Pharmacology for Various Dermatological Diseases

Question 1

Basal Cell Carcinoma treatments

Answer 1

o First line: topical fluorouracil with imiquimod
o Metastatic: No set regimen; cisplatin recognized as best single agent
o New therapy: Vismodegib

Question 2

Squamous Cell Carcinoma treatments

Answer 2

o First line: Surgery with radiation

o Metastatic: No set regimen; cisplatin recognized as best single agent

Question 3

Malignant Melanoma treatments

Answer 3

• Immunotherapy: aldesleukin, interferon-a-2B, ipilimumab, nivolumab, pembrolizumab
• Signal transduction inhibition: dabrafenib, sorafenib, trametinib, vemurafenib
• Classic chemotherapy: several agents, often with short-lived responses

Question 4

Actinic Keratosis treatments

Answer 4

• Topical fluorouracil with imiquimod
• Diclofenac – an NSAID that acts as a chemical peel and decreases inflammation
• Trichloroacetic acid – acts as a chemical peel

Question 5

Imiquimod

Answer 5

• Used for treatment of basal cell carcinoma, actinic ketatosis, and HPV infection
• Topical
• Immunostimulant that…
o Activates TLR7/TLR8 as a ligand (stimulates TH1CD4 cells to ramp up immune response)
o Blocks adenosine receptors
o Represses Hedgehog signaling as a ligand for oncogenic glioma-associated oncogene
• Adverse effects
o Photosensitivity (patients should avoid sunlight)
o Rash at application site
o Compromise condom/diaphragm contraceptives in HPV treatment

Question 6

Vismodegib

Answer 6

• Used in treatment of basal cell carcinoma
• Oral
• Works by blocking smoothened (SMO) downstream signaling of Hedgehog pathway
• Adverse effects
o Intraurterine fetal death – you must confirm you are not pregnant, be on effective birth control, and continue that birth control for 7 months post treatment
o Male mediated teratogenicity – it can get in sperm and fertilization will yield a severely affected baby
o Alopecia – not uncommon for cancer treatments, but not fun

Question 7

Aldesleukin

Answer 7

• Used to treat malignant melanoma
• Exogenous IL-2 agonist – results in proliferation/differentiation of B/T-cells, monocytes, macrophages, CTLs, and NK cells)
• IV or SC infection (inpatient only)
• Adverse effects
o Can cause damage to ANY organ system
o CNS/cardiac/pulmonary toxicities are all BBW
o Capillary leak syndrome is a major concern
• Stimulation of CD122hi-NK cells and direct IL-2-CD25 endothelium cause release of pro-inflammatory cytokines and vasoactive mediatory production
• These result in increased vascular permeability, hypotension, pulmonary edema, liver cell damage, and renal failure
o Can stimulate T-reg cells that dampen robustness of immune response
• Necessary testing
o Thallium stress testing for to establish normal cardiac/pulmonary function
o PFTs to establish normal pulmonary function
o Baseline and daily on-treatment CXRs

Question 8

Interferon-a 2b

Answer 8

•	Used to treat malignant melanoma
•	Exogenous interferon – stimulates CD8 T-cells/NK cells to kill tumor cells (perforin, granzyme, and FAS-ligand mediated cell death)
•	Adverse effects
o	Increased risk of autoimmune disease
o	Increased risk of cardiac disease
o	Depression and suicidal ideation
o	Damage to blood, lungs, and liver
•	Necessary testing
o	ECG monitoring for cardiac function
o	Routine CBCs to manage blood
o	Regular CXRs for lungs
o	LFTs/enzyme screenings for liver

Question 9

Ipilimumab

Answer 9

• Used to treat malignant melanoma
• CTLA4 antagonist – binds and blocks interactions by CTLA4 to promote T-cell activation
• Side effects
o Toxic epidermal necrolysis
o Endocrineopathies, diarrhea, peripheral neuropathy
o Avoid using in pregnancy
o Often CTLA4 blockers have a higher risk of serious side effects (more activation of the immune reponse, rather than difficulty turning it off)

Question 10

Nivolumab

Answer 10

• Used to treat malignant melanoma
• PD1 antagonist – blocks PD1 so once T-cells are turned on, it won’t dampen the immune response
• Side effects
o Toxic epidermal necrolysis
o Endocrineopathies, diarrhea, peripheral neuropathy
o Avoid using in pregnancy

