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Elaina-Derm > Pharmacology > Flashcards

Pharmacology Flashcards

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
Q

what class of drug is fluconazole (diflucan)?

A

oral antifungal (azole antifungal; fluorinated)

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26
Q

mechanism of action of fluconazole (diflucan)?

A

alters permeability of fungal cell wall

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27
Q

when will we use fluconazole?

A

candida & tinea species, fungal infections cryptococcal meningitis (AIDS)

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28
Q

your patient has been diagnosed with candida vaginitis, what is the best treatment option for her?

A

fluconazole; single 150 mg dose

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29
Q

who do we avoid using fluconazole in?

A

marked renal or hepatic disease (must adjust dose in renal disorders)

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30
Q

side effects of oral fluconazole?

A

seizures, N/V, dizziness, chemical hepatitis, SJS

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31
Q

which drug do we have to be super careful (and likely avoid) in patient’s with liver disease?

A

lamisil; monitor AST/ALT & hepatic function

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32
Q

drug drug interactions of lamisil?

A

tricyclic antidepressants increase toxicity of lamisil; lamisil decreases effectiveness of codeine

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33
Q

your patient’s kidney function is less than 50 percent CrCl and they want lamisil for their onychomycosis. what can you do?

A

you cannot prescribe it orally. you can attempt to use it topically

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34
Q

what is the main limitation of lamisil?

A

40% bioavailability (1st pass effect)

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35
Q

how much of lamisil is protein bound? why is this a good thing?

A

99% protein bound; accumulates in nails, skin & fat where we need it

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36
Q

this drug is a nucleoside anti-viral oral/topical medication

A

acyclovir

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37
Q

MOA of acyclovir?

A

blocks herpesvirus nucleic acid synthesis

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38
Q

signs of overdose with acyclovir?

A

tremors, seizures, delirium, nephritis

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39
Q

two main drug/drug interactions to be aware of with acyclovir?

A

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

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40
Q

what is the unique feature of acyclovir in regards to how our body processes the drug?

A

requires viral kinase activation, so accumulates ONLY in virus infected cells!

41
Q

does resistance occur with acyclovir?

A

yes; should be effective up to 10 years

42
Q

bioavailability of acyclovir is only ~10-30%. what happens when we increase the dose?

A

bioavailability actually DECREASES

43
Q

your patient wants to take acyclovir prophylactically to prevent herpes outbreaks. what do you tell them?

A

it decreases the risk of viral shedding by ~90% & decreases risk of transmission by 50%

44
Q

what is the name of the prodrug of acyclovir?

A

valcyclovir (valtrex); more potent but way more expensive

45
Q

drug class of tretinoin?

A

acne topical; vitamin A or retinoic acid

46
Q

MOA of tretinoin?

A

binds to retinoic acid & retinoic X receptor to regulate gene expression & increase epidermal cell turnover

47
Q

when would we use tretinoin? what must you absolutely tell your patient about?

A

acne & photoaging (wrinkles). it causes a LOT of burning, stinging, dryness & the acne will get WORSE before it gets better

48
Q

what should your patient avoid while using topical tretinoin?

A

astringents, abrasives (any scrubs with exfoliants), & not in pregnancy

49
Q

which drug is our oral retinoic acid indicated ONLY for severe acne?

A

isotretinoin

50
Q

what is the MOA of isotretinoin?

A

undefined to normal keratinization in sebaceous gland follicle & inhibits sebaceous gland size & function

51
Q

it is VERY risky to prescribe isotretinoin. what are some side effects?

A

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
Q

drug class & MOA of benzoyl peroxide?

A

topical benzoid acid w/ undefined MOA but maybe antimicrobial activity against P acnes, peeling & comedolytic activity

53
Q

what do you want to warn your patient of before prescribing benzoyl peroxide?

A

will make them really dry & photosensitive & will bleach their clothing!

54
Q

which drug is our retinoid-like anti-acne agent?

A

adapaline (differin)

55
Q

MOA of differin?

A

retinoid-like compound, a modulator of cellular differentiation, keratinization, and inflammatory processes

56
Q

what should you warn your patient about when using differin?

A

photosensitivity, erythema & stinging (do not use on broken skin)

*vitamins ADEK will amplify photosensitization effect

57
Q

your patient is interested in a topical with both retinoid & benozyl peroxide properties. what can we give?

A

epiduo; its a combo of adapaline & benzoyl peroxide

58
Q

which drug is our topical pedicullicide, anti-parasitic agent?

A

permethrin 1% lotion/permethrin 5% cream

59
Q

what is the MOA of permethrin?

A

inhibits Na channel in parasite cell membrane disrupting nerve transmission causing paralysis and death

60
Q

when would we use the permethrin 5% cream?

A

scabies; will cause skin irritation

61
Q

when would we use the permethrin 1% lotion rinse?

A

head lice; will cause skin irritation

62
Q

can your patient get permethrin OTC?

A

NIX is OTC; otherwise Elemite is an RX (but contains formaldehyde!)

