Dermatologic Pharmacology Flashcards by Madelaine Hess

is alcohol-based hand disinfection effective against c. diff?

NO! must use soap and water to kill c. diff

alcohol-based is effective against gram(+), gram(-) and viral pathogens

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this moisturizer component forms an oily layer on top of the skin, traps water

give examples

emollients

ex: petrolatum, lanolin, mineral oil, dimethicone

good for dry skin

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this moisturizer component draws water into the outer layer of the skin

give examples

humectants

ex: glycerin, lecithin, propylene glycol

(osmotic)

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this moisturizer component loosens the bonds b/w the top layer of cells and helps dead skin cells fall off; helps the skin retain water, gives smoother and softer feeling

give examples

horny substance (keratin) softener

ex: urea, a-hydroxy acids (lactic, citric, glycolic), allantoin

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what moisturizer do you need for normal skin?

water-based

lightweight oils (cetyl alcohol) or silicone-derived (cyclomethicone)

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what moisturizer do you need for dry skin?

heavier, oil-based w/ antioxidants
- grape seed oil or dimethicone also help hydrate

pretrolatum-based products for very dry/cracked skin
- prevent water from evaporating

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what moisturizer do you need for oily skin?

water-based that is labeled “noncomedogenic” to provide moisture while limiting acne breakouts

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what moisturizer do you need for sensitive skin?

one with soothing ingredients – chamomile, aloe

no potential allergens (fragrance, dyes) or acids

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what moisturizer do you need for mature skin?

oil-based w/ petrolatum + antioxidants or a-hydroxy acids

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what radiation causes most erythema/sunburn, skin aging, and photocarcinogens?

UVB

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what radiation causes skin aging and cancer?

UVA

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name the three chemical compounds of sunscreen that absorb UV light

PABA - active in UVB
benzophenones - in range of UVB and UVA, less effective than PABA
dibenzoylmethanes - active in UVA, useful for drug-induced photosensitivity and cutaneous lupus erythematous

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name the target and MOA of the antiseptic: glutaraldehyde

there are 2 for this one

target: cell envelope (cell wall, outer membrane)
MOA: cross-linking of proteins

target: cross-linking of macromolecules
MOA: cross-linking of proteins in cell envelope and elsewhere in cell

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name the target and MOA of the antiseptic:

quaternary amines

target: cytoplasmic (inner) membrane

MOA: generalized membrane damage involving phospholipid bilayers

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name the target and MOA of the antiseptic:

chlorhexidine

target: cytoplasmic (inner) membrane

MOA: low concentrations affect membrane integrity, high concentrations cause congealing of cytoplasm

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name the target and MOA of the antiseptic:
halogens

(there are 2 for this one)

target: effects on DNA
MOA: inhibition of DNA synthesis

target: oxidizing agents
MOA: oxidation of thiol groups to disulfides, sulfoxides, or disulfoxides

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name the target and MOA of the antiseptic:

peroxygens

target: oxidizing agents

MOA: hydrogen peroxide (formation of free radicals, oxidizes thiol groups in enzymes and proteins)

peracetic acid (disruption of thiol groups in proteins)

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broad-spectrum antimicrobial agent widely used in homes and hospitals due to general efficacy on skin (including oral mucosa) and low irritability

chlorhexidine

{prevents development of spores; mycobacteriostatic; active against yeast membranes and can cause intracellular coagulation; lipid enveloped viruses more sensitive}

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name a gel that reduces bacterial load while providing a moist wound environment

cadexomer idodine

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what is toxic to bacteria and widely used by clinicians to decrease bacterial surface contamination? is rate of wound healing improved?

silver (silvadene)

2. no, rate of healing is not improved

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what should you suspect in patients with chronic illnesses, inadequate societal support, multisystemic trauma, or GI or neurological problems?

malnutrition – these conditions may impair intake

must address protein-calorie malnutrition and deficiencies of vitamins and minerals; nutrition is imperative to wound healing

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what is the usual reason for inadequate oxygenation?

local vasoconstriction due to sympathetic overactivity

common causes: blood volume deficit, unrelieved pain, hypothermia; oxygenation is imperative to wound healing

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how does removing dead tissue and debris promote wound healing?

limits protease production and conserves local resources needed for healing

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this should be routine; flushes bacteria and removes loose material

low-pressure irrigation w/ normal saline

*esp. for larger wounds

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this is appropriate for removing large areas of necrotic/infected tissue

surgical debridement

what enzyme may promote endothelial cell and keratinocyte migration for angiogenesis and epithelialization?