Question 11

Pembolizumab

Answer 11

• Used to treat malignant melanoma
• PD1 antagonist – blocks PD1 so once T-cells are turned on, it won’t dampen the immune response
• Side effects
o Toxic epidermal necrolysis
o Endocrineopathies, diarrhea, peripheral neuropathy
o Avoid using in pregnancy

Question 12

Dabrafenib

Answer 12

BRAF V600E/V600K/V600D and wild-type BRAF

• Used for malignant melanoma
• Oral
• Have VERY widespread adverse effects throughout the body
o Skin = new primary tumor development (BCC/SCC) and Steven-Johnson syndrome
o Eye = retinal detachment
o Avoid during pregnancy

Question 13

Sorafenib

Answer 13

multiple intracellular/cell surface kinases

• Used for malignant melanoma
• Oral
• Have VERY widespread adverse effects throughout the body
o Skin = new primary tumor development (BCC/SCC) and Steven-Johnson syndrome
o Eye = retinal detachment
o Avoid during pregnancy

Question 14

Trametinib

Answer 14

MEK1/MEK2

• Used for malignant melanoma
• Oral
• Have VERY widespread adverse effects throughout the body
o Skin = new primary tumor development (BCC/SCC) and Steven-Johnson syndrome
o Eye = retinal detachment
o Avoid during pregnancy

Question 15

Vemurafenib

Answer 15

BRAF V600E

• Used for malignant melanoma
• Oral
• Have VERY widespread adverse effects throughout the body
o Skin = new primary tumor development (BCC/SCC) and Steven-Johnson syndrome
o Eye = retinal detachment
o Avoid during pregnancy

Question 16

Ketoconazole (“-azole”)

Answer 16

• Used for local or widespread tinea and potentially for hormone-sensitive prostate cancer
• Topical for local and oral for widepsread
• At normal doses: inhibits fungal cytochrome P450, blocking 14-alpha-sterol demethylase to block ergosterol synthesis to stop formation of the fungal cell membrane (fungistatic)
• At high doses: inhibits adrenal steroid synthesis (decreased aldosterone, cortisol, testosterone)
o May be used to treat hormone-sensitive prostate cancer
• Side effects
o CYP3A4 substrate (competes with other drugs)
o Hepatotoxicity (from metabolism)
o Classic hormone-derived adverse effects
• Erectile dysfunction, gynecomastia, male breast pain (from testosterone decrease)
• Menstrual irregularity, hot flashes (aldosterone decrease)

Question 17

Griseofluvin

Answer 17

• Used to treat widespread tinea and onychomycosis
• Oral (poor skin penetration)
• Inhibits the mitotic spindle in the nucleus (no replication for the fungus)
• Side effects
o CYP3A4 inducer
• Decreased anticoagulant effects of Coumadin/Warfarin
• Decreased contraceptive ability of oral birth control
• Decreased cyclosporine serum levels
• Increased ethanol effects
o Porphyria – enzyme disorder porphyrin metabolism caused by this drug
• Results in porphyrin accumulation
• Vomiting, muscle weakness, seizure, and skin manifestations typically occur
o Teratogen so don’t take while pregnant
o B-lactam allergy cross reactivity because its derived from Penicillium
o Photosensitivity often occurs

Question 18

Terbinafine

Answer 18

• Used to treat tinea and onychomycosis
• Topical or oral
• Inhibit squalene epoxidase to block ergosterol synthesis and cause toxic squalene accumulation (fungicidal)
• Side effects
o Lympho/neutropenia – routine CBCs are recommended; increased risk for opportunistic infection; don’t use in immunosuppressed patients
• OK to use in pregnancy!

Question 19

Naftifine

Answer 19

• Used for tinea and cutaneous bacterial infections
• Topical
• Mechanisms include:
o Fungicidal: Selective inhibition of squalene epoxidase to block ergosterol synthesis and cause toxic squalene accumulation
o Anti-inflammatory/vasoconstriction: inhibition of prostraglandins/leukotrienes/ histamine
o Anti-bacterial: can kill off gram+ and gram- infections locally
• Side effects
o Don’t use with “-azole” drugs, they work on the same pathway
o Avoid if patient is allergic

Question 20

Cicloprirox

Answer 20

• Used for local tinea/onychomycoses
• Topical
• Poorly understood mechanism of action
• Some worry of hypersensitivity

Question 21

Amorolfine

Answer 21

• Used for local tinea/onychomycoses
• Topical
• Poorly understood mechanism of action
• Some worry of hypersensitivity

