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Systemic Drugs in Dermatology
Kabir Sardana
CHAPTER 1:
Antibiotics
INTRODUCTION
Typical Structure of a Bacterial Cell (From Inside to Outside) (Fig. 1.1)
Gram-positive bacteria
Gram-negative Cell Structure
Classification Based on Mechanism of Action
PENICILLINS
β-Lactamase Inhibitors
CEPHALOSPORINS
MRSA INFECTIONS AND TREATMENT
Management
β-LACTAM ANTIBIOTICS
Mechanism of Action
Classification
Spectrum
Pharmacology
Absorption and Distribution
Clinical Use in dermatology
Dose
Usage guidelines
Special considerations
Penicillin Allergy Testing
Epicutaneous (Prick) Tests
Intradermal Test
Drug interactions
Adverse Effects
Special Groups
CEPHALOSPORINS
Spectrum
First generation
Second generation
Third generation
Fourth-Generation Cephalosporins
Fifth-Generation Cephalosporins
Pharmacology
Excretion
Dosages
First-generation Cephalosporins
Second-generation Cephalosporins
Third-generation Cephalosporins
Fourth-generation Cephalosporin
Fifth-generation Cephalosporin
Indications
First generation
Second generation
Third generation
Fifth Generation
Interactions
Adverse Effects
GIT
Hypersensitivity reactions and cross-reaction potential
Hematologic effects
Miscellaneous Side Effects
Special Populations
CARBAPENEMS
Spectrum of Action
MONOBACTAMS
GLYCOPEPEPTIDE
Mode of Action
Spectrum
Spectrum of activity of Glycopeptides
Pharmacology
Dosages
Indications
Clinical use
Drug interactions
Adverse Effects
Dermatological Side effects
Systemic Side effects
Special Population
Mode of action
MLSK (MACROLIDES, LINCOSAMIDES, STREPTOGRAMINS, KETOLIDES)
Classification
Spectrum of Action
Mode of Action
Macrolides
Mechanism of Action
Pharmacology
Absorption and Distribution
Clinical Use in dermatology
Usage guidelines
Special considerations
Drug interactions
Adverse effects
Special Groups
Clindamycin
Mode of Action
Spectrum
Pharmacology
Dosage
Uses
Drug Interactions
Adverse effects
Special Populations
TETRACYCLINES (TCN)
Mechanism of Action
Spectrum
P. acnes Resistance
Pharmacology
Minocycline (Extendedrelease versusimmediaterelease) (Del Rosso J)
Doxycline (MR/Low dose)
Absorption and Distribution
Usage guidelines
Clinical use
1. Acne
2. Rosacea
3. Perioral dermatitis
4. Granulomatous dermatoses
5. Immunobullous dermatoses
6. CA-MRSA infections
7. Rickettsial Diseases
8. Syphilis
9. Lymphogranuloma venereum (LGV)
10. Atypical mycobacterial infections
11. Vitiligo
Monitoring
Special considerations
Drug interactions
Adverse effects
Common
Rare Side Effects
Special Groups
TIGECYCLINE
Mechanism of Action
Spectrum
Dose
Special Population
LINEZOLID
Mechanism of Action
Spectrum
Pharmacology
Dosage
Uses
Interactions
Adverse Effects
Special Populations
RIFAMYCINS
Mechanism of Action
Spectrum
Pharmacology
Indications
Dose
Clinical Use
A. Infections
B. Hidradenitis Suppurativa
C. Granuloma Annulare
D. Pruritus
E. Sarcoidosis
Interactions
Adverse effects
A. Common
B. Rare Side Effects
Special Populations
TRIMETHOPRIM-SULFAMETHOXAZOLE
Mechanism of Action
Spectrum
Absorption and Distribution
Uses
Dose
Drug interaction
Special Considerations
Advice to patient
Side Effects
Others
Monitoring
Special Groups
POLYMYXIN
CYCLIC LIPOPEPTIDES
Mechanism of Action
Uses
Spectrum
Dose
Side Effects
CHAPTER 2:
Antifungal Medications
INTRODUCTION
Classification of Antifungals
ANTIFUNGAL DRUGS
According to Chemical Structure
According to Mode of Action
According to Site of Action
Mechanism of Action
AMPHOTERICIN B
Classification
Category
Mechanism of Action
Absorption and Distribution
Uses
Dosage
Alternative Routes of Administration
Drug Interaction
Side Effects
A. Infusion-related Toxicity
B. Cumulative Toxicity
Monitoring
Special Groups
Liposomal Amphotericin B
GRISEOFULVIN
Classification
Mechanism of Action
Pharmacology
Absorption and Distribution
