Topical
Circulation

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3
Q

____ dosing has more systemic circulation and delivery to more tissues beyond the skin. Need to consider first pass effect, plasma protein binding

A

Oral

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4
Q

Layers of the skin:

A
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5
Q

Topical drugs need to make it to the ___ to have full effect

A

Dermis

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6
Q

Skin ___ varies by location which results in differences in drug absorption. Drugs are more readily absorbed in ___ layers of skin.

A

Structure
Thin

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7
Q
A

Stratum corneum: lipids and dead cells

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8
Q

_____ delivery is when the drug moves around the cells. ____ delivery is when the drug moves through the cells. Both are considered ___ delivery.

A

Intercellular
Transcellular
Transepidermal

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9
Q

____ is when drugs gain access to the dermis through a gland. ___ is when drugs gain access to the dermis through the hair follicle. Both are considered ____ delivery.

A

Transglandular
Transfollicular
Transappendageal

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10
Q

Other factors that affect topical drug absorption are ___ skin and ____ skin.

A

Aged
Damaged

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11
Q

Many factors effect the skin integrity and effect topical drug absorption:

A
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12
Q

Other factors affecting topical drug delivery to the skin:

A
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13
Q

Concentration of the topical drug is highest at the ___ ___. Burning to proteins will decrease concentration as it moves to the ___, where there are blood vessels.

A

Stratum corneum
Dermis

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14
Q

____ skin absorbs drugs better especially for polar drugs

A

Hydrated

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15
Q

Formulations and vehicles of topical drug delivery:

A
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16
Q

Moisturizers are sorted into 3 categories:

A
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17
Q

____ tend to dry the skin, have patients avoid use of this to optimize absorption.

A

Soaps

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18
Q

The main cellular pathways and systems that commonly targeted in skin pharmacology:

A

Inflammation, infection, cell devision

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19
Q

_____ play a major role in the treatment of many dermatologic conditions especially inflammation and itchy conditions.

A

Corticosteroids

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20
Q

____ are effective for conditions involving hyper-proliferation as well as immune and inflammatory dysfunctions

A

Corticosteroids

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21
Q

Mechanism of actions for corticosteroids: activate the ____ receptor (GR) which acts as a transcription factor that upregulates ____ genes and down regulates ____ genes. Allows thousands of genes to be targets.

A

Glucocorticoid
Anti-inflammatory
Pro-inflammatory

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22
Q

The immediate effects of corticosteroids involves there ability to effect ___ cells without requiring gene transcription

A

Immune

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23
Q

Examples of topical corticosteroids

A
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24
Q

Potency of corticosteroids is based on their ability to ____.

A

Vasoconstrict

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25
Q

Side effects of corticosteroids:

A

Skin atrophy, striae (stretch marks), acne, suppression of hypothalamus pituitary adrenal (HPA) axis.

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26
Q

Hypothalamus pituitary adrenal (HPA) axis is how regular ___ is regulated in the body. When someone uses corticosteroids medication, it shuts down this pathway because the drug is acting like ___. Not a problem for short term use.

A

Cortisol
Cortisol

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27
Q

____ ___ ____ can develop from long term use of highly potent corticosteroids. Presents as a rash at the target site. Caused by disregulation of HPA axis

A

Topical steroid withdrawal (TSW)

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28
Q
A
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29
Q

Non steroidal anti-inflammatory topical calcineurin inhibitors (TCI):

A
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30
Q

Table comparing tacrolimus versus hydrocortisone:

A
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31
Q

Tacrolimus and Pimecrolimus bind ____ and inhibits the ability of ___ to dephosphorylate the NFAT transcription factor which inhibits ____.

A

FKBP
Calcineurin
Inflammation

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32
Q

____ is approved to treat mild to moderate eczema in patients two years and older

A

Primecrolimus

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33
Q

Side effects of Topical Calcineurin Inhibitors (TCI):

A
34
Q

____ is a non-steroidal anti inflammatory drug that inhibits PDE4. It can also be used to treat mild to moderate eczema.

A

Crisaborole

35
Q

Crisaborole:
Other actions of PDE4 inhibition, other anti inflammatory effects:

A
36
Q

Side effects of Crisaborole:

A
37
Q

____ is a topical medication that is an immune response modifier that draws in immune system to attack the target. Approved for genetically warts, actinic keratosis, precancerous lesions.

A

Imiquimod

38
Q

Imiquimod stimulates ___ and ___ immunity leading to inflammatory cell infiltration within the field of drug application, followed by apoptosis of diseased tissue. It is available in one use packets because it is not stable in ___ or ___.

A

Innate
Adaptive
Air
Light

39
Q

Imiquimod is recognized by __ ___ and stimulates the activation of ____ transcription factor, release cytokines and draws in immune cells.

A

T cells
NFKB

40
Q

Imiquimod stimulates innate and acquired immunity:

A
41
Q

Side effects of Imiquimod:

A
42
Q
A
43
Q

Topical medications that do not regulate inflammatory response:
____ is derived from vitamin D, it is an analogue of vitamin D. It regulates the production and growth of skin cells. Used in eczema and psoriasis.

