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Medication pearls Flashcards

What conditions do we treat with this medication Warnings and adverse effects (Most common and most serious) Contraindications (major) F/u Labs Key points (91 cards)

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1
Q

What class(es) of drugs do we use to treat atopic dermatitis

A

Topical Corticosteroids, Calcineurin inhibitors, cyclosporine, dupilumab (biologic)

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2
Q

What class(es) of drugs do we use to treat psoriasis?

A

Topical corticosteroids
salicylic acid
Vit D analogs
Methotrexate, acitretin, cyclosporine, apremilast
TNFa inhibitors
IL-23 inhibitors
IL-17 inhibitors

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3
Q

What class(es) of drugs do we use to treat Acne Vulgaris

A

Topical retinoids
Oral isoretinoin
Oral ABx (doxy)
Topicals (Benzoyl peroxide, salicylic acid, clindamycin, azelaic acid)

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4
Q

What class(es) of drugs do we use to treat Rosacea

A

Azelaic acid, metronidazole gel

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5
Q

What class(es) of drugs do we use to treat Tinea

A

Butenafine, terbinafine, ketoconazole

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6
Q

What class(es) of drugs do we use to treat bacterial infections of the skin?

A

Mupirocin (bactroban)

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7
Q

What class(es) of drugs do we use to treat seborrheic dermatitis?

A

selenium sulfide

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8
Q

What class(es) of drugs do we use to treat oychomycosis?

A

oral terbinafine, topical ciclopirox

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9
Q

What class(es) of drugs do we use to treat pruritis?

A

diphenhydramine, hydroxyzine

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10
Q

What drugs are used to target increased follicle proliferation and abnormal desquamination in Acne Vulgaris?

A

Topical reinoids, isoretinoin, azelaic acid, azelaic acid

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11
Q

What drugs are used to target increased sebum production in Acne Vulgaris?

A

oral isoretinoin, OCP, spironolactone, clascoterone

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12
Q

What drugs are used to target cutibacterium acnes in Acne Vulgaris?

A

Benzoyl peroxide, topical ABx (clindamycin, minocycline), oral ABx (tetracyclines), azelaic acid

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13
Q

What drugs are used to target inflammation in Acne Vulgaris?

A

oral isoretinoin, oral ABx (tetracyclines), topical retinoids, azelaic acid, Dapsone

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14
Q

What is generally first line treatment in Acne vulgaris?

A

retinoids (+ benzoyl perozide w/ papulopustular)

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15
Q

What medications could you consider if first line Acne treatment doesn’t work?

A

OCP & Spironolactone (females only), isoretinoin, tetracyclines for 3 months (papulopustular)

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16
Q

What additional considerations should patients take in regards to oral hygiene with Acne vulgaris?

A

Use gentle cleansers/scrubbing
Noncomedogenic agents
no picking

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17
Q

What therapeutic targets does isoretinoin have?

A

Follicular proliferation, abnormal desquamination, sebum production, c. acne bacteria, inflammation

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18
Q

Isoretinoin contraindications

A
  • Pregnancy
  • Severe soy allergy
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19
Q

Isoretinoin adverse effects

A

Mucotaneous (dry skin/eyes), Hyperlipidemia, Psychiatric (depression/SR), IBD, Hepatotoxicity, IC HTN

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20
Q

What medications/treatments/procedures should a patient avoid who is on isoretinoin and why?

A

Tetracycline (IC HTN), Vitamin A supp, skin procedures, Excessive EtOH, nursing, blood donation

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21
Q

Isoretinoin screening (patient Hx)

A

Prior contraceptive failure
depression (uncontrolled)
hyperlipidemia or FHx of early
FHx IBD
Dry eyes
Heavy EtOH
Extreme physical activity (photosensitive?)

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22
Q

Isoretinoin monitoring

A

Need to wait 2-3 months to gauge improvement

Worsening of acne
depression sx
bowel sx
hyperlipidemia
dry eyes/vision changes
headaches (IC HTN)

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23
Q

What labs should you order for a patient starting isoretinoin?

A

Serum ALT
Triglyceride levels
urine or serum pregnancy testing

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24
Q

Adverse effects of high potency topical steroids

A

striae, irritation; d/c after 2 weeks.