Clinical Use in Dermatology
Usage Guidelines
Special Considerations
Drug Interactions
Adverse Effects
Special Groups
AZOLES
Itraconazole
Classification
Category
Mechanism of Action
Mechanisms of Resistance
Absorption and Distribution
Pharmacokinetics in Skin
Pharmacokinetics in Nail
Pharmacokinetics in Hair
Metabolism
Uses/Dosages
Drug Interaction
Special Considerations
Side Effects
Monitoring
Special Category
Fluconazole
Classification
Category
Mechanism of Action
Absorption and Distribution
Pharmacokinetics in Skin
Pharmacokinetics in Nail
Pharmacokinetics in Hair
Metabolism
Uses/Dosages
Drug Interaction
Special Considerations
Side Effects
Special Category
Ketoconazole
Mechanism of Action
Absorption and Distribution
Uses
Drug Interaction
Side Effects
TERBINAFINE
Classification
Category
Mechanism of Action
Absorption and Distribution and Metabolism
Pharmacokinetics in Skin
Pharmacokinetics Nail
Pharmacokinetics in Hair
Metabolism
Uses/Dosages (Table 2.10)
Drug Interaction
Special Considerations
Side Effects
Monitoring
Special Category
NEWER ANTIFUNGAL AGENTS
1. Voriconazole
Classification
Absorption and Distribution
Metabolism
Dosage
Drug Interaction
Side Effects
Special Groups
2. Posaconazole
Absorption and Distribution
Dose
Uses
Side Effects
3. Echinocandins
Dose
Clinical Use
Caspofungin
Absorption and Distribution
Dose
Uses
Dosage
Drug Interactions
Side Effects
Special Groups
CHAPTER 3:
Antihistaminics
INTRODUCTION
Classification
Dibenzoxepin Tricyclics
Ethanolamines
Alkylamines
First-generation Piperazines
Second-generation Piperazines
First-generation Piperidines
Second-generation Piperidines
HISTAMINE AND ITS RECEPTORS
MECHANISM OF ACTION OF ANTIHISTAMINES
OVERVIEW OF PHARMACOKINETICS AND PHARMACODYNAMICS
Absorption
Distribution
Metabolism and Elimination
Action on Target organ
Tachyphylaxis
OTHER THERAPEUTIC AGENTS WITH ANTIHISTAMINIC ACTIVITY
Tricyclic Antidepressants
Ketotifen
ANTIHISTAMINES IN URTICARIA
Comparative Effectiveness
Combination therapy with antihistamines
Making Sense of Guidelines
ANTIHISTAMINES IN PRURITUS
ANTIHISTAMINES IN ATOPIC DERMATITIS
OTHER USES
ANTIHISTAMINE DRUGS
Second Generation Non-sedating Antihistamines
1. Cetirizine (Piperazine)
2. Levocetirizine (Piperazine)
FIRST GENERATION SEDATING ANTIHISTAMINES
1. Chlorpheniramine Maleate
Classification
Mechanism of Action
Absorption and Distribution Metabolism
Uses/Dosages
Dexchlorpheniramine
Drug interaction
Special Considerations
Side Effects
Special Category
2. Hydroxyzine Hydrochloride
Classification
Category
Mechanism of Action
Absorption and Distribution
Uses
Dosage
Drug interaction
Special Considerations
Side Effects
Special Populations
3. Doxepin
Category
Mechanism of Action
Absorption and Distribution
Uses
Dosage
Special Considerations
Side Effects
Contraindications
Special Groups
Pregnancy
Lactation
4. Promethazine
Classification
Absorption and Distribution
Uses
Special Considerations
Drug Interactions
Side Effects
Special Populations
KETOTIFEN
Classification
Absorption and Distribution
Uses
Dose
Drug interaction
Adverse Effects and Precautions
CHAPTER 4:
Antiandrogens
INTRODUCTION
Alopecia
Acne
Hirsutism
SPIRONOLACTONE
Classification
Chemical Class
Mechanism of Action
PK, Absorption and Distribution
Clinical Use in Dermatology
Usage Guidelines (Table 4.4)
1. Hirsutism
2. Acne Vulgaris
How to Suspect and when to Treat as a Case of Hormonal Acne
Special Considerations
Drug Interactions
Adverse Effects
Common
Rare
Cutaneous
Monitoring
Special Groups
Pregnancy
Children
Lactation
Renal
Hepatic
Elderly
DROSPIRENONE
Classification
Mechanism of Action
Clinical use in Dermatology
Usage Guidelines
Acne
Hirsutism
Monitoring
Special Considerations
Drug Interactions
CYPROTERONE ACETATE
Classification
Mechanism of Action
Clinical use in Dermatology