collagenase (enzymatic debridement) this has mixed results

this results in liquefaction of necrotic tissue while leaving healthy tissue intact

maggot therapy (biologic debridement) {pressure ulcer healing time not consistently reduced}

platelet derived growth factor, promotes cel proliferation and angiogenesis

becaplermin *only agent approved for the treatment of chronic diabetic foot ulcers; black box warning for malignancy (>3 tubes)

what is the only agent approved for treatment of chronic diabetic foot ulcers?

becaplermin

does epidermal growth factor significantly improve epithelialization?

no ("good distractor on exam because this is surprising")

what comprises the fluid of wounds during healing?

metalloproteases, cytokines

name the agents for the 1. debridement stage 2. granulation stage 3. epithelialization stage

1. debridement stage -- hydrogels 2. granulation stage -- foam and low-adherence dressings 3. epithelialization stage -- hydrocolloid and low-adherence dressings

- peptide antibiotic, inhibits bacterial wall synthesis - active against gram(+), and others - often causes contact dermatitis; poorly absorbed through skin

bacitracin

- aminoglycoside antibiotic, binds to 30S ribosomal subunit - active against gram(-) - often causes contact dermatitis; poorly absorbed through skin

neomycin

- peptide antibiotic, binds to phophor-lipids to alter permeability and damage bacterial cytoplasmic membrane - effective against gram(-)

polymixin B "detergent-like effect" *active agains P. aeruginosa, E. coli, Enterobacter, Klebsiella

what is the most common cause of jock itch, athlete's foot, and onychomycosis?

dermatophyte Trichophyton rubrum

as a class, these block ergosterol synthesis and have a wide range of activity against dermatophytes and yeasts (antifungals)

topical imidzaoles; usually apply 1-2x/day for 2-3 weeks, may cause stinging, pruritus, erythema, and local irritation - miconazole - clotrimazole - efinaconazole - ketoconazole

topical imidazole; vaginal cream or suppositories useful in vulvovaginal candidiasis

miconazole | clotrimazole also effective, tablet or cream

topical imidazole; onychomycosis treatment, given for 48 weeks (low complete cure rate)

efinaconazole

topical imidazole; cream for treatment of dermatophytosis and candidiasis, shampoo for seborrheic dermatitis

ketoconazole **inhibitor of CYP450**

synthetic broad-spectrum topical antimycotic agent, disrupts macromolecular synthesis what is it active against? OTC or prescription?

ciclopirox - active against dermatophytes, Candida, and Malassezia; prescription

allylamine, selectively inhibits squalene epoxidase (key enzyme for synthesis of ergosterol) what is it effective against?

terbinafine - highly active against dermatophytes, less active against yeasts; avoid contact w/ mucous membranes

synthetic antifungal compound, distorts hyphae/shunts mycelial growth what is it effective against? OTC or prescription?

tolnaftate - effective against dermatophytes, Malessezia; NOT Candida; OTC

binds to fungal sterols, alters membrane permeability limited to topical treatment of cutaneous and mucosal candida infections

nystatin

binds to fungal sterols, alters membrane permeability limited to topical treatment of cutaneous candida infections, may cause temporary yellow staining of skin

amphotericin B

synthetic guanine analog w/ inhibitory activity against HSV 1 and 2

acyclovir - used for recurrent orolabial HSV infection in immunocompetent adults; administered as ointment, cream or buccal tablet

pruritus without primary rash, due to compression or degeneration of nerves in the skin, en route to the spine or in the spine itself is known as... what may provide relief?

...neuropathic localized pruritus - anticonvulsants gabapentin and pregabalin may provide relief

topical therapy particularly useful for anogenital pruritus, may experience transient burning and stinging

topical calcineurin inhibitors dose: tacrolimus (ointment); pimecrolimus (cream)

topical therapy for pruritus; H1 antagonist avoid in children, 20-25% risk of sedation

doxepin

topical therapy for pruritus; TRPM8 antagonist useful for patients who report cooling as an alleviating factor

menthol

topical therapy for pruritus; TRPV1 agonist useful for neuropathic itch, may experience initial transient burning

capsaicin

topical therapy for pruritus; COX inhibitor and keratolytic useful in lichen simplex chronicus; acne and dandruff; avoid in acute inflammatory dermatoses and children

salicyclic acid | also antibacterial -- can open clogged pores

where do you use class 7 topical steroids?

