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Derm/intro Final rev
Pharm I Final review
| Question | Answer |
|---|---|
| The study of action of the body on drugs | Pharmacokinetics |
| Study of action of drugs on the body | pharmacodynamics |
| Fraction or percentage of drug that reaches the systemic circulation | bioavilability |
| Blood from GI tract passes thru liver before systemic circulation and metabolized prior to reaching target | first pass effect |
| Factors that influence absorption | Ionization state (unionized), molecular wt, solubility (lipophilicity), formulation, |
| What types of drugs readily diffuse | small, non-ionized, lipid-soluble drugs |
| Patient-associated factors to drug absorbtion | food in GI tract (slows), stomach acidity, blood flow to GI tract: slower abs w/ CHF, gastric emptying time |
| Amount of drug in body/plasma drug concentration | Volume of distribution (Vd) |
| Drug reactions that are oxidized or reduced to a more polar form | phase I rxns |
| Drug rxs that adds a polar group to the drug to ^ polarity | phase II rxns |
| Systems that controls phase I rxns | Cytochrome P450 system |
| Small Vd meals what of half life | hydrophilic (trapped in plasma) small T1/2 |
| Large Vd means what T1/2 | lipophilic (into tissues) large T1/2 |
| Drug metabolized by cytochrome P450 system | Substrate (lipophilic drugs) |
| Drug that causes more rapid metabolism of substrate drugs | Induced: chronic EtOH |
| Drug that causes slower metabolism of substrate drugs | Inhibitor: cimetidine |
| Inactive substances metabolized to an active substance w/I the body | prodrug |
| Metabolite that also has a therapeutic activity | active metabolite |
| Factors that influence drug metabolism | hepatic dysfunction, severe CHF, advanced age |
| Methods of elimination of drugs | Filtration, secretion, reabsorption |
| Drugs diffuse from blood to nephron | filtration |
| Active transport of drug into nephron | secretion |
| Drugs reabsorbed into blood stream by diffusion from nephron tubule | reabsorption |
| Absorption equals elimination | steady state, generally reached in 5T1/2’s |
| Action of Alpha, B1, and B2 receptors | alpha: smooth-muscle contraction, B1: cardiostimulation B2: smooth-must relaxation |
| Drug interactions: plasma protein binding competition | distribution |
| Four types of drug interactions | ADME absorption, distribution, metabolism, elimination |
| 1+1 equals 2 | addition |
| 1+1 equals 3 | synergisim |
| 0+1 equals 2 | potentiation |
| 1+1 equals 0 | antagonism |
| Drugs that have the same effect on the body and nearly identical chemical structure | bioequivalence |
| Drugs that have essentially the same effect on the body, but do not have an identical chemical structure | therapeutic equivalence |
| Note those stupid drug approval process steps and MILESTONES | GRRRRR |
| Steps to drug development in U.S. | discovery and characterization, pre-clinical studies, IND application, Clinical studies, submission of NDA, approval of NDA, postmarketing surveillance |
| Rx required from a licensed prescriber | legend drugs |
| When do we use zeros when writing prescriptions? | Always b4 a decimal 0.1, NEVER trailing zero 1, not 1.0 |
| Patho of acne vulgaris | d/t ^sebum production, sloughing of keratinocytes:comednoes, propionibacterium acnes ->convert sebut to free fatty acid: inflammatory response |
| Length of follicular plugging | ~ 4weeks until inflammatory lesion shows up |
| Goals of acne tx | eliminate existing lesions, prevent new ones, decrease discomfort, prevent/minimize scarring |
| Warning to patients about results | take 6-8 weeks to see improvement, may see initial flare of existing lesions |
| Tx for mild comedonal acne, popular pustular? | Topical retinoid, Topical tetinoid + topical antimicrobial (6-8wks) |
| Tx for moderate acne | Topical retinoid + ORAL abx +/- benzoyl peroxide (6-12wks) till efficacy |
| Tx for severe recalcitrant cystic acne | Isotretinoin: 70% success after 16wk course (may have to repeat) |
| Topical Retinoids | Tretinoin: Retin-A, Adapalene: Differin (same as retinoid-mimetic) more tolerated then tretinoin, Tazarotene Avage,tazorac: new generation, More irritating than tretinoin |
| Topical antimicrobials | benzoyl peroxide: Benzagel |
| Topical abxs | Clindamycin, Erythromycin: bacterial resistance ^ w/months, use BPO when possible |
| Other antimicrobials | Azeliaic acid: interferes w/ bacterial DNA synthesis, may decrease post inflammatory hyperpigmentation, Dapsone: topical abx dec migration of neutrophils to interrupt inflammation cascade |
| Inflammatory papules and pustules w/ some noninflammatory lesions | moderate acne |
| Oral Abx for acne | Doxycycline, Minocycline, Tetracycline, Erythromycin, Bactrim |
| CI’s for Tetracyclines for acne | <8yo or preggo: permanent tooth discoloration |
| AE’s for tetracyclines for acne | Photosensitivity and GI upset, Tetra: take on empty stomach interacts w/ dairy |
| Indications for Bactrim for acne | can’t tolerate tetracyclines or erythromycin or resistance |
| Isotretinoin cycles | 15-20 wks w/ 8 wk drug-free interval |
| Monitoring required for Isotretinoin use | Pregnancy, TG’s, LFT’s, CBC’s all 4 and 8 weeks of tx, preggo: monthly |
| Contract providers, patients, pharmacists, and wholesalers must sign for isotretinoin | iPLEDGE program |
| When should combo therapy be used for acne? Abx D/C’d when? | W/inflammatory lesions, abx stopped when inflammatory lesions go away |
| When to follow-up for acne tx | 6wks, (no set tx time for any drugs) or 2-3m |
| Inert base like petrolatum, water-in-oil emulstions good for? | ointment: Retains moisture, lubricates for dermatitis (promotes bacterial growth) |
| Oil in water | cream: non-occlusive, tinea corporis: clotrimazole cream |
| Semi-solid emulsion of oil in water, propylene glycol | gel: for acne, quick drying, non-staining, best for hairy areas/face (bad d/t drying) |
| Suspenlsion or sol’n of powder in water base (often w/ alcohol or astringents) | lotion: acne and scabies, cooling effect, drying: large areas (bad for hairy, weeping, oozing, dry areas) |
| Medication in water, alcohol, or propylene glycol | solution: seborrheic dermatitis, cooling, dry’s weeping lesions, good for hair (avoid on dry skin, temporary burning) |
| Best applied w/ cotton puff or shaker | powder: tinea pedis, absorbs moisture, cooling and drying, avoid inhaling |
| Good protective barrier | paste: diaper dermatitis: zinc oxide |
| Used for all inflammatory, pruritic eruptions, hyperplastic and infiltrative disorders | topical corticosteroids |
| CI’s for topical corticosteroids | viral, fungal, TB skin lesions, herpes |
| AE’s for topical corticosteroids | atrophy, striae, contact dermatitis, glaucoma, acne |
| Low potency class, high potency class for topical corticosteroids | Low: class VII, high: Class I limit exposre <2wks in small areas (easily absorbed systemically) |
Created by:
becker15
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