Module 9 Unit A Dermatologic Conditions 2024 PDF

Module 9 Unit A Class Drug examples Indications MOA Safety considerations BBW Notes Generic/Trade contraindications...

Module 9 Unit A Class Drug examples Indications MOA Safety considerations BBW Notes Generic/Trade contraindications D2D QT Antifungals- Itraconazole Prototype: Broad Inhibits the synthesis SE/Adverse effects Due to negative Pregnancy/lactation: systemic and (Sporanox) spectrum of fungal of ergosterol, as - Both-GI: nausea, inotropic actions, Benefits must be superficial pathogens. essential component vomiting, diarrhea, should not be used weighed with mycoses Drug of choice for of the fungal headache, abdominal for superficial pregnancy; blastomycosis, cytoplasmic pain, edema fungal infections insufficient data for histoplasmosis, membrane. The result - Itraconazole: Risk for (dermatosis or lactation but most paracoccidioidomy is increased potentially serious onychomycosis), in antifungals are cosis, and permeability and patient with heart considered safe effects: Cardiac sporotrichosis. leakage of cellular failure, a history of except Ketoconazole suppression and liver Also used for components. heart failure, or (high potential for superficial mycosis injury. other indications of hepatotoxicity). - Fluconazole: Stevens- ventricular Johnson syndrome. dysfunction. Note: If patient is taking Warfarin, the Contraindications: PT should be - Those with heart Fluconazole Broad spectrum of monitored; if taking failure, a history of (Diflucan) fungal pathogens; sulfonylureas, blood blastomycosis, heart failure, or other glucose should be candidiasis, indications of monitored. histoplasmosis. ventricular dysfunction. - Concurrent use with Other labs: Statins -Baseline LFT - Itraconazole: Not for use with superficial  dermatosis or onychomycosis. Caution: - Great caution in those with liver disease. D2D interactions: - Several, this is a CYP3A4 inhibitor (of the cyp450), can increase levels of many other drugs. See table 79.3. - Itraconazole: Cisapride, pimozide, dofetilide, and quinidine. When present at high levels these drugs can cause potentially fatal ventricular dysthymias. - Itraconazole: Cyclosporine, digoxin, warfarin, and sulfonylurea-type hypoglycemics. - Drugs that decrease gastric acidity can reduce absorption of oral itraconazole.  - Fluconazole: pimozide, quetiapine,a misulpride, haloperidol, lithium or risperidone, escitalopram, venlafaxine, erythromycin, clarithromycin, ergotamine, amiodarone, warfarin, dabigatran, clopidogrel, carbamazepine, losartan, statins QT prolongation/Risk of TdP - Itraconazole: Conditional risk - Fluconazole: Known Risk of TdP Antibiotics–oral Doxycycline Broad-spectrum. Suppress bacterial SE/Adverse effects: -None noted -GI side effects and (Vibramycin) Active against a growth by inhibiting - GI irritation (epigastric decreased by giving Tetracyclines wide variety of protein synthesis. burning, cramps, with meals Gm+ and Gr-. They bind to the 30S nausea, vomiting, and Minocycline Sensitive organisms ribosomal subunit diarrhea) Pregnancy/Lactation: (Minocin) include Rickettsia, and thereby inhibit - Yellowing or browning Not recommended spirochetes, binding of transfer of teeth, hypoplasia of in pregnancy; Brucella, RNA to the the enamel Chlamydia, messenger RNA- controversial in Mycoplasma, ribosome complex. breastfeeding Helicobacter - If taken during pylori, Borrelia pregnancy after the 4th burgdorferi, month of gestation, the Bacillus anthracis, fetus will acquire and Vibrio staining of deciduous cholerae. (but this does not affect permanent teeth). Acne - If taken between 4 Impetigo MRSA months to 8 years old Cellulitis permanent discoloration will occur. - Tetracycline by pregnant people can suppress the growth of long bones in premature infants (is reversible with discontinuation) - Superinfection - D-diff - Overgrowth with fungi - Fatty infiltration of liver - Hepatotoxicity - May exacerbate renal impairment if preexisting kidney disease - Sun exposure while on tetracycline can cause  