derm drugs Flashcards
(104 cards)
1
Q
what is the treatment for localized BCC? advanced/metastatic?
A
topical fluorouracil, imiquimod
vismodegib
2
Q
in general, how does imiquimod work? what four ways does it accomplish that? how is it administered?
A
topical stimulates immune response to tumor
- activates TLR-7/8 to initiate TH1 response
- inhibits adenosine receptor
- activates NFkB: TNF-alpha and IL’s upregulated
- may directly inhibit hedgehog signaling
3
Q
what are two adverse effects of imiquimod?
A
photosensitivity
compromises condoms and diaphragms
4
Q
describe the mechanism of action of fluorouracil
A
pyrimidine analog, antimetabolite
inhibits thymidylate synthase
5
Q
describe the action of vismodegib. how is it administered?
A
oral SMO inhibitor (inhibits hedgehog pathway)
6
Q
whats the most significant side effect of vismodegib? what are two other adverse effects?
A
- intra-uterine fetal death, male-mediated teratogenecity
- alopecia most common, GI toxicities
7
Q
what are conventional therapies usually based on for BCC and SCC?
A
cisplatin
8
Q
what conventional cytotoxic drugs are used for melanoma?
A
dacarbazine
temozolomide
lomustine
carmustine
9
Q
what is the mechanism of action of aldesleukin? what are the results?
A
binds IL-2 receptor
- proliferation of immune cells
- also stimulates TRegs which can offset this
- stimulates cytokine cascade: IFNs, ILs, TNFs
10
Q
what are the contraindications for aldesleukin use?
A
cardiac, pulmonary or CNS disease/dysfunction
11
Q
what are the side effects of aldesleukin?
A
hypotension, capillary leak, pulmonary congestion, renal failure
12
Q
what is the effect of IFN-alpha2b administration?
A
stimulates immune response by increasing ability to activate CTL’s and NK cells to lyse tumor cells
13
Q
what are contraindications for IFN-alpha2b use?
A
autoimmune disease, cardiac dysfunciton, depression
14
Q
what are the three major adverse effects of IFN-alpha2b use?
A
- worsening of autoimmune disease
- elevated LFTs
- pulmonary toxicity
15
Q
what is the target of ipilumumab?
A
inhibits CTLA-4
-prevents dampening effect of CTLA-4 on CD80/86, thus increasing T cell stimulation
16
Q
what is the target of pembolizumab?
A
inhibits PD1
-prevents PD-ligand from downregulating activity of T cells
17
Q
what is the target of nivolumab?
A
inhibits PD1
-prevents PD-ligand from downregulating activity of T cells
18
Q
what bad adverse effects are common to checkpoint inhibitors due to too much T cell activity?
A
dermatitis, inc. TEN
19
Q
which checkpoint inhibitors have worse adverse effects? what are two of their BBW’s?
A
ipilumumab
-endocrinopathies and peripheral neuropathy
20
Q
what is the target of dabrafenib?
A
BRAF V600E/K/D, wild-type BRAF
21
Q
what is the target of sorafenib?
A
multiple kinases, inc. BRAF
22
Q
what is the target of vemurafenib?
A
BRAF V600E
23
Q
what is the target of trametinib?
A
MEK1 and MEK2
24
Q
what is the mechanism of new skin tumors in treatment of melanoma with kinase inhibitors?
A
loss of inhibition by the inhibited pathway on an alternative oncogenic pathway allows proliferation of new clonal line of cells
25
what drugs used in melanoma should be avoided in pregnancy?
checkpoint inhibitors and kinase inhibitors
26
what drugs used in melanoma should be monitored with regular chest x-rays?
aldesleukin and IFN-alpha2b
27
what is the primary therapy for actinic keratoses? what else is administered and their action? how are each administered?
topical fluorouracil and imiquimod
topical diclofenac: NSAID, anti-inflammatory
topical trichloroacetic acid: chemical peel, cauterizes skin, keratin, tissue
28
what biologic drug in psoriasis treatment is contraindicated in heart failure? what other drugs have CV side effects?
infliximab
| -adalimumab and rituximab
29
what psoriasis biologic drug may increase LFTs?
infliximab
30
what three psoriasis biologics may cause lupus-like syndrome?
infliximab
adalimumab
etanercept
31
what molecule do retinoids mimic? what is the difference between RXR and RAR receptors?
Vitamin A
RAR: affects cell differentiation and proliferation
RXR: induces apoptosis
32
what are five main beneficial effects of retinoid therapy in acne/psoriasis?
- increased keratinocyte turnover
- inhibit keratinization
- decreases sebum production/decreased gland size
- anti-inflammatory
- antimicrobial against P. acnes
33
describe the adverse effects of retinoids that mimic Vit A intoxication
dry skin/mucous membranes, conjunctivits, reduced night vision, hair loss
34
what are four adverse effects of systemic retinoids?