Question 22

Malathion

Answer 22

• Topical shampoo – apply, air dry without rinse, leave on for 8-12 hours, then rinse
• Organophospate insecticide – inhibits acetylcholinesterase so acetylcholine levels are increased in the louse, resulting in excessive stimulation and paralysis
• Proper use yields no side effects
• Incorrect use will yield systemic symptoms of cholinergic toxicity
o Diarrhea, cramping, wheezing, hypotension, etc.
o Can be reversed with atropine or pralidoxime

Question 23

Permethrin

Answer 23

• Topical shampoo – wash hair, then apply for 10 minutes, then rinse
• Voltage gated Na+ channel blocker – results in paralysis
• Toxic to aquatic life and cats
• No major toxicities in humans

Question 24

Ivermectin

Answer 24

• Two formulations
o Topical shampoo – apply to dry hair, then rinse
o Oral – can be used in several parasitic infestations
• Two mechianisms
o Chloride glutamate receptor agonist – allows for Cl- influx into the cell, causing hyperpolarization, thus paralysis
o GABA disruptor – disrupts neural transmission through inhibition of GABA receptors
• No major adverse effects

Question 25

Dimethicone

Answer 25

* Silicone based polymer – apply to dry hair, leave for 10 minutes, then use a lice comb to remove lice. Then clean with regular shampoo * Suffocates the lice, allowing for easy removal * Fairly effective over a 3 week course (1 treatment per week) * No side effects

Question 26

Air Alle

Answer 26

• Fancy air dryer that dehydrates both lice and eggs

Question 27

Aluminum Chloride

Answer 27

Hyperhidrosis drug * Anti-persperant – combines with keratin to produce fibrillar contraction o the duct, thus occlusion and a halt to sweating * Can cause skin inflammation locally if barrier is disrupted (wet, recent shave, cut, etc.)

Question 28

Botulinum toxin

Answer 28

Hyperhidrosis drug • Inhibits release of Acetylcholine through inhibition of intra-neuronal vesicle fusion o Toxin is endocytosed by the neuron o After entering the neuron cytoplasm, the toxin cleaves SNAP-25 and SNARE proteins needed for vesicle fusion to allow for neurotransmitter release o Halts the release of neurotransmitter, resulting in muscle paralysis/inhibition of eccrine sweat gland activity • Side effects o Typical anticholinergic effects o Albumin allergy (used in the formulation of the injectable agent) o Systemic botulism CAN occur although it’s extremely rare

Question 29

Glycopyrrolate/ Propantheline

Answer 29

Hyperhidrosis drug * Off-label use * Anti-muscarinic that can stop the M2, M3 stimulation of eccrine sweat glands * Both quaternary ammonium compounds, so won’t cross BBB

Question 30

Oxybutynin

Answer 30

Hyperhidrosis drug * Off-label use * Anti-muscarinic that can stop the M2, M3 stimulation of eccrine sweat glands * Crosses BBB causing sedation

Question 31

Minoxidil

Answer 31

* Used to promote hair growth (Trichogenic) * Oral * Mechanism is not known! Though to possibly promote bloodflow to hair follicles * Initially marketed as an oral anti-hypertensive, but hair growth was noted as a side effect

Question 32

Finasteride

Answer 32

• Used to promote hair growth (Trichogenic) • Oral • Blocks 5-a-reductase activity – results in decreased dihydrotestosterone levels (no effects on other hormone levels) • Saw palmetto organic supplements work in a similar manner; should not be taken together • Side Effects o Sexual dysfunction/infertility/feminization because of decreased dihydrotestosterone

Question 33

Eflornithine

Answer 33

• Used to decrease hair growth (Anti-trichogenic) • Oral • Inhibits ornithine decarboxylase – reduces cell division/differentiation which includes the hair follicle (6-8 weeks of use needed) o Only to be used on facial cheeks/chin • May help treat African sleeping sickness, but potentially not adequate alone

Question 34

*Tri-Luma (Flourcinolone/Hydroquinone/Tretinoin)

Answer 34

• Used to decrease hyperpigmentation of the skin • Oral multi-drug o Flourcinolone – corticosteroid for anti-inflammation o Hydroquinone – stops melanin formation by blocking the melanocyte from oxidizing [tyrosine → 3,4-dihydroxyphenylalanine (DOPA)] o Tretinoin – increases keratinocyte turnover • Side effects o Increase sensitivity to UV radiation

