Pharmacology Flashcards

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1
Q

Examples of Type I Cutaneous Drug Eruption Reactions (3)

A

Angioedema
Anaphylaxis
Urticaria

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2
Q

Example of Type II Cutaneous Drug Eruption Reactions

A

Blistering Reactions - Pemphigus and Pemphigoid

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3
Q

Examples of Type III Cutaneous Drug Eruption Reactions (3)

A

Purpura
Vasculitis
Rash

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4
Q

Examples of Type IV Cutaneous Drug Eruption Reactions (2)

A

Erythema
Rash

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5
Q

Immunologically-mediated Drug reactions are not dependent on what?

A

Dose

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6
Q

Examples of non-immunological skin reactions (6)

A

Eczema
Drug-induced alopecia
Phototoxicity
Skin erosions
Atrophy
Psoriasis

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7
Q

Example of a drug that can cause drug-induced alopecia

A

Tamoxifen

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8
Q

Example of a drug that can cause skin erosion

A

Topical 5-Fluorouracil

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9
Q

Example of a drug that can cause atrophy

A

Topical corticosteroids

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10
Q

Example of drugs that can cause xerosis (2)

A

Statins
Retinoids

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11
Q

Which gender is at a greater risk to cutaneous drug eruptions?

A

Females

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12
Q

What concomitant diseases increase the risk of cutaneous drug eruptions? (2)

A

Cystic Fibrosis
Viral Infections - HIV, EBV and CMV

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13
Q

Which types of drugs increase the risk of cutaneous drug eruptions? (4)

A

Beta lactam compounds
NSAIDs
High molecular weight drugs
Hapten-forming drugs

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14
Q

What type of drug administration route increases the risk of cutaneous drug eruptions?

A

Topical drugs

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15
Q

Most common drug-associated skin reaction

A

Exanthematous drug eruptions

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16
Q

Exanthematous Drug Eruptions: What type of reaction is this?

A

Type IV Reaction - Idiosyncratic T-cell mediated delayed type hypersensitivity reaction

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17
Q

Exanthematous Drug Eruptions: Spread

A

Widespread symmetrically distributed rash

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18
Q

Exanthematous Drug Eruptions: Location

A

Mucous membranes - eyes and mouth spared

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19
Q

Exanthematous Drug Eruptions: Onset

A

4-21 days after first taking the drug

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20
Q

Exanthematous Drug Eruptions: Examples of associated drugs (6)

A

Penicillins
Sulphonamides
Erythromycin or Streptomycin
Anti-epileptics
NSAIDs
Chloramphenicol

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21
Q

Exanthematous Drug Eruptions: Ulceration occurs where?

A

Mouth
Lips
Genitals

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22
Q

Exanthematous Drug Eruptions: Presentation of rash

A

Erythema
Oedema

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23
Q

Exanthematous Drug Eruptions: General symptoms

A

Fever - >38.5 degrees
Lymphadenopathy
Shortness of breath

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24
Q

Urticarial Drug Eruptions: Most common mechanism

A

Immediate IgE-mediated hypersensitivity reaction after a re-challenge with a drug

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25
Q

Urticarial Drug Eruptions: Examples of drugs inducing IgE reactions (3)

A

Beta Lactams
Antibiotics
Carbamazepine

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26
Q

Urticarial Drug Eruptions: Classic presentation

A

Wheals

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27
Q

Urticarial Drug Eruptions: Time period

A

Presents within minutes or hours

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28
Q

Urticarial Drug Eruptions: Impact on the face

A

Lip swelling
Facial swelling

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29
Q

Urticarial Drug Eruptions: Why does angioedema occur?

A

Intense histamine release

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30
Q

Urticarial Drug Eruptions: What presentation indicates vasculitic skin rashes?

A

Purpura with non-blanching

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31
Q

Urticarial Drug Eruptions: Warfarin can be associated with what feature?

A

Necrosis

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32
Q

Urticarial Drug Eruptions: Less common mechanism of action

A

Direct release of inflammatory mediators from mast cells on first exposure

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33
Q

Urticarial Drug Eruptions: Examples of drugs that cause this by causing the direct release of the inflammatory mediators? (6)

A

Aspirin
Opiates
NSAIDs
Muscle relaxants
Vancomycin
Quinolones

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34
Q

Pustular or Bullous Drug Reactions: Examples of drugs that induce acneiform reactions (5)

A

Glucocorticoids
Androgens
Lithium
Isoniazid
Phenytoin

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35
Q

Pustular or Bullous Drug Reactions: Description of Acneiform reaction

A

Monomorphic lumps with no comodones

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36
Q

Pustular or Bullous Drug Reactions: What does AGEP stand for?

