Exam 1 Flashcards
1
Q
Formulations that are drying and best for oozing/crusting presentations
A
Tinctures, wet dressings, and lotions
2
Q
Formulations that are moisturizing and best suited to xerodermic conditions
A
Creams & ointments
3
Q
Emulsion of water and fat; lipid is biggest component
A
Cream
4
Q
Emulsion of fat and water but with more water, less fat
A
Lotion
5
Q
Emulsion of petroleum jelly and water; very thick & messy
A
Ointment
6
Q
lotion or gel that is aerosolized; beneficial for scalp conditions
A
Foam
7
Q
Emulsion of water and a thickener (polymer or starch)
A
Gel
8
Q
Mixing a powder with a liquid creates a
A
Paste
9
Q
Dry, mostly w/ cornstarch as the base in the US
A
Powder
10
Q
Aqueous base of water and drug
A
Solution
11
Q
Solution that contains alcohol; used when drug isn’t water soluble
A
Tincture
12
Q
Common reasons to use a TCS
A
Atopic and contact derm, psoriasis, localized urticaria/hives
13
Q
Side effects of systemic steroids?
A
Hyperglycemia, HTN, iatrogenic Cushing’s, HPA-axis inhibition
14
Q
Super/Very Potent TCS
A
Clobetasol propionate 0.05% cream/ointment
Brand: Temovate & Clobex
15
Q
Potent TCS
A
Mometsone furoate 0.1% ointment (Elocon)
Betamethasone dipropionate 0.05% lotion (Diprolene)
16
Q
Mild potency TCS
A
Triamcinolone acetonide 0.25% cream
17
Q
Least potent TCS
A
Hydrocortisone acetate (1% or 2.5% cream or lotions)
18
Q
MOA of tacrolimus (Protopic) and pimecrolimus (Elidel) - what type of drugs are these?
A
Topical immunosuppressants
Bind to and inhibit calcineurin; inhibits T-cell activation
19
Q
Topical antipuritics
A
Pramoxine, Doxepin (zonalon as topical, Sinequan oral), Diphenhydramine (topical benadryl)
20
Q
Topical antipuritic that is a tricyclic antidepressant; Plasma levels may be similar whether given oral or topical - anticholinergic effects, sedation, drug interactions
A
Doxepin (zonalon)
21
Q
Antihistamine that is given as a topical antipuritic. Plasma levels may approach that of oral use if used chronically - anticholinergic effects, sedation
A
Diphenhydramine (Topical Benadryl)
22
Q
Peptide abx available topically, covers G+ bacteria
Inhibits transporting NAG/NAM across cell membrane
Poorly absorbed, well tolerated
A
Bacitracin
23
Q
Peptide abx available topically, covers G- bacteria
Binds LPS, disrupts cell membrane
Poorly absorbed, well tolerated
A
Polymyxin B
24
Q
aminoglycosides available topically, covers G- bacteria
Binds to 30S ribosomal subunit
Poorly absorbed, may lead to sensitization
A
Neomycin, Gentamicin
25
What 3 antibiotics are in Neosporin?
Bacitracin, Polymyxin B, and Neomycin
26
Antibiotic active against G+ cocci (Strep, Staph, including MSSA and MRSA)
Inhibits isoleucyl-tRNA synthetase, inhibiting protein synthesis
Used for impetigo as well as other superficial infx caused by susceptible organisms
Mupirocin (Bactroban)
27
Topical antibiotic
Binds 50S ribosomal subunit
Similar in spectrum and use as mupirocin, but not specifically approved for MRSA
Retapamulin (Altabax)
28
Systemic antibiotics for skin infections
Penicillins (amoxi/clav, dicloxacillin)
Cephalosporins (cephalexin, cefprozil, cefuroxime, cefpodoxime, ceftriaxone)
Fluoroquinolones (ciprofoxacin, levofloxacin, moxifloxacin)
Others: clindamycin, daptomycin, linezolid, tigecycline, TMP/SMX, vancomycin
29
MOA, common/serious SE, coverage of Penicillins
Binds to and inhibits PBP, inhibiting peptidoglycan synthesis
SE: hypersensitivity MC, rash, serum sickness, SJS, renal toxicity, diarrhea
Amoxi/Clav covers B-lactamase + organisms, G+ staph and strep, Haemophilis, Listeria, E. coli, Shigella, Salmonella
Dicloxacillin covers B-lactamase + organisms and staph
30
MOA, common/serious SE, coverage of Cephalosporins
MOA: PBP inhibition (same as pcn)
SE: hypersensitivity (MC), bleeding (MTT side chain in Cefotetan), N/V/D, obstructive biliary toxicity w/ Ceftriaxone, C. diff, Disulfiram-like rxn
Coverage: higher gen = broader spectrum; don't cover LAME,
Cephalexin - staph/strep
Cefprozil, Cefuroxime - Enterobacteria (E. coli, Klebsiella) and Bacteroides fragilis
Ceftriaxone, Cefpodoxime - Gram - rods, pcn-resistant Strep pneumo
31