Usage Guidelines
Acne
Hirsutism
Monitoring
Special Considerations
Adverse Effects
FINASTERIDE
Classification
Mechanism of Action
Absorption and Distribution
Clinical Use in Dermatology (Table 4.6)
Usage Guidelines
Special Considerations
Drug Interactions
Adverse Effects
Rare Side Effects
Monitoring
Special Groups
Pregnancy
Children
Lactation
Renal
Hepatic
Elderly
Finasteride and Minoxidil
DUTASTERIDE
Mechanism of Action
Pharmacology
Clinical use in Dermatology
Off-label Use
Usage Guidelines
Dose
Male Pattern Alopecia
Female Pattern Alopecia
Special Considerations
Drug Interactions
Adverse Effects
DANAZOL
Classification
Mechanism of Action
Uses/Dosage
Drug Interaction
Special Considerations
Side Effects
Common
Rare
Monitoring
Special Groups
SERENOA REPENS
Constituents
Classification
Mechanism of Action
Pharmacokinetics
Uses
Dosage
Drug Interaction
Special Considerations
Side Effects
ORAL CONTRACEPTIVES
Mode of Action
Contraceptive Dosing
Risks Associated with OCPs
Adverse Effects
a. Mild Adverse Effects
b. Moderate Adverse Effects
c. Severe Adverse Effects
OCP IN HYPERANDROGENIC STATES
Mode of Action
Measuring Androgen Levels
OCPs Use for Acne
OC vs Antibiotics
Prescription Logic of 24/4 and 21/7 Cycle Pills
COMBINATION OCP
Drospirenone/ethinyl Estradiol
Mechanism of Action
Uses
Dosage
Day 1 Start
Sunday Start
Drug Interaction
Drug Increasing the Plasma Concentrations of COC
Combined Oral Contraceptives on Other Drugs
Special Considerations
Side Effects
Common
Rare
CONCLUSION
CHAPTER 5:
Antiparasitic/Antiprotozoal Agents
DRUGS FOR TROPICAL PARASITIC INFECTIONS
SODIUM STIBOGLUCONATE
Pharmacology: Absorption, Distribution and Metabolism
Mechanism of Action
Uses
Dosage
Contraindications and Precautions
Side Effects
Drug Monitoring
Special Groups
Pregnancy and Lactation
Children
MILTEFOSINE
Metabolism: Absorption, Fate, and Excretion
Mechanism of Action
Spectrum of Activity
Uses
Dosage
Contraindications
Drug Interaction
Side Effects
Monitoring
Special Groups
Pregnancy: X Liver and Kidney Failure
AMPHOTERICIN B
Drug Formulations
Pharmacology: Absorption, Distribution and Metabolism
Mechanism of Action
Uses
Leishmaniasis
Dosage
Contraindications and Precautions
Side Effects
Monitoring
Special Groups
IVERMECTIN
Classification
Mechanism of Action
Absorption and Distribution
Dosage
Uses (Approved/Unapproved)
Resistance
Drug Interaction
Side Effects
Special Groups
Pregnancy
Lactation
ALBENDAZOLE
Category
Absorption and Distribution
Metabolism
Uses (Approved/Unapproved)
Dosage of Albendazole
Drug Interaction
Side Effects
Monitoring
Special Groups
Liver Failure
Kidney Failure
CHAPTER 6:
Antiviral Agents
INTRODUCTION
Clinical Application
Herpes genitalis
Other Herpetic Infections
Comparative Efficacy
Acyclovir Resistance
Pregnancy
ACYCLOVIR
Classification
Mechanism of Action
Absorption and Distribution
Metabolism
Uses
FDA Approved
Unapproved
Dosage
1. Genital HSV
2. Herpes Labialis
3. Chickenpox
4. Herpes zoster (HZ)
Drug interaction
Special Considerations
Side Effects
Monitoring
Special Groups
Pregnancy: C
VALACYCLOVIR
Mechanism of Action
Absorption and Distribution
Bioavailabiliy: 54%
Metabolism
Uses
FDA Approved
Unapproved
Immunocompromised Host
Drug interaction
Side Effects
Special Groups
Lactation
Kidney Failure
FAMCICLOVIR
Absorption and Distribution
Metabolism
Uses
FDA approved
Unapproved
Dosage
Genital HSV
Herpes labialis
Chickenpox
Herpes zoster (HZ)
Immunocompromised Host
Drug interaction
Special Groups
Pregnancy: B
Lactation: Unknown
Kidney Failure:
CHAPTER 7:
Biologicals
BIOLOGICALS FOR PSORIASIS
1. T Cell/APC Interaction
2. Cytokine production
3. Small molecular weight inhibitors (SMIs)
Oral Antipsoriatic Biologicals
New Third Generation Biologicals
Monitoring of patients receiving biologic therapy
What is the Ideal Biological in Psoriasis?
