Derm Pharm Flashcards
(237 cards)
1
Q
corticosteriods, biologic agents, immunomodulators, and phototherapy are used for
A
inflammatory skin diseases
2
Q
retinoids and antimicrobials are used for
A
acne
3
Q
retinoids, corticosteroids, coal tar and phototherapy are used for
A
psoriasis
4
Q
corticosteriods, antihistamines, topcial anesthetics are used for
A
pruritis
5
Q
what are the 3 types of infections we can use drugs for
A
bacterial, viral and fungal
6
Q
pesticides for lice and scabies are used to treat
A
infestations
7
Q
turn over of skin is called
A
keratosis
8
Q
hair loss is called
A
alopecia
9
Q
what are the 4 things that vehicles depend on to do their job
A
Solubility of the active agent
rate of release of the agent
ability of the vehicle to hydrate
stability of the therapectic agent
10
Q
ability of the vehicle to hydrate the ___ to enhance penetration
A
corneum
11
Q
tinctures, wet dressing, lotions, gels, aerosols, powders, paste, creams, foams, ointments are all examples of
A
topical preparations
12
Q
contains alcohol and evaporates the fastest
A
tinctures
13
Q
thick petroleum based and stays on the skin the longest
A
ointments
14
Q
drying preparations
A
tincture, wet dressing and lotions
15
Q
lubricating preparations
A
creams, foams, and ointment
16
Q
acute inflammation (oozing, vesiculation, and crusting) use ____ prepartions
A
drying
17
Q
chronic inflammation (xerosis, scaling, and lichenification) use ____ preparations
A
lubricating
18
Q
largest organ in the body
A
skin
19
Q
some diseases respond better to ___ administration of the drug
A
topical
20
Q
skin may act as a ___ to enhance the concentrations and provide a longer drug half life
A
reservoir
21
Q
__ is avoided and eliminated with topical preparations
A
first pass metabolism which includes GI and liver
22
Q
drugs that may be toxic when given systemically may be given dermally when percutaneous absorption into serum is ___
A
minimal
23
Q
top layer of skin, contains kerationcytes, melanocytes, langerhan’s cells and merkel cells
A
epidermis
24
Q
pigment portion of skin
A
melanocytes
25
antigen presenting portion of the skin
langerhans cells
26
sensory portion of the skin
merkel cells
27
horny layer of the epidermis is __
stratum corneum
28
protects against water loss, prevents absorption of noxious agents
horny layer of epidermis
29
what is the rate limiting step of topical preparation absorption?
percutaneous absorption
30
drugs absorption is increased by increasing ___ content of stratum corneum
water
31
what can happen if the drug gets absorbed in the subcutaneous layer?
systemic toxicity
32
rate of absorption is __ (what letter)
J
33
concentration of drug in vehicle
C(veh)
34
partition coefficent, release of drug from vehicle itself is ___
Km
35
diffusion coefficient
K
36
thickness of stratum corneum
x
37
Which properties are proportional to J
C(veh) and Km and D
38
Which properties are not proportional to J
x
39
drugs may penetrate a particular region more efficiently than another and therefore requires _____
less initial drug concentration
40
resistance to a particular drug may be overcome by ____
increasing the drug concentration that is applied
41
the skin acts as a ___ for many drugs (possibly b/c of its fat content so drug half life may be enhanced and less drug needed to maintain therapeutic concentrations
reservoir
42
choice of vehicle can ___ skin penetration
maximize
43
___ themselves may have a beneficial effect which may be additive or synergistic with that of the compound
vehicles
44
__ a may not be as efficacious as a brand name due to vehicle variation
generic
45
```
major variables that determine response to dermaly applied drugs
-
-
-
-
```
Regional variation in drug penetration
Concentration gradient
Dosing schedule
Vehicles and occlusion
46
vehicle is to topical as ___ is to oral
recipitate
| I think thats how you spell it, he told us this
47
topical administration may not be sufficient so then what?
systemic or intralesional administration may be warranted
48
systemic therapy is needed for the treatment of ____ because topical antifungals wont penetrate
onchomycosis
49
intralesional administration into an inflammatory site (drugs have direct contact with underlying pathology, minimal metabolism and forms a _____)
depot of the drug
50
mainstay of therapy for many inflammatory skin disease
anti inflammatory agents
51
original topical corticosteroid was ___
hydrocortisone
52
___ of derivatives can effect topical efficacy
chemistry
53
what region of the body absorption is the greatest
scrotal skin
54
what region of the body absorption is the worst
planter foot arch
55
list the regional variations in absorptions..