skin sensitivity of skin, exaggerated sunburn Contraindications: - Known allergy - Kids 8 and under Caution: - In existing renal impairment patients - pregnancy D2D interactions: - Do not administer with calcium supplements - milk (because they contain calcium) - iron supplements - magnesium-containing laxatives - most antacids (because they contain magnesium, aluminum, or both). QT prolongation/Risk of TdP: - none Antibiotics–oral Clindamycin Anaerobics (Gr+, Binds to 50S subunit SE/Adverse effects: Clindamycin can Pregnancy: (Cleocin) Gr); most Gr+ of bacterial ribosomes - Clostridium difficile- cause potentially Anti-anaerobic aerobs, Bacteroides and thereby inhibits associated diarrhea Clostridium difficile In clinical trials with Agents fragilis, protein synthesis. (CDAD) is the most diarrhea. Patients pregnant women, the Msc. abx severe toxicity of should promptly systemic  fusobacterium clindamycin. The cause report any diarrhea administration of species. is a super infection of to their health care clindamycin during Clindamycin is the bowel. provider. the second and third usually - -May decrease oral trimesters, has not bacteriostatic. contraceptive activity. been associated with an increased frequency of Acne Contraindications: congenital Impetigo - -In those with a history abnormalities. MRSA of hypersensitivity to Clindamycin should Cellulitis preparations containing be used during the clindamycin or first trimester of lincomycin. pregnancy only if clearly needed. There are no adequate and QT prolongation/Risk of TdP: well-controlled - -none studies in pregnant women during the first trimester of - pregnancy. Lactation: Potential to cause adverse effects on the breastfed infant's gastrointestinal flora. Antibiotics–oral Erythromycin Erythromycin is Control the SE/Adverse effects: -none noted Pregnancy/lactation: (Ery-Tab) broader and development or - Small risk of sudden safe Macrolides preferred tx. reproduction of cardiac death from QT This class is prolongation Early active against most bacteria and inhibit - GI disturbances Generation Gr+, and some Gr - protein synthesis. (epigastric pain, nausea,. vomiting, diarrhea) Acne Contraindications: Impetigo - Known allergy MRSA - If patient is on a Cellulitis CYP3A4 inhibitor - If patient is taking a class IA or III antidysrhythmic drug, calcium channel blocker, azole antifungal, HIV protease inhibitors, and nefazodone (antidepressant) Caution: - In patients with QT prolongation D2D interactions: - Erythromycin can increase plasma levels and half-lives of several drugs, thereby posing a risk for toxicity: theophylline, carbamazepine, warfarin.  - It prevents binding of chloramphenicol and clindamycin to bacterial ribosomes, thereby antagonizing their antibacterial effects. - Should not be combined with Verapamil, diltiazem, HIV protease inhibitors, and azole antifungals (as they inhibit erythromycin metabolism). QT prolongation/Risk of TdP: - Erythromycin: known risk Antivirals used Mucocutaneous SE/Adverse effects -None noted Pregnancy/lactation: in the treatment Acyclovir herpes simplex Inhibits viral - Acyclovir: Oral: Nausea, Acyclovir, of HSV and infections; replication by vomiting, diarrhea, valacyclovir, Varicella Zoster Varicella Zoster suppressing the headache, vertigo. famciclovir safe in VZV infections; synthesis of viral - Topical: transient local pregnancy. They are Herpes simplex DNA. burning or stinging not recommended in genitalis. - Intravenous: Renal lactation. failure. -Elderly: Those with - Valacyclovir: renal impairment Valacyclovir Herpes labialis, Inhibits viral Thrombotic should be started at a (Prodrug of Varicella replication by thrombocytopenic lower dose. Acyclovir) (chickenpox), suppressing the purpura/hemolytic  herpes zoster synthesis of viral uremic syndrome -Labs: Urinalysis, infection (shingles), DNA. And: (TTP/HUS) has liver enzymes herpes simplex represents a more occurred in genitalis (genital efficient way of immunocompromised herpes). getting acyclovir into patients. **Sometimes used the body as