Skin Pharmacology Flashcards
what factors affect cutaneous absorption?
region
concentration gradient
dosing schedule
vehicles/occlusion
when should you use creams?
for oozing/wet skin conditions
when should you use ointments?
for dry skin conditions
less likely to cause allergic rxn
what are emollients?
moisturizers that form an oily layer on top of skin that traps water in the skin
ex: petrolatum, lanolin mineral oil and dimethicone
what are humectants?
moisterizers that draw water into the outer layer of skin
ex: glycerin, lecithin, and propylene glycol
what are keratin softeners?
moisterizers that loosen the bonds between the top layer of cells to help dead skin cells fall of
helps the skin retain water and gives a smoother feeling
ex: urea, AHAs and allantoin
what does UVB radiation cause?
“burn”
erythema/sunburn
skin aging
photocarcinogenesis
what does UVA radiation cause?
“aging”
skin aging
cancer
what is glutaraldehyde?
a disinfectant that cross-links proteins on the cell envelope of microbes
what is chlorhexidine?
a disinfectant and antiseptic that affects the cytoplasmic membrane of microbes
- safe for skin and oral mucosa due to low irritability
- broad-spectrum
what are peroxygens?
a disinfectant that forms free hydroxl radicals which disrupts thiol groups in enzymes and proteins
ex: hydrogen peroxide
what are halogens?
a disinfectant that oxidizes thiol groups of disulfides, sulfoxides or disulfoxides of microbes
what is the protocal for antiseptic wash on wounds?
generally not necessary unless the wound is infected since the antiseptic can impede wound healing
*saline debridement is sufficient
what category of patients should be monitored for wound healing?
diabetics
what is becaplermin?
platelet derived growth factor that promotes cell proliferation and angiogenesis
- only approved treatment of chronic diabetic food ulcers
- black box warning for malignancy
what is the general rule for wound dressings?
wounds should be kept moist and not exposed to air
what are the components of neosporin?
bacitracin: gram +
neomycin: gram -
polymixin B: gram -
what is the MOA of topical imidazoles (antifungals)?
block ergosterol synthesis
what does miconazole treat?
vulvovaginal candidiasis
what does clotrimazole treat?
vulvovaginal candidiasis
what does efinaconazole treat?
onychomycosis
what does ketoconazole treat?
dermatophytosis
candidiasis
seborrheic dermatitis
ciclopirox
broad spectrum topical antifungal
disrupts macromolecular synthesis
treats dermatophytes, candida, and malassezia
terbinafine
topical antifungal agent
selectively inhibits squalene epoxidase, a key enzyme for ergosterol synthesis
treats dermatophytes
tolnaftate
topical antifungal
unknown MOA
treats dermatophytes and malassezia
nystatin
topical antifungal
binds to fungal sterols to alter membrane permeability
treats cutaneous and mucosal candida infection
amphotericin B
topical antifungal
binds to fungal sterols to alter membrane permeability
treats cutaneous candida infections
acyclovir
topical antiviral agent
synthetic guanine analog
acts on HSV 1 and 2
what are nonpharmacologic treatments for pruritis?
skin moisturization cool environment avoidance of skin irritants stress reduction physical intervention
topical corticosteroids
anti-pruritic treatment to treat underlying skin inflammation
what are the topical calcineurin inhibitors? What do they treat?
tacrolimus and pimecrolimus
anogenital pruritus
doxepin
possible H1 antagonist that treats pruritis
menthol
TRPM8 agonist
provides cooling sensation to soothe pruritis
capsaicin
TRPV1 agonist
stimulates neurons to release and eventually deplete neuropeptides to induce lasting desensitization
salicylic acid
COX inhibitor and keratolytic
anti-inflammatory for treatment of acne and dandruff
what local anesthetics are useful for pruritis?
pramoxine
lidocaine
lidocane and prilocaine mixture
what systemic therapies are used to treat pruritis?
antihistamines antidepressants opioid receptor antagonists anticonvulsants (gabapentin) substance P antagonist
brimonidine
alpha 2 agonist: vasoconstriction
applied topically to treat rosacea
oxymetazoline
mixed alpha 1 and alpha 2 agonist: vasoconstriction
applied topically to treat rosacea
what drugs can treat red eyes?
