Derm Pharm Cards Part 2

Question 1

Aldesleukin MAO and use and major AE

Answer 1

Bind to cell surface IL-2 receptor
Induces proliferation and differentiation of B/T cells, monocytes, macrophages and CTLs

Clinical use: melanoma

Renal failure insufficiency caused by capillary leak syndrome

Question 2

Carmustin MAO and use

Answer 2

Alkylation and carbamoylation of amino acids

Clinical use: melanoma

Question 3

Cisplatin MAO, AE, use?

Answer 3

Forms DNA intrastrand crosslinks and adducts

severe nephrotoxicity, myelosuppression, and N/V. Significant ototoxicity (tinnitus and occasionally deafness) reported in children

basal cell carcinoma and squamous cell carcinoma

Question 4

Cyclophosphamide MAO, AE, use?

Answer 4

Pro-drug of active alkylating moiety

Renal compromise, hemorrhagic cystitis (MESNA is protective), N/V, rashes. Amenorrhea / infertility. Monitor for 2° malignancies. Pulmonary fibrosis.

basal cell carcinoma

Question 5

Dacarbazine MAO, use?

Answer 5

Pro-drug of active alkylating moiety

Clinical use: melanoma

Question 6

Imiquimod MAO, use?

Answer 6

Small molecule tumor-directed immune response initiator:

• Direct activation of TLR7 and/or TLR8  activation of NFB  upregulation of proinflammatory cytokines
• Adenosine receptor blockade  blocks AC  cAMP
• Bcl-2/Bax shift & caspase activation  apoptosis (at high concentrations)

Clinical use: basal cell carcinoma, actinic keratosis and HPV

Question 7

Interferon- 2b MAO, use?

Answer 7

Binding to receptor causes signaling through JAK/STAT/IRF-9 and results in increased transcription of >300 genes that inhibit cancer growth, collectively called ISGs

Clinical use: melanoma
Cautiously used in autoimmune diseases, cardiac disease and depression (associated with increased risk of suicidal ideation)

Question 8

What do the following have in common? 
Carmustine
cisplatin 
cyclophosphamide 
dactinomycin 
doxorubicin
lomustine 
methotrexate

Answer 8

increase risk of secondary malignancy

Question 9

Sorafenib MAO, use?

Answer 9

Multi-kinase inhibitor:
VEGF, PDGFR, KIT and RAF kinase

Inhibits tumor cell proliferation by targeting the RAF/MEK/ERK pathway at the level of RAF kinase

Exerts an anti-angiogenic effect by targeting the receptor tyrosine kinases VEGFR-2 and PDGFR and their associated signaling
Clinical use: melanoma

Question 10

Trametinib MAO, use?

Answer 10

Reversible MEK inhibitor for patients with BRAF V6ooE or V600K mutations
Melanoma

Question 11

Trichloroacetic acid MAO, use?

Answer 11

Rapidly penetrates and cauterizes skin, keratin and other tissues
“Chemical peel”
Clinical use: actinic keratosis

Question 12

Vismodegib MAO, use?

Answer 12

Oral SMO inhibitor
Lipophilic agent with extensive metabolism

Clinical use: basal cell carcinoma
AE-intrauterine fetal death, male mediated teratogenicity

Question 13

Vemurafenib

Answer 13

Inhibitor of mutated BRAF, including mutated BRAFV600E
(CONFIRMED by genotyping)
Resistance can occur via alternative pathway activation
Hepatic metabolism, PGP & CYP interactions possible, elevated serum creatinine, elevated liver enzymes, QT prolongation/TP, increased photosensitivity, cutaneous SCC in 1/4th patients and severe dermatologic reactions (SJS) possible

Serious ophthalmologic issues: uveitis, iritis, retinal vein occlusion
Clinical use: melanoma

Question 14

3 best cytotoxic agents for melanoma

Answer 14

Dacarbazine
Lomustine
Carmustine

Question 15

3 immunotherapies for melanoma

Answer 15

Aldesleikin (IL-2R agonist)
INF-alpha
Ipilimumab

Question 16

Ipilimumab

Answer 16

Recombinant antibody that binds to cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) receptor on Tcells and activates them

Bolsters antitumor response of the immune system
Dermatitis including toxic epidermal necrolysis caused by Tcell activation and proliferation
BBW:
Adrenal insufficiency, diarrhea, Guillain-Barre syndrome, hepatitis, hyperthyroidism, hypopituitarism, hypothyroidism, myasthenia gravis, peripheral neuropathy, pregnancy, serious rash
Pregnancy category C

Question 17

3 signal transduction inhibitors for melanoma

Answer 17

Sorafinib
Vemurafenib
Trametinib

Question 18

UVA1

Answer 18

340-400nm

increases photo-aging, cancer risk

Question 19

UVA2

Answer 19

320-340nm

increases photo-aging cancer risk

Question 20

UVB

Answer 20

290-320 nm

burns

Question 21

Only ovicidal therapy available for head lice

Answer 21

Malathion

Question 22

Malathion MAO

Answer 22

Organophosphate insecticide that louse metabolize to malaoxon  inhibits acetyl-cholinesterase  neuronal hyperstimulation and paralysis

Question 23

If accidental consumption of Malathion? AE and Antidote?

