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Dermatology > Systemic Pharmacology > Flashcards

Systemic Pharmacology Flashcards

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1
Q

Examples of Oral Antifungals

A

Griseofulvin
Terbinafine (Lamisil)
Itraconazole (Sporonox)

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2
Q

What do oral antifungals treat?

A

Scalp & nail fungal disorders

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3
Q

Medications to Treat Scalp Fungal Infections

A

1st: Griseofulvin
2nd: Terbinafine (Lamisil)

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4
Q

Medications to Treat Nail Fungal Infections

A

1st: Terbinafine (Lamisil)
2nd: itraconazole (Sporanox)

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5
Q

MOA of Griseofulvin

A

Inhibits fungal cell division

Binds to keratin making it resistant to fungal invasion

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6
Q

Administration of Griseofulvin

A

Take with a fatty meal: increases absorption, lessens GI upset

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7
Q

Distribution of Griseofulvin

A

Deposited in the keratin layer of skin, hair, & nails

Concentrates in liver, fat, & skeletal muscles

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8
Q

Where is griseofulvin metabolized?

A

Hepatically

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9
Q

2 Formulations of Griseofulvin

A

Microsize

Ultramicrosize

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10
Q

Contraindications with Griseofulvin

A 
Liver failure
Porphyria
Pregnancy (Cat. X)
Caution with penicillin allergy
Breast feeding
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11
Q

SE of Griseofulvin

A 
Photosensitivity
SJS
Toxic epidermal necrolysis
Erythema multiforme
Jaundice
Elevated liver enzymes
Granulocytopenia
Dizziness
Headache
Fatigue
N/V
Drug induced lupus like syndrome
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12
Q

Drug Interactions with Griseofulvin

A 
Multiple
Warfarin
Oral contraceptives
Alcohol
Barbiturates
Cyclosporine
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13
Q

Monitoring with Griseofulvin

A

LFTs: liver failure
CBC: granulocytopenia
Renal function tests

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14
Q

MOA of Terbinafine (Lamisil)

A

Creates ergesterol deficiency within the fungal cell wall leading to cell death

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15
Q

Distribution of Terbinafine (Lamisil)

A

Sebum & skin

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16
Q

How is terbinafine (Lamisil) metabolized?

A

Hepatically

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17
Q

Drug Reactions with Terbinafine (Lamisil)

A

Many

Inhibit CYP450 enzymes

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18
Q

Terbinafine (Lamisil) SE

A

Headache
Diarrhea
Elevated liver enzymes

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19
Q

Monitoring for Terbinafine (Lamisil)

A

AST/ALT prior to initiation
CBC
Assess taste/smell disturbances

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20
Q

What is terbinafine used for?

A

Treat tinea capitis, and onychomycosis

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21
Q

Reasons to Treat Onychomycosis

A

Cosmetic reasons
DM & onychomycosis
Hx of lower extremity cellulitis & ipsilateral onychomycosis
Pain/discomfort secondary to infection

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22
Q

Black Box Warning for Itraconazole (Sporanox)

A

Negative inotropic effects have been observed following IV administration
Discontinue or reassess if S/S of HF occur during treatment

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23
Q

Contradictions for Itraconazole (Sporanox)

A

Ventricular dysfunction
CHF
Pregnancy
Concomitant use of other CYP450 drugs

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24
Q

How is itraconazole (Sporanox) metabolized?