Future Concepts
BIOLOGICALS AGAINST B CELLS
Rituximab
ETANERCEPT
Classification
Category
Mechanism of Action
Absorption, Distribution and Metabolism
Uses
Special Considerations (For All Anti-TNF Biologics)
Contraindications
Hepatitic C
Hepatitis B
Tuberculosis
Side Effects
Monitoring
Special groups
Pregnancy Category
Lactation
INFLIXIMAB
Classification
Category
Mechanism of action
Absorption, Distribution and Metabolism
Uses
Special Consideration
Contraindications
Side Effects
Infusion-related reaction with infliximab
Antidrug antibodies
Monitoring Guidelines
ADALIMUMAB
Classification
Category
Absorption, Distribution and Metabolism
Uses
Special Considerations
Side Effects
Monitoring Guidelines
ITOLIZUMAB3
Category
Chemistry
Mechanism of Action
Uses of Itolizumab
Effect on psoriasis
Pharmacokinetics and dynamics
Dosage
Drug interactions
Special considerations
Contraindications
Monitoring
Side effects
Common
Uncommon
RITUXIMAB4
Classification
Category
Mechanism of Action
Absorption and Distribution
Uses
FDA Approved Uses
Off-label Uses
Dosage
Premedication and rituximab administration
Drug interaction
Side Effects
Common
Rare
Contraindications
Monitoring
Special Groups
Pregnancy
Lactation
Liver Failure
Kidney Failure
Children
Geriatric
Carcinogenicity
OMALIZUMAB5
Classification
Category
Mechanism of Action
Absorption and Distribution
Metabolism
Uses and Dosage
Urticaria
Off-label uses
Drug interaction
Special Considerations
Side Effects
Monitoring
Special Groups
Pregnancy
Lactation
Children
CHAPTER 8:
Immunosuppressive Drugs
INTRODUCTION
The Adaptive Immune System
TARGETS OF IMMUNOPHARMACOLOGICAL DRUGS
Cytokines
Lymphocytes
MODE OF ACTION OF IMMUNOPHARMACOLOGICAL DRUGS
MYCOPHENOLATE MOFETIL1
Mechanism of Action
Absorption and Distribution
Metabolism and Distribution
Uses/Indications
Dose
Uses
a. Pemphigus/BP
Drug Interaction
Special Considerations
Availability
Side Effects
Common Side Effects
Uncommon Side Effects
Monitoring
METHOTREXATE
Classification
Mechanism of Action (Box 8.1)
Absorption and Distribution
Metabolism
Uses (Box 8.2)
FDA Approved
Psoriasis
Off Label Use
Dosage
Dose
Drug Interaction
Drugs that Cause Hepatic Damage
Drugs that cause Renal Damage
Increase Levels of Methotrexate
Increased Risk of Blood Dyscrasias
Increased Hematologic Toxicity
Special Considerations
Advice to Patient
Side Effects
Gastrointestinal
Hematologic
Hepatic
Oncogenic Potential
Reproductive Toxicity
Opportunistic Infections
Pulmonary Side Effects
Miscellaneous
Cutaneous
Skeletal
CNS
CVS
Monitoring
What to Monitor?
Baseline Evaluation
Methotrexate Toxicity
Special Groups
Pregnancy
Lactation
Liver Failure
Kidney Failure
Children
Elderly
AZATHIOPRINE
Chemical Class
Mechanism of Action
Pharmacokinetics
Absorption and Distribution
Usage Guidelines
Dosage
Clinical use in Dermatology
Immunobullous Disorders
Photodermatoses
ABCD (Air Borne Contact Dermatitis)
AD
Vasculitis
DM/SLE
Lichen Planus
Vitiligo
Special Considerations
Patient Instructions
Drug Interactions
Side Effects
Common
Rare
Monitoring
TPMT Levels: Critical Analysis
Special Groups
Pregnancy: D
Children
Lactation
Renal
Hepatic
CYCLOSPORINE
Chemical Class
Mechanism of Action
Pharmacokinetics/Absorption and Distribution
Usage Guidelines
Dosage
Clinical use in Dermatology
Special Considerations
Contraindication
Patient Instructions
Drug Interactions
Side Effects
Monitoring
Special Groups
Pregnancy
Children
Lactation
Elderly
CYCLOPHOSPHAMIDE
Classification
Mechanism of Action
Absorption and Distribution
Metabolism and Elimination
Uses (Approved/Unapproved) (Box 8.9)
Pemphigus
Vasculitis
Dosage/Modifications
Dosage and Monitoring
Drug Interaction
Special Considerations
Contraindications
Side Effects
Monitoring (Box 8.13)
Special Groups
Liver Failure
Kidney Failure
CHAPTER 9:
Corticosteroids
INTRODUCTION
History
Classification
Mechanism of Action
A. Genomic and Nongenomic Effects
B. Immune System
C. Hypothalamic–Pituitary–Adrenal Axis
Absorption and Distribution
