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Azathioprine

Questions Q15.1 What are the pros and cons of ordering baseline testing for thiopurine methyltransferase (TPMT) enzyme activity (phenotype) before initiating azathioprine therapy? (Pg. 170×2) Q15.2 What is a general guide for interpretation of the laboratory testing for the genotype for TPMT activity? (Pg. 170) Q15.3 Concerning azathioprine drug interactions, (1) what is the most important drug interaction and its mechanism, and (2) what are several…

Methotrexate

Questions Q14.1 What are the proposed mechanisms by which methotrexate inhibits inflammatory dermatoses? (Pg. 159×4) Q14.2 What is the biochemical rationale behind the use of (1) folinic acid, and/or (2) thymidine in patients with acute methotrexate liver toxicity (especially pancytopenia)? (Pg. 159) Q14.3 What are the pros and cons of routine folic acid supplementation with methotrexate therapy? (Pgs. 159, 163×2, 165) Q14.4 What are four to…

Systemic Corticosteroids

Questions Q13.1 Concerning prednisone and cortisone, what is (1) the active form of each drug, (2) the enzyme necessary for this conversion, and (3) the effect of severe liver disease on this conversion? (Pgs. 134, 135) Q13.2 What are ‘physiologic dose’ levels for (1) prednisone, (2) prednisolone, (3) dexamethasone, (4) methylprednisolone, and (5) triamcinolone? ( Table 13.1 , Pg. 151) Q13.3 What are several cells that…

Systemic Antiparasitic Agents

Questions Q12.1 Concerning ivermectin therapy for scabies, (1) how does ivermectin compare with topical permethrin in success rate, and (2) is ivermectin alone effective treatment for crusted scabies? (Pgs. 126×2, 127) Q12.2 What are several mechanisms of action for ivermectin in parasitic infestations? (Pg. 127) Q12.3 What are the US Food and Drug Administration-approved indications for (1) ivermectin, (2) albendazole, and (3) thiabendazole? (Pgs. 127, 129,…

Systemic Antiviral Agents

Questions Q11.1 What is the spectrum of dermatologic conditions that human herpes virus (HHV) infections can cause? (Pg. 115, Table 11.1 ) Q11.2 What are the two primary steps (one step with two parts) by which acyclovir reaches the form that inhibits viral replication (similar steps for valacyclovir and famciclovir) (Pg. 115, Fig. 11.2 ) Q11.3 How common is acyclovir resistance, and what are the clinical…

Systemic Antifungal Agents

Questions Q10.1 What are several of the drugs currently available for systemic fungal indications or in the drug development process that have a future role in dermatologic drug therapy? (Pg. 100) Q10.2 Considering terbinafine, itraconazole, and fluconazole, (1) which drug has the greatest overall bioavailability, and (2) which drug’s bioavailability is most affected by gastric pH? (Pg. 102) Q10.3 How do the pharmacokinetics of terbinafine, itraconazole,…

Systemic Antibacterial Agents

Questions Q9.1 What are some dermatologic indications of antibiotic use in chronic inflammatory skin disorders, based on their anti-inflammatory properties? (Pgs. 70, 86×3) Q9.2 Which antibiotic classes have significant alterations in bioavailability because of foods and divalent cations? (Pgs. 73, 75, 78, 81, 82, 84×2, 91, 92) Q9.3 What are some of the drugs with the potential for a cross-reaction in patients allergic to penicillins, and…

Drugs Taken Off the Market: Important Lessons Learned

Questions Q8.1 Concerning product labeling for a specific drug, (1) what are the four components of the ‘label,’ (2) what is the purpose of the label, and (3) what are ways that some flexibility is built into the process? (Pg. 62) Q8.2 What is the individual purpose of each of following sections of the product label: (1) clinical studies, (2) adverse reactions, (3) warnings and precautions,…

Pharmacovigilance: Verifying that Drugs Remain Safe

Questions Q7.1 How is pharmacovigilance defined? (Pg. 54) Q7.2 What are some recent examples of drugs removed from the market by the US Food and Drug Administration as a result of the pharmacovigilance process (as well as the reason for the drug being removed)? (Pg. 55) Q7.3 What are the three main categories of adverse effects used in pharmacovigilance? (Pg. 55) Q7.4 What are some of…

The FDA Drug Approval Process

Questions Q6.1 In the broadest sense, what are the general areas of oversight by the US Food and Drug Administration (FDA)? (Pg. 49) Q6.2 Approximately what percentage of the FDA budget comes from user fees? (Pg. 49) Q6.3 Concerning the Food Drug and Cosmetic Law of 1938 and the Kefauver–Harris Drug Amendment of 1962, what is (1) the scope of the laws, and (2) the key…