A

Hepatically

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25
Drug Interactions with Itraconazole (Sporanox)
``` PPIs Anxiolytics Pain medications Antiplatelet agents Antihypertensives Statins ```
26
Itraconazole (Sporanox) SE
``` Nausea Diarrhea Edema Headache Rash Abnormal LFTs Heart failure Arrhythmia Hearing loss Many others ```
27
Monitoring with Itraconazole (Sporanox)
Baseline LFTs Monthly LFTs Serum contraindications
28
5-Alpha-Reductase Inhibitor Medication for Fungal Infections
Finasteride (Propecia)
29
MOA of Finasteride (Propecia)
Inhibits the conversion of testosterone to dihydrotestosterone
30
What is finasteride (Propecia) first line for?
Androgenic alopecia in men
31
What is another name of medication for finasteride (Propecia)?
Proscar: BPH
32
Monitoring for Finasteride (Propecia)
Baseline PSA PSA in 6 months Reduces PSA my 50%
33
Finasteride (Propecia) SE
``` Orthostatic hypotension Dizziness Weakness Sexual dysfunction: decreased libido, ejaculatory dysfunction, erectile dysfunction Gynecomastia Testicular pain Depression ```
34
Why is finasteride (Propecia) hazardous?
Teratogenic | Women should avoid crushed/broken tablets
35
How is finasteride (Propecia) metabolized?
Hepatically
36
Antibiotics used in Dermatology
``` Cephalexin (Keflex) Mupirocin (Bactroban) Doxycycline Minocycline (Minocin) Clindamycin ```
37
Cephalexin (Keflex) Drug Class
1st generation cephalosporin | Beta-lactam antibiotic
38
Dermatology Indications for Cephalexin (Keflex)
Skin infections | Skin structure infections
39
Distribution of Cephalexin (Keflex)
Widely distributed to all tissues except CSF
40
What bugs does cqphalexin cover?
Staph | Strep
41
MOA of Cephalexin (Keflex)
Inhibits bacterial cell wall synthesis
42
Pregnancy Category of Cephalexin (Keflex)
Category B
43
Indications for Mupirocin (Bactroban)
Impetigo: ointment Secondary infected skin lesions: cream MRSA colonization: intranasal
44
MOA of Mupirocin (Bactroban)
Inhibits protein synthesis by binding to bacterial isoleucyl tRNA synthetase
45
Absorption of Mupirocin (Bactroban)
Ointment & cream: minimal systemic absorption | Intranasal: systemic absorption
46
MOA of Tetracyclines
Inhibition of protein synthesis by binding with the 30S ribosomal subunit Alterations in the cytoplasmic membrane
47
Distribution of Tetracyclines
Throughout the body tissues & fluids | Poor CNS penetration
48
SE of Tetracyclines
Photosensitivity
49
Pregnancy Category of Tetracyclines
Category D
50
SE of Doxycyline
Photosensitivity Nausea: empty stomach Esophagitis: no fluids
51
Absorption of Doxycycline
Delayed with high stomach pH
52
Doxycycline Dermatologic Indications
Tick-borne rickettsial infections Acne Rosacea
53
Off-label use of Doxycycline
Animal & human bites Cellulitis secondary to MRSA Skin & soft tissue infections
54
Minocycline (Minocin) Dermatologic Indications
Acne | MRSA cellulitis: off-label
55
SE of Minocycline (Minocin)
Photosensitivity Vertigo Esophagitis: no liquids GI upset: empty stomach
56
Dermatologic Indications for Clindamycin
Acne: only topical | Rosacea
57
Retinoid Acid Derivative Medication(s)
``` Isotrentinoin (Accutane) Absorica Amnesteem Claravis Myorisan Zenatone ```
58
Use for Isotrentinoin (Accutane)
Treatment of severe, recalcitrant, nodular acne
59
MOA of Isotrentinoin (Accutane)
Shrinks sebaceous glands Decreases sebum production Decreases # of sebum dependent bacteria acnes
60
Mucocutaneous SE of Isotrentinoin (Accutane)
``` Cheilitis Dry skin & mucous membranes Epistaxis Desquamation Photosensitivity Pruritis Corneal abrasion Cutaneous staph infections Temporary diffus alopecia or nail brittleness Depression Hypertriglyceridemia Elevated total & LDL cholesterol ```
61
Monitoring in Isotrentinoin (Accutane) Use
CBC Fasting lipid profile LFTs Monthly pregnancy test
62
When would you discontinue Isotrentinoin (Accutane)?
TG >800 | LFTs 3x upper limit of normal
63
Topical Calcineurin Inhibitor Medications
Tacrolimus (Protopic) | Pimecrolimus (Elidel)
64
Indications for Topical Calcineurin Inhibitors
Atopic dermatitis Lichen planus Vitiligo Psoriasis
65
Black Box Warning for Topical Calcineurin Inhibitors
Rare cases of malignancy (skin & lymphoma) | Limited to short-term & intermittent
66
Contraindications for Topical Calcineurin Inhibitors
67
MOA of Topical Calcineurin Inhibitors
Suppresses cellular immunity
68
Recommendations for Topical Calcineurin Inhibitors
Alcohol ingestion = redness/flushing Do not use under occlusive dressing Sun protection
69
Tacrolimus (Protopic) SE
Headache Skin burning at application site Pruritus Erythema
70
Pimecrolimus (Elidel) SE
Burning: less than Protopic
71
Presentation of Drug Induced Lupus like Syndrome
``` Arthralgia Myalgia Malaise Fever Rash Serositis ```
72
Treatment of Drug Induced Lupus like Syndrome
Discontinue drug Symptomatic treatment with NSAIDs Hydroxychloroquine >4-8 weeks Systemic corticosteroid: severe symptoms or quick relief

Dermatology (13 decks)

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