A

Calcipotriene

44
Q

Calcipotriene:
The active metabolite ____ binds to the vitamin D receptor (VDR) which is a transcription factor. Vitamin D is synthesized in the lower layers of the epidermidis through a chemical reaction that is dependent on ___ ___. D has a significant role in ____ homeostasis and metabolism.

A

Calcitriol
Sun exposure
Calcium

45
Q

Mechanism of action of Calcipotriene is somewhat unknown:
It does regulate ___ __ ___ which regulate cell proliferation and differentiation. It also affect the immune system.

A

Vitamin D Receptor

46
Q

Side effects of Calcipotriene:
Should avoid if ___.

A

Pregnant

47
Q

____ is another topical drug medication that inhibits abnormal cell growth and alerts the immune system. It stop cell division. Used for actinic keratosis. Comes in solution or cream

A

5-Fluorouracil (5-FU)

48
Q

Mechanism of action of 5-Fluorouracil:
It inhibits ____ ____ which inhibits nucleotide synthesis.

A

Thymidylate synthase

49
Q

Side effects of 5-Fluorouracil:

A
50
Q

____ effects is side effects during development

A

Teratogenic

51
Q

____ is an oral systemic medication that treats skin diseases that are rooted in the neutrophil being the primary issue (neutrophilic disease)

A

Dapsone

52
Q

Dapsone inhibits ____ (MPO) which is a key element in the innate immune system and is released primarily by neutrophils for defense

A

Myeloperoxidase

53
Q

Side effects of Dapsone:
Due to ___ and ___ of metabolites of the drug

A

Acetylation
Hydroxylation

54
Q

_____ is an oral systemic medication that inhibits dihydrofolate reductase and disrupts ___ synthesis and cell division. Used to treat psoriasis, lupus, cutaneous T cell lymphoma but is starting to not be used as much.

A

Methotrexate
DNA

55
Q

Methotrexate side effects:

A
56
Q

____ is a systemic medication drug class that is the newest generation of drug design. They are bio genetically engineered proteins, which disrupt focused portions of the immune system involved in psoriasis. They often target ___ ___ or ___ ____. They need to be ___. Very ___ so very little side effects. They are expensive.

A

Biologics
Signal molecules
Immune cells
Injected
Specific

57
Q

Generic drugs and branded drugs have the same ____.

A

Efficacy

58
Q

Once the brand name drug ___ expires usually after 17 to 20 years, other drug companies can start making the ___ brand.

A

Patent
Generic

59
Q

____ drugs are medications composed of sugars proteins, and or nucleic acids. Examples:

A

Biologic
Vaccines, therapeutic proteins, monoclonal antibodies

60
Q

____ are not the same thing as generic drugs. Have a different chemical composition, and then namebrand drugs, but accomplish the same results.

A

Bio similar

61
Q

____ drugs use the same molecule, same mechanism of action, and accomplish the same results as brand-name drugs but for cheaper

A

Generic

62
Q

Biologics: the suffix denotes the drug class:

A
63
Q

____ is a biologic drug that inhibits IL-4 and IL-13 which are both involved in BN T cell, activation and stimulation of humoral immunity, including IgE. Treats eczema not controlled by topicals. Subcutaneous shots every two weeks.

A

Dupilumab

64
Q

____ refers to the damage of skin caused by UV light

A

Phototoxicity

65
Q

___ is the most damaging, shorter waves. ___ is less damaging but penetrates deeper.

A

UV-B
UV-A

66
Q

We need sunlight for:

A
67
Q

Responses of sun exposure (phototoxicity)

A
68
Q

If the air is ___ or ___ or higher elevation, UV index will be higher.

A

Thinner
Drier

69
Q

Sunscreen is used to combat ___ and ____, meaning it is broad spectrum. Some contain ___ and ___ which as as reflectors.

A

UVA
UVB
zinc
Titanium

70
Q

SPF sunscreen table:

A
71
Q

____ is abnormal sensitivity to UV and visible light due to genetics, autoimmune diseases, or medication .

A

Photosensitivity

72
Q

Phototoxcity versus photoallergy

A
73
Q

Phototoxicity is a direct response to ___. Photoallergy (photosensitivity) is a delayed response that requires ___ ___ response.

A

Exposure
Immune system

74
Q

___ ___ is the most common neoplasm. Minnesota has one of the higher rates.

A

Skin cancer

75
Q

Sunlight induces ___ ___ that lead to neoplasia. It is also immunosuppressive and reduces immune surveillance

A

Thymidine dimers

76
Q

Review:

A
77
Q

Review:

A
78
Q

Chemical burns are caused by ___ ___ with major tissue damage. Damage is a direct result of the chemical not dependent on tissue reaction to exposure.

A

Coagulative necrosis

79
Q

___ ____ comprises 90% of all occupational skin diseases. Two types: ___ and ___

A

Contact dermatitis
Irritant
Allergic

80
Q

Irritant contact dermatitis:

A
81
Q

Allergic contact dermatitis:

A
82
Q

Skin can be used as an indicator of the type of exposure:

A

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