Answer 23

SLUDGEBBB
Salivation, Lacrimation, Urination, Defecation, GI, Emesis, Bronchospasm, Bronchorrhea, Bradycardia
Give: Pralidoxime or Atropine

Question 24

Term: kills lice vs. kills eggs

Answer 24

Padicuicidal vs. ovicidal

Question 25

Head lice tx 2 methods

Answer 25

chemical: paralyze & dehydrate physical: suffocate

Question 26

Permethrin MAO & rare AE, resistance

Answer 26

Synthetic pyrethrin that binds to voltage-gated Na+ channels and causes hyperexcitability and paralysis Asthma exacerbation in patients allergic to ragweed Efficacy has waned due to knock-down resistance mutations of louse Na+ channels

Question 27

Lindane AE

Answer 27

Headlice tx in pts who have failed first line (works by blocking GABA - a CNS stimulant) disfavored because of neurotoxicity & persistence in environment BBW: skin disease, premies, seizure

Question 28

Compare Trametinib and Vemurafenib for Melanoma

Answer 28

Both: genotyping necessary, Melanoma tx, CV effects, eye effects

Question 29

Ivemectin

Answer 29

Headlice tx Binds selectively and with high affinity to glutamate-gated Cl- ion channels present in invertebrate nerve and muscle cells and causes hyperexcitability and paralysis

Question 30

2 chemotherapies - photosensitivity

Answer 30

Ipilimumab and Vemurafenib

Question 31

Eflornithine

Answer 31

Decreases ornithine decarboxylase  decrease cell division and differentiation of the hair follicle  reduce unwanted facial hair

Question 32

Finasteride

Answer 32

Testosterone analog that blocks 5-reductase activity  decreases scalp and serum [DHT], AE-possible to have decreased sex drive even after discontinuing drug

Question 33

Minoxidil

Answer 33

May activate the hair follicle directly or stimulated follicular microcirculation May alter local androgen metabolism Topical agent for hair growth in male-patterned baldness Drug treatment must continued for effects to be maintained

Question 34

Methoxsalen

Answer 34

Oral and topical pigmenting agent used in the treatment of vitiligo, symptomatic reliefof psoriasis, treatment of cutaneous Tcell lymphoma, alopecia areata, inflammatory dermatoses, eczema and lichen planus Activated by UV-A radiation  conjugation and cross-linkning of DNA  cell death Delayed erythema followed over several weeks by increased epidermal melanization and thickening of the stratum corneum

Question 35

Dactinomycin MAO, use?

Answer 35

DNA intercalator | Clinical use: melanoma

Question 36

Diclofenac MAO, use?

Answer 36

Inhibitor of inflammatory mediator, including PGE2 | actinic keratosis

Question 37

Docetaxel MAO, use?

Answer 37

Microtubule stabilizer; inhibits depolymerization | Clinical use: melanoma

Question 38

Doxorubicin MAO, use?

Answer 38

Intercalator, free radical generator, topo II inhibitor Clinical use: basal cell carcinoma

Question 39

Fluorouracil MAO, use?

Answer 39

Thymidylate synthase (TS) inhibitor; interferes with RNA & RNA synthesis/function Clinical use: basal cell carcinoma and actinic keratosis

Question 40

Vinblastine use

Answer 40

Clinical use: basal cell carcinoma and melanoma

Question 41

Cinoxate

Answer 41

Organic UVB filter (290-320nm)

Question 42

Para-aminobenzoic Acid

Answer 42

Organic UVB filter (290-320nm)

Question 43

Trolamine

Answer 43

Organic UVB filter (290-320nm)

Question 44

Dioxybenzone

Answer 44

``` Organic UVB filter (290-320nm) AND UVA2 filter (320-340) ```

Question 45

Oxybenzone

Answer 45

``` Organic UVB filter (290-320nm) AND UVA2 filter (320-340) ```

Question 46

Avobenzone

Answer 46

Only FDA-approved organic sunscreen that protects against UV-A1 radiation (340-400nm)

Question 47

Titanium dioxide and zinc oxide

Answer 47

UVA and UVB protection Physically reflect and scatters light Thick consistency & tendency to clump

Question 48

Tri-Luma=use? Hydroquinone? Fluocinolone? Tretinoin?

Answer 48

Temporary relief of facial skin darkening by hormonal changes, pregnancy, OCs or HRT Hydroquinone? inhibits melanin formation by blocking melanocyte enzymatic oxidation of tyrosine to DOPA Fluocinolone? : anti-inflammatory corticosteroid Tretinoin?modulates skin growth and pigmentation. Also increased keratinocyte shedding from the retinoid-treated epidermis, which results in decreased epidermal melanin content