(Muscskelint) Cutaneous Pharmacology

Front 1

Which layer of skin is the primary barrier to penetration of a chemical?

Back 1

Stratum corneum

Front 2

Which layer of skin has a brick and mortar structure?

(Where bricks are keratinaceous and the mortar would be lipids holding several layers of the flattened keratinocytes)?

Back 2

Stratum corneum

Front 3

In skin, the basement membrane at this junction is a barrier that may impact the movement of chemicals. What is this junction?

Back 3

Dermalepidermal junction

Front 4

Capillary walls in this layer of skin is a lipid barrier between the epidermis and blood stream.

Back 4

Capillary walls in the upper dermis

Front 5

Parts of the body like the scrotum, face, and scalp and axilla are (more or less) permeable than the forearm to some drugs

Back 5

Those parts are much more permeable than the forearm

Front 6

For the following, state whether it will increase or decrease the flux of a drug through the skin:

Molecular size

Back 6

Bigger molecules will have a harder time getting through the skin

Front 7

For the following, state whether it will increase or decrease the flux of a drug through the skin:

Charge

Back 7

Charged chemicals do not cross membranes very well (at least not passively)

Front 8

For the following, state whether it will increase or decrease the flux of a drug through the skin:

Affinity for lipids

Back 8

Higher affinity lipids enter the skin easier….

However, the ideal drug has some lipid solubility and some water solubility

Front 9

For the following, state whether it will increase or decrease the flux of a drug through the skin:

Thickness of skin

Back 9

The thicker the skin, the slower the flux (inverse relationship)

Front 10

How/when can the skin act as a reservoir for topical drugs?

Back 10

When the partition coefficient (Km) is very low (higher affinity)

Front 11

What is the clinical importance of the skin having a high reservoir capacity for some topical drugs?

Back 11

When the skin has a high reservoir capacity, it means that extra drug can accumulate in the skin, faster than it diffuses in the blood stream. Thus, some drugs may only need to be applied daily even though their half-life in circulation is only a few hours.

Front 12

(T/F) Both the skin and hair follicles have phase I and phase II metabolic actions for metabolizing drugs, and the levels of activity are different in different regions of the body.

Back 12

True

Front 13

Review from PB&T: What are phase I & phase II metabolic actions?

Back 13

Phase I = oxidation and reduction

Phase II = conjugation

Front 14

Do topical steroids and nitroglycerin show a high rate or low rate of metabolism in the skin?

Back 14

Relatively high rate

Front 15

What is the purpose of delivering a chemical in a vehicle rather than delivering the pure chemical through the skin?

Back 15

Increase the amount of flux (higher solubility of the vehicle)

Front 16

(T/F) The rate of release of a drug from a vehicle can make therapeutic concentrations much flatter and more prolonged than oral dosages.

Back 16

True

Front 17

If you want to deliver a drug through the skin faster, is it better to hydrate or dehydrate the skin?

Back 17

Hydrate the skin

Front 18

Who does Dimethyl sulphoxide (DMSO) act as a penetration enhancer of skin?

Back 18

Rearranges skin lipids

Front 19

Which of the following decreases transepidermal loss leading to hydration of skin?

A. DMSO
B. Aloe
C. Patrolatum and other emollients
D. Propylene glycol

Back 19

C. Patrolatum

Front 20

Which of the following attract water to the skin?

A. DMSO
B. Aloe
C. Propylene glycol
D. Patrolatum

Back 20

Humectants such as propylene glycol and aloe do this so both B and C are correct

Front 21

Which skin preparation softens skin by forming an occlusive oil film?

Back 21

Emollients

Front 22

Which skin preparations are semisolid in an oil base?

Back 22

Ointments

Front 23

Which skin preparations are semisolid emultions frequently in propylene glycol or isopropyl alcohol?

Back 23

Gels

Front 24

Which skin preparations are oil in a water emulsion?