1. Plasma-protein Binding
2. Half-life
3. Rate of Metabolism
Uses
Acne
Alopecia Areata
Acute febrile neutrophilic dermatosis (Sweet’s syndrome)
Atopic dermatitis
Behçet’s disease
Hemangiomas
Herpes zoster and postherpetic neuralgia
Kerion
Lichen planus
Pemphigus
Bullous pemphigoid
Cicatricial pemphigoid (mucous membrane pemphigoid)
Sarcoidosis
Stevens–Jöhnson syndrome and toxic epidermal necrolysis
Lupus erythematosus
Dermatomyositis
Vasculitis
Vitiligo
Pyoderma gangrenosum
Acute/Subacute Eczema
Dose
Dosage Regimens (Fig. 9.4)
Glucocorticoid Withdrawal Regimens
Tapering Schedule
Drug Interaction
Special Considerations
Glucocorticoid Sensitivity and Resistance
Side Effects
1. Cutaneous Side effects
2. Skeletal Adverse Effects
3. Myopathy
4. Gastrointestinal Adverse Effects
5. Immunologic Adverse Effects
6. Cardiovascular Adverse Effects
7. Ocular Adverse Effects
8. Endocrine/Metabolic Adverse Effects
9. Suppression of the Hypothalamic–Pituitary–Adrenal Axis
10. Central Nervous System and Behavioral Effects
11. Menstrual Disturbances
Monitoring
Special Groups
Pregnancy
Lactation
Children
CHAPTER 10:
Nonsteroidal Anti-inflammatory Drugs
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
Mode of Action
Inhibition of Prostaglandin Biosynthesis By NSAIDs
Therapeutic Effects
1. Anti-inflammatory Effects
2. Analgesic Effects
3. Antipyretic Effects
4. Antiplatelet Effects
5. Cancer Chemoprevention
ASPIRIN
Mechanism of Action
Uses (Approved/Unapproved)
1. Livedoid vasculopathy (atrophie Blanche)
2. Antiphospholipid Antibody Syndrome
3. Erythema Nodosum
Dosage
Drug interaction
Contraindicated Combinations
Not Recommended Combinations
CHAPTER 11:
Psoralens (UVA)
PSORALEN
Classification
Mechanism of Action
Immunomodulatory action
Pharmacology
Absorption and Distribution
Oral
Topical
PUVA Erythema
Usage Guidelines
1. Oral PUVA
2. Bath PUVA
3. Topical PUVA
4. Topical PUVAsol
5. P-NBUVB
Clinical use in dermatology
Psoriasis
Combination Treatments (Psoriasis)
Vitiligo
a. PUVA
b. PUVA (sol)
c. Bath PUVA
d. Topical PUVA
e. Topical PUVA (sol)
f. P-NBUVB
PUVA for Cutaneous T-cell Lymphoma, in Particular Mycosis Fungoides
PUVA for Atopic Dermatitis
PUVA for Lichen Planus
PUVA for Graft-versus-Host Disease
PUVA for Urticaria Pigmentosa
PUVA for Photodermatoses
PUVA for Miscellaneous Dermatoses
Monitoring
Special Considerations
Drug interactions
Adverse effects
Special Groups
Lactation
UPDATE ON TREATMENT OF VITILIGO AND THE ROLE OF PUVA
Conclusion
PSORIASIS
Systemic Psoralen Plus Ultraviolet A (PUVA) Protocol
Subsequent Treatments
Maintenance Therapy for PUVA
PUVAsol
VITILIGO
Systemic Psoralen Plus Ultraviolet A (Puva) Treatment
Protocol
Subsequent Treatments
Psoralen Lotion Plus Ultraviolet A (Paint Puva)
Protocol
Subsequent Treatments
Oral TMP (TMP/8 MOP)/PUVAsol
Topical PUVAsol
What to Expect?
CHAPTER 12:
Retinoids
SYSTEMIC RETINOIDS
Metabolism and Mode of Action
Classification
ISOTRETINOIN
Category
Mechanism of Action
Absorption and Distribution
Metabolism
Uses
Other
ACNE VULGARIS
Standard Dose
Low Dose
High Dose
How to Decide the Ideal Dose Regimen ?
Acne Variants
Atrophoderma Vermiculatum
Condylomata Acuminata
Rosacea
Darier’s Disease
Hidradenitis Suppurativa and Dissecting Cellulitis of the Scalp
Lupus Erythematosus
Pityriasis Rubra Pilaris
Lichen Planus
Skin Cancer
Drug Interaction
Special Considerations
Side Effects
Dermatological
Ocular
Musculoskleteal
Serum Lipids
Liver
Hematological
Psychiatric
Gastrointestinal Tract
Cardiovascular System
Central Nervous System
Respiratory System
Others
Monitoring
Special Groups
Pregnancy: X
Lactation: X
Kidney Failure
Children
NOVEL ISOTRETINOIN VARIANTS
APPENDIX
ACITRETIN
Classification
Chemical Class
Mechanism of Action
Pharmacology
Absorption and Distribution
Clinical use in Dermatology
Others
Usage Guidelines
Psoriasis
Chemoprevention of Malignancy
Darier’s Disease
Hyperkeratotic Palmoplantar Dermatitis (Keratoderma)
Ichthyosis
Lichen Planus
Lichen sclerosus et Atrophicus (Vulva)
