Miscellaneous Systemic Drugs

shevyatiwari's version from 2015-04-25 07:02


Question Answer
Anticholinergic agents have been used for hyphhidrosisT
Propanthaline bromide and glycopyrollate are cholinergic agentsF, anticholinergic
Good oral absorptionF, variable
Produces 25% decrease in symptomsF, much inter individual variability, due to varied absorption and an individual's sensitivity
Glycopyrrolate is prescribed 1-2mg/dayT, over BD or TDS
Propanthaline is prescribed 1-2mg/dayF, 15mg BD or TDS
Takes 4-6 weeks to see ffectsF, occurs within 1-2 days
Adverse effects are seen only at higher dosesF, seen in effective doses
Anticholinergic symptoms are the most commonT
Interact with TCA due to hepatotoxicityF, increase risk of anticholinergic symptoms
Interact with Atenolol and DigoxinT - actions may be increased
Phenothiazine dose decreasedF, increased

Danazol and Stanozolol

Question Answer
Danazol and Stanozolol are non attenuated androgensF, attenuated
Impressive catabolic propertiesF, anabolic
Used for hyperhidrosisF, for hereditary angioedema. Also - Lipodermatosclerosis, cyofibrinogenemia, livedoid vasculopathy
Danozol can be used for fibrocystic breast disease, endometriosis, and as an adjunct to surgical excision in cases of cutaneous endometriosisT
Potent fibrinolytic activityT
Low anabolic/androgen ratioF, high
increase concentrations of glycoproteins synthesised in the liver, incl several clotting factors, and inhibitor of first component of complementT
Fibriolysis is seen in PO and IV formulationsF, only oral
Stanozolol can increase collagen synthesisT
Both are dosed at 200mg BD or TDSF, - that dosing is for Danozol. Stanozolol is 2mg TDS
Doses are adjusted and weaned based on responseT
C1 INH and C4 levels are reducedF, increase.
Adverse effects are dose dependentT, also duration
Hirsutism, deepening of the voice, alpaca, acne, menstrual abnormalities, weight gain, dyspareunia are S/ET
Neuromuscular dysfunction is possible incl myopathy, rhabdo esp with concurrent statinT
Microscopic haematuria and haemorrhagic cystitis are S/ET
Insulin resistance is generally not seenF
Decreasd sensitivity to anticoagulantsF, increased
UEC is needed for monitoringF, LFT- potential hepatotoxicity
IF hepatotoxicity develops, switching to oxandrolone is effectiveT
Contraindicated in pregnancy and childhoodT

Biotin/Vit H/B7/Co enzyme R

Question Answer
Biotin aka Vit KF, VIt H/B7/Co-enzyme R
Highly liophilicF, Water soluble
Found in vegetablesF, animal products
Deficiency is commonF, rare, mostly seen in TPN
Cutaneous signs of deficiency are similar to multiple carboxylase deficiencyT - thinning of the hair, poliosis
Seborrheic dermatitis eruption is common in deficiencyT - mimics Zn deficiency
Respnose to replacement is rapidT
Brittle nails, atopic dermatitis, uncombable hair syndrome, unna-thost syndrome are reasons for biotin supplmentationT
Can use up to 50mg day for keratodermaT
GI irritation is a S/ET.
Toxicity is possible at high dosesF, unlikely


Question Answer
Clofazamine is the least active antimycobacterial riminophenazine dye known F, most active
Most effective in TBF, in leprosy
Red-orange colourT
Highly lipophilicT
Taking with food increases absorptionT
Half life of 4 daysF, 70-80 days
Metabolised and eliminated primarily via liver/GITT, also excreted in sebum, sputum, tears, sweat
Binds to DNA guanine residues (higher in mycobacteria than humans)T
Inhibits mitochondrial respiratory chains and inhibits prodcution of free radicalsT
Antimycobacterial effects augmented by IFN gamma and alphaT
Alters PMN motility and lymphocyte transformationT, in a dose dependent manner
Orange-brown discolouration occurs of the skin in 2-4 weeks due to drug depositionF, due to induced hypermelanosis
Few patients get dry skinF, 30%
Crystals can deposit in the visceraT, dose and duration dependent
Enteropathy, spenic infarction, eosinophilic enteritis, cardiac dysrhythmia, , Gi S/E, exacerbation of vitiligo are possibleT
Rifampicin, dapsone and isoniazid are potential drug interactionsF - not dapsone
C/I include pregnancy, lactation, GI disease, electrolyte disturbancesT
Cat XF, C
LFT, UEC require periodic monitoringT


Question Answer
Colchicine is derived from a plantT (C autumnale)
Colchicine is activated in UV lightF, must be shielded from UV - degrades drug
Peak levels in 30-120 minutesT
Metabolised in the liverT
Excreted in the kidneysF, predominant bile excretion
Concentrates in WBCT, leucocytes
Binds to dimers of tubulin, preventing assembly to microtubulesT
Antimitotic and antiinflammatoryT
Alters jejunal an ileal functionT, causes GI S/E incl watery diarrhoea
OD can mimic choleraT
B12 malabsorption can occurT
FBP, UEC, urinalysis should be performed 3 monthlyT
Cat DF, C
Causes cell arrest in metaphaseT
Anti mitotic but not anti inflammatoryF, also anti inflammatory
Inhibits histamine release from mast cells, parathormone, insulin release and melanosome movementT

Fumaric acid esters

Question Answer
Fumaric acid esters are used in psoriasisT
Adverse effects include flushing onlyF, also GI problems
Made of a solution comprising an active ingredientF, numerous components in the mixture

