NURS 8024 PHARM EXAM SCRIPT 2025/2026 QUESTIONS
WITH SOLUTIONS GRADED A+
✔✔Adverse local reactions caused by acyclovir or penciclovir - ✔✔Pruritus and mild
pain with transient stinging and burning
✔✔Immunomodulator: Imiquimod (Aldara) - ✔✔tx of external genital and perianal warts
in adults, actinic keratoses on face and scalp, and biopsyproven primary basal cell
carcinomas on trunk, neck, extremities
• MOA: thought to be r/t stimulation of peripheral mononuclear cells to release
interferon, stimulate macrophages to produce interleukins, and tumor necrosis factor-
(TNF)
• Applied to wart 3x wk -left on the skin for 6-10 hours prior to washing off w/ mild soap
and water • Tx continued until eradication of the warts - but not for > total of 16 wks
• Percutaneous absorption minimal
• Adverse effects: local inflammation, pruritus, erythema, superficial erosion
✔✔Immunomodulators: Pimecrolimus (Elidel) and tacrolimus (Protopic) - ✔✔Macrolide
Immunosuppressants
• Indicated for short & intermittent long-term Tx mild to moderate atopic dermatitis
• MOA: inhibits T lymphocyte activation -prevent release of inflammatory cytokines &
mediators from mast cells
• Tacrolimus 0.03% ointment & pimecrolimus 1% cream approved in children > 2 yrs
• Limited to 2nd line treatment of atopic dermatitis/eczema (after failed other therapies)
*FDA added a black box warning r/t long-term safety of topical tacrolimus and
pimecrolimus because of animal tumorgenicity data*
✔✔Fluorouracil (5-FU) - ✔✔• MOA-interferes with DNA synthesis
• Topically used in multiple actinic keratoses, actinic cheilitis& superficial basal cell
carcinomas
• once or twice daily for 2-8 weeks, depending on indication
• Can induce severe inflammation during treatment, subsides after drug discontinued
• Intralesional injection of 5-FU has been used for keratoacanthomas, warts, and
porokeratoses
✔✔Pruritis can result from - ✔✔• dermatological disorders-inflammation or other
cutaneous disease, dry skin or xerosis, atopic eczema, urticaria, infestations
• Pruritis can also be a symptom of many internal disorders-malignant neoplasms,
chronic renal failure, hepatobiliary disease
✔✔Agents for Treatment of Pruritis - ✔✔
✔✔Histamine - ✔✔• Human skin mast cells express H1, H2, and H4 receptors
• H1 and H2 receptors involved in wheal formation & erythema -*only H1 receptor
agonists cause pruritus*
,• Oral antihistamines-esp. H1 receptor antagonists used to Tx pruritis
• anticholinergic activity & sedating
✔✔Oral Antihistamines - ✔✔• First generation H1 receptor antagonists hydroxyzine,
diphenhydramine (benadryl), promethazine (Phenergan), cyproheptadine (Periactin)-
Sedating!
• Second-generation H1 receptor antagonists cetirizine (zyrtec), levocetirizine (xyzal),
loratadine (claritin), desloratadine (clarinex), fexofenadine (allegra) -no anticholinergic
ADE, Non-sedating
✔✔Infestations with Ectoparasites - ✔✔body lice
Scabies
Common Worldwide
• Impact on public health -disabling pruritus, secondary infection, and (in the case of the
body louse) transmission of life-threatening illnesses such as typhus
• Topical and oral medications for treatment
✔✔Lice - ✔✔pediculosis capitis, corporis, pubis
• Eggs on hair shaft, feed up to 5x day, hypersensitivity to saliva causes itching
• life cycle about 1 month, female lays 6 eggs daily, mature in 18 days
✔✔Scabies - ✔✔• mite has 30day life cycle, within 60 minutes on skinfemale burrows in
and lays 2-3 eggs per day (leaves behind eggs and fecal matter)
• Eggs mature in about 2 wks-often no symptoms for about a month
✔✔Treatment of Scabies - ✔✔• Permethrin (Elimite, Acticin) 5% cream- First line
treatment in scabies • Single application applied to the body from the neck down, left on
for 8-14 hours→wash off
• Adverse reactions
• transient burning, stinging, and pruritus
• *Pruritis may persist for weeks*
• Cleaning of environment
✔✔Treatment of Lice - ✔✔• Permethrin 1% cream rinse (Nix) applied to affected area
x10 mins. → rinse off w/ warm water
• Can be used in infants 2 mon. and up
• Resistance becoming widespread- often need to retreat
• Spinosad (Natroba) approved for of head lice in 4 yrs and older 0.9% x10 mins. →
rinse off w/ warm water - Can repeat in 1 wk if needed
• Ivermectin (Sklice) 0.5% lotion approved 6 mon. & up-applied to hair & scalp x 10
