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Skin & MSK > Pharmacotherapy of Skin disease > Flashcards

Pharmacotherapy of Skin disease Flashcards

1
Q

Is there gender bias in the prevalence of acne vulgaris?

A

No
Onset during puberty occurs earlier in girls than boys, but may be more severe in boys during puberty

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2
Q

Does adult acne occur more frequently in males or females?

A

Females

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3
Q

In the first stage of acne vulgaris pathophysiology, there is increased proliferation of these in the follicle

A

Keratinocytes

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4
Q

In the first stage of acne vulgaris pathophysiology, there is reduced clearance of these

A

Corneocytes

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5
Q

What therapy is used to target the first stage of the pathophysiology of acne vulgaris (increased follicular keratinocyte proliferation/reduced corneocyte clearance)?

A

Exfoliant
(salicylic acid, topical retinoids, oral isotretinoin)

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6
Q

In the second stage of acne vulgaris pathophysiology, there is increased production of this

A

Sebum

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7
Q

What 3 therapies focus on the second stage of acne vulgaris pathophysiology (increased sebum production)?

A

Isotretinoin (oral)
Corticosteroids
Drugs that inhibit action of testosterone/androgens (antiandrogens, estrogens)

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8
Q

In the third stage of acne vulgaris pathophysiology, colonizing bacteria convert this to free fatty acids

A

Sebum triglycerides

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9
Q

In the third stage of acne vulgaris pathophysiology, colonizing bacteria convert sebum triglycerides to this

A

Free fatty acids

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10
Q

What therapy focuses on the third stage of acne vulgaris pathophysiology (colonizing bacteria convert sebum triglycerides to free fatty acids)?

A

Topical/oral antibiotics

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11
Q

In the fourth stage of acne vulgaris pathophysiology, these induce inflammation

A

Free fatty acids

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12
Q

In the fourth stage of acne vulgaris pathophysiology, free fatty acids induce this

A

Inflammation

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13
Q

What therapies focus on the fourth stage of acne vulgaris pathophysiology (free fatty acids induce inflammation)?

A

Intralesional and oral corticosteroids
Topical/oral antibiotics

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14
Q

Exfoliants (salicylic acid, topical retinoids, oral isotretinoin) treat this stage of acne vulgaris pathophysiology

A

1st stage
Increased follicular keratinocyte proliferation/reduced corneocyte clearance

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15
Q

Isotretinoin (oral), corticosteroids, and drugs that inhibit action of testosterone/androgens treat this stage of acne vulgaris pathophysiology

A

2nd stage
Increased sebum production

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16
Q

Topical/oral antibiotics treat this stage of acne vulgaris pathophysiology

A

3rd stage
Colonizing bacteria convert sebum triglycerides to free fatty acids

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17
Q

Intralesional corticosteroids, oral corticosteroids, and topical/oral antibiotics treat this stage of acne vulgaris pathophysiology

A

4th stage
Free fatty acids induce inflammation

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18
Q

Exfoliant for acne that is a desmolytic agent

A

Salicylic acid

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19
Q

How does salicylic acid treat acne?

A

It degrades corneodesmosomes so corneocyte cohesion is lost, leading to exfoliation

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20
Q

Does Salicylic acid have anti-inflammatory action?

A

Slight

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21
Q

Tretinoin, adapalene and tazarotene topicals are this type of drug for acne

A

Topical retinoids

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22
Q

Topical retinoids (tretinoin, adapalene, tazarotene) are this type of acne treatment

A

Exfoliants

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23
Q

What is the OTC dose of adapalene topical?

A

0.1%

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24
Q

Retinoids are derived from this

A

Vitamin A

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25
Q

Retinoids are membrane permeable ligands for this type of receptor, and thus control gene expression

A

Nuclear receptors

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26
Q

How do retinoids treat acne?

A

Reduce sebum formation

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27
Q

Retinoids treat acne by reducing the formation of this

A

Sebum

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28
Q

How does Adapalene topical (0.1% OTC) treat acne?