Back 24

Creams

Front 25

Which skin preparations are solutions of a powder in water?

Back 25

Lotions

Front 26

Which skin preparations are solid or liquid colloids where the media is gas?

Back 26

Aerosols

Front 27

Which skin preparations are made by wetting a powder?

Back 27

Pastes

Front 28

Which skin preparations are aggregation of small solid particles?

Back 28

Powders

Front 29

Which skin preparations are alcoholic solutions?

Back 29

Tincutres

Front 30

Which skin preparations are the most 'wetting'?

Back 30

Emollients

Front 31

Which skin preparations are the lest 'wetting'?

Back 31

Tinctures

Front 32

Mnemonic for remembering order of skin preparations from most wetting to least wetting:

Back 32

Every Other Guy Wants Crazy Lovers And PA's POWer Tools

Emollients > Ointments > Gels > Wet dressings > Creams > Lotions > Aerosols > Pastes > Powders > Tinctures

Front 33

Which skin preparations are made of gauze or towels containing lotions or creams?

Back 33

Wet dressings

Front 34

How many grams of topical therapy are needed to cover a 10x10 cm area of the body?

Back 34

1 gram

Front 35

How many grams of topical therapy are needed to cover a leg?

Back 35

4 grams

Front 36

How many grams of topical therapy are needed to cover the face or 2 hands?

Back 36

2 grams

Front 37

How many grams of topical therapy are needed to cover the whole body?

Back 37

30 grams

Front 38

________ can be used to carry non-;lipid soluble chemicals into the skin and can also be used for transdermal delivery:

Back 38

Liposomes (lipid systems)

Front 39

_________ __________ which are 20nM in diameter can penetrate the skin more rapidly than large particles:

Back 39

Nanoparticles

Front 40

__________ are stable membranes that enclose fluid-containing drugs and are used to apply drugs.

Back 40

Microcapsules

Front 41

When it comes to drug delivery technology, what are polymers used for?

Back 41

To enhance stability and release properties of the drug

Front 42

_________ is a drug technology that controls the delivery of charged particles through the skin by causing it to movie in an electrical field:

Back 42

Iontophoresis

Front 43

When it comes to drug delivery technology films:

A. Provide sustained release of drugs
B. Increase skin hydration (improved drug delivery)
C. Alter a drug's pH allowing it to diffuse better
D. Prevent photosensitive damage to the drug

Back 43

A.

Front 44

This drug delivery technology uses sound waves to enhance the absorption of chemicals into the skin with cavitation which alters the structure of the lipid bilayers.

Back 44

Sonophoresis

Front 45

What is sonophoresis used for in drug delivery?

A. Fighting skin tumors
B. Fighting inflammation in tendon sheaths
C. Fight inflammation in joints
D. Fighting infections

Back 45

C.

Front 46

This drug delivery technology uses microscopic beds of nails for delivering large molecules through the skin:

Back 46

Microneedles

Front 47

Patch used for motion sickness

Back 47

Scopolamine

Front 48

How long should Nitroglycerin patches be left on?

What happens if you go over this period?

Back 48

12-16 hours. If you leave it on longer tolerance will build up

Front 49

Name 3 nitroglycerin patches:

Back 49

Transderm Nitro
Nitro Dur
Minitran

Front 50

Review what is Clonidine's mechanism of action?

Back 50

Alpha agonist

Front 51

What is the benefit of administering estradiol transdermally?

Back 51

Avoids first pass metabolism

Front 52

Estradiol/progesterone patches contain which ingredient to reduce cancer risk in women?

Back 52

Norethindrone

Front 53

What is in the skin patch that is used for birth control?

Back 53

Progestin / estrogen

Front 54

For progestin / estrogen patches how long do you wear it for?

Back 54

You change the patch weekly for 3 weeks; no patch on fourth week.

Front 55

What is the fentanyl patch used for?

Review: What class of drugs is fentanyl in?