scrotal skin>vulvar skin> forehead> scalp>forearm>palm>plantar foot arch
56
the adverse effects of anti-inflammaotry agents are more with __ opposed to topical agents
oral
Suppresion of pituitary-adrenal axis, Cushing syndrome, growth retardation in children, localized effects such as erythema, rosacea, atrophy, contact dermatitis, increased intraocular pressure and hypopigmentation
57
how many classes of potency are there ? and which one is the greatest and least
7
1 is most potent
7 is least potent
58
increased potency due to difference in ___ and __
compound chemistry and vehicle
59
what should you consider when rx topical glucocorticoid selection?
potency
site of involvement
severity of disease
60
a more potent steroid is often used ____ than a less potent one
initially
step down if you need to
61
various forms of ___ are very responsive to corticosteriods
dermatitis
62
some forms of ___ are responsive to corticosteriods
psoriasis
63
adjunct therapy with another drug may be more effective for _____ disorders
less responsive
64
atropic dermatits, seborrheic dermatitis, lichen simplex chronica, pruritis ani, later phase of allergic contact dermatitis, later phase of irritant dermatitis, nummular eczematous dermatitis, stasis dermatitis and psorasis on genitalia and face are examples of ___
very responsive disorders
65
discoid lupus erythematosus, psoriasis of palms and soles, necrobiosis lipodicia diabeticorum, sarcoidosis, lichen striatus, pemphigus, familial benign pemphigus, vitiligo and granuloma annulare are examples of
less responsive disorders
66
keloids, hypertrophic scars, hypertrophic lichen planus, alopecia areata, acne cysts, prurigo nodularis and chondrodermatitis nodularis chronic helicis are examples of
least responsive disorders
67
what usually works for least responsive disorders??
intralesional injection
68
what are the 3 treatments for acne?
retinoic acid
benzoyl peroxide
azelaic acid
69
action in acute attributed to decreased cohesion bw epidermal cells and increased epidermal cell turnover
retinioic acid
70
causes slight erythema and mild peeling initially, adverse effects: drying and erythema, increased tumorigenic potential of UV Light
retinoic acid
71
structurally similary to tretinoin, photochemically stable and less irritating than tretinoin, most effective in patients with mild to moderate acne
Adapalene
72
restricted to oral treatment of recalcitrant severe cystic acne, significant side effects: hypervitamiosis A, lipid abnormalities, inflammatory bowel disease, anorexia and teratogenicity
Isotretinoin (accutane)
73
converted to benzoid acid within dermis- causes peeling and comedolytic, possible antimicrobial action against P. acnes, potent contact sensitizer
Benzoyl peroxide
74
Benzoyl peroxide has an addictive effect when used with ____ or ____
erythromycin or clindamycin
75
acne vulgaris and acne rosacea, possible antibacterial action against P.acnes and inhibits formation of dihydroxytestosterone
azelaic acid
76
prototype macrolide antibiotic, proposed inhibitory effect on Propionibacterium acnes, resistant strains may occur.. systemic treatment would then be required with appropriate alternative
erythromycin
77
macrolide antibiotic, ~10% of dose is absorbed, bloody diarrhea and colitis have been reported following topical administration
clindamycin
78
bloody diarrhea and colitis have been reported following topical administrationof clindamycin is called
pseudomembranous colitis
79
effective treatment for rosacea, inhibits demodex brevis, anti-inflammatory by decreasing neutrophil function
metronidazole
80
inhibits p acnes through inhibiting p-aminobenzoic acid utilization, used alone or in combination with sulfur for acne vulgaris and acne rosacea, contraindicated in patients with hypersensitivity to sulfonamides
sodium sulfacetamide
81
3 topical drugs for psoriasis
calcipotriene
anthralin
tazarotene
82
synthetic vitamin D3 derivative, plaque type psoriasis of moderate severity, transient elevated serum calcium, less than 10% of patients have total clearing when on single agent therapy
calcipotriene
83
MOA is unknown, but thought to be inhibition of cellular respiration, primary adverse effects are staining and skin irritation
anthralin
84
acetylenic retinoid prodrug, active forms bind retinoic acid receptors, absorbed percutaneously - use restricted to less than 20% of body bc of teratogenic properties, potentiates photosensitizing agents
Tazarotene
85
3 oral drugs for psoriasis
Acitretin
cyclosporine
anti-inflammatory compounds (biologic agents)
86
metabolite of aromatic retinoid etretinate, effective against pustular forms of psoriasis, adverse effects similar to isotretinoin: hypervitaminosis A, elevated triglycerides and cholesterol, hepatoxicity, more teratogenic
acitretin
87
immunosuppressant (inhibits the phosphatase calcineurin, transcription of IL-2 by T-cells, degranulation of mast cells) and adverse effects: hypertension and renal dysfuntion
cyclosporine
88
alefacept and efalizumab are examples of
t-cell modulators
89
etanercept, inflizimab, and adalimumab are examples of
TNFalpha inhibitors
90
prevent t lymphocyte activation/activity and immunosuppressive
Tcell modulators
91
Bind to TNFalpha and prevent binding and immunosuppresive
TNFs inhibitors
92
what other conditions can TNFalpha be used for?
