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Elaina-Derm > Pharmacology > Flashcards

Pharmacology Flashcards

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1
Q

inhibits cell wall formation by interfering with incorporation of peptidoglycan subunits in bacterial cell wall

A

bacitracin

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2
Q

indicated for superficial gram+ skin or mucosal lesions

A

bacitracin

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3
Q

when would we consider mupirocin?

A

mupirocin can cover MRSA & some gram- skin infections

it is great for impetigo!

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4
Q

which medication is for GI tract or topical use only?

A

bacitracin

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5
Q

why do we not use bacitracin systemically?

A

it is highly nephrotoxic

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6
Q

what is the benefit of using either bacitracin and mupirocin?

A

no cross-resistance with other ABX

BUT: high-level of resistance to mupirocin can develop with prolonged use

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7
Q

which topical ABX is for skin or nasal use only, and is to be avoided over large areas & pressure ulcers?

A

mupirocin

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8
Q

what is the main side effect to warn your patients of when using bacitracin and mupirocin?

A

burning, stinging at application site

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9
Q

what is the MOA of mupirocin?

A

reversibly binds to tRNA synthase and inhibits bacterial protein synthesis

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10
Q

who do we avoid mupirocin in?

A

renal failure

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11
Q

which topical ABX do we use for superficial gram - infections?

A

polymixin B sulfate; good for pseudomonas, e. coli, enterobacter, klebsiella

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12
Q

do we use polymyxin B sulfate in treating gram+ infections?

A

NO; there is no gram+, proteus, and neisseria coverage secondary to resistance

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13
Q

although polymixin B sulfate is absorbed very minimally with topical use, what are signs of toxicity?

A

muscle weakness, paresthesias, vertigo, slurred speech

neurotoxic or ototoxic if absorbed

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14
Q

who to avoid polymyxin B sulfate in?

A

end stage renal disease; monitor CrCl

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15
Q

which of our drugs has an interaction with aminoglycosides?

A

polymixin B sulfate

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16
Q

what is the drug class & MOA of nystatin (mycostatin)?

A

oral/topical antifungal; binds to sterols in fungal cell membrane, increasing cell permeability

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17
Q

what is the indication for nystatin (mycostatin)?

A

topical skin & mucosal candida infections

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18
Q

what are side effects to warn your patient of when using 1) oral nystatin and 2) topical nystatin?

A

oral: N/D, bitter taste, SJS
topical: contact dermatitis

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19
Q

which anti fungal medication inhibits the uptake of precursors of macromolecular synthesis, inhibiting fungal cell membrane formation?

A

Loprox

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20
Q

what is the drug class of loprox?

A

azole antifungal; topical antifungal

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21
Q

when will we use loprox?

A

candida, tinea versicolor (malassezia furfur infections same thing as p orbiculare)

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22
Q

main side effect of loprox (shampoo)?

A

alopecia

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23
Q

which formulation of loprox do we want to use for oncychomycosis treatment? is it effective?

A

8% solution (penlac nail lacquer); not very effective–usually have to do systemic treatment

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24
Q

what formulation of loprox will we use for dermatomycosis, candidiasis, tinea versicolor infections?

