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Clin Med MSKII > Kruse > Flashcards

Kruse Flashcards

1
Q

Topical ANTIBIOTICS for acne

A
  • Clindamycin and Erythromycin

- Should NOT be used as monotherapy because combo (with retinoids, benzoyl peroxide) decreases resistance

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2
Q

Topical Antifungal agents

A
  • Azoles
  • Ciclopirox olamine
  • Allylamines: Terbinafine, naftifine
  • Butenafine
  • Tolnaftate
  • Nystatin
  • Amphotericin B
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3
Q

MOA of Allylamines

A
  • inhibits squalene epoxidase, a key enzyme in ergosterol biosynthesis
  • effective for topical treatment of tinea corporis, tinea cruris, and tinea pedia
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4
Q

What antifungal used as an oral suspension for treatment of thrush

A

Nystatin

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5
Q

What is the antifungal with broad antifungal activity but rarely used topically and has a cumulative organ toxicit

A

Amphotericin B

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6
Q

what are the oral Antifungal agents

A
  • Azoles: drug-Drug interaction (P450 inhibitor)
  • Griseofulvin
  • Terbinafine
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7
Q

what is the MOA for the antiviral agents

A
  • converted to pharmacologically active triphosphate metabolites and inhibit viral DNA synthesis and viral replication
  • Topical: modest benefit for herpes labialis
  • Systemic: most effective in treating herpes labialis, also used systemically for HSV and VZV
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8
Q

Immunomodulators used in treatment of Actinic Keratoses

A
  • Imiquimod

- Tacrolimus and pimecrolimus

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9
Q

which immunomodulators are useful in the treatment of atopic dermatitis and psoriasis but traditionally used to prevent heart, liver, and kidney allograft rejection due to potent immunosuppressive activity (oral forms)

A
  • Tacrolimus

- Pimecrolimus

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10
Q

MOA of Tacrolimus and Pimecrolimus

A

-inhibit T lymphocyte activation and prevent release of inflammatory cytokines and mediators from mast cells

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11
Q

other Acne preparations

A 
-Retinoic acid and derivatives
Topicals
-Retinoic acid
-Adapalene
-Tazarotene

Oral: Isotretinoin

  • Benzoyl peroxide
  • Azelaic acid
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12
Q

common adverse events of topical retinoics for acne

A
  • erythema, mild peelin, dryness

- Avoid or minimize sun exposure (enhanced reactivity to UV radiationg with increased risk of severe sunburn)

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13
Q

what is the MOA of Isotretinoin (oral retinoid preparation)?

what is it used for?

A
  • Reduces sebaceous gland size and reduces sebum production
  • Use restricted to the treatment of unmanageable severe cystic acne, disorders of keratinization, psoriasis, and cutaneous and extracutaneous malignant neoplasms
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14
Q

MAO of Benzoyl Peroxide

A
  • prodrug converted to benzoic acid within the epidermis and dermis
  • MAO: releases free-redical oxygen which oxidizes bacterial proteins in the sebaceous follicles decreasing the number of anaerobic bacteria and decreasing irritating-type free fatty acids
  • antimicrobial against P. acnes
  • avoid contact with eyes and mucous membranes
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15
Q

MOA of Azelaic acid

A
  • antimicrobial activity against P. acnes as well as in vitro inhibitory effects on the conversion of testosterone
  • 6-8 weeks to clinical improvement
  • also used to treat hyperpigmentation
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16
Q

Drugs for Psoriasis

A
  • UV light: photochemotherapy (PUVA), psoralen followed by UVA radiation
  • Topical: Emollients, corticosteroids, vitamin D analogs (calcipotriene and calcitriol), Tar, Tazarotene, Calcineurin inhibitors
  • systemic therapy
17
Q

Systemic therapy options for psoriasis (usually

reserved for pts with more than 10% body surface area involvement or less extensive but debilitating disease

A
  • methotrexate: inhibits diydrofolate reductase
  • Acitretin: systemic retinoid
  • Cyclosporine: inhibits calcineurin (phosphatase that enhances cytokine transcription) and thereby inhibits transcription of IL-1 and 2 receptors, blocks T cell activation
  • Alefacept
  • TNF inhibitors
  • Ustekinumab
18
Q

MOA of emollients

A

keep skin moist and minimizes itching and tenderness

19
Q

MOA of vitamin D analogs

A

hypoproliferative effects on keratinocytes

20
Q

MOA of Alefacept

A
  • immunosuppressive dimeric fusion protein that consst of extracellular CD2-binding portion of the human leukocyte function antigen-3 linked to Fc portion of human IgG1
  • interferes with lymphocyte activation
  • Discontinue when CD4 counts remain below 250
21
Q

what are the TNF inhibitos used for psoriasis

A
  • Etanercept
  • Infliximab
  • Adalimumab
22
Q

highlights for the TNF inhibitors

A
  • can cause serious life threatening infections, exacerbate CHF, and cause demyelinating disease in predisposed pts
  • evaluate for tuberculosis risk factors and latent disease prior to initiating therapy
  • Possible association b/t the use of TNF blockers and the development of LYMPHOMA
23
Q

MOA of Ustekinumab

A
  • Targets and interferes with the proinflammatory cytokines IL-1 and IL-23
  • possible link with major adverse cardiovascular events
24
Q

when are systemic corticosteroids given?

A

-severe dermatological illnesses such as allergic contact dermatitis to plants (poison ivy, poison oak) and for life threatening vesiculobullous dermatoses (pemphigus vulgaris, bullous pemphigoid)

25
Q

what are the low to medium efficacy topical corticosteroids?
used for what?

A
  • Hydrocortisone (lowest)
  • Betamethasone valerate (low)
  • Hydrocortisone valerate (intermediate)

-seborrheic dermatitis

26
Q

what are the high efficacy topical corticosteroids?

used for what?

A
  • Betamethasone dipropionate
  • Clobetasol propionate (highest)

-Psoriasis of palms and soles, sarcoidosis, vilitigo, pemphigus

27
Q

what are the Keratolytic agents

A
  • Salicylic aci

- Fluorouracil

28
Q

highlights for Fluorouracil

A
  • Fluorinated pyrimidine antmetabolite resembling uracin used in the topical treatment of multiple actinic keratosis
  • MAO: inhibits thymidylate synthetase and blocks the synthesis of DNA and RNA
29
Q

what are the first generaion H1-receptor blockers?

highlights?

A
  • diphenhydramine

- have some anticholinergic activity and are sedating, making them useful for control of pruritis

30
Q

2nd gen H1 receptor antagonists?

highlight?

A
  • cetirizine, loratadine, desloratadine, fexofenadine hydrochloride
  • lack anticholinergic side effects and are nonsedating because they do no cross the blood brain barrier
  • Metabolized by CYP3A4 and 2D6 and should NOT be coadministered with med that inhibit these like Imidazole antifungals or macrolides
31
Q

Trichogenic agents (hair growth)

A
  • Minoxidil

- Finasteride

32
Q

what must be monitors when giving Minoxidil

A

-blood pressure in pts with cardiac disease

33
Q

what is finasteride used for?

MOA?

A
  • treatment of androgenic alopecia and BPH
  • competitive and selective inhibitor of type 2 isoenzyme of steroid 5a-reductase; blocks conversion of testosterone to DHT in prostate
34
Q

adverse effects of finasteride

A
  • decreased libido

- ejaculation disorders, erectile dysfunction

35
Q

what must be obtained 2 weeks before starting Isotretinoin for acne

A

-pregnancy test . .teratogen

Clin Med MSKII (16 decks)

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