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Dermatology > Systemic Pharmacology > Flashcards

Systemic Pharmacology Flashcards

1
Q

Examples of Oral Antifungals

A

Griseofulvin
Terbinafine (Lamisil)
Itraconazole (Sporonox)

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2
Q

What do oral antifungals treat?

A

Scalp & nail fungal disorders

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3
Q

Medications to Treat Scalp Fungal Infections

A

1st: Griseofulvin
2nd: Terbinafine (Lamisil)

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4
Q

Medications to Treat Nail Fungal Infections

A

1st: Terbinafine (Lamisil)
2nd: itraconazole (Sporanox)

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5
Q

MOA of Griseofulvin

A

Inhibits fungal cell division

Binds to keratin making it resistant to fungal invasion

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6
Q

Administration of Griseofulvin

A

Take with a fatty meal: increases absorption, lessens GI upset

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7
Q

Distribution of Griseofulvin

A

Deposited in the keratin layer of skin, hair, & nails

Concentrates in liver, fat, & skeletal muscles

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8
Q

Where is griseofulvin metabolized?

A

Hepatically

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9
Q

2 Formulations of Griseofulvin

A

Microsize

Ultramicrosize

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10
Q

Contraindications with Griseofulvin

A 
Liver failure
Porphyria
Pregnancy (Cat. X)
Caution with penicillin allergy
Breast feeding
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11
Q

SE of Griseofulvin

A 
Photosensitivity
SJS
Toxic epidermal necrolysis
Erythema multiforme
Jaundice
Elevated liver enzymes
Granulocytopenia
Dizziness
Headache
Fatigue
N/V
Drug induced lupus like syndrome
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12
Q

Drug Interactions with Griseofulvin

A 
Multiple
Warfarin
Oral contraceptives
Alcohol
Barbiturates
Cyclosporine
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13
Q

Monitoring with Griseofulvin

A

LFTs: liver failure
CBC: granulocytopenia
Renal function tests

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14
Q

MOA of Terbinafine (Lamisil)

A

Creates ergesterol deficiency within the fungal cell wall leading to cell death

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15
Q

Distribution of Terbinafine (Lamisil)

A

Sebum & skin

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16
Q

How is terbinafine (Lamisil) metabolized?

A

Hepatically

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17
Q

Drug Reactions with Terbinafine (Lamisil)

A

Many

Inhibit CYP450 enzymes

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18
Q

Terbinafine (Lamisil) SE

A

Headache
Diarrhea
Elevated liver enzymes

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19
Q

Monitoring for Terbinafine (Lamisil)

A

AST/ALT prior to initiation
CBC
Assess taste/smell disturbances

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20
Q

What is terbinafine used for?

A

Treat tinea capitis, and onychomycosis

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21
Q

Reasons to Treat Onychomycosis

A

Cosmetic reasons
DM & onychomycosis
Hx of lower extremity cellulitis & ipsilateral onychomycosis
Pain/discomfort secondary to infection

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22
Q

Black Box Warning for Itraconazole (Sporanox)

A

Negative inotropic effects have been observed following IV administration
Discontinue or reassess if S/S of HF occur during treatment

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23
Q

Contradictions for Itraconazole (Sporanox)

A

Ventricular dysfunction
CHF
Pregnancy
Concomitant use of other CYP450 drugs

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24
Q

How is itraconazole (Sporanox) metabolized?

A

Hepatically

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25
Q

Drug Interactions with Itraconazole (Sporanox)

A 
PPIs
Anxiolytics
Pain medications
Antiplatelet agents
Antihypertensives
Statins
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26
Q

Itraconazole (Sporanox) SE

A 
Nausea
Diarrhea
Edema
Headache
Rash
Abnormal LFTs
Heart failure
Arrhythmia
Hearing loss
Many others
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27
Q

Monitoring with Itraconazole (Sporanox)

A

Baseline LFTs
Monthly LFTs
Serum contraindications

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28
Q

5-Alpha-Reductase Inhibitor Medication for Fungal Infections

A

Finasteride (Propecia)

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29
Q

MOA of Finasteride (Propecia)

A

Inhibits the conversion of testosterone to dihydrotestosterone

30
Q

What is finasteride (Propecia) first line for?

A

Androgenic alopecia in men

31
Q

What is another name of medication for finasteride (Propecia)?

A

Proscar: BPH

32
Q

Monitoring for Finasteride (Propecia)

A

Baseline PSA
PSA in 6 months
Reduces PSA my 50%

33
Q

Finasteride (Propecia) SE

A 
Orthostatic hypotension
Dizziness
Weakness
Sexual dysfunction: decreased libido, ejaculatory dysfunction, erectile dysfunction
Gynecomastia
Testicular pain
Depression
34
Q

Why is finasteride (Propecia) hazardous?

A

Teratogenic

Women should avoid crushed/broken tablets

35
Q

How is finasteride (Propecia) metabolized?