mins. → rinsed
• Lindane (hexachlorocyclohexane): stored in adipose and nerve tissue -*neurotoxicity,
seizures,* contraindicated in infants, *caution in children and pregnant woman
Treat all family members at once -Meticulous cleaning of environment
,✔✔Hyperkeratotic Disorders - Keratolytic agents - ✔✔lactic acid, glycolic acid, salicylic
acid, urea, sulfer
✔✔Treatment of Hyperkeratosis - ✔✔• Common disorders Tx w/ keratolytics: psoriasis,
seborrheic dermatitis, xerosis, ichthyoses, verrucae (warts)
• Urea: softening, moisturizing effect on stratum corneum, increases skin absorption and
retention of water
• Propylene Glycol-used w/ occlusion or w/ 6% salicylic acid (ichthyosis, palmar and
plantar keratodermas, hypertrophic lichen planus and others)
• Lac-Hydrin:(combination of lactic acid and ammonium hydroxide): moisturizer
indicated for xerosis
• Glycolic acid: in multiple cosmetic preparations (4% to 10%) - tx of xerosis, ichthyosis,
and photoaging
• Salicylic acid-β -hydroxy acid-also used in acne
• Sulfur-anti-septic, anti-parasitic, anti-seborrheic, and keratolytic
✔✔Podophyllin and derivatives - ✔✔active cytotoxic agents used for treatment of
condyloma acuminatum, penil and anogenital warts
-lipid soluble
- wide distribution
- contraindicated in pregnancy*
25% conc. podophyllum in tincture of benzoin used for Tx condyloma acuminatum
-Wash preparation 2-3 hours after initial application
✔✔Podophyllin-ADE - ✔✔• Common- irritation, inflammation, burning, itching,
inadvertent contact w/eye → severe conjunctivitis
• Toxic symptoms w/ Lg. amt.-N/V, altered sensorium, muscle weakness, neuropathy w/
↓DTR, coma, even death
• *Use during pregnancy is contraindicated-possible cytotoxic effects on the fetus.*
✔✔Treatment of Actinic Keratosis - ✔✔• Fluorouracil-topically
• Ingenol mebutate (Picato)topical
• Diclofenac- topical 3% gel- caution with known aspirin hypersensitivity
✔✔Agents for Seborrheic Dermatitis - ✔✔
✔✔Trichogenic agents - Minoxidil (Rogaine) - ✔✔Tx to reverse hair loss associated w/
androgenic alopecia
• (Vertex balding more responsive than frontal balding)
• MOA on hair follicles unknown
• Effect- not permanent
• cessation of tx leads to hair loss in 4-6 month
✔✔Adverse effects of Minoxidil (Rogaine) - ✔✔• Allergic and irritant contact dermatitis
• Hair growth in undesirable locations - reversible on stopping the drug
, • Patients instructed to wash hands after applying
• Percutaneous absorption of minoxidil minimal in normal scalp - possible systemic
effects on blood pressure
✔✔Trichogenic Agents - Finasteride (Propecia) - ✔✔blocks conversion of testosterone
to dihydrotestosterone (androgen responsible for androgenic alopecia in genetically
predisposed men)
Oral agent promotes hair growth, prevents further hair loss.
Tx at leaset 3-6 months to see increased hair growth
Continued Rx necessary to sustain benefit
ADE:decreased libido, ejaculation disorders, erectile dysfunction-resolve in most men
who remain on therapy -and w/ discontinuation
*Pregnant women should not be exposed to the drug because of the potential for
inducing genital abnormalities in male fetuses*
✔✔Bimatoprost (Latisse) - ✔✔*Treatment of the eyelashes*
• Prostaglandin analog, 0.03% ophthalmic solution
• MOA unknown
• QHS application to skin of upper eyelid margins (base of eyelashes) separate
disposable applicator each eye
• Remove contact lenses prior to using
• ADE-pruritus, conjunctival hyperemia, skin pigmentation, erythema of eyelids
• Possible ↑ brown iris pigmentation-likely permanent
✔✔Antitrichogenic Agents - Eflornithine (Vaniqa) - ✔✔effects biosynthesis of
polyamines Polyamines required for cell division growth
• Topical -Reduces facial hair growth in approx. 30% of women when applied twice daily
for 6 months
• Hair growth returns to pretreatment levels 8 weeks after discontinuing
• Local adverse effects-stinging, burning, and folliculitis
✔✔Anti-Inflammatory Agents-Corticosteroids - ✔✔• Efficacy of topical corticosteroids for
tx inflammatory dermatoses
• Numerous types available w/ choices of potencies, concentrations, and vehicles
• Anti-inflammatory and antimitotic effects
• Original-hydrocortisone
*Therapeutic effectiveness -based primarily on their anti-inflammatory activity*
