Dermatology Drugs – Flashcards
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Salicylic Acid (Aveeno)
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Widely available OTC. Well tolerated keratolytic agent. Often used with Benzoyl Peroxide. Break down keratin, loosen comedones, and exert a peeling effect on the skin
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Benzoyl Peroxide (Benzac, Bevoxyl, Desquam X)
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Oxidizing agent. OTC and prescription. Primarily bacteriostatic and bactericidal against P. acnes. Oxidezes bacterial proteins. Bacterial resistance cannot develop. Most useful for mile to moderate acne. Higher potency lead to more topical irritation. Can cause irritation, CD, drying, redness, peeling and stinging.
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Tretinoin (Retin A)
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Vitamin A derivative. Topical retinoid.
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Erythromycin (Akne-mycin)
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Topical, oral, or ophthalmic antibiotic
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Clindamycin (Generic)
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Topical antibiotic used primarily to treat anaerobic bacterial infections.
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Minocycline (Solodyn)
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Oral bacteriostatic antibiotic.
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Isotretinoin (Accutane)
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Oral Retinoid. Vitamin A derivative. Catagory X. Most effective acne treatment available. Mose of action is unknown. Decreases sebaceous gland activity, prevents new comedones form forming, reduces P. acnes. Has anti-inflammatory effect. Can completely clear nodulocystic lesions. Leads to prolonged remissions.
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Calcipotriene (Dovenex)
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Topical Corticosteroid ointment, a synthetic vitamin D3 analog for treating mild to moderate psoriasis. About as effective as medium-potency corticosteroid. Inhibits epidermal proliferation and stimulates cellular differentiation. Generally well tolerated. May cause burning and itching in 10% of patients. May cause hypercalcemiea - promotes Ca and Phos from intestines, promotes reabsorption of Ca by Kidneys
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Tazarotene (Torozac)
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Topical retinoid for treating mild to moderate psoriasis and acne. As effective as high-potency corticosteroids for psoriasis. May cause erythema, burning, pruritis and peeling. Limit contact time to 5 minutes improves tolerability. Contraindicated for pregnancy.
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Methotrexate (Generic)
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Systemic drug used to treat moderate to severe psoriasis. Low doses is highly effective for psoriasis. Indicated for severe psoriasis. May cause hepatotoxicity (most commone adverse side effect of this drug). Teratogenic and contraindicated in pregnancy. Immunosuppressive, should not be used in patients with active infections. Folate antagonist.
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Etanercept (Enbrel)
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Biologic agents for systemic use in the treatment of moderate to severe psoriasis. TNF inhibitor. Given subcutaneously. Binds to TNF with greater affinity than natural receptors. Generally well tolearted. Reactions at injection site/allergic reactions may occur. May cause demyelinating disorders
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Hydrocortisone 1% (Hytone & Cortaid)
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Low potency corticosteroid - used on face, groin, intertriginous areas.
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Triamcinolone 0.1% (Kenalog)
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Medium potency corticosteroid - Thin skin trunk areas, extremities.
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Fluocinonide 0.05% (Lidex)
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High potency - Thick skin trunk area, extremities.
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Clobetasol 0.05% (Temovate)
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Very high potency - Very thick- skinned areas, Palms and Soles.
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Diphenhydramine (Benadryl)
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1st generation H1 antagonist, causes drowsiness, binds cholinergic, adrenergic and serotonin receptors. Stabilize mast cell membranes.
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Loratadine (Claritin)
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2nd generation, Selective H1 antagonist, low doses cause less sedating.
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Cyproheptadine (Periactin)
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1st Generation, non selective H1 antagonist antihistamine with additional anticholinergic, antiserotonergic, and local anesthetic properties. Causes drowsiness.
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Mupirocin (Bactoban)
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Used for Impetigo and eradication of nasal MRSA. Effective against Gram-positives. Inhibits RNA synthesis. Low systemic absorption. Pregnancy class B
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Neomycin/Bacitracin/Polymixin (Neosporin)
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commonly used for minor cuts, burns and abrasions. Can cause contact dermatitis.
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Bacitracin/Polymixin (Polysporin)
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Commonly used for minor cuts, burns, and abrasions. Less likely to cause contact dermatitis.