A

Acute generalised exanthematous pustulosis

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37
Q

Pustular or Bullous Drug Reactions: Examples of drugs that cause AGEP (3)

A

Antibiotics
Calcium Channel Blockers
Anti-malaria drugs

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38
Q

Pustular or Bullous Drug Reactions: How does AGEP present?

A

Monomorphic sheets of pustules

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39
Q

Pustular or Bullous Drug Reactions: Examples of drugs that cause bullous pemphigoid? (3)

A

ACE Inhibitors
Penicillin
Furosemide

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40
Q

Pustular or Bullous Drug Reactions: Example of a drug that causes linear IgA disease?

A

Vancomycin

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41
Q

Pustular or Bullous Drug Reactions: Linear IgA Disease presentation

A

Annular ring forms of blisters

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42
Q

Pustular or Bullous Drug Reactions: Bullous eruptions can be induced by what drug?

A

Metronidazole

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43
Q

Examples of drugs that cause hyperpigmentation reactions (2)

A

Hydroxyurea
Minocycline

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44
Q

Fixed Drug Eruptions: Locations (4)

A

Hands
Genitals
Lips
Oral mucosa

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45
Q

Fixed Drug Eruptions: Presentation

A

Well demarcated round plaques that are red and painful

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46
Q

Fixed Drug Eruptions: How to resolve this?

A

Stop the drug - may re-occur if restarted

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47
Q

Fixed Drug Eruptions: Examples of drugs causing these reactions (5)

A

Tetracycline
Doxycycline
Paracetamol
NSAIDs
Carbamazepine

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48
Q

Severe Cutaneous Adverse Drug Reactions: 4 potential symptoms (4)

A

Stevens-Johnson Syndrome
Toxic Epidermal Necrolysis
Drug Reaction with Eosinophilia and Systemic symptoms
Acute generalised exanthematous pustolosis

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49
Q

SJS

A

Stevens Johnson Syndrome

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50
Q

TEN

A

Toxic Epidermal Necrolysis

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51
Q

DRESS

A

Drug reaction with Eosinophilia and Systemic Symptoms

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52
Q

AGEP

A

Acute generalised exanthematous pustulosis

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53
Q

Severe Cutaneous Adverse Drug Reactions: SJS - Associated with what drugs? (3)

A

Anti-epileptics
Cephalosporin
HIV drugs

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54
Q

Severe Cutaneous Adverse Drug Reactions: SJS - Location

A

Mucosa - mouth, eyes and lips

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55
Q

Severe Cutaneous Adverse Drug Reactions: SJS - Presentation

A

Erythema multiforme rash

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56
Q

Severe Cutaneous Adverse Drug Reactions: TEN - Presentation

A

Fluid-filled blisters
Bullae

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57
Q

Severe Cutaneous Adverse Drug Reactions: TEN - Examples (4)

A

Sulphonamides
Cephalosporins
Carbamazepine
NSAIDs

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58
Q

Severe Cutaneous Adverse Drug Reactions: DRESS - Presentation

A

Rash with marked facial involvement and a high temperature

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59
Q

Severe Cutaneous Adverse Drug Reactions: DRESS - Examples of drug that induces this (4)

A

Sulphonamides
Anti-convulsants
Allopurinol
NSAIDs

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60
Q

Severe Cutaneous Adverse Drug Reactions: AGEP - Presentation

A

Sheets of pustules that can coalesce or sheet off

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61
Q

Drug-Induced Photosensitivity: These reactions are typically (immunological/non-immunological) phytotoxicity?

A

Non-immunological

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62
Q

Drug-Induced Photosensitivity: Examples of Acute reactions (3)

A

Skin toxicity
Systemic Toxicity
Photo-degradation

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63
Q

Drug-Induced Photosensitivity: Examples of Chronic reactions (3)

A

Pigmentation
Photoageing
Photocarcinogenesis

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64
Q

Phototoxic Cutaneous Drug Reactions

A

Non-immunological skin reaction due to light activation of a photoreactive drug

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65
Q

Phototoxic Cutaneous Drug Reactions: Increased sensitivity to light can occur through what two physiological states?

