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70 Cards in this Set
- Front
- Back
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dead, highly keratinized lipophilic cells
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stratum corneum (corneocyte)
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1st line of defense against environment; 1st LIVE layer
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epidermis
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- rich in CT, fibroblasts, mast cells, macrophages, migratory cells.
- Contains sebaceous glands, BVs, hair & nail appendages. - Supports/nourishes epidermis. Complex series of diffusion barriers |
dermis
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What are the 6 variables determining pharmacological response?
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1. regional anatomical variations
2. concentration gradient 3. dosing schedule 4. vehicle 5. age 6. application frequency |
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What is regional anatomical variation?
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permeability inversely proportional to thickness of S. corneum
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What is concentration gradient?
What can it lead to?? |
inc tolerance gradient inc. mass of drug transferred
**can lead to tolerance-tachyphylaxis |
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What is dosing schedule?
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Skin acts as reservoir -> half-life in skin may be longer than systemic so can use once daily w/ effectiveness
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How can the vehicle used determine pharm response?
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Appropriate vehicle can maximize efficacy.
Occlusion maximizes efficacy |
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How is age important in determining dose response?
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Children have > SA: mass = high systemic quantity
**Careful esp w/ corticosteroids |
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How is application frequency important?
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Intermittent pulse therapy prevents tachyphylaxis
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Which 2 of the 6 variables determining pharm response were highlighted as important?
Define 'em |
2. Concentration gradient
5. Age |
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What are 2 depigmentation agents?
What is their function? |
1. Hydroquinone
2. Monobenzone Reduce hyperpigmentation |
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Which of the depigmentation agents causes temporary lightening?
Which causes permanent (irreversible) lightening? |
Hydroquinone - temporary
Monobenzone - permanent |
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What is the MOA of the depigmentation agents?
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Inhibition of tyrosinase, interferes w/ production of melanin
--> Prevent oxidation of tyrosine to DOPA in melanocytes |
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What are the sfx of depigmentation agents?
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systemic absorption (monobenzone) can lead to HYPOpigmentation at other sites in body
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What are the 2 repigmentation agents?
What are they classified as? |
1. Trioxsalen
2. Methoxsalen Psoralens |
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What are psoralens?
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Agents that must be photoactivated by UVA to produce beneficial effects
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What do the psoralens used for?
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Repigmentation of depigmented macules of vitiglio
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What are the 3 functions of psoralens?
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1. Erythemogenic
2. Melanogenic 3. Cytotoxic |
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What is the MOA of psoralens?
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Once photochemotherapy is administered s/p oral use of psoralens, the -->
formation of DNA adducts inhibit DNA replication |
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What do psoralens inhibit?
What do they promote? |
- inhibit cell proliferation
- promote differentiation of epithelial cells |
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What is the indication of use for Methoxsalen?
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severe, recalcitrant, disabling psoriasis not responsive to other forms of therapy
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What is Trioxsalen used for?
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Vitiglio
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What are the sfx of psoralens?
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ocular damage, aging of skin, skin ca
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Which of the 2 psoralens can be used for the pallative tx of cutaneous T-cell lymphoma?
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Methoxsalen
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What are the 5 different acne preperations?
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1. Retinoic acid
2. Adapalene 3. Isotretinoin 4. Benzoyl peroxide 5. Azelaic acid |
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What are the 3 classifications of acne?
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1. follicular
2. papular 3. pustular |
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Do the acne medications require UV activation for effects?
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Nah
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What are the routes of administration for the acne meds mentioned?
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Oral or topical
NO IV |
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Retinoic acid is aka?
Retinoic acid is effective against? |
all-trans retinoic acid
acne vulgaris |
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Retinoic acid and vitA relationship?
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Analogue of vitA
EtOH to acid and cis to trans transformation to form retinoic acid |
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What are the biological effects of retinoic acid?
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cellular proliferation & differentiation, immune function, inflammation & sebum production
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What is the MOA of retinoic acid (RA)?
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Ra binds w/ RXR/RAR --> RXR or RAR--Ra complex binds w/ RAREs (retinoic acid response elements) and result in ----> activation of gene transcription
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What are the effects of Ra on skin?
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-> inc epidermal cell turnover
-> stabilize lysosomes, inc PGE2, cAMP & cGMP levels, and incorporate thymidine into DNA in ----> epithelial tissue |
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effects of retinoids on P. acnes?
What does the "p" stand for? |
-> decrease action & concentration, decrease PGE2, collagenase, and inflammation
-> propionibacterium thus ==> there is possibly some anti-bacterial effects |
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Retinoic acid can cause what skin irritation?
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slight erythema & mild peeling
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Sfx of retinoic acid?