Cutaneous Lupus Erythematosus
Pityriasis Rubra Pilaris
Adverse Effects
Common
Rare
Monitoring
Special Considerations
Drug Interactions
Special Groups
Pregnancy: X
Children
Lactation
Renal
Hepatic
BEXAROTENE
Mechanism of Action
Clinical Use
Usage Guidelines
CTCL – Mycosis Fungoides and Sézary Syndrome
Chronic Hand Eczema
Monitoring
Special Considerations
Drug Interactions
Adverse Effects
Common
Rare
8ALITRETINOIN
RETINOIC ACID METABOLISM BLOCKING AGENTS
CHAPTER 13:
Vasoactive Drugs
VASODILATOR DRUGS
Calcium-channel blockers (Nifedipine/Diltiazem)
Mechanism of Action
Absorption and Distribution
Uses
1. Raynaud's Phenomenon, Systemic Sclerosis, Chilblains
2. Calcinosis Cutis
3. Wound Healing
4. Keloids
5. Chronic Anal Fissures
6. Cyclosporine-induced Hypertension
Side Effects
PROPRANOLOL (Ciplar 10 mg, 20 mg)
Mechanism of Action
Absorption and Distribution
Uses (Approved/Unapproved)/Dosage
Hemangioma
Drug interaction
Special Considerations
Cardiac monitoring
Hypoglycemia
Side Effects
Common
Rare
Monitoring of Propranolol
SILDENAFIL (Suhagra/Suhagra Force) (Sildenafil 25 mg, 50 mg)/(Sildenafil 50 mg/Dapoxetine 30 mg)
Mechanism of Action
Absorption and Distribution
Biotransformation
Elimination
Uses (Approved/Unapproved)
Dosage
Use in adults
Drug interaction
Special Considerations
Side Effects
Special Groups
Elderly patients
Patients with renal impairment
Patients with hepatic impairment
Pediatric population
Use in patients taking other medicinal products
BOSENTAN (62.5 mg/125 mg)
Mechanism of Action
Absorption and Distribution
Absorption
Distribution
Biotransformation and elimination
Dosage
Adults
Uses (Approved/Unapproved)
Drug Interaction
Side Effects
Liver function
CHAPTER 14:
Psychotropic Agents
PSYCHOTROPIC DRUGS
Classification
Overview of Common Psychiatric Afflictions
1. Anxiety Disorder
2. Depression
3. Psychosis
4. Obsessive–Compulsive disorder
ANTIPSYCHOTICS
Treatment of Dermatologic Conditions with Underlying Psychotic/Delusional Functioning
Chemistry
Mechanism of Action
Drugs Overview
1. Risperidone
2. Quetiapine
3. Olanzapine
4. Aripiprazole
5. Pimozide
Pharmacology
Clinical Uses
Delusion of Parasitosis
Psychogenic Excoriation
Post-herpetic Neuralgia
Dermatitis Artefacta
Lichen Simplex Chronicus
Others
Drug interaction
Side Effects
EPS
Cardiovascular System
Others
Monitoring
DEPRESSIVE DISORDERS
Antidepressants
Pharmacology
Mechanisms of Action
Indications
Obsessive–Compulsive Disorder (OCD)
Generalized Anxiety Disorder (GAD)
Body Dysmorphic Disorder (BDD)
Pain Disorders
Premenstrual Dysphoric Disorder
Other Uses for Antidepressants
How to Choose an Antidepressant?
TRICYCLIC ANTIDEPRESSANTS
Pharmacology
Mechanisms of Action
Adverse Effects
Special population
Monitoring
Doxepin
Spectra (10 mg, 25 mg)
Dermatological Uses
Dosages
Special considerations
Adverse Effects
Amitriptyline and Nortriptyline
Sensival (Nortriptyline)
Dosages
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
Pharmacology
Clinical Uses in Dermatology
1. OCD
2. Psychogenic excoriations
3. Body dysmorphic disorder
4. Raynauds phenomenon
5. Pruritus
6. Trichotillomania
Drug Interactions
Side Effects
a. Common
b. Rare
NON-SSRI DRUGS
1. Mirtazapine
Pharmacology
Dosage
Indication
Adverse Reactions
2. Venlafaxine
Indication
Dose
Side effects
BENZODIAZEPINES
1. Alprazolam
2. Diazepam
NONBENZODIAZEPINES
Buspirone
Dose
Side Effects
Hypnotics
CHAPTER 15:
Nutritional Supplements
INTRODUCTION
NUTRITIONAL AGENTS AND ALOPECIA
Iron
Amino Acids
Gelatin
Botanical Antiandrogens
Fats and Essential Fatty Acids
Trace Elements
Vitamins
Phytoestrogens
Conclusion
NUTRITIONAL AGENTS AND PSORIASIS
Antioxidants
Fish Oil
Gluten-free Diet
Vitamin D
Conclusion
NUTRITIONAL AGENTS AND ATOPIC DERMATITIS
Hydrolized Formula
Delayed Introduction of Solid Foods
Exclusions
Fish Oil
Probiotics/Prebiotics
DIET AND URTICARIA
Wheat
Pseudoallergens
Artificial Pseudoallergens
Natural Pseudoallergens
Probiotics
Natural Remedies
Conclusion
DIET AND BULLOUS DISORDERS