A

Lupus
Immunosuppression

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66
Q

Skin Phototoxicity: Examples of drugs that cause immediate prickling with delayed erythema and pigmentation (2)

A

Chlorpromazine
Amiodarone

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67
Q

Skin Phototoxicity: Chlorpromazine and Amiodarone cause what reactions?

A

Immediate prickling with delayed erythema and pigmentation

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68
Q

Skin Phototoxicity: Examples of drugs that induce exaggerated and easy sunburn (3)

A

Quinine
Thiazide
Demeclocycline

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69
Q

Skin Phototoxicity: Quinine, Thiazides and Demclocycline induce what reactions?

A

Exaggerated and easy sunburn

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70
Q

Skin Phototoxicity: Calcium channel antagonists induce what?

A

Telangiectasia

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71
Q

Skin Phototoxicity: Example of a drug that can induce telangiectasia

A

Calcium channel antagonists

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72
Q

Skin Phototoxicity: What reaction can Psoralens induce?

A

Delayed (3-5 days) Erythema and pigmentation

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73
Q

Skin Phototoxicity: What drugs can induce a delayed erythema and pigmentation?

A

Psoralens

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74
Q

Skin Phototoxicity: Example of drugs that can increase skin fragility with bruises and blisters (4)

A

Nalidixic Acid
Tetracycline
Naproxen
Amiodarone

75
Q

Examples of Bases or Vehicles (6)

A

Gels
Creams
Ointments
Pastes
Lotions
Foams

76
Q

Cream

A

Semi-solid emulsion of oil in water with emulsifier and preservative

77
Q

Creams: Water content

A

High

78
Q

Creams: Function

A

Cools and moisturises

79
Q

Ointment

A

Semi-solid grease or oil with soft paraffin

80
Q

Example of disease treated with cream

A

Child hand dermatitis

81
Q

Example of disease treated by ointments

A

Hyperkeratotic Hand Eczema

82
Q

Ointments: Main disadvantage

A

No preservative - risk of bacterial contamination

83
Q

Ointments: Restricts what?

A

Transepidermal water loss

84
Q

Lotions: Example of disease treated by lotions

A

Ichthyosis

85
Q

Lotion

A

Liquid formulation of suspension or solution of medication in water, alcohol or other liquid

86
Q

Lotions: Why may the compliance be poor?

A

Alcohol can cause stinging

87
Q

Lotions: Used on what areas?

A

Hair-bearing areas - including the scalp

88
Q

Gel

A

Thickened aqueous solution

89
Q

Gels: Example of disease treated by this

A

Psoriasis on the scalp

90
Q

Gels: Contain what compounds?

A

High molecular weight polymers e.g. Methylcellulose

91
Q

Gels: Treats what areas? (3)

A

Scalp
Hair bearing areas
Face

92
Q

Paste

A

Semi-solid containing finely powdered material

93
Q

Paste: Often used in what?

A

Cooling, drying and soothing bandages

94
Q

Paste: Example of powdered material used in this?

A

ZnO

95
Q

Foam

A

Colloid with two or three phases - typically hydrophilic liquid in continuous phase with foaming agent dispersed in gaseous phase

96
Q

Foams: Main advantage

A

Increased penetration of active agents e.g. steroids and vitamin D

97
Q

Emollients: Function

A

Enhances rehydration of the epidermis

98
Q

Emollients: Used for all … or … skin conditions

A

Dry or scaly

99
Q

Emollients: Prescription

A

300-500g weekly

100
Q

Emollients: Prescription - Apply when?

A

Immediately after bathing

101
Q

Emollients: Prescription - Apply in what direction?

A

In direction of hair growth

102
Q

Emollients: Prescription - How do we reduce the risk of bacterial contamination?

A

Use a clean spoon or spatula to remove from the tub

103
Q

Emollients: Prescription - Main Risk group

A

Smokers - Fire risk if paraffin-based

104
Q

Emollients: Prescription - Avoid what type?

A

Those containing SLS - can cause irritation

105
Q

Emollients: Prescription - What type of application is used for xerotic skin?