when this - Famciclovir: Nausea off label for drug is given orally, and headaches prophylaxis of the effective HSV, VZV, CMV bioavailability of Contraindications: in patient s with acyclovir is increased - Valacyclovir: cancer, or to about 50% Immunocompromised sometimes cancer (otherwise acyclovir’s patients with the related HSV and bioavailability is 15% exception of chronic VZV. to 30%). suppressive therapy for recurrent genital herpes in patients with HIV infection. This undergoes Caution: Famciclovir Prodrug of intracellular - Those with decreased (prodrug of penciclovir. conversion to renal function. penciclovir) Approved for penciclovir herpes zoster and triphosphate, a D2D interactions: herpes simplex compound that - None notated with genitalis. inhibits viral DNA significance. polymerase and thereby prevents QT prolongation/Risk of TdP replication of viral DNA. - none Agents for warts (podophyllum Perianal and Inhibition of DNA SE/Adverse effects: -None noted Note: resin; Podocon- Venereal warts synthesis and mitosis. - Podocon-25: central and -Podophyllin is 25) Lead to cell death and peripheral neuropathy, provider applied. erosion of warty kidney damage, and tissue. blood dyscrasias. -Imiquimod and - Aldara: Erythema, Sinecatechins are Imiquimod erosion, and flaking at patient applied. (Aldara) Stimulates production the site of of interferon alpha, administration. Local tumor necrosis factor, and several itching, burning, and interleukins and pain. thereby intensifies - Veregen: Erythema, immune responses to pruritus, burning, pain, HPV. erosion or ulceration, edema, induration, and rash. Sinecatechins Contraindications: (Veregen) Veregen is thought to - Pregnancy/Lactation include antioxidative - Veregen: effects, induction of Immunocompromised, apoptosis, and HIV-infected pts, inhibition of genital herpes telomerase. Caution: - Kidney disease D2D interactions: - No significant QT prolongation/Risk of TdP:  - None Antibiotics- Benzoyl First-line drug for Suppressing the SE/Adverse effects: -None noted Pregnancy/Lactation: Topical peroxide mild to moderate growth of P. acnes. - Burning, blistering, Safe acne, is both an Release of active scaling, swelling. antibiotic and oxygen. Reduces Potentially serious keratolytic inflammation and hypersensitivity promote keratolysis reactions especially in (peeling of the horny patients with asthma. layer of the epidermis). Contraindications: - none Caution: - Asthmatic patients D2D interactions: - None specially noted QT prolongation/Risk of TdP: - None Retinoids Topical: Considered the Topical: They can SE/Adverse effects: -Isotretinoin: Pregnancy/Lactation: (Derivative of Adapalene cornerstone of unplug existing - Differin: Exacerbate Carries a high risk Do not use vitamin A) (Differin) acne therapy (mild comedones and acne (expected for the of severe structural to moderate). prevent development and cognitive. first 8 to 12 weeks); of new ones. Reduce erythema, scaling, defects in the inflammation and dryness, pruritis, developing fetus. It improve penetration burning, stinging. is also associated of other topical with an increased - Accutane: nosebleeds, agents. Differin risk of spontaneous inflammation of the lips Modulates abortion. inflammation, and eyes, dryness,  epithelial itching, pain, tender or keratinization, and stiff ness in muscles, differentiation of bones, and joints. Rash follicular cells. As a headaches, hair loss, result, the drug peeling of skin from reduces formation of palms, and soles. comedones and Reduction in night inflammatory lesions. vision. Depression. Sunburns. Contraindications: - Differin: Hypersensitive to adapalene or any of the components in the cream vehicle. Oral: Severe Decreases sebum Isotretinoin nodulocystic acne production, sebaceous - Accutane: (Accutane) vulgaris. gland size, - Both: Pregnancy, inflammation, and lactation keratinization. Also, Caution: by decreasing the - Differin: Avoid contact availability of sebum, with the eyes, lips, a nutrient of P. acnes, angles of the nose, and isotretinoin