- teratogens
- elevated serum lipids
- elevated LFTs
- blood dyscrasias
35
what are three adverse effects of topical retinoid use?
- increased susceptibility to sunburn
- burning, stinging
- desquamation
36
how are steroids used in psoriasis? acne?
psoriasis: topical, not oral (risk of flare on discontinuation)
acne: topical, oral for moderate/severe (move to retinoids)
37
what topical therapy should NOT be applied to face?
fluorinated steroids
38
what are some adverse effects of topical steroid use?
```
dermal atrophy: cigarette-paper skin
corticoid rosacea/perioral dermatitis
steroid acne
hypopigmentation
ACD
hypertrichosis
```
39
what drug similar to retinoids is used in psoriasis? what is its mechanism of action? how is it administered? what is its adverse effect? what is an alternative for sensitive/intertriginous areas of skin?
calcipotriene
binds RXR and DNA Vit D response elements
administered with steroids, b/c topical irritant
hypercalcemia/hypercalciuria with high doses
calcitriol (hormonally active Vit D)
40
adalimumab: target, disease
TNF-alpha
| psoriasis
41
etanercept: target, disease
TNF-alpha
| psoriasis
42
infliximab: target, disease
TNF-alpha
| psoriasis
43
alefacept: target, disease
CD2 on memory T cells, promotes apoptosis/prevents activation
psoriasis
44
apremilast: target, disease, unique characteristic
increases cellular cAMP
psoriasis
given orally
45
ustekinamab: target, disease
inhibits IL-12 and IL-23
| psoriasis
46
benzoyl peroxide: mechanism, disease
acne
converted to benzoic acid, free radical liberation lethal for P acnes
keratolytic activity: drying and desquamative
47
what are the adverse effects of benzoyl peroxide? solution?
too much drying/peeling: erythema, irritation, contact dermatitis (may administer with corticosteroids)
bleaching of hair, clothes
48
salicylic acid: mechanism, disease
acne, calluses, warts, psoriasis
| keratolytic: desquamation
49
what are two adverse effects of salicylic acid? what are possible contraindications and why?
teratogen, contact irritation
| hepatic/renal failure increase risk of salicylism
50
what is recommended for widespread tinea infection?
oral:
- terbinafine
- itraconazole, fluconazole
- griseofulvin
- ketoconazole
51
what is recommended for localized tinea infection?
topical:
- topical azoles
- terbinafine
- naftifine
- ciclopirox
52
what is recommended for onychomycosis?
oral:
- terbinafine
- griseofulvin
- itraconazole and fluconazole
53
what is recommended for topical onychomycosis?
topical:
- ciclopirox
- amorolfine
54
what is the mechanism of action of amorolfine? how can it be administered?
depletes ergosterol
| only topical
55
how does griseofulvin work? how can it be administered?
binds tubulin, inhibits microtubule formation in mitosis
| oral only
56
how does ciclopirox work? how can it be administered?
unclear: acts in nucleus to affect RNA/DNA synthesis
| topical only
57
what is the mechanism of action of naftifine?
inhibits conversion of squalene epoxide to lanosterol by 2,3-squalene epoxidase
58
how does terbinafine work?
blocks conversion of squalene to squalene epoxide
59
which antifungals are CYP3A4 inducers/inhibitors?
inducers: griseofulvin
inhibitors: azoles
60
which azole is the only non-CYP3A4 substrate? which is the only one renally eliminated?
posaconazole
| fluconazole
61
which antifungal inhibits adrenal steroid synthesis at high doses? what are the corresponding adverse effects?
ketoconazole
| impotence, menstrual irregularity, gynecomastia, hot flashes
62
which antifungal can have cross-sensitivity with beta-lactams?
griseofulvin
63
what are four adverse effects of griseofulvin?
- teratogen
- hepatotoxicity
- interferes with porphyrin metabolism
- photosensitivity
64
what does malathion treat? MOA? according adverse effects and treatment of that?
lice
acetylcholinesterase inhibition
excessive cholinergic stimulation on systemic ingestion, give atropine
65
what is permethrin used for? MOA?
lice
| inhibits voltage-gated Na channels
66
what is ivermectin used for? MOA? adverse effects?
lice
binds glutamate receptor, increases permeability to Cl causes hyperpolarization of cells
binds GABA, disrupts CNS transmission on systemic ingestion
67
what are two physical therapy treatments for lice?
benzyl alcohol
| dimethicone: silicone polymer, lubricates hair for nit/lice removal; suffocates louse, inhibits water secretion
68
what is the first-line treatment for hyperhidrosis and what is its mechanism?