chrons and ulcerative colitis
93
3 drugs used to treat pruritics
antihistamines
corticosteriods
anesthetics
94
name the antihistamines
antagonists of H1 receptors
diphenhydramine cream
doxepin
95
atopic dermatitis treatment, possible anticholingergic side effects
doxepin
96
decreases inflammation
corticosteroids
97
decrease nerve sensitivity
anesthetic
98
name the anesthetics
pramoxine
99
pruritis assocaited with mild eczema
pramoxine
100
other treatment options for pruritics, non pharmacological treatments
```
lukewarm baths
nonfragranced soaps
mild soaps
pat dry
cooling of the skin
humidifiers
emollient creams
```
101
What are Bacitracin and Gramicidin usually mixed with?
Poly B and/or Neomycin (tripple antibiotic ointments- "Neosporin")
102
What do you use for skin lesions, wounds, or mucous membranes?
Bacitracin and Gramicidin
103
Bacitracin & Gramicidin are highly toxic to what organ in the body?
Neprotoxic (topical use only)
104
what is effective against MRSA?
Mupirocin (Bactroban)
105
Which vehicle of Mupirocin would irritate mucous membranes?
PEG (Polyethylene Glycol) - water soluble base
106
A patient is diagnosed with impetigo caused by S. aureus and Streptococci. The patient is tested for MRSA and it comes back positive. What would u prescribe this patient?
Mupirocin (Bactroban)
| *effective against MRSA
107
An adult or pediatric patient patient are diagnosed with impetigo and both were tested for MRSA and results were negative. What would you prescribe this patient?
Retapamulin
| *not indicated for MRSA
108
What are the three gram positive active antibacterial agents?
1. Bacitracin & Gramicidin (Neosporin)
2. Mupirocin (Bactroban)
3. Retapamulin (Altabax)
109
What is Polymyxin B Sulfate effective against?
1. Pseudomonas aeruginosa
2. E. Coli
3. enterobacter
4. Klebsiella
110
What is resistant to Polymyxin B Sulfate?
Gram + organisms are resistant
111
What is at risk of toxicity when administrating Polymyxin B Sulfate?
Neuro and nephrotoxic
| *nerve damage & kidney damage
112
What is the safe dose of Polymyxin B Sulfate to avoid toxicity?
< 200 mg/day usage (IV)
| ****BE VERY CAREFUL!
113
any of a group of bacterial antibiotics derived from various species of Streptomyces that interfere with the function of bacterial ribosomes
Aminoglycoside
| *poorly absorbed in the GI tract
114
Which of the gram negative active antibacterial agents are aminoglycosides?
Neomycin & Gentamycin
115
What is Neomycin active against?
1. E. coli
2. Proteus
3. Klebsiella
4. Enterobacter
116
What is an adverse effect of Neomycin?
Can cause sensitization (enhancing the drugs effect)
117
Gentamycin is similar to Neomycin except it has a greater effect against ________ than Neomycin.
P. Aeruginosa
118
If Gentamycin is applied to denuded skin what could possibly happen to serum levels?
can result in elevated serum concentrations
119
A patient who was prescribed Gentamycin in the previous weeks, was admitted to the ER today with neprho, neuro, and ototoxicity. What would be your diagnosis?