63
Q

your patient has moderate psoriasis and is interested in treating it for the first time. what should you try first?

A

calcipotriene

64
Q

drug class & MOA of calcipotriene?

A

psoriasis drug; topical vitamin D that regulates skin cell production/proliferation

65
Q

side effects of calcipotriene?

A

burning, dry skin, skin atrophy, hyperpigmentation, hypercalcemia

66
Q

what must you as a provider be aware of when prescribing calcipotriene?

A

less than 10 percent of people get total clearing with calcipotriene alone; likely have to add steroid

67
Q

what do we need to monitor when giving a patient topical calcipotriene?

A

Ca+ response; also the drug may cause vitamin D toxicity & hypercalcemia

68
Q

when should your patient using topical calcipotriene expect to see improvement?

A

2 weeks; 8 weeks max improvement

69
Q

triamcinalone is availabile in two strength formulations. what are they?

A

1) 0.025% (intermediate efficacy; glucocorticoid & topical)
2) 0.5% (high efficacy topical & glucocorticoid)

70
Q

besides topical, how else may you administer triamcinalone?

A

intralesional kenalog (when you inject someone with steroids)

71
Q

MOA of triamcinalone?

A

attaches to GR receptor & inhibits protein synthesis

72
Q

side effects of triamcinalone? why do you want to avoid long term use?

A

striae, increases susceptibility of infection, changes in fat distribution, cataracts

**LONG TERM USE will cause atrophy & thinning of the skin

73
Q

who should we avoid long term triamcinalone in?

A

people on immunosuppressions or chronic NSAIDS

74
Q

what is our HIGH strength topical steroid & glucocorticoid?

A

clobetasol

75
Q

MOA of clobetasol?

A

same as triamcinalone! attaches to GR receptor & inhibits protein synthesis

76
Q

side effects, DX/DX interactions, monitoring w/ clobetasol?

A

all same as triamcinalone!
SE: skin atrophy (worse bc higher potency)
DXDX: no NSAIDS, immunosuppressants
MONITOR: only if long term-lipids, glucose, CrCl

77
Q

class & MOA of sulfasalazine?

A

oral psoriasis drug; MOA=undefined local impact; systemic impact of decreased prostaglandins & other inflammatory cytokine production

78
Q

what are the indications for sulfasalazine?

A

off-label psoriasis & psoriatic arthritis, Crohns, ulcerative colitis

79
Q

side effects of sulfasalazine?

A

N/V/D, photosensitivity, hemolytic anemia, SJS/TEN

80
Q

who to avoid sulfasalazine in?

A

hepatic impairment; it is metabolized in the liver. monitor LFT & CrCl (renal clearance) if you have to give it

81
Q

your patient just got the varicella vaccine. what do we need to be careful of given the fact that they are on sulfasalazine?

A

this vaccine increases the concentration of sulfasalazine

82
Q

which drug is our folate antimetabolite drug indicated for psoriasis & RA?

A

methotrexate

83
Q

MOA of methotrexate?

A

dihydrofolate reductase inhibitor which inhibits proliferation and induces apoptosis of immune-inflammatory cells

84
Q

side effects of methotrexate?

A

PULMONARY & hepatic fibrosis, vasculitis & seizures

85
Q

who to avoid methotrexate in?

A

alcoholic cirrhosis, renal or hepatic dysfunction

86
Q

what to monitor when your patient is on methotrexate?

A

pulmonary function tests! also liver & kidney functino

87
Q

class & MOA of hydroxyurea?

A

oral antimetabolite with undefined interference with DNA synthesis

88
Q

when will we use hydroxyurea?

A

many! but psoriasis (off-label)

89
Q

side effects of hydroxyurea?

A

alopecia, drowsiness, hepatotoxicity, peripheral neuropathy, PULMONARY FIBROSIS

90
Q

like every oral psoriasis drug, what do we want to monitor?

A

CBC, LFT, CrCl (these people will be on these meds long term and you will definitely need to do this)

91
Q

what do you need to make sure to do before prescribing your patient Enbrel?

A

PPD test; it is contraindicated in patient’s with TB

92
Q

drug class of enbrel?

A

biologic response modifier (BRM); TNF alpha & beta blocker

93
Q

MOA of enbrel?

A

blocks TNF alpha receptor binding thereby inhibiting TH1 activity

94
Q

indications for enbrel?

A

refractory psoriasis unresponsive to other things, psoriatic arthritis, JRA, ankylosing spondylitis

95
Q

side effects to be weary of with enbrel?

A

immunosuppression, anemia, exacerbation of CHF & demyelinating disorders

96
Q

what other conditions must you pre-test before prescribing and avoid enbrel in if positive?

A

HIV, Hep B, CHF

97
Q

how is enbrel given?

A

SQ injection every 1-2 weeks

98
Q

drug class & MOA of polymyxin B sulfate?

A

topical ABX; interacts with phospholipids and disrupts bacterial cell membrane; binds to and activates endotoxin

Elaina-Derm (1 decks)

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