Ovicidal lice drug
Malathion
Malathion MOA
applied topically; organophosphate that is metabolized by the louse to malaoxon, inhibiting acetylcholinesterase causing neuronal hyperstimulation and paralysis
Malathion Human Metabolism
rapidly converted to inactive metabolites and excreted by kidneys
Malathion Adverse Effects
Not associated with many, but if accidentally ingested can cause cholinergic excess that can be treated with atropine and pralidoxime
Permethrin MOA
cause hyperstimulation and paralysis by binding voltage-gated sodium channels within the louse
Permethrin Adverse Effects
asthma exacerbation in patients allergic to ragweed; minimal percutaneous absoprtion with no interactions
Permethrin Resistance
Knock down resistance (kdr) mutations of louse sodium channels
Lindane Uses
louse treatment for people who cannot tolerate or have failed first line therapy; administered topically as shampoo or lotion
Lindane Adverse Effects
Neurotoxicity - CNS stimulant promoting seizures, blockade of GABA action); black box - skin diseases, neonatal prematurity, people with uncontrolled seizure disorders
Ivermectin MOA
causes louse hyperexcitability and paralysis by binding selectively and with high affinity to glutamate-gated chloride ion channels present in invertebrate nerve and muscle cells
Ivermectin Adverse Effects
Elevated liver enzymes, cross BBB of children, worsen bronchial asthma
Physical methods of removing lice
lice comb, benzyl alcohol, petroleum jelly
Cinoxate
organic UV filter sunscreen that absorbs UV-B radiation
Para-aminobenzoic acid (PABA)
organic UV filter sunscreen that absorbs UV-B radiation
Trolamine
organic UV filter sunscreen that absorbs UV-B radiation
Dioxybenzone, Oxybenzone
organic UV filter sunscreen that absorbs UV-B and UV-A2 radiation
Avobenzone
Only FDA approved organic sunscreen that protects against UV-A1 radiation
Titanium Dioxide and Zinc Oxide
sunscreens of inorganic compounds that function by reflecting and scattering UV radiation; provide UV-A and UV-B protection
Microionized Titanium Dioxide Exception
Does not provide UV-A1 protection; nonionized form does
SPF
the amount of UV radiation required to produce a sunburn on protected skin relative to that of unprotected skin; primarily a measure of UV-B exposure
Targeted Drugs for Basal Cell Carcinoma
Imiquimod and Vismodegib
Targeted Drugs for Melanoma
Aldesleukin, Interferon, Ipilimumab, Sorafenib, Trametinib, Vemurafenib
Targeted Drugs for Actinic Keratosis
Diclofenac and Trichloroacetic Acid
Targeted Drugs for Squamous Cell Carcinoma
None available
Standard chemotherapuetics for BCC
5-Fluorouracil
Imiquimod MOA
Topical immune response initiator through direct activation of TLR7/8, involves adenosine receptor blockage and activation of NFkB causing upregulation of cytokines like TNFa and interfleukins; also acts on GLI to repress HH signaling
Imiquimod Uses
BCC, Actinic Keratosis, HPV
Imiquimod Adverse Effects
Skin reactions, allergy, increased photosensitivity, compromise of condom/diaphragm
Vismodegib MOA
oral SMO inhibitor; lipophilic agent with extensive metabolism
Vismodegib Adverse Effects
Black Box: intrauterine fetal death, M/F Teratogenicity,
Others: alopecia, GI issues, weight loss, fatigue
Treatment of SCC
No standard regimens, but usually Cisplatin based therapy
Aldesleukin MOA
binds to cell surface IL-2 receptor, inducing proliferation and differentiation of B and T cells, monocytes, macrophages, and CTLs; given IV or SC
Aldesleukin Contraindications
Significant CNS, Cardiac, Pulmonary, renal, or hepatic disease; organ transplant recipient
Aldesleukin Adverse Effects
Capillary leak syndrome; CNS, Cardiac, Pulm issues; all organ systems affected
Interferon alpha 2b
IV or SC administered immunomodulator
Interferon Adverse Effects
AI disease, Cardiac disease, depression, flu like symtoms, neutropenia, leukopenia, anemia, alopecia, elevated hepatic enzymes, cough, dyspnrea, pulmonary infiltrates, pneumonitis, pneumonia
Routine tests run while on Interferon
CBC, pulmonary X-ray, ECG, LFTs
Ipilimumab MOA
CTLA4 recombinant antibody that bolsters antitumor response of immune system by blocking the interaction of CTLA4 with CD80/86 on T cells thus increasing activation and proliferation
Ipilimumab Adverse Effects
severe and fatal immune reactions; dematitis, toxic epidermal necrolysis; adrenal insufficiency, diarrhea, Gullain-Barre, hepatitis, hyper/hypothyroidism, myasthenia gravis, peripheral neuropathy, pregnancy, rash
Sorafenib MOA
oral multi-kinase inhibitor - VEGF, PDGFR, KIT, Raf kinase; hepatic metabolism
Sorafenib Adverse Effects
Hand and foot syndrome, rash/desquamation, anemia, bone marrow suppression, neutropenia, increased bleeding in GI, Resp, and brain, Hepatitis, teratogen
Trametinib MOA
oral reversible MEK inhibitor for patients with BRAF V600E/K mutations
Trametinib Adverse Effects
rapid onset of skin toxicity, GI toxicity, decreased LVEF, HTN, hemorrhage, cardiomyopathy, interstitial lung disease, retinal pigment epithelial detachment, teratogen
Vemurafenib MOA
oral inhibitor of mutated BRAF, including V600E; resistance is via alternative pathway activation;
Vemurafenib Pharm
Hepatic metabolism with potential PGP and CYP interactions
Vemurafenib Adverse Effects
Elevated serum creatinine, QT prolongation and TP, increased photosensitivity, cutaneous SCC, SJS, opthalmologic issues (uveitis, iritis, retinal vein occlusion), teratogen
Tests to run on Pt receiving Vemurafenib
LFTs, ECG, electrolyte monitoring, derm exams
BRAF/MEK inhibitors common toxicities
Liver, Heart, Eye, possible secondary malignancies, skin issues (SJS)
Diclofenac MOA
used for Actinic Keratosis; inhibitor of inflammatory mediators including PGE2
Diclofenac Adverse Effects
itchy rash, dry skin, skin peeling, and redness
Trichloroacetic Acid MOA
used for actinic keratosis; chemical peel - rapidly penetrates and cauterizes skin, keratin, and other tissues
Trichloroacetic Acid Adverse Effects
Burning, inflammation, localized tenderness
Standard Chemo for Melanoma
Dacarbazine, Lomustine, Carmustine
Platinums, Vincas, Taxanes