RENAL FAILURE!!!!!!!
**Gentamycin is excreted in urine! if a patient who is using Gentamycin has renal failure, then this can cause accumulation and nephro, neuro, and ototoxicity
120
What is the difference between Neosporin + pain relief & Neosporin Ointment with regards to formulation?
Neosporin + pain relief CREAM does not contain BACITRACIN! instead it contains PRAMOXINE
121
What is the formulation of Neosporin + pain relief cream?
Neomycin, Polymyxin B, and Pramoxine
122
What is the formulation of Neosporin Ointment?
Neomycin, Polymyxin B, and Bacitracin
123
Can you list the 7 topical imidazoles?
| READY SET GOOOOOO!!!!!!
1. Clotrimazole
2. Ketoconazole
3. Miconazole
4. Oxiconazole
5. Sulconazole
6. Sertaconazole
7. Econazole (in the book but not listed in the slides)
124
The 7 topical imidazoles are used for _____ and _____.
Dermatophytes - Epidermophyton, Microsporum, and Trichophyton
Yeasts = Candida albicans & Pityrosporum orbiculare
125
What would you prescribe a patient presenting with Vulvovaginal candidiasis? The patient prefers a suppository.
Miconazole - (Monistat, Micatin)
| *available in cream or lotion and as a vaginal cream or suppositories
126
What would you prescribe a patient presenting with Vulvovaginal candidiasis? You suggest Miconazole, but the patient says NO! She wants a PILL GIRL!
Clotrimazole (Lotrimin, Mycelex)
127
How can you provide a patient with more rapid symptomatic improvement than an anti fungal agent alone?
Topical antifungal-corticosteroid fixed combinations have been introduced on the basis of providing more rapid symptomatic improvement than an anti fungal agent alone.
128
A patient presents with Seborrheic dermatitis should be treated with what? How many times a day?
twice daily with Ketoconazole
129
Ciclopirox olamine (Cloprox, Penlac) is a snthetic boad spectrum antimycotic agent against what?
candida species, dermatophytes, and P orbiculare
130
What has been approved for the topical treatment of mild to moderate onychomycosis of fingernails and toenail?
Penlac nail lacquer
131
Topical antifungal agent against dermatophytes but less active against yeasts
Terbinafine (Lamisil)
132
What is Terbinafine (Lamisil) useful against?
dermatophytes
133
What are the adverse effects of Terbinafine (Lamisil)?
irritation, burning, sensation, and erythema
134
What should be avoided when using Terbinafine (Lamisil)?
Contact with mucous membranes
135
This drug inhibits the epoxidation of squalene, thus blocking the synthesis of ergosterol, an essential component of fungal cell membranes. Used for the treatment of superficial dermatophytosis.
Butenafine (Mentrax, Lotrimim Ultra)
136
T/F Tolnaftate (Tinactin) is effective against candida.
FALSE!!!
Tolnaftate (Tinactin) is effective against dermatophyte infections caused by erpidermophyton, microsporum, and trichophyton. Also effective against P orbicular but NOT candida
137
What two drugs are useful in the topical therapy of C albicans infections but ineffective against dermatophytes?
Nystatin & Amphotericin B
138
What drug is limited to topical treatment of cutaneous and mucosal candid infections because of its narrow spectrum and negligible absorption tom the gastrointestinal tract following oral administration?
Nystatin
139
Amphotericin B (Fungizone) is available for topical use in cream and lotion form. The recommended dosage in the treatment of ____ and _____ is application two to four times daily to the affected area.
paronychial and intertiginous candidiasis
140
What are the adverse effects of oral nystatin?
mild nausea, diarrhea, and occasional vomiting.
141
What are the adverse effects of topical application of nystatin?
nonirritating, and allergic contact hypersensitive is exceedingly uncommon!
IT ALL GOOD GIRL!!!
142
What family of drugs is effective against the herpesviral family (including type 1 and 2); synthetic guanine analogs (interferes with viral DNA polymerase and subsequent DNA replication).
THe "clovir" family
1. Acyclovir
2. Valacyclovir
3. Penciclovir
4. Famciclovir
143
What family of drugs is used to treat orolabial herpes simplex infection in immunocompetent adults?