face, genitals, skin-folds | hydrocorticosterone, prednisolone

describe the MOA of capsacin

1. activate transient TRPV1 (ion channel in cutaneous nerve fibers) 2. neurons release and eventually deplete certain neuropeptides (substance P) - can also induce lasting desensitization of neurons to variety of stimuli

describe the keratolytic effects of salicylic acid

dissolves the intercellular cement, causes epidermal cells to shed more rapidly

this systemic pruritic medication is only effective for utricaria

antihistamines

systemic therapy for nocturnal pruritus

mirtazapine antidepressant; NaSSA (a2-agonist)

systemic therapy for cholestatic pruritus

sertraline antidepressant; SSRI

systemic therapy for cholestatic and CKD-associated pruritis

naltrexone u-opioid receptor antagonist

systemic therapy for nocturnal and intractable pruritus

butorphanol k-opioid receptor agonist/u-opioid receptor antagonist

systemic therapy for neuropathic pruritus

gabapentin, pregabalin anticonvulsants

has shown benefits for patients with intractable pruritus, typically used for N/V from chemo

aprepitant substance P antagonist

a2-adrenergic agonist applied as topical gel for rosacea; vasocontricts

brimonidine stimulates post-synaptic vascular a2-receptors

a1A/a2-adrenergic agonist applied as a topical cream for rosacea; vasoconstricts

oxymetazoline

name the four adrenergic receptor agonists for red eyes

1. tetrahydrozoline (visine) 2. naphazoline 3. phenylepherine 4. oxymetazoline

topical agent, organophosphate cholinesterase inhibitor [for ectoparasites]

malathion

topical agent, binds to Na channels and blocks membrane repolarization [for ectoparasites]

permethrin - synthetic insecticide, similar to chyrsanthemums

administered orally, binds to glutamate-gated Cl channels and hyperpolarizes nerve and muscle cells [for ectoparasites]

ivermectin

topical agent, toxicity means used only after all other agents fail; disrupts GABAergic transmission in insects [for ectoparasites]

lindane

what is the first choice of treatment for mild comedonal acne?

topical retinoid

what is the first choice of treatment for mild mixed and papular/pustular acne?

topical retinoid + topical antimicrobial

what is the first choice of treatment for moderate mixed and papular/pustular acne?

oral antibiotic + topical retinoid +/- BPO

what is the first choice of treatment for moderate nodular acne?

oral antibiotic + topical retinoid + BPO

what is the first choice of treatment for severe nodular/conglobate acne?

oral isotretinoin

topical retinoid taken once daily before bed; alters gene expression to normalize keratinization, decreases keratinocyte cohesiveness and decreases microcomedone formation

tretinoin - may cause local skin irritation, dryness, flaking - Atralin contains soluble fish proteins

topical antimicrobial; twice daily; gels, lotions, creams, pads, masks, cleansers

benzoyl peroxide may cause local skin irritation, may bleach hair or clothing

topical antimicrobial; twice daily or once daily as foam

clindamycin - rare risk of pseudomembranous colitis (C. diff) - works similar to macrolides; kills anaerobes and useful for range of infections (acne, osteomyelitis)

topical antimicrobial; twice daily; gel, solution, pledget oral antibiotic; may cause GI distress; well-known CYP450 inhibitor

erythromycin

this medication kills acne bacteria (p. acne) and decreases the production of keratin; it is a dicarboxylic acid and is involved in the plant defense to infection used to treat mild to moderate acne, post-inflammatory hyperpigmentation

azaleic acid 20% cream, 15% gel may cause local skin irritation

oral antibiotic; may cause photosensitivity, GI distress; contraindicated in pregnancy and young children (grey teeth); twice daily

tetracycline

oral antibiotic; may cause photosensitivity, GI distress; contraindicated in pregnancy and young children; can be once or twice daily

doxycycline

oral antibiotic; may cause dizziness, drug-induced lupus, skin (dark pigmentation) or sclera (blue) discoloration; contraindicated in pregnancy and young children

minocycline

oral antibiotic; may cause GI distress; intermittent dosing due to long drug half-life; unusual because it is taken up by phagocytes and released at the site of infection

azithromycin does not inhibit CPY450

oral antibiotic; may cause SJS, TEN

trimethoprim-sulfamethoxazole

hormonal agent that is partial adrenergic agonist; especially useful for women w/ menstrual-cycle related breakouts of acne; contraindicated in pregnancy

spironolactone - K-sparing diuretic - can be used for male pattern baldness in women

oral retinoid; teratogenic (absolute contraindication in pregnancy); increases risk of suicidal ideation

oral isotetinoin for very severe acne; iPledge program

what enzymes convert Vitamin A (retinol) to retinal?

alcohol dehydrogenase/retinol dehydrogenase

what enzyme converts retinal to all-trans-RA

retinal dehydrogenase

what are the topical treatment options for mild to moderate psoriasis?

emollients, corticosteroids

which topical therapy for psoriasis reduces keratinocyte production?

topical vitamin D analogs | calcipotriene, calcitriol

what is a topical retinoid gel used for psoriasis?

tazarotene

what topical therapy for psoriasis blocks the lymphocytic burst in trans.?

calcineurin inhibitors

what topical therapy for psoriasis has anti-inflammatory effects?

anthralin

what are the initial treatment choices for moderate-severe psoriasis?