lowers the skin population of mucous membranes; this microbe. For external use only - Accutane: Liver disease, hyperlipidemia D2D interactions: - Differin: Concomitant use of other potentially  irritating topical products (medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect, and products with high concentrations of alcohol, astringents, spices or lime rind) - Particular caution should be exercised in using preparations containing sulfur, resorcinol, or salicylic acid - Accutane: Tetracyclines and Vitamin A QT prolongation/Risk of TdP: - None Combined oral Approved for (1.) Suppression of SE/Adverse effects: -COC’s: Pregnancy/Lactation: Hormonal contraception managing acne in ovarian androgen - COC’s: Serious Warning: Cigarette Do not use agents (COC): those born with a production, and (2.) cardiovascular events smoking and serious uterus and ovaries. Increased production and stroke, vascular cardiovascular (YAZ, Tx is limited to of sex hormone- events, liver disease. events: Estrostep, being at least 15 binding globulin, a - Spironolactone: Cigarette smoking Ortho Tri- years of age who protein that binds Hyperkalemia, increases the risk of cyclin, Beyaz) want androgens and serious hypotension with contraception, and thereby renders them cardiovascular worsening renal failure,  have reached inactive. By electrolyte and events from menarche, and decreasing androgen metabolic combination oral have not availability, estrogens abnormalities, contraceptives responded to decrease production gynecomastia, impaired (COC) use. This topical agents. of sebum. neurologic risk increases with function/coma in age, particularly in women over 35 patients with hepatic years of age, and impairment, cirrhosis with the number of and ascites; cigarettes smoked. Digestive: Gastric For this reason, bleeding, ulceration, COCs should not Spironolactone gastritis, diarrhea and be used by women (Aldactone) Blocks a variety of cramping, nausea, who are over 35 steroid receptors, vomiting. years of age and including those for - Reproductive: Decreased smoke [see aldosterone and sex libido, inability to Contraindications hormones. Blockade achieve or maintain of aldosterone erection, irregular receptors underlies menses or amenorrhea, the drug ‘s use as a postmenopausal diuretic as well as it’s use in heart failure. bleeding, breast and Blockade of androgen nipple pain. receptors underlies - Hematologic: Leukopeni benefits to those born a (including with a uterus and agranulocytosis), ovaries with acne. thrombocytopenia. - Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous  eruptions, anaphylactic reactions, vasculitis. Contraindications: - COC’s: Renal impairment, Adrenal insufficiency, A high risk of arterial or venous thrombotic diseases, Undiagnosed abnormal uterine bleeding, Current diagnosis of, or history of, breast cancer, which may be hormone- sensitive, Liver tumors, benign or malignant, or liver disease, Use of Hepatitis C drug combinations containing ombitasvir, paritaprevir/ritonavir, with or without dasabuvir due to the potential for ALT elevations - Spironolactone: contraindicated in the patients with: Hyperkalemia -  Addison’s disease - Concomitant use of eplerenone Caution: - Other co-morbidities and on any medication they can interact with. D2D interactions: - COC’s: - Spironolactone: That can can increase potassium include: ACE inhibitors, angiotensin receptor blockers, non-steroidal anti-inflammatory drugs (NSAIDs), heparin and low molecular weight heparin, trimethoprim; Other D2D- Lithium. Digoxin, Cholestyramine, Acetylsalicylic Acid. QT prolongation/Risk of TdP - None Oral Prednisone Severe Anti- SE/Adverse effects: -None noted Pregnancy/lactation: Corticosteroids (Use Daily Med disease: inflammatory/ - Fluid and Electrolyte use with caution and for this Pemphigus, immunosuppressant. Disturbances: Sodium only when necessary. module) psoriasis, retention, Fluid seborrheic retention, Congestive dermatitis, contact heart failure in dermatitis, susceptible patients. exfoliative - Hypokalemic