A

creams/lotions

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25
what class of drug is fluconazole (diflucan)?
oral antifungal (azole antifungal; fluorinated)
26
mechanism of action of fluconazole (diflucan)?
alters permeability of fungal cell wall
27
when will we use fluconazole?
candida & tinea species, fungal infections cryptococcal meningitis (AIDS)
28
your patient has been diagnosed with candida vaginitis, what is the best treatment option for her?
fluconazole; single 150 mg dose
29
who do we avoid using fluconazole in?
marked renal or hepatic disease (must adjust dose in renal disorders)
30
side effects of oral fluconazole?
seizures, N/V, dizziness, chemical hepatitis, SJS
31
which drug do we have to be super careful (and likely avoid) in patient's with liver disease?
lamisil; monitor AST/ALT & hepatic function
32
drug drug interactions of lamisil?
tricyclic antidepressants increase toxicity of lamisil; lamisil decreases effectiveness of codeine
33
your patient's kidney function is less than 50 percent CrCl and they want lamisil for their onychomycosis. what can you do?
you cannot prescribe it orally. you can attempt to use it topically
34
what is the main limitation of lamisil?
40% bioavailability (1st pass effect)
35
how much of lamisil is protein bound? why is this a good thing?
99% protein bound; accumulates in nails, skin & fat where we need it
36
this drug is a nucleoside anti-viral oral/topical medication
acyclovir
37
MOA of acyclovir?
blocks herpesvirus nucleic acid synthesis
38
signs of overdose with acyclovir?
tremors, seizures, delirium, nephritis
39
two main drug/drug interactions to be aware of with acyclovir?
1) probencid (gout) increases concentration & increases risk of renal & neuro toxicity 2) acyclovir decreases elimination of methotrexate so be careful with patients on this drug
40
what is the unique feature of acyclovir in regards to how our body processes the drug?
requires viral kinase activation, so accumulates ONLY in virus infected cells!
41
does resistance occur with acyclovir?
yes; should be effective up to 10 years
42
bioavailability of acyclovir is only ~10-30%. what happens when we increase the dose?
bioavailability actually DECREASES
43
your patient wants to take acyclovir prophylactically to prevent herpes outbreaks. what do you tell them?
it decreases the risk of viral shedding by ~90% & decreases risk of transmission by 50%
44
what is the name of the prodrug of acyclovir?
valcyclovir (valtrex); more potent but way more expensive
45
drug class of tretinoin?
acne topical; vitamin A or retinoic acid
46
MOA of tretinoin?
binds to retinoic acid & retinoic X receptor to regulate gene expression & increase epidermal cell turnover
47
when would we use tretinoin? what must you absolutely tell your patient about?
acne & photoaging (wrinkles). it causes a LOT of burning, stinging, dryness & the acne will get WORSE before it gets better
48
what should your patient avoid while using topical tretinoin?
astringents, abrasives (any scrubs with exfoliants), & not in pregnancy
49
which drug is our oral retinoic acid indicated ONLY for severe acne?
isotretinoin
50
what is the MOA of isotretinoin?
undefined to normal keratinization in sebaceous gland follicle & inhibits sebaceous gland size & function
51
it is VERY risky to prescribe isotretinoin. what are some side effects?
extreme dryness, anorexia, myalgias, lipid increase, bronchospasm, hepatotoxicity, premature epiphyseal closure, DEPRESSION & SUICIDAL THOUGHTS (this medication has a lot of messed up side effects. we didn't really stress that in class but i think its important to know in the real world)
52
drug class & MOA of benzoyl peroxide?
topical benzoid acid w/ undefined MOA but maybe antimicrobial activity against P acnes, peeling & comedolytic activity
53
what do you want to warn your patient of before prescribing benzoyl peroxide?
will make them really dry & photosensitive & will bleach their clothing!
54
which drug is our retinoid-like anti-acne agent?
adapaline (differin)
55
MOA of differin?
retinoid-like compound, a modulator of cellular differentiation, keratinization, and inflammatory processes
56
what should you warn your patient about when using differin?
photosensitivity, erythema & stinging (do not use on broken skin) *vitamins ADEK will amplify photosensitization effect
57
your patient is interested in a topical with both retinoid & benozyl peroxide properties. what can we give?
epiduo; its a combo of adapaline & benzoyl peroxide
58
which drug is our topical pedicullicide, anti-parasitic agent?
permethrin 1% lotion/permethrin 5% cream
59
what is the MOA of permethrin?
inhibits Na channel in parasite cell membrane disrupting nerve transmission causing paralysis and death