A

Is a retinoid
Controls gene expression, reduces sebum formation

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29
Q

Retinoids promote gene expression that has these 2 effects

A

Inhibits sebum production
Controls keratinocyte proliferation

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30
Q

Approved OTC topical retinoid for mild-to-moderate acne

A

Adapalene

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31
Q

Is Adapalene stable in sunlight?

A

Yes

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32
Q

What severity of acne is Adapalene used for?

A

Mild-to-moderate

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33
Q

How does Adapalene react with benzoyl peroxide?

A

Is stable when combined with benzoyl peroxide

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34
Q

More potent topical retinoid that is a prescription for severe acne

A

Tretinoin

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35
Q

What severity of acne is tretinoin used to treat?

A

Severe

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36
Q

Is Adapalene OTC or prescription?

A

OTC

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37
Q

Is Tretinoin OTC or prescription?

A

Prescription

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38
Q

Is Tazarotene OTC or prescription?

A

Prescription

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39
Q

Is Tretinoin stable in sunlight?

A

No, should be applied at night

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40
Q

How does Tretinoin react with benzoyl peroxide?

A

Is inactivated by benzoyl peroxide

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41
Q

Prescription topical retinoid for moderate-to-severe acne

A

Tazarotene

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42
Q

What severity of acne is Tazarotene used for?

A

Moderate-to-severe

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43
Q

Topical retinoid with anti-aging properties

A

Tazarotene

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44
Q

The primary toxicity of topical exfoliants has to do with this

A

At site of application
Irritation, stinging, burning, pruritus, peeling

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45
Q

Benzoyl peroxide is this type of topical acne treatment

A

Antibacterial

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46
Q

Erythromycin, Clindamycin, Dapsone, Azelacid acid and Metronidazole are this type of topical acne treatment

A

Antibacterials

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47
Q

Azelaic acid is this type of acne treatment

A

Topical antibacterial

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48
Q

What is the MOA of benzoyl peroxide?

A

Slowly release free radical oxygen species to oxidize bacterial proteins, thus inhibiting bacterial growth and reducing production of inflammatory free fatty acids

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49
Q

Topical acne treatment that slowly releases free radical oxygen species to oxidize bacterial proteins

A

Benzoyl peroxide

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50
Q

Is benzoyl peroxide anti-inflammatory?

A

May INDIRECTLY suppress inflammation by inhibiting bacterial growth, thereby reducing production of inflammatory free fatty acids

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51
Q

Topical acne treatment that indirectly suppresses inflammation by inhibiting bacterial growth, thereby reducing production of inflammatory free fatty acids

A

Benzoyl peroxide

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52
Q

Patients with a cinnamon hypersensitivity should not use this topical acne treatment

A

Cinnamon

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53
Q

Topical acne treatment that may bleach hair and clothing
Body odor may also occur from degradation

A

Benzoyl peroxide

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54
Q

Pigmentation problems are observed with this topical antibacterial for acne

A

Azelaic acid

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55
Q

2 toxicities of Azelaic acid

A

Hypopigmentation
Hypersensitivity

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56
Q

This is the standard of care for moderate to severe acne and treatment of resistant acne

A

Oral antibacterials

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57
Q

Oral antibacterials are the standard of care for this severity of acne

A

Moderate to severe

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58
Q

3 systemic antibacterials for acne

A

Tetracycline, Doxycycline, Minocycline

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59
Q

Teeth discoloration if given to children <8 years and photosensitivity are adverse effects of these

A

Systemic antibacterials for acne - tetracycline, doxycycline, minocycline

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60
Q

Use of this should be avoided in lactating patients

A

Systemic antibacterials for acne - tetracycline, doxycycline, minocycline

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61
Q

These interact with metals, so avoid taking with calcium-rich foods or antacids

A

Systemic antibacterials for acne - tetracycline, doxycycline, minocycline

62
Q

Systemic antibacterials for acne - tetracycline, doxycycline, minocycline - interact with these

A

Metals
Should avoid taking with calcium-rich foods or antacids

63
Q

Do Systemic antibacterials for acne - tetracycline, doxycycline, minocycline - have anti-inflammatory activity?