Pemphigus (Pemphigus Vulgaris, Foliaceus, Paraneoplastic Pemphigus, and IgA Pemphigus)
Bullous Pemphigoid
Linear IgA Disease
Dermatitis Herpetiformis
Gluten
DIET AND ACNE
Vitamin A
Essential Fatty Acids
Essential Elements
High Glycemic Diet
Conclusion
ORAL IRON
Absorption and Distribution
Uses
Iron Deficiency
Pruritus
Iron and Hair
Iron and Nails
Dosage
Compound Preparations
Side Effects
VITAMIN D
Vitamin D Synthesis in Skin (Fig. 15.1)
Mechanism of Action
Inhibition of Proliferation and Induction of Differentiation in Keratinocytes
Immunomodulatory Effects in the Skin (Fig. 15.2)
Dosage
Vitamin D Deficiency in the Tropics
Implications of Low Vitamin D Status and Low Dietary Calcium Intake in India
Other Causes of Vitamin D Deficiency
Uses
Psoriasis
Ichthyosis
Scleroderma
Vitiligo
Vitamin D and Other Skin Diseases
Side Effects
VITAMIN E
Metabolism
Uses and Mode of Action
Ultraviolet Protection
Cancer Prevention
Melasma
Photodamage
Combination
CAROTENOIDS (VITAMIN A)
Dietary Carotenoids
Metabolism
Carotenoids Biodistribution to Skin
Deficiency States
Uses of Carotene
Photoprotection
Aging, and Skin Cancer
Dysplastic Nevi
VITAMIN K
Absorption and Distribution
Deficiency States
Investigations
Treatment
VITAMIN B2 (RIBOFLAVIN)
Deficiency States
Clinical Features
Treatment
VITAMIN B3 (NIACIN)
Deficiency States
Clinical Features
Treatment
VITAMIN B6
Absorption and Metabolism
Deficiency States
Clinical Features
Treatment
VITAMIN B7
Absorption and Distribution
Deficiency States
Clinical Features
Treatment
VITAMIN B9 AND B12
Deficiency States
VITAMIN B12
Deficiency States
Clinical Features
Treatment
VITAMIN C
Absorption and Distribution
Mechanism of Action
Uses (Approved/Unapproved)
Deficiency States
Clinical Features
Management
INTRODUCTION
ANTIOXIDANT SYSTEMS IN THE SKIN
Primary Antioxidants
Secondary Antioxidants
Protective Repair Enzymes and their Cofactors
Chelation Agents
Categories of Cosmetic Antioxidants
Endogenous (Biological) Antioxidant Systems
Exogenously Supplied Antioxidants
Plant-derived Antioxidants
Antioxidant Synergy
INDIVIDUAL ANTIOXIDANTS
Fat-soluble Antioxidants
Vitamin E
Coenzyme Q10 (Ubiquinone)
Idebenone
Lycopene
Curcumin
Water-soluble Antioxidants
Glutathione
Vitamin C
Green Tea
The Fat- and Water-soluble Antioxidant
Alpha Lipoic Acid
Conclusion
INTRODUCTION
Dermatological Significance of EFA
Absorption and Distribution
PUFAs Metabolism
PUFA-derived Signaling Molecules
Cox and Lox Enzymes
MECHANISM OF ACTION
Skin Barrier
PPAR Receptors and EFA
TLR Receptors and ω-3 Fatty Acids
Immune-modulating Roles of ω-3 fatty Acids in the Epidermis and Skin Disease
INDICATIONS
Hypertriglyceridemia (FDA Approved)
Off Label Indication
Atopic Dermatitis
Psoriasis and ω-3 Fatty Acids
Skin Cancer and ω-3 Fatty Acids
Systemic Lupus Erythematosus and ω-3 Fatty Acids
Acne Vulgaris
Stasis Dermatitis and Decubitus Ulcers
Conclusion
CHAPTER 16:
Analgesics
INTRODUCTION
PAIN CLASSIFICATION
ANALGESICS
A. Antidepressants
1. Tricyclic Antidepressants
2. Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
B. Anticonvulsants
1. Gabapentin
2. Pregabalin
Toxicity of Gabapentin and Pregabalin
OPIOIDS
1. Codeine
2. Tramadol
3. Tapentadol
4. Naltrexone
Classification
Mechanism of Action
Pharmacology
Uses
Dosage
Drug Interaction
Monitoring
Side Effects
MANAGEMENT OF CHRONIC NEUROPATHIC PAIN
Stepwise Management (Fig. 16.1)
CHAPTER 17:
Miscellaneous Agents
COLCHICINE (ZYCOLCHIN)1
Mechanism of Action
Absorption and Distribution
Uses (Approved/Unapproved)
Dosage
Drug Interaction
Special Considerations
Side Effects
Common
Rare
Monitoring
Special Groups
CLOFAZIMINE
Mechanism of Action
Absorption and Distribution
Uses (Approved/Unapproved)
Drug interaction
Side Effects
Cutaneous Effects
Systemic Effects
Monitoring
CHLOROQUINE AND HYDROXYCHLOROQUINE
Chemical Class
Mechanism of Action
Immunomodulatory
Anti-inflammatory Properties
Dermatological Actions
Pharmacology
Absorption and Distribution
Excretion
Clinical Use in Dermatology (Box 17.2)
