Pharmacology part 2

Question 1

What medication has been approved for EPP?

Answer 1

Afamelanotide is used in Europe to prevent phototoxicity in adults with erythropoietic protoporphyria.[1] It is an implant that is injected and placed under the skin; an implant lasts two months.[1]

Question 2

PUVA is a reaction between what? How do you dose the psoralen?

Answer 2

8 methoxypsoralen and UVA.

Psoralen 0.4mg/kg 1-2 hrs before UVA

Question 3

SE of PUVA?

Answer 3

Phototoxic reactions, NMSC ( SCC» BCC) and cataracts

Question 4

How does UVB work?

Answer 4

Decreases DNA synthesis and increasing p53 and cause cell cycle arrest and keratinocyte apoptosis

Question 5

What is the nm wavelength range for broad band UVB? nbUVB?Excimer?

Answer 5

broadband UVB is 280-320nm
narrow band 311-313nm
Excimer is 308nm

Question 6

How does Blue light PDT work? Discuss from ALA to apoptosis. What nm?

Answer 6

ALA (aminoleuvulinic acid) converted to protoporphyrin 9 within cells, which when exposed to light is activated to a higher energy state and causes apoptosis. NM is the soret band at 410nm.

Question 7

Whats the soret band? What is it used for?

Answer 7

Blue light band 410nm

Question 8

What wave length is Red light PDT?

Answer 8

Red light band 635nm

Question 9

How long do you incubate methyl aminolevulinate for? How many Joules/m2 for how long?

Answer 9

Incubate for 3-4hrs and then light exposure at 37J/m2 for 7 minutes

Question 10

How long do you incubate aminolevulinic acid for? How many Joules/m2 for how long?

Answer 10

Incubate for 1-4 hrs, then expose at 10J/cm2 for 16 minutes

Question 11

How do the chemical sunscreen work?

Answer 11

They absorb radiation and convert it to longer, lower-energy wavelengths

Question 12

What are chemical sunscreens targeted to UVB?

Answer 12

octinoxate, octisalate,PABA, cinnamates, octylcrylene, padimate O

Question 13

What are chemical sunscreens targeted to UVA?

Answer 13

avobenzone, oxybenzone, ecamsule, meradimate

Question 14

Most common chemical sunscreen ingredient culprit-is it a UVB irritant? UVA irritant?

Answer 14

1 is UVA onxybenzone. Other ones are cinnamate and PABA, which are UVB.

Question 15

How does eflornithine work? Most common SE?

Answer 15

Inihibits ornithine decarboxylase. used in treatment of female facial hirsutism. Most common SE is acne

Question 16

How does hydroquinone work?

Answer 16

auto-oxidizes melanin, tyrosinase and phenol oxidases

also competes with tyrosinase as a substrate for tyrosinase

Question 17

How does topical Pimecrolimus and tacrolimus work?

Answer 17

binds to FK506 binding protein and forms a complex which inhibits calcineurin from dephosphorlating NFAT-1 (transcription factor), decreasing transcription of cytokine IL2

Question 18

What does of pimozide do you give for delusions of parasitosis? What are some common SE? (name 2)

Answer 18

3-5mg/day. Extrapyramidal adverse effects (drug-induced movement). Cardiac effects (arrhythmia from prolonged QT).

Question 19

Whats the dosage on IVIG?

Answer 19

2g/kg total over 3 days.

Question 20

What are 3 disease you can give IVIG for?

Answer 20

Kawasaki, SJS, Dermatomyositis

Question 21

SE of IVIG? name 4

Answer 21

Infusion-related ( headaches, myalgias, flushing, fever, wheezing), fluid overload, Aseptic Meningitis, thromboembolic events (MI and stroke as a result of increased serum viscosity).

Question 22

How does finasteride work? dutasteride?

Answer 22

Finasteride is a type 2 5 alpha reductase inhibitor. Dutasteride is a type 1 &2 5 alpha reducatase inhibitor

Question 23

SE of finasteride/dutasteride? name 3

Answer 23

gynecomastia, decrease libido/ejaculation/impotence, increase in high-grade prostate cancer, but decrease in overall risk of prostate cancer

Question 24

How does calcipotriene and calcitriol work? What is the end cytokine and enzymes affected?

Answer 24

the product + vitamin D receptor complex binds to DNA decreasing keratinocyte proliferatoin and epidermal differentiation. Decreases IL2/IL6. Increases involucrin/transglutaminase, enhancing cornified envelope formation.

Question 25

What do you use danazol and stanozolol for? name 4

Answer 25

hereditary angioedema, cryofibrinogenemia, lipodermatosclerosis, livedoid vasculitis

Question 26

What are some SE of danazol? name 2 categories

Answer 26

male hormonal-related SE (hirsutism, deeper voice, alopecia, acne, menstrual irreg), Muscle Cramps, Myalgias, Myopathy (in patients on statins)

Question 27

What is clofazimine used for? name 3

Answer 27

leprosy, erythema dyschromicum perstans, SLE/DLE

Question 28

SE of clofazimine?

Answer 28

orange-brown skin and body fluid

Question 29

MOA of colchicine?

Answer 29

binds tubulin dimers in leukocytes causing mitotic arrrest in metaphase

Question 30

SE of colchicine?

Answer 30

GI SE (cramping, diarrhea, abdominal pain), bone marrow suppression, neuropathy, and myopathy

Question 31

MOA of nicotinamide?

Answer 31

inhibits PARP-1 decreasing NFkB transcription. Also decreases leukocyte chemotaxis, decreases mast cell degranulation

Question 32

What is nicotinamide used in?

Answer 32

Pellagra, BP, NMSC chemoprevention (23% reduction in new skin cancers)

Question 33

What is potassium iodide used for? Common SE? Name 4.

Answer 33

sporotrichosis, erythema nodosum/induratum. Common SE include GI SE #1, hypothyroidsim, iododerma, exacerbation of dermatitis herpetiformis, Also wiht metallic taste/sore burning mouth.

Question 34

MOA of thalidomide?

Answer 34

Inhibits TNFa, IFNy, IL12.

Question 35

What is thalidomide used for?

Answer 35

Prurigo nodularis, kaposi sarcoma, erythema nodosum (FDA approved), lupus erythematosus, neutrophilic disorders, GVHD

Question 36

SE of thalidomide?

Answer 36

teratogenic (phocomelia), peripheral neuropathy (proximal muscle weakness, distal sensory pain/loss), venous thrombosis, sedation /drowsiness (most common)

Question 37

What are substrates of CYP3A4?

Answer 37

Warfarin, H1 antihistamines, statins, OCPs, cyclosporin, tacrolimus, pimozide, protease inhbitors, dapsone. The house and senate are waring over political power in DC.