aluminum chloride
| short-term occlusion of eccrine and aprocrine sweat glands
69
what is the general target for systemic therapy of hyperhidrosis? why?
anticholinergics: sweat glands are stimulated by M2 stimulation by Ach
70
what is the second therapy for hyperhidrosis?
botulinum toxin: light chain cleaves SNAP25, preventing interaction with synaptobrevin and thus fusion of Ach vesicles with membrane
71
what are used as third-line therapy of hyperhidrosis?
antimuscarinics: atropine, oxybutynin, glycopyrrolate and propantheline
72
what else is used off label for hyperhidrosis? specifically for emotion-related sweating?
propanolol
clonidine (alpha2-agonist)
-block sympathetic tone centrally
73
which antimuscarinics don't cross BBB and don't cause hallucinations/drowsiness?
glycopyrrolate and propantheline
74
how does diltiazem work in hyperhidrosis?
blocks vesicle release by blocking pre-synaptic rise in Ca
75
minoxidil: use, MOA,
topical hair growth drug
| -unknown MOA: alters androgen metabolism?, stimulate hair follicle?
76
what is eflornithine used for
reduce unwanted female facial hair
77
finasteride: use, MOA
oral hair growth drug
| testosterone analog: inhibits 5-alpha-reductase thus reducing scalp/serum levels of DHT
78
Saw Palmetto is used for what? what should be avoided with it?
benign prostatic hyperplasia
| finasteride
79
what is the mechanism of action of hydroquinone, used in combo with fluocinolone and tretinoin?
inhibits oxidation of tyrosine and thus melanin synthesis
80
methoxsalen: use, MOA
oral, topical pigmenting agent
UVA activates it, causes cross-linking of DNA and apoptosis
delayed erythema followed by melanization and thickening of s. corneum
81
what is the treatment regimen for tuberculoid and leprematous leprosy?
tuberculous: dapsone, rifampin
leprematous: dapson, rifampin, clofazimine
82
what is second line treatment for leprosy? when do you use it?
clarithromycin, minocycline or ofloxacin
| -when clofazimine contraindicated
83
what should be monitored in patients on leprosy treatment?
CBC/platelets, LFTs
84
dapsone:use, MOA, major toxicity and its treatment
leprosy
folate antagonist
methemoglobinemia: cimetidine or omeprazole (H2 inhibitors with CYP inhibition acitivity)
85
rifampin: use, MOA, major adverse effect
leprosy
inhibits RNA synthesis by inhibiting beta-subunit of DNA-dependent RNA polymerase
red-orange body fluids
86
clofazimine: use, MOA, usefulness, main adverse effect
leprosy
binds mycobacterial guanine/cytosine in DNA
-anti-inflammatory to offset immunologically-mediated adverse effects of treating the infection
-stains skin/body fluids red to brownish-black
87
which drugs in leprosy treatment don't require dose adjusting for renal failure?
rifampin: hepatic metabolism/elimination
clofazimine: hepatic elimination without metabolism
88
which leprosy drug is a CYP inducer? what is the significance of this?
rifampin, increase toxicity of dapsone
89
what is thalidomide used for and why? MOA?
leprosy: treat immune-mediated adverse effects of treatment
| inhibits NFkB and TNF produciton
90
how is uncomplicated non-MRSA treated?
1. acid-stable penicillins
2. first gen cephalosporins
3. clindamycin or 4. vancomycin if beta-lactam allergy
91
how is CA-MRSA treated?
- bactrim
- minocycline, doxycycline
- clindamycin
- linezolid
92
what should be avoided in the treatment of MRSA?
fluoroquinolones
93
how should serious MRSA be treated?
- vancomycin
- linezolid (esp. for toxin synthesis)
- daptomycin
94
how should polymicrobial infections be treated?
MRSA drug +:
- bactrim
- imipenem-cilastin
- meropenem
- ceftaroline
95
what is an adverse effect of acid-stable penicillins?
rarely, interstitial nephritis
96
what are four adverse effects of vancomycin?
- Red Man syndrome
- hypotension
- nephrotoxicity
- ototoxicity
97
which antibiotics cause discolored teeth, photosensitivity, teratogen?
tetracyclines
98
what antibiotic causes serotonin syndrome and optic neuropathy?
linezolid
99
what antibiotic can cause rhabdomyolysis?
daptomycin
100
what is given with cidofovir and why?
probenecid, minimize nephrotoxicity
101
which antivirals require phosphorylation by virus?
acyclovir, ganciclovir and their prodrugs
102
what is indicated for pox viruses?
cidofovir
103
what is indicated for VZV?
acyclovir/valcyclovir
| famciclovir for shingles
104
what is indicated for HHV-6?
cidofovir
foscarnet
ganciclovir/valganciclovir