A

Yes

64
Q

Estrogen has antiandrogenic effect that reduces production of this

A

Sebum

65
Q

Ethinyl estradiol is a form of this

A

Estrogen

66
Q

How does estrogen treat acne?

A

Has an antiandrogenic effect that reduces sebum production

67
Q

How do oral corticosteroids treat acne?

A

May inhibit serum production

68
Q

Oral isotretinoin is a derivative of this

A

Vitamin A
Is thus a retinoid

69
Q

Acne agent that inhibits sebum production by shrinking sebaceous glands, high doses may reduce P. acnes population

A

Oral isotretinoin

70
Q

Does Oral isotretinoin have anti-inflammatory action?

A

Yes, inhibits follicular keratinization

71
Q

Only acne treatment that provides prolonged remission

A

Oral isotretinoin

72
Q

Oral isotretinoin increases the levels of this in the blood

A

Lipids (cholesterol, LDL)

73
Q

Oral isotretinoin inhibits these 2 things

A

Sebum production
Follicular keratinization

74
Q

Black box warning for Oral isotretinoin

A

No safe dose in pregnancy

75
Q

Anti-sebum acne agent there should not be used in pregnancy or blood donation

A

Oral isotretinoin

76
Q

Oral isotretinoin is this type of acne treatment

A

Retinoid

77
Q

Oral isotretinoin toxicities are related to this

A

Too much vitamin A
Retinoid/vitamin A toxicity

78
Q

What is cheilitis?

A

Inflammation of the lips

79
Q

Cheilitis is an adverse effect of this acne anti-sebum agent

A

Oral isotretinoin

80
Q

Xerosis, peeling, pruritus, and peeling of palms and soles are adverse effects of this acne anti-sebum agent

A

Oral isotretinoin

81
Q

Incoordination, irritability, depression, headaches, suicide ideation, blurred vision and dizziness are adverse effects of this acne anti-sebum agent

A

Oral isotretinoin

82
Q

Injections of anti-inflammatory doses of these are indicated for severe inflammatory acne

A

Steroids

83
Q

Erythematous plaque with silvery white scale is seen in this condition

A

Psoriasis

84
Q

Condition that is associated with comorbidities such as heart disease, diabetes and metabolism syndrome, screening is recommended

A

Psoriasis

85
Q

Psoriasis is associated with comorbidities such as heart disease, diabetes, and this

A

Metabolic syndrome

86
Q

Stress-reduction strategies, non-medicated moisturizers, oatmeal baths, skin protection, and avoiding harsh soap/detergents, fragranced cleansers and hot water are non-pharmacological therapies for this condition

A

Psoriasis

87
Q

Topical agents are the standard of care for this condition

A

Psoriasis

88
Q

This is the standard of care of psoriasis

A

Topical agents

89
Q

These are typically used when comorbidities are present to treat psoriasis

A

Biological response modifiers

90
Q

Biological response modifiers are typically used in psoriasis when:

A

When comorbidities are present

91
Q

Calcipotriene is an analog of this

A

Vitamin D3

92
Q

What is the MOA of Calcipotriene?

A

Binds to Vitamin D receptors to inhibit keratinocyte proliferation and modulate differentiation, and inhibits inflammatory cytokine expression and cytotoxic T cell function

93
Q

Topical agent for psoriasis that binds to Vitamin D receptors to inhibit keratinocyte proliferation and modulate differentiation, and inhibits inflammatory cytokine expression and cytotoxic T cell function

A

Calcipotriene

94
Q

What condition is Calcipotriene used to treat?