60
when would we use the permethrin 5% cream?
scabies; will cause skin irritation
61
when would we use the permethrin 1% lotion rinse?
head lice; will cause skin irritation
62
can your patient get permethrin OTC?
NIX is OTC; otherwise Elemite is an RX (but contains formaldehyde!)
63
your patient has moderate psoriasis and is interested in treating it for the first time. what should you try first?
calcipotriene
64
drug class & MOA of calcipotriene?
psoriasis drug; topical vitamin D that regulates skin cell production/proliferation
65
side effects of calcipotriene?
burning, dry skin, skin atrophy, hyperpigmentation, hypercalcemia
66
what must you as a provider be aware of when prescribing calcipotriene?
less than 10 percent of people get total clearing with calcipotriene alone; likely have to add steroid
67
what do we need to monitor when giving a patient topical calcipotriene?
Ca+ response; also the drug may cause vitamin D toxicity & hypercalcemia
68
when should your patient using topical calcipotriene expect to see improvement?
2 weeks; 8 weeks max improvement
69
triamcinalone is availabile in two strength formulations. what are they?
1) 0.025% (intermediate efficacy; glucocorticoid & topical) 2) 0.5% (high efficacy topical & glucocorticoid)
70
besides topical, how else may you administer triamcinalone?
intralesional kenalog (when you inject someone with steroids)
71
MOA of triamcinalone?
attaches to GR receptor & inhibits protein synthesis
72
side effects of triamcinalone? why do you want to avoid long term use?
striae, increases susceptibility of infection, changes in fat distribution, cataracts **LONG TERM USE will cause atrophy & thinning of the skin
73
who should we avoid long term triamcinalone in?
people on immunosuppressions or chronic NSAIDS
74
what is our HIGH strength topical steroid & glucocorticoid?
clobetasol
75
MOA of clobetasol?
same as triamcinalone! attaches to GR receptor & inhibits protein synthesis
76
side effects, DX/DX interactions, monitoring w/ clobetasol?
all same as triamcinalone! SE: skin atrophy (worse bc higher potency) DXDX: no NSAIDS, immunosuppressants MONITOR: only if long term-lipids, glucose, CrCl
77
class & MOA of sulfasalazine?
oral psoriasis drug; MOA=undefined local impact; systemic impact of decreased prostaglandins & other inflammatory cytokine production
78
what are the indications for sulfasalazine?
off-label psoriasis & psoriatic arthritis, Crohns, ulcerative colitis
79
side effects of sulfasalazine?
N/V/D, photosensitivity, hemolytic anemia, SJS/TEN
80
who to avoid sulfasalazine in?
hepatic impairment; it is metabolized in the liver. monitor LFT & CrCl (renal clearance) if you have to give it
81
your patient just got the varicella vaccine. what do we need to be careful of given the fact that they are on sulfasalazine?
this vaccine increases the concentration of sulfasalazine
82
which drug is our folate antimetabolite drug indicated for psoriasis & RA?
methotrexate
83
MOA of methotrexate?
dihydrofolate reductase inhibitor which inhibits proliferation and induces apoptosis of immune-inflammatory cells
84
side effects of methotrexate?
PULMONARY & hepatic fibrosis, vasculitis & seizures
85
who to avoid methotrexate in?
alcoholic cirrhosis, renal or hepatic dysfunction
86
what to monitor when your patient is on methotrexate?
pulmonary function tests! also liver & kidney functino
87
class & MOA of hydroxyurea?
oral antimetabolite with undefined interference with DNA synthesis
88
when will we use hydroxyurea?
many! but psoriasis (off-label)
89
side effects of hydroxyurea?
alopecia, drowsiness, hepatotoxicity, peripheral neuropathy, PULMONARY FIBROSIS
90
like every oral psoriasis drug, what do we want to monitor?
CBC, LFT, CrCl (these people will be on these meds long term and you will definitely need to do this)
91
what do you need to make sure to do before prescribing your patient Enbrel?
PPD test; it is contraindicated in patient's with TB
92
drug class of enbrel?
biologic response modifier (BRM); TNF alpha & beta blocker
93
MOA of enbrel?
blocks TNF alpha receptor binding thereby inhibiting TH1 activity
94
indications for enbrel?
refractory psoriasis unresponsive to other things, psoriatic arthritis, JRA, ankylosing spondylitis
95
side effects to be weary of with enbrel?
immunosuppression, anemia, exacerbation of CHF & demyelinating disorders
96
what other conditions must you pre-test before prescribing and avoid enbrel in if positive?
HIV, Hep B, CHF
97
how is enbrel given?
SQ injection every 1-2 weeks
98
drug class & MOA of polymyxin B sulfate?
topical ABX; interacts with phospholipids and disrupts bacterial cell membrane; binds to and activates endotoxin

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