A

Wet wrap therapy

106
Q

Topical Corticosteroids: Mechanism of Action (3)

A

Vasoconstrictive
Anti-inflammatory
Anti-proliferative

107
Q

Topical Corticosteroids: Example with mild potency

A

Hydrocortisone

108
Q

Topical Corticosteroids: Examples with moderate potency (2)

A

Modrasone
Clobetasone Butyrate

109
Q

Topical Corticosteroids: Examples of potent drugs (2)

A

Mometasone furoate
Betamethasone valerate

110
Q

Topical Corticosteroids: Example of very potent drug

A

Clobetasol proprionate

111
Q

Topical Corticosteroids: Indications (4)

A

Eczema
Psoriasis
Non-infective inflammatory dermatoses e.g. Lichen planus
Keloid scars

112
Q

Topical Corticosteroids: Use in caution in what disease?

A

Rebound or triggering pustular psoriasis

113
Q

Topical Corticosteroids: Guidance on application

A

20-30g of ointment for the whole body - 1 fingertip used for 2 hand areas

114
Q

Topical Corticosteroids: When do we not use these?

A

Infection present

115
Q

Topical Corticosteroids: Systemic absorption can have what side effects (3)

A

Adrenal suppression
Cushings Syndrome
Growth retardation

116
Q

Topical Corticosteroids: Side effects (4)

A

Skin thinning
Purpura
Stretch marks
Steroid rosacea

117
Q

Topical Corticosteroids: Reversible side effects (3)

A

Contact allergies
Acneiform eruptions
Tachyphylaxis

118
Q

Topical Corticosteroids: Permanent side effects (3)

A

Striae - stretch marks
Atrophy - thinned epidermis
Bruising

119
Q

Calcineurin Inhibitors: Examples (2)

A

Tacrolimus
Pimecrolimus

120
Q

Calcineurin Inhibitors: Mechanism of action

A

Suppresses lymphocyte activation

121
Q

Calcineurin Inhibitors: Used topically for the treatment of what?

A

Atopic eczema - face or children

122
Q

Calcineurin Inhibitors: Reason for reduced compliance

A

Burning sensation on application

123
Q

Calcineurin Inhibitors: Increased risk of what?

A

Cutaneous infections

124
Q

Calcineurin Inhibitors: Do not use for what two conditions?

A

Infections
Cold sores

125
Q

Calcineurin Inhibitors: Increased risk of what?

A

Skin cancer

126
Q

Anti-septics: Examples (4)

A

Povidone Iodine
Chlorhexidine
Triclosan
Hydrogen Peroxide

127
Q

Anti-septics: Indications (3)

A

Recurrent infections
Skin cleansing
Wound irrigation

128
Q

Anti-biotics: Indications (3)

A

Acne
Rosacea
Skin infections e.g. Impetigo
Infected eczematous processes e.g. Otitis externa

129
Q

Anti-virals: What administration route is used for HSV?

A

Topical

130
Q

Anti-biotics: What administration route is used for Eczema Herpeticum?

A

Oral

131
Q

Anti-biotics: What administration route is used for Herpes Zoster Virus?

A

Oral

132
Q

Anti-Fungals: Indications (3)

A

Candida
Dermatophytes
Pitriasis versicolor

133
Q

Anti-Fungals: Treatment options for Candida (2)

A

Nystatin
Clotrimazole

134
Q

Anti-Fungals: Treatment options for Dermatophytes (2)

A

Clotrimazole
Terbinafine cream

135
Q

Anti-Fungals: Treatment option for Pityriasis versicolor

A

Ketoconazole

136
Q

Anti-pruritics: Examples (4)

A

Menthol
Capsaicin
Camphor or Phenol
Crotamiton

137
Q

Anti-pruritics: Mechanism of Action of Capsaicin

A

Depletes Substance P at nerve endings to reduce neurotransmission

138
Q

Anti-pruritics: Indication for Crotamiton

A

Used after the treatment of Scabies to relieve residual itch

139
Q

Keratolytics: Function

A

Softens keratin

140
Q

Keratolytics: Indications (4)

A

Viral warts
Hyperkeratotic eczema
Psoriasis
Corns and Calluses

141
Q

Keratolytics: Example

A

Salicyclic Acid Ointment

142
Q

Indications for 5-Fluorouracil (3)

A

Solar damage
Bowens Disease
Superficial basal cell carcinoma

143
Q

Indications for Imiquimod (2)

A

Solar damage
Superficial basal cell carcinoma

144
Q

Salicyclism

A

Constellation of symptoms due to acute or chronic overdose of salicyclate containing compounds

145
Q

Systemic effects of Vitamin D analogues (2)

A

Hypercalcaemia
Hypercalcuria

146
Q

Topical Steroids: Cause suppression of what?