Question 35

Methoxsalen

Answer 35

• Used in many skin conditions to: o Resolve hypopigmentation: vitiligo o Induce cell death/turnover: psoriasis, mycosis fungoides, eczema, lichen planus o Promote hair growth: alopecia areata • Topical or oral • Works through application/dosing then exposure to UVA (320-400nm) o Thought to cause crosslinking of DNA and cell death o Allows for replacement of non-functional cells or malignant cells with new, normal cells

Question 36

Chemotherapy Induced Allopecia

Answer 36

* Induced via 1decreased Bcl-2 or 2increased Bax/p53 * Often psychologically devastating for cancer patients * Will resolve from buldge stem cells which are not affected by the chemo * Scalp cooling = not approved method to keep hair; may stop drug action at scalp micrometastases

Question 37

Uncomplicated, Non-MRSA infections Treatments

Answer 37

* Dicoxacillin/Nafcillin/Oxacillin – B-lactamase resistant penicillins (PBP binding) * Cephalexin/Cefazolin – cephalosporins (PBP binding) * Clindamycin/ Vancomycin – for those with B-lactam allergies

Question 38

CA-MRSA Treatments

Answer 38

* Can be treated with incision/drainage alone * Trimethoprim-Sulfamethoxizole – folate synthesis antagonist * Minocycline/Doxycycline/Clindamycin/Linezolid – ribosome inhibitors (different subunits)

Question 39

Serious MRSA Treatments

Answer 39

* Vancomycin (IV) – typical inpatient empiric therapy * Linezolid – effective and stops exotoxin production * Daptomycin – may be effective (in vitro studies) but can’t be used in lung (surfactant inactivation)

Question 40

Polymicrobial Infections Treatments

Answer 40

* MRSA drug + broad spectrum anti-biotic * Piperacillin +tazobactam * Imipenem-cilastin + meropenem * Ceftraroline fosamil – new cephalosporin on the block

Question 41

Pox virus family treatments

Answer 41

Smallpox, molluscum contagiosum | o Cidofovir

Question 42

• Varicella Zoster

Answer 42

chickenpox, cold sores | o Acyclovir/Valacyclovir/Famciclovir

Question 43

HHV-6

Answer 43

Roseola | o Cidofovir, Foscarnet, Ganciclovir/Vanganciclovir

Question 44

HHV-7

Answer 44

Roseola | o Cidofovir

Question 45

HHV-8

Answer 45

Kaposi sarcoma | o Cidofovir, Famciclovir, Ganciclovir/Vanganciclovir, Valacyclovir

Question 46

Adalimumab

Answer 46

• Used to treat psoriasis • SC injection • TNF-a monoclonal antibody – binds TNF-a to stop it from interacting with p55/p75 cell surface receptors. Allows for decrease in inflammation/produce immunosuppression • Side effects o Increased susceptibility to opportunistic infections • Don’t start with active infection • Report any signs of chronic infection re-activation • Don’t receive vaccines with this drug o Increased chance for new malignancy development o Cardiotoxic – worry of CHF, hypotension, angina, arrhythmia o Lupus- like syndrome – fever, arthralgia, rashes o Irritation at injection site – consider injection site rotation

Question 47

Alefacept

Answer 47

• Used to treat psoriasis • IM injection • [LFA3-IgG1] fusion protein (human) – binds CD2 on T-cells to prevent activation, thus inflammation/produce immunosuppression. Also induces apoptosis • Side effects o Increased susceptibility to opportunistic infections • Don’t start with active infection • Report any signs of chronic infection re-activation • Don’t receive vaccines with this drug o Increased chance for new malignancy development o Irritation at injection site – consider injection site rotation

Question 48

Apremilast

Answer 48

• Used to treat psoriasis • Oral • Phosphodiesterase-4 (PDE4) inhibitor – increases cellular cAMP to decrease inflammation. Not well understood, but decreases inflammation/produce immunosuppression • Side effects o Increased susceptibility to opportunistic infections • Don’t start with active infection • Report any signs of chronic infection re-activation • Don’t receive vaccines with this drug o Increased chance for new malignancy development

Question 49

Etacercept

Answer 49

• Used to treat psoriasis • SC injection • [p75 TNF receptor-FcIgG1 segment] fusion protein – false receptor that binds to/inactivates TNF but doesn’t affect production to decrease inflammation/produce immunosuppression • Side effects o Increased susceptibility to opportunistic infections • Don’t start with active infection • Report any signs of chronic infection re-activation • Don’t receive vaccines with this drug o Increased chance for new malignancy development o Lupus- like syndrome – fever, arthralgia, rashes o Irritation at injection site – consider injection site rotation