Nicotinamide/Vit B3/niacin

Question Answer
Nicotinamide aka vit B2F, Vit B3, or niacin
Deficiency -> scurvyF, pellagra
Converted to nicotinic acid in the body which functions as a crucial coenzyme that accepts H ionsF, nicotinic acid is converted to nicotinamide
Nicotinic acid and nicotinamide are variably absorbed from the GITF, well absorbed and distributed to all tissues
Inhibits PARP1T
Increases lysosomal enzyme releaseF, inhibits
Potentiates cAMP PDEF, inhibits
Speeds up keratinocyte differentiationT
Reduces transepidermal water lossT
Used in pellagra, Hartnup, carcinoid tumoursT
Can be used in psoriasisF, in autoimmune bullous dermatoses
Can be used topically for ageing, isoniazid induced pellagra like lesionsT
Very safe, S/E include GI and headacheT
Hepatotoxicty is commonF, extremely rare.
Flushing and glucose tolerance impariment are S/EF for nicotinamide, T for nicotinic acid
Increased risk of myopathy with statinsT
Typcial dose between 300-500 TDST


Question Answer
Used in pruritis, mastocytosis, UV induced erythema, niacin induced cutaneous reactions, chemoprevention of malignancyT


Question Answer
Penicillamine is a breakdown product of penicillinT
Chelates heavy metals -> biliary excretionF, urinary
Variable PO absorptionT, 40-70%
Food an antacids increase absorptionF, reduce
Half life of 1-3 hoursT
Metaboliesd in the liverT
Renal dysfunction is not a C/IF
GI, proteinuria, blood and platelet dycrasias, hepatotoxicity are S/ET
Adverse cutaneous effects include bulls dermatoses, lupus like syndrome, lichen plans, elastosis perforans serpiginosa, pseudoxanthoma elasticumT
Nail changes, dermatopathy, Goodpasture syndrome are S/ET
C/I with gold, phenylbutazone, oxyphenbutazone, antimalarials, cytotoxicsT

Potassium Iodide

Question Answer
Potassium Iodide affects SporothrixF
Effect mediated by alteration of host's immune response to organismT, also non immune response
May be mediated by heparin - suppresses delayed hypersensitivity reactionsT
Cat CF, D
S/E include hypothyroidism, brassy and burning taste, increased salivation, coryza, sneezing, eye irritation, parotid and submaxillary gland enlargement and tendernessT
GI irritation is not commonF
Vasculitic syndromes can occurT
Iododerma can occur, can trigger EM and flare PG, DH and pustular psoriasisT
UEC, TFT and autoantibodies should be checkedT
No invitro effect on Sporothrix schenckiiT
Efficacy is via alteration in hosts immunologic or non immunologic responseT
Immunosuppressive effect mediated through warfarinF, heparin
Heparin is released in large quantities from mast cells by iodideT. Suppresses type 4 reactions
Can suppress generation of inflammatory oxygen intermediatesT
1 drop contains 1mg KIF, 67mg
15 drops/day is maintenanceT
Once daily dosing is not as safe as divided dosesF, just as safe
Can induce hyperthyoidismF, iodine goitre with or without hypothyroidism
Brassy and burning tasteT
Can cause decreased salivationF, increased salivation
Coryzal symptoms are commonT
Parotid and submaxillary gland enlargement with tenderness is possibleT
GI effects are commonT
Diarrhoea, fever, anorexia, deperssion, vasculitis are reportedT
Iododerma is a vegetating eruptionT
Cat XF, D - can cause iodide goitre and hypothyroidism in the foetus
TFT's should be checked in 1 month then yearlyT


Question Answer
Thalidomide available IMF, only oral
LipophilicT, BA difficult to determine
Slow absorptionT
Metabolised by CYP 2C9T
Half life of 9 hoursT
Excretion is predominantly renalF
Sedative, immunmodulatory (inhibits TNFa), inhibits angiogenesissT
Cat DF, X
C/I in men engaging in sexual intercourse with women of childbearing ageT
Causes proximal muscle weakness with symmetric painful paraesthesias of the hands and feet, frequently associated with lower limb sensory lossT
Sensory weakness improves more than motor weakness on cessationF, other way around
Has additive sedative effects with alcohol, barbiturates, chlorpromazine, reserpineT
Potentiates the effects of histamine, serotonin, acetylcholine and prostasglandinsF, antagonises the effects
3A4 inducers are potential interactions due to interference with thalidomideF, due to interference with OCP
Isoniazid, metronidazole, vincristine can increase the risk of hepatotoxicityF, can increase risk of peripheral neuropathy

Vitamin E/tocopherol

Question Answer
Vitamin E aka tocopherolT
Fat solubleT
Found in vegetables onlyF, meat and nuts too
Deficiency is common in the western worldF, very rare
There are specific cutaneous findings due to deficiency of vitamin EF
Epidermolysis bullosa, chronic CLE, yellow nail syndrome, granuloma annulare and claudication are conditions in which vitamin E may workT
Atopic dermatitis, psoriasis, DH, porphyria, subcorneal pustular dermatosis may benefit from Vitamin EF, no evidenc
High dose >400 may be beneficial in pregnant womanF, may increase mortality levels


Question Answer
Zinc deficiency is common T, esp in TPN and breastfed infants
Circumferential and acral dermatitis accompanying diarrhoea are symptoms of Zn deficiencyT
Deficiency is mimicked by acrodermatitis enteropathicaT (autosomal recessive disorder of Zn metabolism that presents in infancy)
1-2mg TDS is standard replacement doseF, 1-2mg/kg
Used inconsistently in acne, alopecia, verrucae, acute cutaneous leishmaniasis, leg ulcersT, varying results