Therapies, Dermatology

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  1. Acitretin (Soriatane)

    • Dose: 25-50mg po OD, max 75mg/d
    • Indications:severe psoriasis, hyperkeratinization (Darier's diease)
    • Contraindication: Women childbearing potential
    • Monitor: LFT, lipids q1-2wks til stable
    • Interacts: systemic retinoids, MTX, tetracyclines, OCP
    • S/E:

    Valacyclovir (Valtrex)
    • Valtrex
    • 1g po BID x 7-10days if first epidode genital herpes
    • 500mg po BID x 5d for recurrent

    • indications: chickenpox, herpes zoster, genital herpes, herpes labials
    • Side effects: headache, N/D, abd pain
  3. Cyclosporin (Neoral)
    • Cyclosporin
    • 2.5-4mg/kg/d po divided BID
    • After 1 month may incr by 0.5mg/kg/day q2wks

    Dose of Mg may protect kidney

    Indications: psoriasis, lichen planus, DH, EM, urticaria, Atopic derm resistant

    • Monitor: BP, Renal fn
    • Contraindications: AbN RF, HTN uncontrolled, malignancy, infx, immunodeficiency

    Ok to use for 2 yrs

    Best to use for short term only

    Avoid grapefruit juice
  4. Dapsone
    • Dapsone
    • 500-100-150mg po OD tapering to 25-50mg po OD

    Indications: Pemphigus vulgaris, Derm Herpetiformis

    • Monitor: G6PD, thiopurine methyl transferase b/f start, q2ks = methemoglobin, CBC
    • S/E: neuropathy, hemolysis
  5. Isotretinoin (Accutane)
    Isotretinoin 0.5-1mg/kg/day given OD to a total dose of 120mg/kg (ie 20wks)

    • Indications: severe nodular / inflam acne
    • Contra: teratogenic in f, need contraception x2
    • S/E: night blindness, decr contact lenses tolerance, dry eyes/lips/nose, epistaxis, at start worsens acne, depression, incr TG, incr LFT

    Drug interactions: tetracycline/minocycline, Vit A supplements
  6. Itraconazole (Sporanox)
    Itraconazole 100-400mg po OD depending on infx

    • Toenails - 200mg po BID x7d per month, repeat 3
    • Fingernails - 200mg BID po x7d per month, repeat 2

    Indications: Tinea capitis, onychomycosis

    • S/E: hepatotoxic
    • Contraind: CHF
  7. Methotrexate (Trexall)
    • Methotrexate
    • 10-25mg qwks po, IM, or IV
    • max = 30mg/qwk

    Add Folic acid 1mg po OD on days not taking MTX

    • Indications: psoriasis, Atopic derm, CTCL, Sezary
    • Monitor: renal fn, liver fn, CBC
    • Contra: preg, lactation, alcohol abuse. liver dysfn
  8. Minocycline (Minocin)
    • Minocycline
    • 50-100mg po BID

    Indications: Acne vulgaris, Rosacea

    • Contra: decr renal or liver fn
    • Drug interaction: don't use tih Accutane

    S/E: extensive, CNS, teeth, bones, renal, photosensitive, blue pigment
  9. Terbinafine (Lamisil)
    • Terbinafine
    • 250mg po OD x2wks
    • fingernails - 6wks
    • Toenails - 12wks
  10. Tetracycline
    • 250-500mg po OD
    • Take 1hr b/f meal or 2 hrs a/f meal

    Indication: Acne, Rosacea, Bullous pemphigoid
  11. Biologics
    -side effects
    • Indications
    • -mod-severe psoriasis, failed systemic tx, contraindication or s/e from other po meds, concurrent P.arthritis, significant impact on QofL

    • S/E
    • -Administration rxn = hives, erythema, H/A, BP
    • -Opportunistic infx = TB
    • -Infx = cellulitis, HZV, fungal
    • -Malignancy = lymphoma, leukemia, mal melanoma, solid organ tumors
    • -Demylination = PML, MS, GBS, Sz
    • -Hematologic AbN = pancytopenia
    • -Hepatotoxicity
    • -CHF

    • Use:
    • -Definite = psoriasis, PsA, RA, IBD

    • Monitor:
    • -Baseline: PPD, CBC, lytes, HBV, HCV, HIV
    • -q3months = ROS, MS, CBC, lytes, infx s/s
    • -q6months = CBC, lyes
    • -qyr = PPD
  12. Bioogics Nomeclature
    • -cept = receptor drug, blocks binding of R to cell
    • eg. Etanercept (enbrel)

    • -ximab = chimeric monoclonal Ab
    • eg Infiximab (Remicade)

    • -mumab = monoclonal Ab
    • eg new = Belimumab
  13. Interferon (IFN)
    Metabolism = renal

    MofA = Needs to bind to specific R on target cell surface. Antivrial effects, Antiproliferation (affects all phases of cell cycle), Immunologic effect (incr NK cells)

    • Uses = Genital warts (HPV 6,11)
    • AIDS with Kaposi's sarcoma
    • Chronic granulomatous disease
    • Malignant melanoma* - esp stage 1,2

    • Side effects
    • -fatigue, neutropenia, fever, mylagia, anorexia, N/V, incr LFTs, Headaches

    • Monitor
    • -B/f, 2wks after, qmonthly - CBC, lytes, Cr, BUN, CK, LFT, TSH
  14. Phototherapy
    • -visible light 400-770nm
    • -UVA: 320 - 400nm (penetrates epi + dermis)
    • UVA1 340-400nm
    • UVA2 320-340nm
    • -UVB: 290-320nm (penetrates epidermis)

    MofA: immunosuppresion of CD4 T cells (direct DNA damage)
  15. Phototherapy (con't)

    • Forms
    • -systemic, topical, bath
    • -use: Psoriasis, A derm, vitiligo, A Areta, CTCL, LS, GA, pruritis, mastocytosis
    • -contraind: <10yo, preg, hx melanoma, XP, SLE
  16. Phototherapy (con't)

    NB UVB
    -indications: psoriasis, vitiligo, A derm, MF, PMLE, uremia prutisi, PPD, LP, PR, LS
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Therapies, Dermatology
2011-06-23 02:17:31

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