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Clotrimazole (Lotrimin and Mycelex)
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Oral antifungal commonly used for Tinea Pedis, cruris, corporis and versicolor. May be used for cutaneous candidiasis. Inihbits fungal wall synthesis by block CYP 450 enzymes in fungi. May inhibit human steroid synthesis.
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Terbinafine (Lamisil)
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Allylamine. Inhibist ergestrol and fungal wall synthesis. Less human steroid inhibition than imidazoles. Used for tinea pedis, cruris, corporis and versicolor.
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Griseofulvin (Grifulvin V)
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Binds to fungal microtubules and inhibits mitosis and reproduction. Oral administration. Given for months, for tinea unguium (Fingernail infections).
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Acyclovir (Zovirax)
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Causes premature viral DNA chain termination. May be used to treat chickenpox in kids older than 12
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Famcyclovir (Famvir)
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Easiest dosing schedule. Treatment for recurrent genital herpes, herpes labialis, and Zoster
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Valacyclovir (Valtrex)
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Antiviral used to treat herpes simplex 1 and 2, Varicella zoster, Epstein-Barr, and cytomegalovirus. Prodrug, converted to acyclovir in vivo.
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Selenium Sulfide (Selsun Blue)
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Toxic to fungi. Treatment for Seborrhea. Comes as a shampoo.
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Pyrithione Zinc (Head and Shoulders, Tegrin)
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Keratolytic agent. Comes as bar soap, shampoo, cream, lotion. Used to control/reduce severity of scaling. Mile antifungal.
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Antibacterials
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Clindamycin and erythromycin are commonly used to treat mild to moderate acne. Both are equally effective. Antibacterial and anti-inflammatory properties. Generally safe and well tolerated. DO NOT effect existing lesions, only prevent future lesions. Reduce subsequent inflammation. Can develop resistance. Addition of benzoyl peroxide increases effectiveness.
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Oral antibiotics
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Second most effective treatment available for inflammatory acne, after isotretinoin. Usually taken for months, which can lead to bacterial resistance. Ex: Doxycycline, miniocycline, tetracycline, erythromycin. Systemic effects. Decrease effectiveness of oral contraceptives. Tetracycline has teratogenic effects on bone and tooth development.
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Retinoids
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provide beneficial, novel way of treating many dermatological disorders. Used for numerous inflammatory and keratotid dermatoses. Topical are more advantageous over systemic. Used alone or with antibiotics. Help normalize hyperkeratinization. Siginificant anti-inflammotory effects. Can normalise abnormal growth in keratinocytes. Inhibit various immune factors. May result in dry skin, scaling, photoirritation, erythema, burning, pruritus.
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Oral Retinoid Side effects
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May be associated with teratogenesis, hepatotoxicity, Elevated triglycerides, depression, alopecia, Musculoskeletal symptoms, altered night vision.
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Corticosteroids
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Most widely used drugs to treat psoriasis. Come in a variety of vehicles. Ointments are generally most effective. Low, medium, high and super high potency. Psoriasis usually starts with medium potency agents. Low potency is used on the face and is considered safest for children/infants. High and super high reserved for thick chronic plaque non-responsive to lower potency.
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Corticosteroid side effects
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May cause flare-ups of psoriasis, tachyphylaxis (medication loses efficacy with prolonged use), may induce adrenal suppression (rare). Atrophy and dermis of epidermis, telangiectasias, irreversible striae due to keratinocyte growth suppression and decreased collagen production. Most common with prolonged use.
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Topical steroids
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Once daily dosing is as effective as BID/TID. Increased skin temp and hydration increases absorption. Occlusion increases potency 10 fold.
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TNF Inhibitors
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Help regulate inflammatory process. Would normally "turn on" immune cells. Too much overwhelms the immune systems ability to control inflammatio in the joints or of psoriasis-affected skin areas. Component of Biologic agents. Very expensive. Unknown long term safety.
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Viral infections
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Painful, episodic, vesicular, pruritic rash and lesions on one side of the body alone a single (in most cases) dermatome. Breakout/remission cycle. Start medication within 72 hours of onset of first lesion. Topical treatment for mild infections, oral for sever infections.
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Seborrhiac Drugs
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Topical corticosteroids, Topical calcineurin inhibitors, Kartolytic agents, Antifungals, Tee tree oil.