A

Psoriasis

95
Q

Calcipotriene binds to Vitamin D receptor to inhibit proliferation of these

A

Keratinocytes

96
Q

Psoriasis topical agent that inhibits inflammatory cytokine expression and cytotoxic T cell function

A

Calcipotriene

97
Q

Hyperkalemia and hypercalciuria occur with high dose or long duration therapy are adverse effects of this topical agent

A

Calcipotriene

98
Q

These 2 things occur with high dose or long duration therapy of Calcipotriene

A

Hyperkalemia and Hypercalciuria

99
Q

Erythema, xerosis and exfoliative dermatitis may occur in up to 10% of patients and require discontinuation of drug therapy with this topical agent for psoriasis

A

Calcipotriene

100
Q

Following topical application, tazarotene is hydrolyzed to this, which binds to specific nuclear retinoid receptors

A

Tazarotenic acid

101
Q

Tazarotene MOA has these 3 effects

A

Normalize abnormal keratinocyte differentiate
Diminish keratinocyte hyperproliferation
Reduce inflammatory responses

102
Q

Topical retinoid for psoriasis that has these 3 effects:
Normalize abnormal keratinocyte differentiate
Diminish keratinocyte hyperproliferation
Reduce inflammatory responses

A

Tazarotene

103
Q

Absolute contraindication of tazarotene

A

Pregnancy

104
Q

Topical agent for psoriasis that is a photosensitizer, and recommended not to be used with other photosensitizing agents

A

Coal tar

105
Q

Topical agent for psoriasis that has some carcinogenic concern, although considered unlikely when used therapeutically

A

Coal tar

106
Q

Coal tar is a topical agent for this condition

A

Psoriasis

107
Q

Anthralin is a topical agent for this condition

A

Anthralin

108
Q

What is the MOA of anthralin?

A

Unknown

109
Q

With use of this topical agent for psoriasis, it is recommended that protective zinc oxide or thick non-medicated paste (petroleum jelly) be applied around lesions to prevent irritation and burning of healthy tissue

A

Anthralin

110
Q

With use of Anthralin, it is recommended that either of these be applied around lesions to prevent irritation and burning of healthy tissue

A

Protective zinc oxide or thick non-medicated paste (petroleum jelly)

111
Q

What is the MOA of pimecrolimus and tacrolimus?

A

Inhibit calcineurin
Binds to FKBP-12, immunosuppression

112
Q

Pimecrolimus and tacrolimus should not be used in these patients

A

Infants or children
Neoplastic disease

113
Q

Type of phototherapy that is preferred as it is more efficacious in psoriasis

A

Narrowband (NB-UVB)

114
Q

What is the MOA of UVB phototherapy for psoriasis?

A

Unclear
Decreases proliferation and induces apoptosis of multiple cell types, including keratinocytes and lymphocytes

115
Q

Therapy for psoriasis with unclear MOA, decreases proliferation and induces apoptosis of multiple cell types, including keratinocytes and lymphocytes

A

UVB phototherapy

116
Q

Therapy for psoriasis with these adverse effects:
Skin irritation, photo-aging, increased risk of skin cancer

A

UVB phototherapy

117
Q

UVB phototherapy has adverse effects including skin irritation, photo-aging, and increased risk of this

A

Skin cancer

118
Q

Photochemotherapy for psoriasis involves this wavelength of light

A

UVA (320-400 nm)

119
Q

Most common oral photosensitizer used prior to UVA photochemotherapy

A

8-MOPS (8-methoxypsoralen)

120
Q

Photochemotherapy is contraindicated in these patients

A

Children < 12 years

121
Q

Photochemotherapy has adverse effects including GI intolerance, burn, cataracts, photo-aging, and increased risk of this

A

Skin cancer

122
Q

Cyclosporine, methotrexate, acitretin and apremilast are non-biologic therapies for this condition

A

Psoriasis

123
Q

Oral retinoid that is a non-biologic therapy for psoriasis

A

Acitretin

124
Q

Acitretin is contraindicated in this

A

Pregnancy
2 forms of birth control and monthly pregnancy testing during treatment; regular pregnancy testing for 3 years after treatment (long biological half life)

125
Q

What type of drug is Acitretin?