Back 55

Analgesic for post operative and cancer pain.

Opioid

Front 56

What is the most widely used patch? What is it used for?

Back 56

Nicotine - used for smoking cessation

Front 57

(T/F) Nicotine patches are very effective for smoking cessation - often it's the only treatment necessary.

Back 57

False! Need to have second therapy

Front 58

What are 2 uses for testosterone patches?

Back 58

1. Hormone replacement therapy in men
2. Libido in women

Front 59

What condition is lidocaine patches often used for?

Back 59

Postherpetic neuralgia (shingles)

Front 60

How does Oxytrol (the overactive bladder patch) work?

Back 60

Works on acetylcholine release by nerves and muscle cells

Front 61

Which drug is in the ADHD patch?

Back 61

Methylphenidate (Ritalin)

Front 62

Which antidepressant comes in patch form?

Review: What class of drug is it?

Back 62

Selegiline

MAO-B inhibitor

Front 63

Which patch treats early Parkinson's?

Back 63

Rotigotine

Front 64

Which drug treats mild to moderate dementia?

What's its mechanism of action?

Back 64

Rivastigmine (Cholinesterase inhibior)

Front 65

Bacitracin (ointment)

Uses:
Mechanism of action:
Side effects:

Back 65

Uses: Skin infections and minor wounds (Gram positives and anaerobics)
Mechanism: Incorporates into cell wall
Side effects: Resistance w/ prolonged use, contact urticaria, nephrotoxicity (w/ burned skin). Red man syndrome from POD.

Drug is in the Vanco class

Front 66

Polymyxin B:

Uses:
Mechanism of action:
Side effects:

Back 66

Uses: Cutaneous infx (Gram negatives)
Mechanism: Peptide binds to cell membrane phospholipids and increases permeability
Side effects: Nephrotoxicity or neurotoxicity in high doses

Front 67

Miconazole:

Uses:
Mechanism of action:
Side effects:

Back 67

Uses: Antifungal (vaginal candidiasis, tinea, cutaneous candidiasis)
Mechanism: Messes with fungi's P450 which prevents ergosterol synthesis
Side effects: Minor (irritation, pruritus)

Front 68

Acyclovir:

Uses:
Mechanism of action:
Side effects:

Back 68

Uses: Herpes
Mechanism: Guanine derivative (interferes w/ viral replication)
Side effects: Mild itching or pain

Front 69

Hydrocortisone:

Uses:
Mechanism of action:
Side effects:

Back 69

Uses: Atopic dermatitis, seborrheic dermatitis, and others
Mechanism: Stops biosynthesis of histamine, kinins, prostaglandins, leukotrienes, and other inflammatory mediators
Side effects: Itching, burning, if metabolized in the skin will have minimal absorption

Front 70

Salicylic acid:

Uses:
Mechanism of action:
Side effects:

Back 70

Uses: Acne, psoriasis, seborrheic dermatitis, warts
Mechanism: Desquamization of horny layer
Side effects: Minor irritation

Front 71

5-Fluorouracil:

Uses:
Mechanism of action:
Side effects:

Back 71

Uses: Actinic Keratosis, superficial basal cell carcinoma
Mechanism: Interferes with DNA synthesis (thymidylate synthase)
Side effects: Irritation, photosensitivity, swelling

Front 72

Imiquimod:

Uses:
Mechanism of action:
Side effects:

Back 72

Uses: Genital warts, superficial basal cell carcinoma
Mechanism: Ramps up immune system (increases IL-1, IL-6, TNF-alpha)
Side effects: None

Front 73

Doxepin cream:

Uses:
Mechanism of action:
Side effects:

Back 73

Uses: Atopic dermatitis, eczema, or lichen simplex chronicus
Mechanism: Thought to be secondary to blockage of H1-receptors
Side effects: Burning or stinging at application site; don't want to occlude since that increases systemic absorption

Front 74

Minoxidil:

Uses:
Mechanism of action:
Side effects:

Back 74

Hair loss (Rogaine)
Mechanism: Activates hair follicle or stimulates microcirculation around hair follicles
Side effects: (Minor) Headache and scalp irritation

Front 75

Which of the following cosmeceutical has the biggest market segment?