MOA, common/serious SE, coverage of Fluoroquinolones
MOA: targets DNA gyrase in G- and Topoisomerase IV in G+
SE: QT interval, insulin resistance, CNS - myasthenia gravis, N/V/D, cartilage toxicity in pregnancy and children, drug interactions w/ cations, CYP1A2 inhibition
Covers Gram- such as Enterbacteriaceae, Haemophilus, Moraxella, and Pseudomonas
Cipro and moxifloxacin can cover G+ and anaerobes
32
Not as broad spectrum, significantly inhibit p450 enzymes, almost totally regulated to topical treatment (*1 exception)
Imidazoles (Ketoconazole*, clotrimazole, econazole, miconazole, oxiconazole, sertaconazole, sulconazole)
33
Tend to be broader spectrum with less drug interactions; almost all used systemically
Triazoles (*Efinaconazole, *terconazole, fluconazole, itraconazole, posaconazole, voriconazole)
34
MOA of Azole-antifungals
Inhibits lanosterol-14a-demethylase (needed to convert lanosterol to ergosterol)
35
Toxicity of systemic azole-antifungals
Nausea, abdominal discomfort, hepatotoxicity, drug interactions, avoid in pregnancy
36
Orally (Nizoral)
Foam for Seb derm (Extina)
Shampoo for dandruff (Nizoral AD)
Topical use well tolerated
Ketoconazole
37
Side effects of systemic ketoconazole
Hepatotoxicity common, strong p450 inhibition (drug interactions), inhibits synthesis of androgens, estrogens, progestins, cortisol, and aldosterone
38
Clotrimazole, Butoconazole, Econazole, Luliconazole, Miconazole, Oxiconazole, Sertaconazole, Sulconazole, Tioconazole
Imidazole Antifungals
39
Used topically for tineas and vaginal candidiasis
Imidazole antifungals
40
Used orally for tinea, onychomycosis, or serious systemic infections
Negative inotrope - avoid in heart failure
Itraconazole (Sporanox)
41
Used orally or IV. Less drug interactions than itraconazole. Used for candidiasis (thrush, vulvovaginal, or systemic) or other systemic fungal infx, including fungal meningitis
Fluconazole (Diflucan)
42
Used orally or parenterally; similar # of drug interactions as fluconazole; Often chosen as prophylaxis against fungal infx in high-risk patients; Used for oropharyngeal and esophageal candidiasis in AIDS patients
Posaconazole (Noxafil)
43
Used for vaginal candidiasis
Terconazole (Terazol) or Fluconazole (Diflucan)
44
Used topically for onychomycosis (only indication); used daily for a year & cures 15% of cases
Efinaconazole (Jublia)
45
MOA of Allylamines & Tolnaftate
Inhibits squalene epoxidase (enzyme involved in ergosterol synthesis); ergosterol decreases, squalene increases, which is likely toxic
46
Orally for onychomycosis and other dermatophyte infx - most effective for onychomycosis
Topically for minor tineas
Toxicity (Systemic): GI, increased liver enzymes, hepatotoxicity
Terbinafine (Lamisil)
47
Allylamines & Use
Naftifine (Naftin), Butenafine (Mentax), Tolnaftate (Tinactin), Terbinafine (Lamisil)
Have good activity against dermatophytes and Candida
48
MOA of Griseofulvin (Gris-PEG)
Deposits into keratin (skin & nails), binds to fungal microtubules and inhibits mitosis
49
Use of Griseofulvin
Orally for dermatophyte type infections; Not considered first-line - usually requires months of tx and high relapse rates
50
Poorly absorbed from gut; high fat meals improves absorption
Griseofulvin
51
DOC for cutaneous kerion
Griseofulvin - inflammatory reaction against canine dermatophyte species
52
Toxicity of Griseofulvin
GI, hepatotoxic, AVOID w/ OCP, AVOID in patients w/ porphyria (increases synthesis of heme)
53
Available topically as cream, gel, shampoo
Used for tinea versicolor, seb derm, onychomycosis
Ciclopirox (Loprox)
54
MOA of Ciclopirox
speculative - chelates iron; iron-dependent enzymes (catalases and peroxidases) fail to function
55
MOA of Tavaborole (Kerydin)
Inhibits leucyl-tRNA synthetase; decreases leucine-charged tRNA pool
56
Available topically for onychomycosis - cure rate 6.5% after 48wks
Tavaborole (Kerydin)
57
Topical Meds for Herpetic Lesions
Acyclovir (Zovirax) & Penciclovir (Denavir)
Docosanol (Abreva) OTC
58
Topicals for Papillomatous disease
Salicylic acid (Compound W, others)
Podophyllum resin (Podofilm) & Podofilox (Condylox)
59