Question 50

Infliximab

Answer 50

• Used to treat psoriasis • IV administration • IgG1k monoclonal antibody for TNF-a – binds soluble/trans-membrane TNF-a to inactivate it and decrease inflammation/produce immunosuppression • Side effects o Increased susceptibility to opportunistic infections • Don’t start with active infection • Report any signs of chronic infection re-activation • Don’t receive vaccines with this drug o Increased chance for new malignancy development o Cardiotoxic – worry of CHF, hypotension, angina, arrhythmia • Contraindicated with history of heart failure o Lupus- like syndrome – fever, arthralgia, rashes o Hepatotoxic – regular LFTs are recommended

Question 51

Uztekinamab

Answer 51

• Used to treat psoriasis • IV administration • IgG1k monocloncal antibody for IL – binds p40 subunits of IL12/IL23 to decrease inflammation/produce immunosuppression • Side effects o Increased susceptibility to opportunistic infections • Don’t start with active infection • Report any signs of chronic infection re-activation • Don’t receive vaccines with this drug o Increased chance for new malignancy development

Question 52

Calcipotriene

Answer 52

• Used to treat psoriasis • Topical • Vit. D receptor agonist – after binding the drug-VitD complex associated with RXR-a to influence DNA expression via Vitamin D response elements • Side effects o Irritation at the application site – often reduced through formulation with corticosteroids o Photosensitivity at application site o Hypercalcemia/hypercalciuria with large doses • With maximum dose over more than 4 weeks, this occurs due to Vit D influecnce

Question 53

Calcitriol

Answer 53

* Used to treat psoriasis * Topical * Hormonally active Vit.D3 – works to promote DNA expression via Vitamin D response elements * Typically better tolerated so recommended for use on sensitive skin areas

Question 54

5 other RAR drugs that weren't really discussed

Answer 54

* Acitretin * Tazarotene * Adapalene * Isotretinoin * Tretinoin

Question 55

Hydrocortisone

Answer 55

• Used to treat ance • Topical • Mild corticosteroid – best used on face/sensitive areas • Side effects o Cushingoid syndrome if applied in large quantities/used extensively

Question 56

Betamethsone valerate

Answer 56

• Used to treat ance • Topical • Moderate corticosteroid – fluorinated for increased efficacy • Side effects o Cushingoid syndrome if applied in large quantities/used extensively o Rosacea-like rash – should never be used on the face due to fluorination

Question 57

Fluocinonide

Answer 57

• Used to treat ance • Topical • Potent corticosteroid – fluorinated for increased efficacy • Side effects o Cushingoid syndrome if applied in large quantities/used extensively o Rosacea-like rash – should never be used on the face due to fluorination

Question 58

Clobetasol proprionate

Answer 58

• Used to treat ance • Topical or Intralesional Injection • Very potent corticosteroid – best used on areas of thick skin (hyperkeratotic, lichenfield dermatoses, palms, sole of feet) • Side effects o Cushingoid syndrome if applied in large quantities/used extensively

Question 59

Benzoyl Peroxide

Answer 59

• Used to treat acne and decubitus ulcers • Topical • Pro-drug that is converted to benzoid acid which: o Liberates free radicals to kill P. acnes o Keratolytic to produce drying/desquamative actions • Often will be formulated with antimicrobials • Side effects o Drying, peeling, and irritation of skin at application site o Bleaching hair/colored fabrics (strong oxidant) o Damage to eyes and mucous membranes if contact

Question 60

Salicyclic acid

Answer 60

• Used to treat acne/hyperkeratotic disorders • Topical • Causes desquamation of the horny layer of skin • Side effects o Prolonged/application over large areas can cause salicylism o Neonatal toxicity via breast milk or contact if applicated to the mother’s chest

Question 61

Treatment for Tuberculoid Leprosy

Answer 61

o Tuberculoid: Dapsone + Rifampicin (12 months)

Question 62

Treatment for Lepromatous Leprosy

Answer 62

o Lepromatous: Dapsone + Rifampin + Clofazimine (24 months)