Lupus Erythematosus
Dermatomyositis
Jessner's Lymphocytic Infiltrate
Pseudolymphoma
Porphyria Cutanea Tarda
PMLE
Chronic Ulcerative Stomatitis
Sarcoidosis
Granuloma Annulare
Lichen Planus
Panniculitis
Dosage
Usage Guidelines
Monitoring (Table 17.5)
Special Considerations
Drug Interactions
Adverse Effects
Ocular Symptoms
Dermatological
Hematological
Neuromuscular Symptoms
Cardiovascular
Special Groups
Children
Pregnancy
Lactation
DAPSONE
Mechanism of Action
Absorption and Distribution
Uses (Approved/Unapproved) (Table 17.8)
Dosage
Children
Drug Interaction
Special Considerations
Side Effects
Common
Rare
Dermatological
Nervous system
Gastrointestinal Effects/Hepatic Reactions
Hypersensitivity Syndrome (HS)
Monitoring
Strategies to Reduce Hematologic Adverse Effects
LEFLUNOMIDE
Classification
Mechanism of Action
Pharmacokinetics
Usage Guidelines
Clinical Use
Rheumatoid Arthiritis
Psoriasis and Psoriatic Arthritis
Others
Monitoring
Special Considerations
Adverse Effects
Common
Gastrointestinal and Hepatic Side Effects
Rare
Special Groups
Pregnancy
Washout Procedure
Hepatic
LEUCOVORIN: CALCIUM FOLINATE (CALCIUM LEUCOVORIN)
Classification
Absorption and Metabolism
Mechanism of Action
Pharmacology
Clinical Use in Dermatology
Monitoring
Special Considerations
Drug Interactions
Adverse Effects
Special Groups
METFORMIN
Absorption and Distribution
Pharmacokinetics
Dosage
Uses (Approved/Unapproved)
Approved
Unapproved
Side Effects
Drug Interactions
Monitoring
Special Populations
OXYBUTYNIN HYDROCHLORIDE
Mechanism of Action
Absorption and Distribution
Pharmacodynamic Properties
Pharmacokinetic Properties
Uses (Approved/Unapproved)
Dosage
Drug Interaction
Special Considerations
Contraindications
Special Advise
Side Effects
Special Groups
Children
Obese
Women
PENICILLAMINE
Mechanism of Action
Absorption and Distribution
Uses (Approved/Unapproved)
Rheumatoid Arthritis
Progressive Systemic Sclerosis
Periocular Pigmentation
Drug Interaction
Special Considerations
Contraindications
Side Effects
Monitoring
PENTOXIFYLLINE2
Classification
Absorption and Distribution
Mechanism of Action
Immune Modulation
Hemorheological Effects
Wound Healing and Connective Tissue
Nonselective Inhibitor of Cyclic-3', 5'-phosphodiesterase (PDE)
Others
Pharmacology
Dose
Clinical Use in Dermatology
Special Considerations
Drug Interactions
Adverse Effects
Special Groups
POTASSIUM IODIDE
Classification
Mechanism of Action
Absorption and Distribution
Dosage
Dose
Uses
Drug Interaction
Special Considerations
Contraindication
Side Effects
Monitoring
Special Groups
SULFASALAZINE (SAAZ DS 100 mg SAAZ 500 mg)
Classification
Mechanism of Action
Pharmacology
Absorption and Distribution
Usage Guidelines
Clinical Use in Dermatology
Alopecia Areata
Discoid Lupus Erythematosus
Lichen Planus (Omidian M)
Pemphigus
Psoriasis
Urticaria
Dermatitis Herpetiformis (Willsteed E)
Monitoring
Special Considerations
Drug Interactions
Adverse Effects
Gastrointestinal and Hepatic
Hematologic
Dermatologic
Pulmonary
Miscellaneous
Special Groups
MESALAMINE [(5-AMINOSALICYLIC ACID (5-ASA)]
TRANEXAMIC ACID
Mechanism of Action
Absorption and Distribution
Pharmacodynamic Properties
Pharmacokinetic Properties
Uses (Approved/Unapproved)
FDA Approved
Unapproved
Drug Interaction
Contraindications
Special Considerations
Side Effects
Common
THALIDOMIDE (Redemide, Thalix)3
Classification
Metabolism
Mechanism of Action
Pharmacology
Dosage Principles
Drug Interactions
Clinical Use in Dermatology
Monitoring
Special Considerations
Drug Interactions
Adverse Effects
Special Groups
Females
Men
Elderly Population
Patients with Renal or Hepatic Impairment
ZINC SALTS
Absorption and Distribution
Dosage
Uses (Approved/Unapproved)
Acquired Zinc Deficiency
Acrodermatitis Enteropathica
Acne Vulgaris
Behcet's Disease and Oral Aphthosis
Verruca Vulgaris
Cutaneous Leishmaniasis
Leprosy
Drug Interaction
Side Effects
Special Groups
INDEX
TOC
Index
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