A. Topical energy boosters (Shower Shock)
B. Products that protect against photodamage and aging
C. Estrogens
D. Antioxidants

Back 75

B

Front 76

Can cosmeceuticals make claims about the functionality of their product?

Back 76

No!

Front 77

When it comes to cosmeceuticals, why aren't estrogen creams as popular now as they used to be?

Back 77

Systemic effects of estrogen

Front 78

When it comes to cosmeceuticals what do antioxidants do?

Back 78

They are vitamin derivatives that act as scavengers of free radicals

Front 79

List 5 antioxidants:

Back 79

Analogs of Vitamins A, C, D, E
Lycopene
Alpha lipoic acid (powerful)
Retin A (tretinoin)
Retinol

Front 80

Rank the surface area of the following organs:

Lung, GI tract, Skin

Back 80

Skin = 1.8 sq meters
Lung = 140 sq meters
GI = 200 sq meters

Front 81

Rank the thickness of the barrier of the following organs:

Lung, GI tract, Skin

Back 81

Lung = 0.2-0.4 micro meters
GI tract = 8-12 micro meters
Skin = 100-1000 micrometers

Front 82

Which of the following has the highest blood flow, which has the lowest?

Lung, GI tract, Skin

Back 82

Lung has the highest (5.8 L/min)
Skin has the lowest (.5 L/min)

Front 83

What is the most common occupational skin disease?

Back 83

Irritant contact dermatitis

Front 84

(T/F) Irritation occurs without the production of antibodies.

Back 84

True

Front 85

What is the pathology involved in irritant contact dermatitis?

Back 85

PMN cell margination, epidermal necrosis and dermal inflammation

Front 86

How does allergic contact dermatitis differ from irritant contact dermatitis?

Back 86

Allergic contact dermatitis is due to more than one contact with a chemical / substance and is due to antibody production.

Front 87

(T/F) You would expect the cellular reaction that occurs in allergic contact dermatitis to occur as fast as it does for irritant contact dermatitis.

Back 87

False - allergic contact dermatitis is a delayed hypersensitivity reaction

Front 88

What is the largest predictor for how corrosive a chemical will be?

Back 88

pH

Front 89

Your friend, Mary works at a local brewery. She used to rant and rave about how much better her lifestyle is compared to your crappy med school lifestyle.

However, recently she has gotten concerned because she read in a report that one of the chemicals used to make the adhesives for beer bottles has been linked to cancer in animals.

What do you tell her?

Back 89

You should tell her that it is extremely difficult to get skin cancer from chemicals since they would first cause irritation to the skin which would lead to skin cracking.

Front 90

Name 3 ways that a person can be exposed to pesticides:

Back 90

Through direct contact
Through contact with spray, mist, or fumes
Through contact with residue

Front 91

What is dichlorophenol? What is it's mechanism?

Back 91

A volatile feedstock chemical that has caused deaths

It uncouples oxidative phosphorylation

Front 92

What are Sarin, Soman, Tabun, & VX?

Back 92

Chemical warfare agents - all lethal through the skin

Front 93

This toxic chemical can causes denaturation of proteins and leads to death when 2% of the body's surface area is exposed:

Back 93

Phenol

Front 94

This acne medication has been linked to a few deaths when used in large areas over prolonged times

Back 94

Salicylic acid

Front 95

Symptoms of green tobacco sickness:

Back 95

Headache, nausea, and dizziness.

Front 96

Benzidine, when absorbed through the skin has been linked to cancer of which organ?

Back 96

Bladder cancer

Front 97

Arsenic, when absorbed through the skin has been linked to cancer of which organ?

Back 97

Liver