Question 63

Dapsone

Answer 63

• Used to treat all forms of leprosy (Hansen’s disease) • Mechanisms o Inhibits dihydropteroate synthetase conversion of [PABA → dihydropteroatic acid], ultimately inhibiting formation of tetrahydrofolate production in the mycobacterium (stops thymidine synthesis, halting nucleic acid synthesis) o Inhibits neutrophil chemotaxis by an unknown mechanism • Side effects o Metabolized into Hydroxylamine • Causes hemolysis • Causes methemoglobinemia (oxidation of iron in heme, resulting in impaired oxygen binding/transport) often resulting in blue nailbeds and blue lips o Contraindicated in patients with G6PD deficiency o Can cause sulfone syndrome • Dermatitis often of the forehead • Lymphadenopathy of the cervical lymph nodes • Liver enzyme abnormalities are seen in used long-term o Steven-johnson syndrome may occur o Impaired renal function can cause toxic accumulation of the drug

Question 64

Rifampin

Answer 64

• Mechanism o Inhibits RNA synthesis by binding B-subunit of RNA polymerase; halting protein synthesis • Low affinity for mammalian polymerase • Bactericidal for intra/extracellular TB or leprosy • Resistance o Alteration of B-subunit of RNA polymerase (quite common, never use this drug alone) • Pharmacology o Absorption is good orally • Food/para-aminosalicyclic acid can decrease absorbtion o Distribution into all tissues and fluids • Penetrates CSF • Largely protein bound o Metabolized in the liver via deactylation • Liver dysfunction will change metabolic dynamics of the drug • Increased deacetylation will be noted in the first two weeks of treatment o Excreted in bile in the GI tract; will be reabsorbed via enterohepatic circulation if unchanged • Adverse Effects o Hepatotoxicity – jaundice will occur in people with liver disease/alcoholics/elderly/slow acetylators o Body fluid discoloration is not really bad, but kinda weird • Patients are advised to wear glasses because tears will stain contacts • Drug interactions o CYP inducer, worry of drug-drug interactions

Question 65

Clofazimine

Answer 65

• Used to treat leprosy (Hansen’s Disease) • Mechanism o Binds guanine/cytosine of mycobacterial DNA (these bases happen to appear more frequently in the bacterium than human host cells) • Adverse effects o Immune mediated inflammatory reactions, often of skin and peripheral nerves o Staining of body • Tanning/bronzing of the skin • Sweat, tears, urine, poop, and breast milk stained brown-black (can be misinterpreted as GI bleeding!) • May cause depressions/suicide o Allergy may warrant use of several anti-microbials in combination therapy

Question 66

Thalidomide

Answer 66

• Mechanism o Inhibits NfKB up-regulation of TNF-a production o Blocks leukocyte migration involved in disease process • Adverse effects o Major teratogen causing phochomelia (severe birth defect with muted limb growth) o May increase HIV viral load due to leukocyte effect

Question 67

Clarithromycin

Answer 67

- alternative treatment for leprosy used in place for clofazimine - look in annotated FA for info!

Question 68

Minocycline

Answer 68

- alternative treatment for leprosy used in place for clofazimine - look in annotated FA for info!

Question 69

Ofloxacin

Answer 69

- alternative treatment for leprosy used in place for clofazimine - look in annotated FA for info!

Question 70

Monitoring/other facts for skin anti-virals

Answer 70

* All given orally; viral infections come from within, so no topicals dammit! * They all block viral DNA polymerase * Creatinine monitoring (for kidney function) is vital; these drugs are renally eliminated

Question 71

Anti-virals and phosphorylation

Answer 71

* Remember! Many of these drugs need phosphorylation in order to be activated! * Cidofovir and foscarnet both do not require this step * Viruses can stop encoding for the kinases needed to activate anti-virals, so these two drugs are of select advantage when you’re facing a resistant virus

Question 72

Anti-virals and cross-hypersensitivity

Answer 72

* While we have a handful of drugs, an adverse reaction can result in removing several anti-virals from consideration for treatment. * As listed we have 5 for viral skin infections that can cross react all ending in “-clovir”

Question 73

Toxicities for anti-virals (5)

Answer 73

* Acyclovir/Valacyclovir → seizure induction * Cidofovir → nephrotoxicity; use with probenecid to prevent this * Famciclovir → NO ISSUES (“good for the whole family”) * Foscarnet → electrolyte imbalances; chelates Ca2+ * Ganciclovir/Valganciclovir → anemia, leukopenia, neutropenia, thrombocytopenia, teratogen!