Medical Decision Making

Questions Q5.1 Why is a uniform treatment approach for all patients with a given dermatosis inappropriate? ( Pg. 40 ) Q5.2 How do you communicate the uncertainty of a diagnosis or treatment plan to a patient? ( Pg. 41 ) Q5.3 What three tenets characterize the overall approach to medical decision making and what general concepts are represented by these tenets? ( Pg. 41 ) Q5.4…

Adherence to Drug Therapy

Questions Q4.1 What is the most basic definition of adherence in clinical practice? (Pg. 34) Q4.2 What is the estimated cost to the US healthcare system of poor adherence in terms of (1) percentage of hospital admissions, and (2) total monetary cost? (Pg. 34) Q4.3 How is the ‘medication possession ratio’ defined? (Pg. 35) Q4.4 How are the following terms defined (1) acceptance, (2) persistence, and…

Polymorphisms: Why Individual Drug Responses Vary

Questions Q3.1 How are ‘polymorphism’ and ‘variability’ defined in the most basic sense? (Pg. 22) Q3.2 Regarding the cytochrome P-450 (CYP) isoforms discussed in this chapter, (1) which isoforms are most important to drug interactions, and (2) which of these isoforms have polymorphisms? (Pg. 22) Q3.3 Which three CYP isoforms are most important for drug metabolism based on the percentage of drugs metabolized by the respective…

Principles for Maximizing the Safety of Dermatologic Drug Therapy

Questions Q2.1 What four words characterize the overall approach to maximizing drug safety, and what general concepts are represented by these words? (Pg. 12) Q2.2 How are the ‘standards of care’ for drug therapy monitoring determined? (Pg. 13) Q2.3 What are several of the typical characteristics of the most worrisome adverse effects to systemic drug therapy (Pg. 13) Q2.4 In general, what are the most important…

Basic Principles of Pharmacology

Questions Q1.1 What are the simplest definitions of ‘pharmacokinetics’, ‘pharmacodynamics’, and ‘pharmacogenetics’? (Pg. 1, Table 1.1 ) Q1.2 What are several drugs or drug families for which the absorption may be altered by (1) food, (2) cations such as iron, calcium, and magnesium, and (3) variations in gastric pH? (Pg. 2) Q1.3 What are some of the pros and cons to the decision of whether to…

Skin Resurfacing Complications

Introduction Considering that skin resurfacing is, for the most part, an elective procedure, the tolerance for complications is very low on the part of the patient. For the physician, resurfacing the skin involves creating a controlled injury to the skin surface followed by the natural healing process of the skin. The recovery period for a medium-depth to deep peel can range from 7 to 14 days.…

Segmental Phenol Croton Oil Peels for Brow Lifting, Eyelid Tightening, and Lip Eversion

Introduction This special topic chapter explores a still pioneering aspect of deep chemical peeling using phenol–croton oil formulas. Although the basic concepts of safety, perioperative care, formulas, and the application of deep chemical peeling were well covered by Dr. Richard Bensimon, Dr. Marina Landau, and Dr. Peter Rullan in Chapter 12, Chapter 7, Chapter 8 , some extremely important phytochemical aspects are reinforced in this chapter…

Chemical Peeling as an Adjunct to Facelift and Eyelid Surgery

In this day and age of high technology, younger patients and surgeons often think that only devices or new technology is the answer to skin rejuvenation. Although contemporary technology has in fact opened new doors, the historic chemical peel still stands as a stalwart in skin rejuvenation. Many colleagues have spent upward of $200,000 for a skin rejuvenation device that produced the same results that could…

New Advances Combining the Chemical Reconstruction of Skin Scars (CROSS) and Subcision

Introduction Minor acne scarring occurs in up to 95% of acne cases, and 22% of these patients are affected with a more significant and psychologically disturbing degree of scarring (as reported by Layton et al., 1994). Various treatment modalities are used for reconstructing and improving the appearance of acne scars, including dermabrasion, punch excision, punch elevation, dermal fillers, microneedling (with/without radiofrequency), subcutaneous incision (subcision), and chemical and…

The Rullan Two-Day Croton Oil–Phenol Chemabrasion Peel

Introduction The phenol peel has been called a chemical facelift because it removes photodamage-related wrinkles and tightens the skin more effectively than other ablative techniques. To accomplish this, a deep croton oil–phenol peel extends to the upper to midreticular dermis (approximately 600 microns). Many physicians who perform cosmetic surgery still equate deep phenol peels with the well-known Baker-Gordon phenol peel. However, formula modifications made in the…