"the clovir" family
1. Acyclovir
2. Valacyclovir
3. Penciclovir
4. Famciclovir
144
What antiviral agent is used to treat moist wards of condyloma (HPV)?
podophyllin and podofilox
145
What antiviral agent is an immune response modifier (induces interferon production)?
Imiquimod
146
what antiviral drug is used to treat condyloma, verrucae, and molluscum contagiousum?
Imiquimod
147
what would you use for the treatment of recurrent orolabial herpes simplex virus infection in immocompetent adults?
```
Topical acyclovir (Zovirax) 5% ointment
Topical penciclovir (Denavir) 1% cream
```
148
what are the adverse reactions to acyclovir and penciclovir?
pruritis and mild pain with transient stinging or burning
149
treatment of external genital and perianal warts in adults, actinic keratoses on the face and scalp, and biopsy-proven primary basal cell carcinomas not he trunk, neck and extremitites
Imiquimod available in 5% cream (Aldara)
150
What is 3.75% Zyclara - Imiquimod used for?
scalp actinic keratoses
151
How long should Imiquimod be applied to wart skin?
3 times per week to wart tissue and left on the skin for 6-10 hours prior to washing off with mild soap and water.
152
What is the longest amount of time u should use Imiquimod consistently?
no longer than 16 weeks
153
What is the specific treatment of actinic keratosis with Imiquimod?
twice weekly with 5% cream on the contiguous area of involvement or nightly application of the 3.75 % cream.
154
How long should the Imiquimod cream be left on the skin before being washed off with mild soap and water?
approximately 8 hours
155
What is the specific treatment of superficial basal cell carcinoma using Imiquimod cream?
5 times per week to the tumor, including a 1 cm margin surrounding the skin, for a 6 week period.
156
What are the adverse side effects of Imiquimod?
local inflammatory reactions, including pruritus, erythema, and superficial erosion
157
what ectoparasitic drug is used for lice and scabies? (FIRST LINE)
Permethrin
158
How much permethrin is absorbed?
less than 2%
159
What is the treatment for pediculosis using permethrin?
1% cream (Nix) for 10 minutes
160
What is the treatment for scabies using Permethrin?
5% cream (Elmite) to body from neck down for 8-14 hours.
161
What are the adverse effects associated with Permethrin?
burning, stinging, pruritis
162
What do you use Lindane (Hexachlorocyclohexane) to treat?
Lice and Scabies
| - it is an organochlorine
163
Is Lindane absorbed easily? How much?
up to 10% absorbed percuaneously
164
How is lindane excreted?
Once lindane is absorbed it is excreted in urine over a 5 day period
165
Where is lindane concentrated after absorption?
fatty tissue, including brain
166
T/F Lindane is available orally.
FALSE!
| available as a shampoo or lotion
167
A patient comes into ur office with lice or pubis and prefers to use Lindane to treat this. What would be explain to the patient on how to use this drug?
30 mL of Lindane shampoo applied to dry hair on scalp or genital area for 4 minutes and then rinsed off
168
When should you tell ur patient to use an additional application of Lindane for lice?
ONLY use a SECOND treatment if the LICE is still living 1 week after the first treatment!!!
169
A patient comes into your office and is diagnosed with scabies. The patient prefers to use Lindane for her treatment. What would be ur instructions on how to use this drug?
apply a SINGLE application from the NECK DOWN, leave on for 8-12 hours, then wash it off
170
T/F Patients who still scabies after a treatment using Lindane should repeat the treatment ASAP!
FALSE!!!!
- patients with scabies should be retreated with lindane ONLY if active mites can be demonstrated after the first treatment. NEVER RETREAT within 1 eek!!!!
171
What toxicity side effects should you advise your patient of who is being treated with Lindane?
Neurotoxicity and hematotoxicity
172
Who is most susceptible for neurotoxicity and hematotoxicity when using Lindane?
1. infants
2. children
3. pregnant women
173
In the textbook, it was mentioned that there is now a USA package insert advising patients who are using Lindane to do what??
Lindane should NOT be used for scabies in premature infants and in patients with known seizure disorders.
174
T/F Systemic toxicity when using Lindane is minimal.
TRUE!
175
What is Malathion used for?
treatment of lice
176
what is the usual formulation of malathion?