adrenergic receptor agonists
phenylephrine, naphazoline, and tetrahydrozoline
malathion
topical organophosphate AchE inhibitor
treats ectoparasites
permethrin
topical agent that binds to insect Na+ channel to block membrane potential
treats ectoparasites
ivermectin
oral glutamate-gate Cl- channel agonist to hyperpolarize insect nerve and muscle cells
treats ectoparasites
lindane
topical agent that disrupts GABAergic transmission in insects
treats ectoparasites
what is the preferred treatment for mild comedonal acne?
topical retinoid
what is the preferred treatment for mild mixed papular/pustular acne?
topical retinoid + topical antibiotic
what is the preferred treatment for moderate mixed papular/pustular acne?
oral antibiotic + topical retinoid +/- benzoyl peroxide
what is the preferred treatment for moderate nodular acne?
oral antibiotic + topical retinoid + benzoyl peroxide
what is the preferred treatment for severe nodular/conglobate acne?
oral isotretnoin
what are the topical retinoids for acne treatment?
tretinoin
adapalene
tazarotene
what are the topical antimicrobials for acne treatment?
benzoyl peroxide clindamycin erythromycin dapsone sulfacetamide
azaleic acid
a dicarboxylic acid that kills acne bacteria and decreases keratin production
can treat acne and post-inflammatory hyperpigmentation
topical application
what oral antibiotics are used for acne treatment?
tetracycline doxycycline minocycle erythromycin azithromycin trimethoprim-sulfamethoxazole
what hormonal agents are used for acne treatment?
oral contraceptives
spironolactone
what is the major risk when taking oral isotretinoin?
teratogenicity
what topical therapies can treat psoriasis?
emollients corticosteroids topical vitamin D analogs tar tazarotene calcineurin inhibitors anthralin salt water baths
What is the clinical application of UV light therapy?
UVB and photochemotherapy (PUVA) can treat moderate to severe psoriasis
what systemic therapies can treat psoriasis?
methotrexate apremilast retinoids systemic calcineurin inhibitors biologic agents (secukinumab and ustekinumab)
apremilast
PDE4 inhibitor which increases cAMP in cells
reduces inflammatory mediators (NOS, TNFa and IL-23)
increased anti-inflammatory mediators (IL-10)
crisaborole
PDE4 inhibitor recently approved for topical dermatitis therapy
ustekinumab
monoclonal Ab that targets proinflammatory cytokines IL-12 and IL-23
treats psoriasis, psoriatic arthritis and Crohn disease
*risk of infection
secukinumab
monoclonal Ab that targets proinflammatory cytokine IL-17A
treats psoriasis, psoriatic arthritis and ankylosing spondylitis
*risk of infection
what are some treatments for actinic keratosis?
liquid nitrogen cryotherapy surgical removal pharmacotherapy red light therapy dermabrasion chemical peels
5-fluroruracil
topical agent that inhibits thymidylate synthetase to prevent cell proliferation and causes cell death
results in erythema, blistering, necrosis, and then re-epithelialization
treatment for actinic keratosis
what topical medications can treat BCC/SCC?
imiquimod
5-fluorouracil
imiquimod
topical immune response modifier that stimulates local cytokine induction
effective therapy for actinic keratosis
what is used to treat BCC?
vismodegib
sonidegib
*oral SHH signal pathway inhibitors
dacarbazine
conventional chemotherapy for melanoma
+/- (camustine and tamoxifen) or (cisplatin and vinblastine)
vemurafenib
MAP kinase pathway inhibitor for BRAF mutation (melanoma)
results in apoptosis
what is the preferred treatment method for non-metastatic melanoma?
surgical excision
minoxidil
vasodilates hair follicles due to K+ channel opening
promotes hair growth for male and female pattern baldness
Rogaine
finasteride
oral inhibitor of DHT production
treats male pattern baldness
what anti-androgens can treat female pattern baldness?
spironolactone
finasteride
flutamide
DPCP (diphenylcyclopropenone)
causes contact dermatitis which results in hair growth
treats alopecia areata