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25
Length of treatment for high and medium potency steroids
High: 2 weeks (taper) Med: 3 months
26
Adverse effects/warnings of topical retinoids
Avoid in eyes Avoid in pregnancy Photosensitivity No spot treatment
27
What topical retinoids are the most and least irritating?
Most: Tazarotene least: Adapalene
28
What medications should you avoid when taking topical retinoids?
UV light & Benzoyl peroxide b/c it can deactivate it.
29
Adverse effects of Benzoyl peroxide
drying or peeling of the skin
30
Adverse effects of salicylic acid
drying or peeling of the skin
31
Adverse effects of azelaic acid
burning/tingling
32
What conditions can be treated with salicylic acid
Acne Psoriasis
33
MOA for calcineurin inhibitors
suppress cellular (T Cell) immunity
34
Calcineurin inhibitors are indicated for what disease(s)?
Atopic dermatitis. Can apply to face and intertriginous areas. Can also be used for vitiligo, mucosal lichen planus, graft vs host disease, allergic contact dermatitis, and rosacea
35
Calcineurin inhibitor adverse effects/warnings
- Transient erythema, burning, pruritis - Rare: systemic immune-related effects (Tacro > Pimecro) - Black Box warning: malignancy - Avoid long-term continuous use - Avoid in Netherton Syndrome
36
Which calcineurin inhibitor has fewer adverse effects?
Pimecromilus
37
What diseas(s) are Vitamin D analogs used to treat?
Psoriasis
38
Name 2 Vitamin D analogs
Calcipotriene, Calcitrol
39
Vitamin D analog MOAs
binds Vit D receptors and inhibits keratinocyte proliferation while enhancing keratinocyte differentiation
40
Vit D analogs Adverse effects
Hypercalcemia and Hypercalciuria possible if exceeding recommended weekly dosage limit (100g Calcipotriene; 100g calcitrol (2-7yrs), 200g calcitrol (7+ yrs) Irritation Mild photosensitive
41
what treatment can be used with Vit D analogs to produce synergistic effect?
Topical corticosteroids Will also reduce irritation
42
Things to avoid with Vit D analogs
Vitamins/Calcium supplements Occlusive dressings sunlight/UV exposure
43
Indications for Clindamycin topical gel
Acne (inhibits growth of Cutibacterium acnes)
44
Adverse effects of Clindamycin topical gel
Erythema, burning, itching, peeling, oiliness. Can also cause D. diff associated diarrhea. Avoid eyes
45
When in an acne treatment should you consider clindamycin gel?
After 3 mo of mild papulopustular acne that has failed to improve with Benzoyl peroxide and topical retinoids.
46
Mupirocin indications
Impetigo, MRSA derm infection
47
Mupirocin adverse effects
Dryness, burning, erythema, stinging, tenderness. Allergies! Angioedema, anaphylaxis, generalized rash
48
Metronidazole gel indications
Rosacea
49
Length of treatment for Mupirocin ointment
TID 3-5 days
50
Warnings and adverse effects of metronidazole gel
do not use vaginal prep on face. Can also cause dizziness, HA, N/V, diarrhea
51
When should you see improvement in rosacea with metronidazole gel?
within 3 weeks, continuing improvement through 9 weeks.
52
oral tetracyclines dermatological indications
Acne
53
Adverse effects of tetracyclines
Esophagitis (take with glass of water) Photosensitivity/skin discoloration idiopathic IC HTN Gi issues No pregnancy and children <8. retards skeletal development Don't take with calcium + minerals (chelation)
54
When in an acne treatment plan should you consider Tetracyclines?
Mod/severe papulopustular acne. Concomitant use with topical retinoids and Benzoyl peroxide.
55
Methotrexate indications
psoriasis, sarcoidosis, RA, oncology (high dose)
56
MTX MOA
Folate antagonist/antimetabolite. Targets cells during DNA synthesis and reduces hyperproliferation
57
MTX contraindications
Pregnancy/nursing Liver issues (chronic disease, EtOH liver disease) Immunodeficiency syndromes Preexisting blood dyscrasias
58
Warnings/cautions for MTX
Black box: toxicity, teratogenicity Abnormalities in renal function Abnormalities in liver function Active infections Many drug interactions
59
MTX adverse effects (low dose)
GI issues Hepatoxicity CNS effects Rash Pancytopenia
60
What medication should you supplement with MTX?
Folic Acid 1mg
61
Baseline labs for MTX
Pregnancy CBC with diff BUN and serum creatinine (kidney function) Liver tests: LFTs Serum albumin Noninvasive liver fibrosis assessment Hep B&C screening Latent TB testing CXR (some providers for pulm tox)
62
Ongoing labs for MTX monitoring
CBC Liver tests: LFTs, serum albumin, serum creatinine (3-6 mo) FIB-4, Fibrosure, Fibrometer, Hepascore (annual) After 3.5-4.0 cumulative dose-> GI consult
63
Apremilast indication, warnings, and notes
Psoriasis, GI effects, titrate
64
butenafine indication
Tinea
65
Butenafine Hydrochloride warnings/AE
Dermatitis, burning, worsening of condition.
66
Considerations to make when using butenafine HCL
if not improvement in 4 weeks, reconsider Dx
67
Ketoconazole indications
Tinea, seborrheic derm, dandruff
68
Ketoconazole AEs/warnings
burning, stinging, irritation, erythema. Allergic: angioedema
69
Ketoconazole considerations
Shampoo--sit for 5 mins before rinsing
70
Terbinafine indications
Tinea
71
Terbinafine considerations
Not indicated for Tinea unguium Improvement usually in 3-4 days, but continue for 1-4 weeks
72
Ciclopirox indications
Onychomycosis
73
Ciclopirox warnings/AEs
pruritis, erythema, burning
74
Ciclopirox considerations
Trim nails closesly not as effective as oral Tx
75
Selenium sulfide indications
Seborrheic dermatitis, tinea versicolor
76
Selenium sulfide warnings/AEs
dryness or oiliness of skin
77
Topical Antifungal medications
Butenafine HCL, Ketoconazole, Terbinafine, Ciclopirox, Selenium Sulfide
78
Acitretin indication
Psoriasis
79
Acitretin warnings
Hepatotixicity Elevated lipid levels No blood donation during and 3 years post Tx
80
Acitretin contraindications
Avoid in pregnancy (and for 3 years post-Tx) No EtOH (and 2mo Post Tx)
81
Terbinafine indications
onychomycosis
82
Medications that treat onychomycosis
Terbinafine (oral AF), Ciclopirox (topical AF)
83
Terbinafine warnings/AEs
Hepatotoxicity, Steven's Johnson Syndrome, TEN, N/V/Rash
84
Terbinafine C/Is
Liver Disease Severe Renal Disease
85
Terbinafine baseline labs
LFTs Nail Bx
86
Diphenhydramine indications
Pruritis
87
Hydroxyzine indications
Pruritis
88
oral Antihistamines indicated for pruritis
Diphenhydramine, Hydroxyzine
89
oral Antihistamines warnings/AEs
Anticholinergic drowsiness, sedation, dry mouth
90
Oral antihistamines C/Is
NA Glc, BPH, bladder obstruction
91
Oral antihistamine considerations
Don't use to treat URI Don't use in older adults

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