WITH SOLUTIONS GRADED A+
✔✔Adverse local reactions caused by acyclovir or penciclovir - ✔✔Pruritus and mild
pain with transient stinging and burning
✔✔Immunomodulator: Imiquimod (Aldara) - ✔✔tx of external genital and perianal warts
in adults, actinic keratoses on face and scalp, and biopsyproven primary basal cell
carcinomas on trunk, neck, extremities
• MOA: thought to be r/t stimulation of peripheral mononuclear cells to release
interferon, stimulate macrophages to produce interleukins, and tumor necrosis factor-
(TNF)
• Applied to wart 3x wk -left on the skin for 6-10 hours prior to washing off w/ mild soap
and water • Tx continued until eradication of the warts - but not for > total of 16 wks
• Percutaneous absorption minimal
• Adverse effects: local inflammation, pruritus, erythema, superficial erosion
✔✔Immunomodulators: Pimecrolimus (Elidel) and tacrolimus (Protopic) - ✔✔Macrolide
Immunosuppressants
• Indicated for short & intermittent long-term Tx mild to moderate atopic dermatitis
• MOA: inhibits T lymphocyte activation -prevent release of inflammatory cytokines &
mediators from mast cells
• Tacrolimus 0.03% ointment & pimecrolimus 1% cream approved in children > 2 yrs
• Limited to 2nd line treatment of atopic dermatitis/eczema (after failed other therapies)
*FDA added a black box warning r/t long-term safety of topical tacrolimus and
pimecrolimus because of animal tumorgenicity data*
✔✔Fluorouracil (5-FU) - ✔✔• MOA-interferes with DNA synthesis
• Topically used in multiple actinic keratoses, actinic cheilitis& superficial basal cell
carcinomas
• once or twice daily for 2-8 weeks, depending on indication
• Can induce severe inflammation during treatment, subsides after drug discontinued
• Intralesional injection of 5-FU has been used for keratoacanthomas, warts, and
porokeratoses
✔✔Pruritis can result from - ✔✔• dermatological disorders-inflammation or other
cutaneous disease, dry skin or xerosis, atopic eczema, urticaria, infestations
• Pruritis can also be a symptom of many internal disorders-malignant neoplasms,
chronic renal failure, hepatobiliary disease
✔✔Agents for Treatment of Pruritis - ✔✔
✔✔Histamine - ✔✔• Human skin mast cells express H1, H2, and H4 receptors
• H1 and H2 receptors involved in wheal formation & erythema -*only H1 receptor
agonists cause pruritus*
,• Oral antihistamines-esp. H1 receptor antagonists used to Tx pruritis
• anticholinergic activity & sedating
✔✔Oral Antihistamines - ✔✔• First generation H1 receptor antagonists hydroxyzine,
diphenhydramine (benadryl), promethazine (Phenergan), cyproheptadine (Periactin)-
Sedating!
• Second-generation H1 receptor antagonists cetirizine (zyrtec), levocetirizine (xyzal),
loratadine (claritin), desloratadine (clarinex), fexofenadine (allegra) -no anticholinergic
ADE, Non-sedating
✔✔Infestations with Ectoparasites - ✔✔body lice
Scabies
Common Worldwide
• Impact on public health -disabling pruritus, secondary infection, and (in the case of the
body louse) transmission of life-threatening illnesses such as typhus
• Topical and oral medications for treatment
✔✔Lice - ✔✔pediculosis capitis, corporis, pubis
• Eggs on hair shaft, feed up to 5x day, hypersensitivity to saliva causes itching
• life cycle about 1 month, female lays 6 eggs daily, mature in 18 days
✔✔Scabies - ✔✔• mite has 30day life cycle, within 60 minutes on skinfemale burrows in
and lays 2-3 eggs per day (leaves behind eggs and fecal matter)
• Eggs mature in about 2 wks-often no symptoms for about a month
✔✔Treatment of Scabies - ✔✔• Permethrin (Elimite, Acticin) 5% cream- First line
treatment in scabies • Single application applied to the body from the neck down, left on
for 8-14 hours→wash off
• Adverse reactions
• transient burning, stinging, and pruritus
• *Pruritis may persist for weeks*
• Cleaning of environment
✔✔Treatment of Lice - ✔✔• Permethrin 1% cream rinse (Nix) applied to affected area
x10 mins. → rinse off w/ warm water
• Can be used in infants 2 mon. and up
• Resistance becoming widespread- often need to retreat
• Spinosad (Natroba) approved for of head lice in 4 yrs and older 0.9% x10 mins. →
rinse off w/ warm water - Can repeat in 1 wk if needed
• Ivermectin (Sklice) 0.5% lotion approved 6 mon. & up-applied to hair & scalp x 10