UVB and PUVA *PUVA increases risk of melanoma, must be protected in the sun

what will patients ingest prior to PUVA treatment?

photosenitizer psoralen

inhibits PDE4 and increases cAMP for moderate-severe plaque psoriasis, active psoriatic arthritis oral administration (expensive) may cause NVD, HA; mood changes/suicidal ideation possible

apremilast | decreases NO synthase, TNF-a and IL-23; increases IL-10

PDE4 inhibitor recently approved as topical therapy for dermatitis

crisaborole

hmAb, targets proinflammatory cytokines: IL-12, IL-23 treatment for plaque psoriasis, psoriatic arthritis, Crohn disease subQ at 8-12 week intervals, expensive increases risk of infection, possible increase risk SCC

ustekinumab (blunted cytokine effects include: decreased NK activation; decreased CD4 differentiation and activation; decreased MCP-1, TNF-a, CXCL-10 and IL-8 expression)

hmAb, targets proinflammatory cytokine: IL-17A treatment for ankylosing spondylitis, plaque psoriasis, psoriatic arthritis subQ for weeks 0-4, then e/ 4 weeks; expensive increased risk of infection; IBD exacerbation

secukinumab (blunted cytokine effects include: decreased IL-6, GC-CSF, IL-1B, TGF-B, TNF-a; decreased IL-8, GRO-a, NCP-1; decreased prostaglandins)

hmAb against iIL-17A

ixekuzumab

topical immune response modifier that stimulates local cytokine induction (via TLRs?); effective for actinic keratosis

imiquimod also useful for genital warts, SCC

treatment for actinic keratosis 1. disrupts cell plasma membranes and mitos --> cell necrosis (chemoablation) 2. neutrophil-mediated Ab-dependent cellular toxicity eliminates remaining tumor cells

ingenol mebutate derived from sap of Euphorbia peplus plant

treatment for actinic keratosis NSAID

topical diclofenac benefits suggest PGs may be important for skin carcinogenesis

treatment for actinic keratosis inhibits thymidylate synthetase

topical 5-fluorouracil 4-6 weeks skin progresses: erythema --> blistering --> necrosis w/ erosion --> re-epithelialization

what are the two topical medications for BCC and SCC? (not for advanced)

imiquimod (esp. spuamous) and 5-FU

what are the two medications for advanced BCC? describe MOA

vismodegib, sonidegib oral hedgehog signaling pathway inhibitors

describe the treatment of melanoma

1. surgical excision -- 1-2 cm margins, sentinel node bx 2. conventional chemo -- dacarbazine +/- carmustin and tamoxifen OR cisplatin and vinblastine 3. MAP kinase inhibitors -- vemurafenib if V600D gene mutation (~60%), results in apoptosis

what is the chemo drug for melanoma?

dacarbazine +/- carmustin and tamoxifen OR cisplatin and vinblastine

if a patient with melanoma has V600D mutation, what drug is apropriate?

vemurafenib | MAP kinase inhibitor

this treatment for male pattern baldness vasodilates d/t K-channel opening (hyperpolarization) promotes hair growth by increasing anagen (growth) phase and decreasing telogen (rest) phase, and enlarging miniaturized follicles

minoxidil aka rogane

this treatment for male pattern baldness is an oral inhibitor of DHT production

finasteride first line treatment, can cause ED

what is the first line treatment for female pattern hair loss (androgenetic alopecia)?

minoxidil

what are the second-line treatments for female pattern hair loss (androgenetic alopecia)?

1. spironolactone (androgen partial agonist) 2. finasteride (blocks DHT synthesis) 3. flutamide (protypical non-steroid androgen antagonist; can be used for prostate cancer)

this is a chronic, relapsing immune-mediated (auto-Abs) inflammatory disorder affecting hair follicles and resulting in non-scarring hair loss

alopecia areata

name the treatment options for alopecia aerata

- intralesional or topical corticosteroids | - topical immunotherapy -- DPCP (diphenylcyclopropenone); induces contact dermatitis which causes hair growth

Dermatologic Pharmacology Flashcards

(115 cards)