5% precipitated sulfer in petrolatum = (Ovide)
177
When should you apply malathion?
when the hair is dry
178
What is Sulfur used for?
scabies
179
Non irritating, bad odor, and is staining drug that is a scabicide
sulfur
180
What specific patients is sulfur good for?
pregnant women and infants
181
What is the usual formulation for Sulfur?
5% precipitation sulfur in petroleum
182
A scabicide with some antipruritic properties that is a good alternative to Lindane
Crotamiton
183
What are the bad side effects that are associated with crotamiton?
allergic contact hypersensitivity and irritation may occur
184
A patient comes is rushed to the ER. Your differential diagnosis is suspecting Crotamiton toxicity. How could you test this?
percutaneous absorption reveals detectable levels in URINE!
185
T/F Crotamiton is available as a cream or lotion.
TRUE! 10% cream or lotion= called EURAX!
186
A patient is diagnosed with scabies. The patient prefers Crotamiton over Lindane, which you agree with their decision. How would u explain to this patient the correct way to use Crotamiton?
2 applications to the entire body from CHIN down at 24 hour intervals with a cleansing bath 48 hours after the last application.
187
Where should u avoid use of Crotamiton on the body?
avoid application to eyes or mucous membranes
188
a scabicide that has been replaced by better alternatives but is still a possibility for infants and pregnant women
sulfur
189
may solubilize cell surface proteins and results in desquamation of keratotic debris; this drug is used on warts and other instances of epidermal growth
Salicylic acid
190
What are some precautions that should be taken when treating a patient with salicylic acid to remove a wart?
1. Make sure the patient is not allergic; a patient who IS allergic may have urticarial, anaphylactic, and erythema multiform reaction.
2. if you use >6% can be destructive
191
at what percentage is salicylic acid most effective to remove a wart?
3-6% …. anything greater than 6% will be destructive
192
A patient presents with salicylic acid toxicity. What treatment would you use?
What age patient is at higher risk?
Hemodialysis treatment (children are at higher risk of salicylic acid toxicity)
193
Who are more at risk of harmful side effects of salicylic acid when it is applied to the extremities?
diabetes patients and patients with peripheral vascular disease
194
What are some side effects of topical use of salicylic acid?
local irritation, acute inflammation, and even ulceration with higher concentration
195
keratolytic at 40-70% when used alone; can be used alone or in combination with salicylic acid 6%; used extensively in topical preps b/c its such a good vehicle for organic substancs
propylene glycol
196
T/F Propylene Glycol is NOT absorbed well through the stratum corneum.
true
197
Approximately how much of Propylene glycol is exerted unchanged in urine?
12-45%
198
What is good for removal of hyperkeratotic debris; effective humectant and increases the water content of the stratum corneum; can draw water out from underlying tissue to superficial skin; used to remove warts and other epidermal growths
Propylene glycol
199
Propylene glycol can be used with 6% Salicyclic acid for treatment of what?
1. Ichthyosis
2. palmar and plantar keratoderms
3. psoriasis
4. pityriasis rubera
5. pilaris keratosis
6. hypertrophic lochen planus
200
What are some of the adverse effects of Propylene glycol?
allergic contact dermatitisoccurs
201
What is recommended for patients using Propylene glycol for the use of patch testing?
4% aqueous propylene glycol solution
202
used for warts or epidermal growths; in a compatible cream vehicle or ointment base that has softening and moisturizing effect; makes creams and lotions feel less greesy; a white crystalline powder with a slight ammonia oder when moist
urea
203
T/F Urea increases the water content of stratum corneum and is excreted in urine.
true
204
What concentration is urea used in creams and lotions?
2-20%
205
Urea is used at 20% concentration in treating what?
1. ichthyosis vulgaris, hyperkeratosis of palms and soles, xerosis, and keratosis pilaris
206
Urea is used at 30-50% on what?
nail plate to soften the nail prior to avulsion
207
What is the major use of Podophyllum resin?
condyloma acuminatum
208
What is the major use of Podofilox?
genital condylomas
209
an alcoholic extract of Podophyllum peltatum commonly known as _______ or _____ , is used in the treatment of condyloma acuminatum?
Mandrake root or May apple
210
T/F Podophyllum resin is soluble in lipids and is therefore distributed throughout the body including the CNS.
TRUE!
211
What is the recommended concentration of Podophyllum resin for the treatment of condyloma acuminatum?