mins. → rinsed
• Lindane (hexachlorocyclohexane): stored in adipose and nerve tissue -*neurotoxicity,
seizures,* contraindicated in infants, *caution in children and pregnant woman
Treat all family members at once -Meticulous cleaning of environment
,✔✔Hyperkeratotic Disorders - Keratolytic agents - ✔✔lactic acid, glycolic acid, salicylic
acid, urea, sulfer
✔✔Treatment of Hyperkeratosis - ✔✔• Common disorders Tx w/ keratolytics: psoriasis,
seborrheic dermatitis, xerosis, ichthyoses, verrucae (warts)
• Urea: softening, moisturizing effect on stratum corneum, increases skin absorption and
retention of water
• Propylene Glycol-used w/ occlusion or w/ 6% salicylic acid (ichthyosis, palmar and
plantar keratodermas, hypertrophic lichen planus and others)
• Lac-Hydrin:(combination of lactic acid and ammonium hydroxide): moisturizer
indicated for xerosis
• Glycolic acid: in multiple cosmetic preparations (4% to 10%) - tx of xerosis, ichthyosis,
and photoaging
• Salicylic acid-β -hydroxy acid-also used in acne
• Sulfur-anti-septic, anti-parasitic, anti-seborrheic, and keratolytic
✔✔Podophyllin and derivatives - ✔✔active cytotoxic agents used for treatment of
condyloma acuminatum, penil and anogenital warts
-lipid soluble
- wide distribution
- contraindicated in pregnancy*
25% conc. podophyllum in tincture of benzoin used for Tx condyloma acuminatum
-Wash preparation 2-3 hours after initial application
✔✔Podophyllin-ADE - ✔✔• Common- irritation, inflammation, burning, itching,
inadvertent contact w/eye → severe conjunctivitis
• Toxic symptoms w/ Lg. amt.-N/V, altered sensorium, muscle weakness, neuropathy w/
↓DTR, coma, even death
• *Use during pregnancy is contraindicated-possible cytotoxic effects on the fetus.*
✔✔Treatment of Actinic Keratosis - ✔✔• Fluorouracil-topically
• Ingenol mebutate (Picato)topical
• Diclofenac- topical 3% gel- caution with known aspirin hypersensitivity
✔✔Agents for Seborrheic Dermatitis - ✔✔
✔✔Trichogenic agents - Minoxidil (Rogaine) - ✔✔Tx to reverse hair loss associated w/
androgenic alopecia
• (Vertex balding more responsive than frontal balding)
• MOA on hair follicles unknown
• Effect- not permanent
• cessation of tx leads to hair loss in 4-6 month
✔✔Adverse effects of Minoxidil (Rogaine) - ✔✔• Allergic and irritant contact dermatitis
• Hair growth in undesirable locations - reversible on stopping the drug
, • Patients instructed to wash hands after applying
• Percutaneous absorption of minoxidil minimal in normal scalp - possible systemic
effects on blood pressure
✔✔Trichogenic Agents - Finasteride (Propecia) - ✔✔blocks conversion of testosterone
to dihydrotestosterone (androgen responsible for androgenic alopecia in genetically
predisposed men)
Oral agent promotes hair growth, prevents further hair loss.
Tx at leaset 3-6 months to see increased hair growth
Continued Rx necessary to sustain benefit
ADE:decreased libido, ejaculation disorders, erectile dysfunction-resolve in most men
who remain on therapy -and w/ discontinuation
*Pregnant women should not be exposed to the drug because of the potential for
inducing genital abnormalities in male fetuses*
✔✔Bimatoprost (Latisse) - ✔✔*Treatment of the eyelashes*
• Prostaglandin analog, 0.03% ophthalmic solution
• MOA unknown
• QHS application to skin of upper eyelid margins (base of eyelashes) separate
disposable applicator each eye
• Remove contact lenses prior to using
• ADE-pruritus, conjunctival hyperemia, skin pigmentation, erythema of eyelids
• Possible ↑ brown iris pigmentation-likely permanent
✔✔Antitrichogenic Agents - Eflornithine (Vaniqa) - ✔✔effects biosynthesis of
polyamines Polyamines required for cell division growth
• Topical -Reduces facial hair growth in approx. 30% of women when applied twice daily
for 6 months
• Hair growth returns to pretreatment levels 8 weeks after discontinuing
• Local adverse effects-stinging, burning, and folliculitis
✔✔Anti-Inflammatory Agents-Corticosteroids - ✔✔• Efficacy of topical corticosteroids for
tx inflammatory dermatoses
• Numerous types available w/ choices of potencies, concentrations, and vehicles
• Anti-inflammatory and antimitotic effects
• Original-hydrocortisone
*Therapeutic effectiveness -based primarily on their anti-inflammatory activity*