Structural analogs of DNA bases; Prodrugs converted by viral thymidine kinase to monophosphate form & converted by host enzymes to triphosphate form
Triphosphate form inhibits viral DNA synthase
Acyclovir & Penciclovir
60
Inhibits fusion of viral coat to cell membrane
Docosanol (Abreva)
61
Keratolytic agent; may cause skin irritation or skin damage if used too aggressively; may cause hypersensitivity reaction to pts sensitive to salicylates (including aspirin)
Salicylic acid (Compound W)
62
Derived from Mayapple plant; mechanism likely due to inhibition of topoisomerase II (inhibiting DNA synthesis); may cause skin irritation; AVOID in pregnancy
Podophyllum & podofilox
63
MOA of Clindamycin
binds to 50S ribosomal subunit preventing translocation down mRNA
64
Coverage & SE of Clindamycin
Broad spectrum & covers anaerobes
SE: High risk of C. diff; hepatotoxicity, hypotension, EKG changes may occur but rare
65
Daptomycin MOA, Coverage, SE
Forms a pore in cell membrane
Covers Gram + bacteria (including VRSA)
SE: N/V, myopathy, rhabdomyolysis, peripheral neuropathy and paresthesia
66
Linezolid MOA, coverage, SE
Binds to 23S site on 50S subunit
Covers G+ resistance to other drugs (MRSA, VRSA, VRE, nosocomial pneumonia)
SE: N/V/D, bone marrow suppression, acts as MAOI w/ similar drug interactions, mitochondrial toxicity (lactic acidosis, peripheral & optic neuropathy)
67
Tigecycline MOA, coverage, SE
Binds to 30S ribosomal subunit preventing tRNA from entering A site
Covers G+, G-, and atypicals + MRSA/VRSA
SE: N/V/D, C.diff, photodermatitis, reduces enterohepatic circulation
68
Vancomycin MOA, coverage, SE
Binds D-ala-D-ala preventing PBP from binding
Covers G+ and MRSA
SE: Nephrotoxicity, ototoxicity, histamine release (Red-man syndrome)
69
TMP/SMX MOA, coverage, SE
SMX blocks first step in folate synthesis, TMP blocks last step in folate synthesis (DHFR)
Covers staph (MRSA), strep, E.coli, Salmonella, Shigella
SE: folate deficiency, N/V/D, myelosuppression, Hemolysis in G6PD def, avoid in late pregnancy, allergy, drug interactions
70
First-line treatment of AOM
Amoxicillin (Amoxil)
71
MC Side Effects of Amoxicillin
N/V/D
72
Tx of AOM if pt doesn't respond to Amoxil or if pt has had antibiotics in the previous month
Amoxicillin/Clavulanic Acid (Augmentin)
73
Treatment for AOM if pt is allergic to PCN or if Augmentin has failed
Ceftriaxone (Rocephin) or other 3rd gen. Ceph (Cefdinir)
74
MC Side Effects of Ceftriaxone & Cefdinir
N/V/D
75
Alternative tx for AOM if pt is allergic to PCN and/or cephalosporins
Clindamycin (Cleocin)
76
Side effects of clindamycin
N/V/D are MC; C. diff overgrowth may occur
77
Tx primarily used for Acute Otitis Externa
Otic formulations of antibiotics with or without corticosteroids
Ofloxacin (Floxin) or Ciprofloxacin (cetraxal or Otiprio)
78
What meds can be used for AOE regardless if the TM is intact or not?
Ofloxacin & ciprofloxacin
79
What meds can be used for AOE only if the TM is INTACT?
Neomycin, polymyxin B, and HCT (cortisporin)
80
Antihistamines
Azelastine intranasal (Astelin)
Second gen orals: Loratadine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra)
First gen: Diphenhydramine (Benadryl), Chlorpheniramine (Chlor-Trimeton)
81
Nasal Corticosteroids
Triamcinolone (Nasocort), Fluticasone (Flonase), Mometasone (Nasonex), Ciclesonide (Omnaris)
82
First Generation Antihistamines are (Drowsy or Non-Drowsy)
Drowsy - Diphenhydramine & Chlorpheniramine
83
Second generation antihistamines are (drowsy or non-drowsy)
Non-drowsy - Loratadine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra)
84
MOA of decongestants
Alpha-1 agonists
85
OTC decongestants
Phenylephrine (Sudafed-PE, oral) & Oxymetazoline (Afrin, intranasal)
86
BTC decongestant
Pseudoephedrine (Sudafed, oral)
87
Side effects of decongestants
Systemic exposure may increase BP and worsen Benign Prostatic Hypertrophy (BPH); Rebound hyperemia may occur after long-term or high-dose use
88
MOA of Montelukast (Singulair)
Leukotriene receptor antagonist
89
MOA of Cromolyn nasal (NasalCrom)
mast-cell degranulation inhibitor; available OTC
90
What type of sinusitis has symptoms < 10 days with no or low grade fever?