A

The pituitary-adrenal axis

147
Q

Topical application of drugs allows diffusion into what structure first?

A

Stratum corneum

148
Q

Topical Drugs: Optimal molecular size for skin penetration

A

100-500 Da

149
Q

Topical Drugs: Drugs can undergo metabolism where in the skin?

A

Epidermis

150
Q

Topical Drugs: Intracellular route is favoured by what drugs?

A

Lipophilic drugs

151
Q

Topical Drugs: Intercellular route is favoured by what drugs?

A

Hydrophilic drugs

152
Q

What are vehicles designed for?

A

Hydration of the stratum

153
Q

Drugs may be encapsulated within what to increase permeability?

A

Liposome vehicles

154
Q

Liquid Formulations: What is the main component?

A

Water

155
Q

Liquid Formulations: Type of preparations (3)

A

Bath
Soak
Paint

156
Q

Liquid Formulations: Indication

A

Inflamed lesions

157
Q

Liquid Formulations: How do they induce a vasoconstrictive effect for inflammation?

A

Evaporates water to cool the skin

158
Q

Liquid Formulations: How can the vasoconstrictive effect be furthered?

A

Addition of alcohol

159
Q

Liquid Formulations: Example of shake lotion

A

Calamine lotion - powder dissolved in water

160
Q

Liquid Formulations: How does it produce a greater diffusion gradient?

A

Hydrates the skin to increase the volume in the stratum corneum

161
Q

Cream Formulations: What property is useful for hydrophilic drugs?

A

Can be Oil-in-Water - the cream mix with the serous discharges

162
Q

Cream Formulations: What property is useful for lipophilic drugs?

A

Can be Water-in-Oil creams - will not mix with serous discharges

163
Q

Cream Formulations: Example of Water-In-Oil cream

A

Zn Creams

164
Q

Cream Formulations: Creams have a lesser ability to do what?

A

Hydrate the stratum corneum

165
Q

Ointment Formulations: What is the function of ethanol in these formulations?

A

Disrupts the stratum corneum lipid bilayer to increase drug permeability

166
Q

Ointment Formulations: Water soluble ointments contain what?

A

Polythene glycol

167
Q

Ointment Formulations: Non-emulsifying ointments - difficult to remove without what?

A

Detergents or Oil

168
Q

Ointment Formulations: Non-emulsifying ointments - Useful for what?

A

Atopic eczema

169
Q

Collodions

A

Preparations of cellulose nitrate which have been dissolved in a solvent e.g. Ether or Alcohol

170
Q

Collodions - How is the drug held to the skin?

A

Solvent evaporates and leaves a thin film holding the drug to the skin

171
Q

Gel

A

Suspension that can be used as a vehicle or lubricant

172
Q

Paste

A

Stiff ointment that can be used as a vehicle for insoluble powders to restrict the active ingredient to the affected area without spread to the surrounding skin

173
Q

Paste - Powder function

A

Acts as an absorbent for discharge

174
Q

Transdermal Drug Administration

A

Passive diffusion through the skin via incorporation of the drug in a stick on patch

175
Q

Transdermal Drug Administration: Does not undergo what type of metabolism?

A

First pass metabolism in the liver

176
Q

Transdermal Drug Administration: Drug must be of what structure?

A

Lipophilic

177
Q

Glucocorticoids: Mechanism of Action

A

Binds to intracellular receptors that bind to DNA-binding domains to allow control of gene transcription

178
Q

Order of potency of administration route

A

Ointment
Gel
Cream
Lotion

179
Q

Glucocorticoids: Suppresses the proliferation of what cells? (2)

A

Fibroblasts
Lymphocytes

180
Q

Glucocorticoids: 2 modes of physiological action

A

Suppress inflammation
Vasoconstriction

181
Q

Transdermal Drug Administration: Enhancements - Chemical enhancer mechanism of action

A

Increases permeability through the stratum corneum

182
Q

Transdermal Drug Administration: Enhancements - What impact does water have?

A

Water accumulates and swells corneocytes and formation of pores to increase permeability

183
Q

Transdermal Drug Administration: Enhancements - Peptide example

A

Maginin

184
Q

Transdermal Drug Administration: Enhancements - Ethanol and Methanol mechanism

A

Disrupt the lipid bilayer of corneocytes