A

Oral retinoid

126
Q

Acitretin is used to treat this condition

A

Psoriasis

127
Q

Apremilast is used to treat this condition

A

Psoriasis

128
Q

3 TNF alpha inhibitors used for psoriasis

A

Etanercept
Adalimumab
Infliximab

129
Q

Etanercept, Adalimumab, Infliximab treat psoriasis through this MOA

A

Anti-inflammatory
Are TNF alpha inhibitors

130
Q

Cytokine that is strongly associated with inflammation and is a target for biological response modifiers used to treat psoriasis

A

TNF alpha

131
Q

Cyctokine produced by dermal dendritic cells that activates the pathogenic Th17 lymphocytes that produce IL-17 and are associated with psoriasis

A

IL-23

132
Q

Cytokine that is strongly associated with inflammation, neutrophil accumulation and epidermal microabscesses and is a target for biological response modifiers used to treat psoriasis

A

IL-17

133
Q

2 types of treatments for skin disorders involving inflammation with pruritus

A

Topical corticosteroids
Histamine type 1 receptor inhibitors (H1 blockers)

134
Q

Most hypersensitivity symptoms can be elicited by activation of this

A

Histamine type 1 receptors (H1R)

135
Q

Blockers of this histamine receptor are used to reduce stomach acid production

A

Histamine type 2 receptors

136
Q

Are first or second generation H1R blockers more selective?

A

Second generation are more selective for peripheral H1R, polar drugs that do not cross into CNS, so less sedation than 1st gen

137
Q

What is the MOA of bacitracin?

A

Blocks bacterial cell wall formation
Narrow gram+ spectrum
For cuts and scrapes

138
Q

What is the MOA of Mupirocin and Retapamulin?

A

Inhibit bacterial protein formation
Gram+ spectrum
Indicated for impetigo

139
Q

Topical antifungals for skin that block ergosterol synthesis by inhibiting 14-a-demethylase (CYP51A1)

A

Azoles (miconazole, itraconazole, clotrimazole)

140
Q

What is the MOA of Azoles?

A

Block ergosterol synthesis by inhibiting 14-a-demethylase (CYP51A1)

141
Q

What is the MOA of Naftifine?

A

Block ergosterol synthesis by inhibiting squalene epoxidase

142
Q

Melanoma tumor with this mutation is a good candidate for targeted therapy with vemurafenib +/- cobimetinib

A

BRAF mutation V600E

143
Q

Competitive BRAF inhibitor (V600E mutation) used to treat melanoma

A

Vemurafenib

144
Q

Vemurafenib is metabolized by this

A

CYP3A4
Expect drug interactions

145
Q

What is the MOA of Vemurafenib?

A

Competitive BRAF inhibition (V600E mutation)

146
Q

Common mutation in melanoma that is the target of Vemurafenib

A

BRAF (V600E)

147
Q

Melanoma treatment that binds CTLA4 on T cells, preventing interaction with CD80/86 (B7) on tumor cells
Promotes co-stimulation needed to activate T cells

A

Ipilimumab

148
Q

What is the MOA of Ipilimumab in the treatment of melanoma?

A

Binds CTLA4 on T cells
Prevents interaction with CD80/86 (B7) on tumor cells
Promotes co-stimulation needed to activate T cells

149
Q

Melanoma treatment with severe immune-mediated reactions, mostly in colon, liver, skin

A

Ipilimumab

150
Q

What is the black box warning for Ipilimumab?

A

Severe immune-mediated reaction, mostly in colon, liver, skin

151
Q

Ipilimumab is a monoclonal antibody against this, and is indicated for melanoma

A

CTLA4

Skin & MSK (8 decks)

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