pharmacology and prescribing

Question 1

how are medications in the UK licensed?

Answer 1

MHRA - medicines and healthcare products regulatory agency

EMA - European medicines agency

Question 2

name a process by which medicines are ensured to be of high standards of safety and quality?

Answer 2

SMC submission - Scottish Medicines Consortium

Question 3

what is off-label medication?

Answer 3

licensed medication which is used for unlicensed indication

Question 4

what are special medications?

Answer 4

unlicensed dermatological preparations

these tend to have a long history of use which is clinically effective, despite having no strong evidence base

Question 5

name 4 reasons for prescription errors?

Answer 5

lack of knowledge - about patient, meds, allergies etc.

poor communication

mistake writing/ generating prescription

no local/ national guidelines

Question 6

differentiate between pharmacokinetics and pharmacodynamics?

Answer 6

pharmacokinetics - effect of body on drug

pharmacoDynamics - effect of Drug on body

Question 7

3 factors associated with pharmacokinetics?

Answer 7

distribution - where drug goes

metabolism - esp. liver disease

excretion - esp. renal disease

Question 8

key factor affecting pharmacokinetics?

Answer 8

route of administration

optimal absorption is key - topical is often best

Question 9

3 things to think about with pharmacodynamics?

Answer 9

age of patient
risk of pregnancy
drug interactions

Question 10

4 factors associated with poor concordance to medication?

Answer 10

psychiatric co-morbidities

multiple applications per day

lack of patient education

unintentional non-adherence

Question 11

2 components that combine to make a topical therapy?

Answer 11

vehicle + active drug

Question 12

what is a vehicle?

Answer 12

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

Question 13

5 factors affecting absorption?

Answer 13

concentration of drug

base/vehicle used

thickness and hydration of stratum corneum

temperature

skin site

Question 14

4 examples of vehicle?

Answer 14

solution
cream
gel
lotion

Question 15

4 examples of topical drugs?

Answer 15

corticosteroid
anti-inflammatory
antibiotic
salicylic acid

Question 16

topical steroids have anti-inflammatory and immunosuppressive properties - name 4 ways this is demonstrated?

Answer 16

regulation of pro inflammatory cytokines

vasoconstriction

suppress fibroblast, endothelial, leukocyte function

inhibition of vascular permeability

Question 17

how much is a finger tip unit?

Answer 17

~0.5g

Question 18

what size of area should a finger tip unit cover?

Answer 18

an area that is double the size of one hand

Question 19

name 5 side effects of topical steroids?

Answer 19

thinning of skin 
striae 
bruising 
hirsutism 
glaucoma

Question 20

which 3 classes of medication are used as systemic treatments?

Answer 20

retinoids
Immunosuppressants
biologics

Question 21

what are retinoids and what are their function?

Answer 21

vitamin A analogues

normalise keratinocyte function
anti-inflammatory and anti-cancer effects

Question 22

which retinoid, taken orally, is commonly used to treat acne?

Answer 22

Isotretinoin

Question 23

which retinoid, taken orally, is commonly used to treat psoriasis?

Answer 23

Acitretin

Question 24

which retinoid, taken orally, is commonly used to treat cutaneous T cell lymphoma?

Answer 24

Bexarotene

Question 25

which retinoid, taken orally, is commonly used to treat hand eczema?

Answer 25

Alitretinoin

Question 26

name 2 common side effects of retinoids?

Answer 26

cheilitis (dry lips)

xerosis (dry skin)

Question 27

rarer side effects of retinoids?

Answer 27

psychiatric, eye, bone side effects

Question 28

what are immunosuppressants used to treat?

Answer 28

inflammatory skin disorders

Question 29

5 examples of immunosuppressants?

Answer 29

oral steroids 
azathioprine 
ciclosporin 
methotrexate 
mycophenolate mofetil

Question 30

2 major risks with immunosuppressants?

Answer 30

malignancy

serious infections

Question 31

what must be regularly carried out for patients using immunosuppressants?

Answer 31

regular blood test monitoring - especially:
FBC
Renal function
liver function

Question 32

when is it particularly important to monitor FBC?

Answer 32

methotrexate and azathioprine

Question 33

when is it particularly important to monitor renal function?

Answer 33

ciclosporin

Question 34

when is it particularly important to monitor liver function?

Answer 34

methotrexate

Question 35

name 1 advantage and 1 disadvantage to biologics?

Answer 35

adv - very effective, due to specific inhibition of components of immune system

dis - very costly

Question 36

what does suffix -mab denote?

Answer 36

monoclonal antibodies

Question 37

name 3 risks of infection associated with the use of biologics?

Answer 37

TB reactivation
serious infection
avoid live vaccines

Question 38

name another risk associated with the use of biologics?

Answer 38

malignancy

Question 39

name a risk associated with the use of TNF inhibitors?

Answer 39

risk of demyelination

Question 40

name 2 targeted treatments for melanoma?

Answer 40

if BRAF 600 mutation -

vemurafenib
dabrafenib

Question 41

name 2 immunotherapies for melanoma?

Answer 41

ipilimumab

pembrolizumab