Dermatology Pharmacology and Prescription Flashcards Preview

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Flashcards in Dermatology Pharmacology and Prescription Deck (39)
1

What % of hospital admissions are due to ADRs?

3-6% (with half of these being preventable)

2

Define "off labels" medications

A licensed medication that is being used for an unlicensed indication

3

Define "specials" medication

– Unlicensed dermatological preparations
– Long history of use, no strong evidence base but clinically effective

4

List some causes of prescription error

• Lack of knowledge - About patient/medication/ allergies
• Mistake writing/generating the prescription
• Poor communication
• No local or national guidelines
• Pharmacy/medicine info service

5

Define pharmacology

The branch of medicine concerned with the uses, effects, and modes of action of drugs.

6

Define pharmacokinetics

The effect of the body on the drug (ADME)

7

Define pharmacodynamics

The effect of the drug on the body

8

What are the 4 main principles underlying pharmacokinetics?

Absorption
Distribution
Metabolism
Excretion

9

What can cause variation in pharmacokinetics?

Individual variation in response
Think about
– Age of patient
– Pregnancy risk
– Drug interactions
– Pharmacogenetics

10

What are some factors associated with poor adherence?

• Psychiatric co-morbidities
• Slower acting agents
• Multiple applications per day
• Lack of patient education
• Cosmetic acceptability of treatments
• Unintentional non-adherence

11

What is a drug vehicle?

Vehicle: pharmacologically inert, physically and chemically stable substance that carries the active drug

12

What factors affect absorption?

• Concentration
• Base/vehicle
• Chemical properties of the drug
• Thickness and hydration of stratum corneum
• Temperature
• Skin site
• Occlusion

13

What forms can a drug vehicle be?

• Solution
• Paste
• Cream
• Spray powder
• Lotion
• Shampoo
• Gel
• Ointment
• Foam
• Paint
• Tape

14

What is the therapeutic effect of topical steroids?

Anti- inflammatory and immunosuppressive properties:
– Regulate pro inflammatory cytokines
– Suppress fibroblast, endothelial + leukocyte function
– Vasoconstriction
– Inhibit vascular permeability

15

How much is a fingertip unit, and how large is the area that can be treated by one unit?

• About 0.5 g
• Should treat area double the size of one hand

16

What drugs can be given in fingertip units?

Topical steroid creams - very useful in children

17

List some side effects of topical steroid creams

• Thinning /atrophy of the skin
• Striae - stretch marks
• Bruising
• Hirsutism - excess hair
• Telangiectasia ("spider veins")
• Acne/rosacea/perioral dermatitis
• Glaucoma
• Systemic absorption
• Cataracts

18

List 3 systemic drug types used in dermatology

• Retinoids
• Traditional immunosuppressants
• Biologics (also immunosuppressive)

19

What are retinoids and what is their function?

Vitamin A analogues
– Normalise keratinocyte function
– Anti inflammatory and anti cancer effects

20

List 4 retinoid drugs and their indications

– Acne isotretinoin
– Psoriasis acitretin
– Cutaneous T cell lymphoma bexarotene
– Hand eczema alitretinoin

21

What retinoid drug is used for acne?

Isotretinoin

22

What retinoid drug is used for psoriasis?

Acitretin

23

What retinoid drug is used for cutaneous T cell lymphoma?

Bexarotene

24

What retinoid drug is used for hand eczema?

Alitretinoin

25

What are some contraindications and side effects of retinoids?

Teratogenic
– Careful patient selection

Side effects include
– Cheilitis (dry lips) and xerosis (dry skin)
– ↑ transaminases, ↑triglycerides
– Rarely psychiatric, eye and bone side effects

26

List some immunosuppressants and their indication

Treatment of inflammatory skin disorders; includes:
• Oral steroids
• Azathioprine
• Ciclosporin
• Methotrexate
• Mycophenolate mofetil

27

What are some risks associated with immunosuppressants?

Risk of malignancy and serious infection

Need regular blood test monitoring, in particular
• FBC (esp in methotrexate and azathioprine)
• Renal function (esp ciclosporin)
• Liver function (esp methotrexate)

28

Which immunosuppressants have to be closely monitored in terms of effects on FBC?

methotrexate and azathioprine

29

Which immunosuppressant has to be closely monitored in terms of effects on renal function?

Cyclosporin

30

Which immunosuppressant has to be closely monitored in terms of effects on liver function?

Methotrexate

31

What does the suffix "-cept" mean?

Suffix '-cept’ indicates that it is a it is a receptor fusion

32

What does the suffix "-mab" mean?

Suffix "-mab" is used to denote monoclonal antibodies

33

What does the infix "-zu-" mean?

humanised biologic

34

What does the infix "-ix-" mean?

chimeric biologic

35

What does the infix "-u-" mean?

fully human biologic

36

What does the infix "-li/l-" mean?

immunomodulator biologic

37

List some current licensed biologics for plaque psoriasis in UK

– Etanercept
– Infliximab
– Adalimumab (Also licensed for hidradenitis suppurativa)
– Ustekinumab
– Secukinumab
– Ixekizumab

38

What are some risks associated with biologics?

Risk of infection
– TB reactivation
– Serious infection
– Avoid live vaccines

Risk of malignancy

TNF inhibitors – risk of demyelination

39

What are biologics?

The next generation in treatment of inflammatory conditions
– Genetically engineered proteins derived from human genes
– Designed to inhibit specific components of the immune system
– Very effective, but expensive