A

Hepatically

36
Q

Antibiotics used in Dermatology

A 
Cephalexin (Keflex)
Mupirocin (Bactroban)
Doxycycline
Minocycline (Minocin)
Clindamycin
37
Q

Cephalexin (Keflex) Drug Class

A

1st generation cephalosporin

Beta-lactam antibiotic

38
Q

Dermatology Indications for Cephalexin (Keflex)

A

Skin infections

Skin structure infections

39
Q

Distribution of Cephalexin (Keflex)

A

Widely distributed to all tissues except CSF

40
Q

What bugs does cqphalexin cover?

A

Staph

Strep

41
Q

MOA of Cephalexin (Keflex)

A

Inhibits bacterial cell wall synthesis

42
Q

Pregnancy Category of Cephalexin (Keflex)

A

Category B

43
Q

Indications for Mupirocin (Bactroban)

A

Impetigo: ointment
Secondary infected skin lesions: cream
MRSA colonization: intranasal

44
Q

MOA of Mupirocin (Bactroban)

A

Inhibits protein synthesis by binding to bacterial isoleucyl tRNA synthetase

45
Q

Absorption of Mupirocin (Bactroban)

A

Ointment & cream: minimal systemic absorption

Intranasal: systemic absorption

46
Q

MOA of Tetracyclines

A

Inhibition of protein synthesis by binding with the 30S ribosomal subunit
Alterations in the cytoplasmic membrane

47
Q

Distribution of Tetracyclines

A

Throughout the body tissues & fluids

Poor CNS penetration

48
Q

SE of Tetracyclines

A

Photosensitivity

49
Q

Pregnancy Category of Tetracyclines

A

Category D

50
Q

SE of Doxycyline

A

Photosensitivity
Nausea: empty stomach
Esophagitis: no fluids

51
Q

Absorption of Doxycycline

A

Delayed with high stomach pH

52
Q

Doxycycline Dermatologic Indications

A

Tick-borne rickettsial infections
Acne
Rosacea

53
Q

Off-label use of Doxycycline

A

Animal & human bites
Cellulitis secondary to MRSA
Skin & soft tissue infections

54
Q

Minocycline (Minocin) Dermatologic Indications

A

Acne

MRSA cellulitis: off-label

55
Q

SE of Minocycline (Minocin)

A

Photosensitivity
Vertigo
Esophagitis: no liquids
GI upset: empty stomach

56
Q

Dermatologic Indications for Clindamycin

A

Acne: only topical

Rosacea

57
Q

Retinoid Acid Derivative Medication(s)

A 
Isotrentinoin (Accutane)
Absorica
Amnesteem
Claravis
Myorisan
Zenatone
58
Q

Use for Isotrentinoin (Accutane)

A

Treatment of severe, recalcitrant, nodular acne

59
Q

MOA of Isotrentinoin (Accutane)

A

Shrinks sebaceous glands
Decreases sebum production
Decreases # of sebum dependent bacteria acnes

60
Q

Mucocutaneous SE of Isotrentinoin (Accutane)

A 
Cheilitis
Dry skin & mucous membranes
Epistaxis
Desquamation
Photosensitivity
Pruritis
Corneal abrasion
Cutaneous staph infections
Temporary diffus alopecia or nail brittleness
Depression
Hypertriglyceridemia
Elevated total & LDL cholesterol
61
Q

Monitoring in Isotrentinoin (Accutane) Use

A

CBC
Fasting lipid profile
LFTs
Monthly pregnancy test

62
Q

When would you discontinue Isotrentinoin (Accutane)?

A

TG >800

LFTs 3x upper limit of normal

63
Q

Topical Calcineurin Inhibitor Medications

A

Tacrolimus (Protopic)

Pimecrolimus (Elidel)

64
Q

Indications for Topical Calcineurin Inhibitors

A

Atopic dermatitis
Lichen planus
Vitiligo
Psoriasis

65
Q

Black Box Warning for Topical Calcineurin Inhibitors

A

Rare cases of malignancy (skin & lymphoma)

Limited to short-term & intermittent

66
Q

Contraindications for Topical Calcineurin Inhibitors

A
67
Q

MOA of Topical Calcineurin Inhibitors

A

Suppresses cellular immunity

68
Q

Recommendations for Topical Calcineurin Inhibitors

A

Alcohol ingestion = redness/flushing
Do not use under occlusive dressing
Sun protection

69
Q

Tacrolimus (Protopic) SE

A

Headache
Skin burning at application site
Pruritus
Erythema

70
Q

Pimecrolimus (Elidel) SE

A

Burning: less than Protopic

71
Q

Presentation of Drug Induced Lupus like Syndrome

A 
Arthralgia
Myalgia
Malaise
Fever
Rash
Serositis
72
Q

Treatment of Drug Induced Lupus like Syndrome

A

Discontinue drug
Symptomatic treatment with NSAIDs
Hydroxychloroquine >4-8 weeks
Systemic corticosteroid: severe symptoms or quick relief

Dermatology (13 decks)

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