25% concentration of podophyllum resin in compound tincture of benzoin
212
A patient is prescribed Podophyllum resin for the treatment of condyloma acuminatum. What would be your instructions on how to use this drug?
* for large condyloma limit application to the area only to avoid systemic absorption
* wash off 2-3 hours after 1st application, or could be extended to 6-8 hours depending on patient
* after 3-5 application sand no solution; find another treatment
213
What are the toxic symptoms associated with Podophyllum resin?
nasua, vomiiting, alterations in sensorium, muscle weakness, neuropathy and diminished tendon reflexes, coma, and even death
* local irritation is common, advent contact with eye can cause conjunctivitis
* *NO USE IN PREGO WOMEN
214
approved as a .5% solution or gel to treat genital condylomas; low systemic absorption; men with penile warts may use less than 70 micro liters/dose; not commonly detected in serum
Podofilox
215
What are ur instructions on how to use Podofilox for genital warts?
use twice a day for 3 consecutive days followed by a 4 day drug free period
216
what are some adverse effects associated with Podofilox?
inflammation, erosion, burning pain, and itching
217
used for actinic keratoses; avoid excessive sunlight (may speed up reaction); available in .5%, 1%,2% and 5%; responses to treatment begins with erythema -> vesiculation -> erosion -> superficial ulceration -> necrosis -> usually reepithiliazaiton; but can be continued until it reaches ulceration or necrosis in 3-4 weeks, which at that time treatment needs to be terminated
5- fluorouracil
218
how long does it take a patient to heal after a treatment using 5-Fluorouracil?
1-2 months
219
what are some adverse effects with a treatment of 5-Fluorouracil ?
pain, pruirits, a burning sensation, tenderness, and residual post - inflammatory hyperpigmentation
220
T/F 5-fluorouracil is excreted unchanged in urine.
FALSE!!
| excreted as CO2, urea, and alpha-fluro beta-alanine
221
T/F The mechanism of Fluroacil is inhibition of thymidylate synthetase activity, interfering with DNA synthesis and to a lesser extent RNA synthesis.
true
222
endogenous precursor or photosynthesizing porphyrin metabolites; cytotoxic superoxide and hydroxyl radicals form when exposed to appropriate blue light illumination; used in conjugation with phototherapy
NSAIDS: Amimolevulinic acid (ALA)
223
what is Aminolevulinic acid (ALA) used for?
actinic keratoses
224
how long should you avoid sunlight when using Aminolevulinic acid (ALA)?
40 hours after application
225
T/F During the treatment using Aminolevulinic Acid (ALA) transient stinging nd burning at the treatment site occurs during the period of light exposure.
true
226
Describe the course of treatment using Aminolevulinic Acid (ALA)? What happens?
treatment consist of applying ALA 20% topical solution to individual actinic keratoses followed b blue light photodynamic illumination 14-18 hours later. Redness, swelling,and crusting of the actinic keratoses will occur and gradually resolve over a 3-4 week period
227
What are some adverse effects that may occur using ALA?
allergic contact dermatitis to methyl ester may occur
228
What are the three drugs used in a patient with hyperpigmentation?
1. Hydroquinone
2. Monobenzone
3. Mequinol
229
Which of the three drugs that cause depigmentation is permeant?
Monobenzone
230
Which of the three drugs causes temporary depigmentation?
Hydroquinone and Mequinol
231
What is the mechanism of action of Hydroquinone, Monobenzone, and Mequinol?
Inhibit the enzyme tyrosinase and decreased biosythensis of melanin
232
Can Monobenzone be absorbed systematically?
yes! causes depigmentation at distant sites
233
T/F The depigmentation drugs are more effective acting alone than in combination with other drugs.
FALSE!
*Prescription combinations of hydroquinnone, fluocinolone, acetone, and retinoid acid (Tri-Luma) and mequinol and retinoid acid (Solage') are more effective than their individual components
234
What are the two drugs used in patients with hypopigmentaiton?
Trioxsalen & Methoxalen
235
used for repigmenation of depigmented macules of vitiligo
Psoralens - Trioxsalen & Methoxsalen
236
What activates the Psoralen drugs for repigmentation?
high intensity long wave UV light (320-400 nm; UVA)
237
What are the major long term risks of Psoralens?
cateracts and skin cancer