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-> tumorigenic w/ UV irradiation
thus pts advised to avoid sun exposure |
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What is isotretinoin?
What is the spectrum of use? |
1st generation retinoic acid
limited to only severe cystic acne |
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What is the MOA of Isotretinoin?
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inhibits sebaceous gland size and fnxn
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What are the adverse effects of Isotretinoin?
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Hypervitaminosis-like symptoms
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In what population are retinoids absolutely CI?
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Pregos and women w/ potential for child bearing
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What is etretinate?
What is the indication of use for it? |
2nd generation retinoid
psoriasis |
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What is benzoyl peroxide used to tx?
What layer of the skin does it penetrate? |
acne vulgaris
stratum corneum |
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What is azelaic acid used to treat?
What is its MOA? |
acne
antimicrobial effects & inhibitory effect on conversion of testosterone -> DHT |
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What are the 3 meds used for psoriasis?
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Acitertin
Tazarotene Calcipotriene |
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What is psoriasis caused by?
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increased epidermal cell proliferation (scaly silvery patches)
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What is Etretinate and what is it used for?
Brand name? |
Aromatic retinoid for pustular psoriasis
Tegison |
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What is Acitretin and what is it used for?
Brand name? |
etretinate metabolite for pustular psoriasis
Soritane |
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What are the adverse effects of Acitretin (Soritane) and the contraindications?
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Hypervitaminosis
elevated cholesterol & triglycerides Teratogenic CI in pregos and 3 yrs post therapy in women planning to have kids EtOH should be avoided during & 2 mos post therapy Can't donate blood for 3 yrs post |
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What is Tazarotene & its brand name?
What are its effects? |
Acetylated retinoic acid
Tazorac Inhibition of proliferation & differentiation of epithelial cells |
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Importance of photochemotherapy?
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used in managing psoriasis
w/ administration of oral psoralen DNA adduct formation inhibits DNA rep Inhibits proliferation & promotes differentiation of epithelial cells |
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What is calcipotriene?
What are its actions? On immune system? Adverse effects? |
synthetic vitD3 derivative
inhib proliferation & differentiation of epithelial cells decrease local T-CMI (immunosup) itching, dryness, burning, irritation, erythema |
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What are the properties of glucocorticoids?
What are the routes of administration? |
immunosuppressive and anti-inflammatory
locally via topical & intralesional routes |
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What is the MOA of glucocorticoids?
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varies
inhibitory effects on arachindonic acid cascade, depression of production of cytokines & effects on inflamm cells |
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What are glucocorticoids used for?
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eczema, dermatitis, pruritis, mild psoriasis, inflammation
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What are the different classes of glucocorticoids?
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1. lowest efficacy
2. low efficacy 3. intermediate efficacy 4. high efficacy 5. highest efficacy |
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What are the toxic effects of glucocorticoids?
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atrophy, striae/band formation, acneiform eruptions, dermatitis, hypopigmentation, rosacea, fungus overgrowth
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What are the withdrawal symptoms of glucocorticoids?
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perioral dermatitis & rosacea on the face
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What are the toxic effects on children?
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systemic toxicity (depression of hypothalamic-hypophyseal-adrenal axis and growth retardation)
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What are insoluble preps of glucocorticoids?
What can they cause? |
Triamcinolone
cause atrophy & hypopigmentation |
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What does Minoxidil do?
What disorder is it used to help? |
Potent arterial vasodilator that also reverses progressive miniaturization of terminal scalp hairs
Adrogenic alopecia |
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What does stopping Minoxidil cause?
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hair loss
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What is the MOA of Minoxidil?
What can Minoxidil also do to androgens in scalp? |
May either:
1. activate hair follicle directly or 2. stimulation microcirculation surrounding the follicle, increasing cutaneous blood flow May also alter metabolism of androgens in scalp |
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What does systemic therapy do?
What does topical therapy NOT cause? |
Stimulate hair growth
does not lead to hypotension |
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What is Finasteride?
What does it do (physiologically)? What are its 2 uses? |
Testosterone analogue
5-alpha-reductase inhibitor (blocks conversion of T --> DHT) orally for androgenic alopecia; BPH |
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What does Finasteride decrease concentrations of?
Where? Why is this imporatant? |
decreases DHT concentrations
in scalp and serum in pattern hair loss, there is an inc amount of DHT |
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What are the adverse effects of Finasteride?
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decreases libido, dec ejac vol, ejac dysfnxn, erectile dysfnxn
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WHat does it cause in male fetuses if handled by pregos?
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Hypospadias
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What is hypospadias
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developmental anomaly characterized by defect on ventral surface of penis --> urethral meatus is PROXIMAL to nL
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Absolute CI of finasteride?
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children, females, pregos
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