alkalosis. dermatitis. - Hypertension. - Musculoskeletal: Muscle weakness, Steroid myopathy, Loss of muscle mass, Osteoporosis. - Gastrointestinal: Peptic ulcer with possible perforation and hemorrhage, Pancreatitis. - Dermatologic: Impaired wound healing, Thin fragile skin, Petechiae and ecchymoses, Facial erythema, Increased sweating. - Neurological: Convulsions, Increased intracranial pressure with papilledema (pseudo-tumor cerebri)  usually after treatment, Vertigo, Headache. - Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. - Endocrine: Menstrual irregularities, Development of Cushingoid state. - Secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress, as in trauma, surgery or illness. - Manifestations of latent diabetes mellitus. - Increased requirements for insulin or oral hypoglycemic agents in diabetics. - Ophthalmic: Posterior subcapsular cataracts,  Increased intraocular pressure, Glaucoma. - Exophthalmos. - Additional Reactions: Urticaria and other allergic, anaphylactic or hypersensitivity reactions. Caution: - hypothyroidism and in those with cirrhosis. - ocular herpes simplex because of possible corneal perforation. - Ulcerative colitis. - Other comorbid conditions. Contraindications: - Prednisone tablets are contraindicated in systemic fungal infections and known hypersensitivity to components. D2D interactions: - NSAIDS - Aspirin QT prolongation/Risk of TdP:  None Topical Hydrocortisone Relieve and itching Anti-inflammatory/ SE/Adverse effects: - None noted corticosteroids associated with immunosuppressant - Infection and irritation Betamethasone insect bites are potential side effects. inflammation, Atrophy of the skin, Clobetasol dermatitis, striae, acne, and adrenal propionate psoriasis, eczema, suppression are all (Clobex) and pemphigus potential side effects. Caution: - Open skin Contraindications: - Known sensitivity D2D interactions: - None noted (topically) QT prolongation/Risk of TdP: - None noted Topical immune- Tacrolimus Moderate to severe Not known. It has SE/Adverse effects: - None noted *May pose a risk for suppressants (Protopic) atopic dermatitis been demonstrated - headache cancer. that tacrolimus -increased sensitivity of the Children 2-16 use inhibits T-lymphocyte skin to hot or cold 0.03% adults may activation by first temperatures use either 0.1% or binding to an -irritation at the site or sites 0.03%. intracellular protein, where you apply this FKBP-12. A complex medicine including Treatment should be of tacrolimus-FKBP- stinging, soreness, a intermittent or short- 12, calcium, burning feeling, tingling, or term. calmodulin, and itching calcineurin is then -muscle pains formed and the -nausea phosphatase activity Caution: of calcineurin is - Should be avoided on pre- inhibited. malignant and malignant skin conditions. Some malignant skin conditions, such as cutaneous T-cell lymphoma (CTCL), may mimic atopic dermatitis. Contraindications: - In patients with a history of hypersensitivity to tacrolimus or any other component of the ointment. D2D interactions: - alcoholic beverages or medicines containing high percentages of alcohol - calcium channel blockers like diltiazem, nifedipine, nimodipine, nisoldipine - certain medicines used to treat fungal infections like itraconazole, ketoconazole, and fluconazole - cimetidine - erythromycin - vaccines QT prolongation/Risk of TdP:  - None noted Misc. Topical Topical infection; Binds to the 30S SE/Adverse effects: -Nephrotoxicity: Aminoglycosid Prevention in ribosomal subunit, - Can make it look like The risk increases in es neomycin minor cuts; ocular thereby disrupting condition is getting patients using high bacterial bacterial protein worse with topical due doses, with incections. synthesis to sensitivity prolonged use, and Caution: in patients with - In renal impairment preexisting renal - For external use only impairment. Contraindications: - Known sensitivity D2D interactions: - None noted (topically) QT prolongation/Risk of TdP: - None noted Resources:Textbook, Lexicomp, LactMed, CredibleMeds