Viral Sinusitis
91
What type of sinusitis has symptoms > 10 days, high fever, and purulent drainage?
Bacterial Sinusitis
92
Treatment for viral sinusitis
Supportive - acetaminophen or NSAIDS, nasal irrigation, decongestants, or nasal glucocorticoids
93
DOC for bacterial sinusitis
Amoxicillin + Clavulanic acid (Augmentin)
94
Alternative treatments for bacterial sinusitis
Levofloxacin (Levaquin) - don't use during pregnancy or in children
Ceftriaxone or clindamycin
Macrolides - Clarithromycin or Azithromycin (may be resistant)
95
Centor criteria for Group A Strep
+1 for swelling/exudate on tonsils, swollen anterior cervical LN, Fever >100, absent cough
Age 3-14 +1
Age 15-44 0
Age > 44 -1
Score 4-5 = Treat w/ antibiotics
Score 2-3 = RADT
Score 0-1 = very unlikely strep
96
First-line treatment of strep throat
Penicillin or Amoxicillin
97
Alternative treatment for strep throat
Macrolides (Clarithromycin, Azithromycin)
Clindamycin
98
Treatments for Thrush
Nystatin (swish & swallow), Clotrimazole (troche), Miconazole (buccal tab), Fluconazole (oral)
99
MOA of Nystatin
Polyene antifungal: binds ergosterol and polymerizes in cell membrane
100
MOA of azole antifungals
Inhibits lanosterol-14a-demethylase - needed to convert lanosterol into ergosterol
101
Treatment of aphthous ulcers
Triamcinolone oral paste or fluocinonide oral gel
102
Treatment of Pulpitis
Amoxicillin/clavulanic acid (Augmentin) or Clindamycin (Cleocin)
103
What is pulpitis?
an infection inside of the tooth
104
Oral retinoid used for more severe cases of Psoriasis that has similar SE & toxicity to Isotretinoin
Acitretin (Soriatane)
105
How long after treatment is Acitretin (Soriatane) contraindicated in pregnancy?
3 years
106
Oral PDE4 inhibitor used in the treatment of psoriasis
Apremilast (Otezla)
107
Systemic med for psoriasis that inhibits calcineurin
Cyclosporine A (Sandimmune)
108
SE of Cyclosporine A (Sandimmune)
Diarrhea/vomiting, HTN, paresthesia, gingival hyperplasia, renal vasoconstriction --> kidney failure, HTN, gout
109
What types of medications should you avoid taking with Cyclosporine A (Sandimmune)?
potent p450 inhibitors/inducers
110
Systemic medication for psoriasis that inhibits DHFR and folate activation
Methotrexate
111
SE of Methotrexate
bone marrow suppression, alopecia, diarrhea, mucositis, hepatitis (all similar to cancer chemo)
112
Etanercept (Enbrel), Infliximab (Remicade), Adalimumab (Humira), Golimumab (Simponi)
TNF inhibitors used to treat psoriasis
113
SE of TNF inhibitors
avoid during infx or those susceptible to infx, avoid w/ live attenuated vaccines, avoid in those at risk of TB as it may increase risk of lymphoma and other cancers
114
MOA of Ustekinumab (Stelara)
antibody against IL 12 & 23; involved in T-cell activation
115
MOA of Alefacept (Amevive)
reduces T-cell activation & reduces CD2+ cell counts
116
MOA of Efalizumab (Raptiva)
decreases activation & migration of T cells
117
What do you monitor in patient's taking Efalizumab (Raptiva)?
Platelet counts
118
MOA of Secukinumab (Cosentyx) & Ixekizumab (Taltz)
Antibodies against IL 17
119
Treatments for Scabies
Permetrin (Elimite cream), Lindane, Crotamiton (Eurax)
120
MOA of Permethrin
Pyrethroid-type insecticide - causes neuronal depolarization via VGNaCs
121
MOA of Malathion (Ovide)
acetylcholinesterase inhibitor
122
MOA of Lindane
organochlorine insecticide: interferes w/ GABA-A chloride channel
123
Which ectoparasitic tx should be avoided in young children and pregnant women?
Lindane
124
Medications activated by UVA for vitiligo
Trioxsalen or Methoxsalen
