Pharmacology and Prescribing

Question 1

what is an unlicensed drug

Answer 1

not approved for use in the UK

Question 2

what is an off label drug

Answer 2

a licensed medication that is being used for an unlicensed indication

Question 3

what are specials drugs

Answer 3

unlicensed dermatological preparations - long history of use, no strong evidence bas but clinically effective

Question 4

what are 4 causes of prescription error

Answer 4

1. lack of knowledge
2. mistake writing generating prescription
3. poor communication
4. no local/national guidelines

Question 5

what is the definition of pharmacokinetics

Answer 5

the effect of the body not the drug

Question 6

what is the definition of pharmacodynamics

Answer 6

the effect of the drug on the body

Question 7

what are the 4 factors to take into account in pharmacokinetics

Answer 7

1. route of administration - affects absorption
2. distribution - where the drug goes
3. metabolism - esp in liver disease
4. excretion - esp in renal disease

Question 8

what are the 5 factors to take into account in pharmacodynamics

Answer 8

1. individual variation in response
2. age of patient
3. pregnancy risk
4. drug interactions
5. pharmacogenetics

Question 9

what are 6 factors related to poor adherence of taking medication

Answer 9

1. Psychiatric co-morbidities
2. Slower acting agents
3. Multiple applications per day
4. Lack of patient education
5. Cosmetic acceptability of treatments
6. Unintentional non-adherence

Question 10

what is the definition of topical therapy

Answer 10

medication applied to the skin

Question 11

what are the two components in a topical medication

Answer 11

vehicle and active drug

Question 12

what is the definition of the vehicle in topical medication

Answer 12

pharmacologically inert, physically and chemically stable substance that carries the active drug

Question 13

give examples of topical vehicles

Answer 13

solutions, creams, lotions, gels, foams, tapes, paste, spray powder, shampoo, ointment, paint

Question 14

what factors can affect absorption of topical medications

Answer 14

concentration, base/vehicle, chemical properties of drug, thickness & hydration of stratum corneum, temperature, skin site, occlusion

Question 15

give examples of drugs than can be used topically

Answer 15

corticosteroids, antibiotics, antivirals, dithranol, vitamin analogues, chemotherapy, parasiticidals, coal tar, anti-inflammatory, salicylic acid

Question 16

what are the main properties of topical steroids

Answer 16

anti-inflammatory and immunosuppressive

Question 17

how do topical steroids work

Answer 17

1. regulate pro inflammatory cytokines
2. suppress fibroblast, endothelial and leukocyte function
3. vasoconstriction
4. inhibit vascular permeability

Question 18

what are the range of potencies of topical steroids

Answer 18

mild, moderate, potent, ultra potent

Question 19

how much is a finger tip unit and what area can it cover

Answer 19

about 0.5g - should treat area double the size of one hand

Question 20

what are the side effects of topical steroids

Answer 20

Thinning /atrophy
Striae
Bruising
Hirsutism
Telangiectasia
Acne/rosacea/perioral dermatitis
Glaucoma
Systemic absorption
Cataracts

Question 21

name 3 groups of systemic treatments in dermatology

Answer 21

1. retinoids
2. traditional immunosuppressants
3. biologics (also immunosuppressive)

Question 22

what are retinoids and what do they do

Answer 22

vitamin A analogues - normalise keratinocyte function, anti-inflammatory and anti cancer effects

Question 23

what retinoid is used for acne

Answer 23

isotrtinoin

Question 24

what retinoid is used for psoriasis

Answer 24

acitretin

Question 25

what retinoid is used for cutaneous T cell lymphoma

Answer 25

bexarotene

Question 26

what retinoid is used for hand eczema

Answer 26

alitretinoin

Question 27

what aspect of retinoids mean you must be careful in patient selection

Answer 27

it is teratogenic

Question 28

what are the side effects of retinoids

Answer 28

1. Cheilitis(dry lips) and xerosis (dry skin) 2. ↑transaminases, ↑triglycerides 3. Rarely psychiatric, eye, bone side effects

Question 29

what are immunosuppressants used for in dermatology

Answer 29

inflammatory skin conditions

Question 30

give examples of immunosuppressants

Answer 30

``` Oral steroids Azathioprine Ciclosporin Methotrexate Mycophenolate mofetil ```

Question 31

what are the risks of taking immunosuppressants

Answer 31

malignancy, serious infection

Question 32

what monitoring is needed when on immunosuppressants

Answer 32

regular blood tests - FBC - renal function - liver function

Question 33

what are biologics

Answer 33

Genetically engineered proteins derived from human genes

Question 34

what are biologics designed to do

Answer 34

designed to inhibit specific components of the immune system

Question 35

in biologics what does the suffix -cept indicate

Answer 35

is is a receptor fusion eg EtanerCEPT -genetically engineered fusion protein

Question 36

in biologics what does the suffix -mab indicate

Answer 36

used to denote Monoclonal AntiBodies

Question 37

what do the following infixes which immediately precede -mab denote

Answer 37

- zu- = humanised - ix- = chimeric - u- = fully human - li-/-l- = immunomodulator

Question 38

name the comments of e.g. adaLImUMAb

Answer 38

- li- = immunomodulator - u- = fully human - mab = monoclonal antibodies

Question 39

name the components of e.g. infLIXiMAB

Answer 39

- l- = immunomodulator - xi- = chimeric - mab - monoclonal antibodies

Question 40

what are the current biologics licensed for plaque psoriasis in the uk

Answer 40

Etanercept Infliximab Adalimumab* Ustekinumab Secukinumab Ixekizumab *also licensed for hidradenitis supportive

Question 41

what biologic is licensed in the UK for chronic spontaneous urticaria

Answer 41

omalizumab

Question 42

what are the risks associated with biologics

Answer 42

1. risk of infection - TB reactivation, serious infections 2. risk of malignancy 3. risk of demyelination - TNF inhibitors

Question 43

what biologics are used to treat melanoma with the BRAF 600 mutation

Answer 43

Vemurafenib | Dabrafenib

Question 44

what biologics are used to as immunotherpies in melanoma

Answer 44

Ipilumumab | Pembrolizumab