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therapeutics > 75: Dermatology > Flashcards

75: Dermatology Flashcards

1
Q

When to refer skin

A

-multiple/extensive burns, cuts, abrasions
-human/animal bites
-bad rash
-tumors/growths
-yellow skin
-deep infection (cellulitis)
-large blisters of unknown origins
-exposed deep tissue, muscle, bone

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2
Q

Choosing a base for skin tx

A
  1. desired effect
  2. area of application
  3. patient acceptability
  4. nature of incorporated medication (stability, compatibility)
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3
Q

Basic vehicles for most skin rx

A

-ointment
-cream
-lotion gel
-solution/foam/spray

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4
Q

Ointments

A

-best for hydration and drug delivery
-removes scales
-greasy, low acceptance, no good for hairy areas

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5
Q

Creams

A

-good for hydration and drug delivery
-can apply to most areas
-high acceptance

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6
Q

Lotions

A

-watered down creams
-easy to apply
-good acceptance
-requires freq applications
-not ideal for very dry skin

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7
Q

Gels

A

-great for alcohol soluble drugs
-can apply to most areas
-nongreasy
-can be drying

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8
Q

Solutions, foams, sprays

A

-can apply to most areas
-easy to apply in hairy earea
-not ideal for drug delivery
-can be drying
-not ideal for hydration
-requires freq application

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9
Q

best vehicles for hair bearing skin

A

-solution/spray
-foam
-gel
-cream

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10
Q

Dry Skin (xerosis)

A

-fall and winter
-feet, lower legs
-hands, elbows, face
-rough, dry, scales, cracks
-itching common

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11
Q

Who is at risk of dry skin (xerosis)

A

-elderly
-dec activity of sweat and sebaceous glands
-warm, dry environments
-freq bathing

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12
Q

Dry skin (xerosis) tx

A
  1. emollients
  2. agents for itching
  3. alter bathing habits
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13
Q

Rule of 3s

A

-bathe no more than 3x week
-water 3 degress above body temp
-bathe 3 minutes
-pat dry
-apply emollients within 3 minture 3x daily

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14
Q

Emollients

A

-vaseline
-aquaphor
-cetaphil, cerave
-eucerin
-ointments vs creams vs lotions

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15
Q

Agents to reduce itching

A

-menthol + camphor
-praxomine
-aluminum acetate
-hydrocortisone

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16
Q

Menthol and camphor

A

-relieve itching
-0.5-1%
-cooling sensation

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17
Q

Praxomine

A

-relieve itching
-1%
-local anesthetic

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18
Q

Aluminum acetate

A

-relieve itching
-0.2%
-alters C-fiber nerve transmission

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19
Q

Hydrocortisone

A

-relieve itching
-0.5-1%
-anti-inflammatory

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20
Q

Dermatitis

A

-inflammatory process of upper two layers of skin

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21
Q

Acute dermatitis

A

-red patches/plagues
-pebbly surface or blisters
-INTENSE itching
-contact dermatitis

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22
Q

Contact dermatitis

A

-acute
-irritant vs allergic
-poison ivy

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23
Q

Sub-acute dermatitis

A

-dry
-less red
-crusting, oozing
-mild thickening
-itching common
-atopic dermatitis

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24
Q

Atopic dermatitis

A

-sub-acute
-eczema

25
Q

Chronic dermatitis

A

-epidermal thickening
-exaggerated skin markings
-excoriations, fissures, scaling
-LICHENIFICATION
-less itching
-stasis dermatits
-any long standing acute/sub-acute dermatitis

26
Q

Irritant contact dermatitis

A

-non-immunologic
-more common than allergic
-rx within a few hours
-metals, cosmetics, adhesives

27
Q

Poison Ivy

A

-24-48 hrs after exposure
-Pruritis is intense (2’ infections)
-wash skin and nails within 10 min
-topical therapy okay if less than 10% of BSA

28
Q

Poison Ivy tx

A

-remove source
-calamine
-topical antihistamines
-oral antihistamines
-topical vs oral corticosteroids

29
Q

MOA of topical corticosteroids

A

-anti-inflammatory
-anti-mitotic
-immunosuppressive
-apply BID-QID 3-4 days

30
Q

Oral corticosteroid regimen for acute dermatitis tx

A

-start Prednisone 40-60mg qd
-taper every 3 days
-minimum 10-14 days
-avoid dose packs bc they dont last long enough

31
Q

Non-sedating antihistamines

A

-loratidine (claritin)
-Desloratidine (clarinex)
-Fexofenadine (Allegra)

32
Q

Sedating antihistamines

A

-diphenhydramine (benadryl)
-cetirizine (zyrtec)
-Hydroxyzine (atarax) rx
-Doxepin rx

33
Q

Atopic triad

A

-comorbidities:
1. atopic dermatitis
2. allergic rhinitis
3. asthma

34
Q

atopic dermatitis

A

-pruritis
-sym red papules/plaques
-scaling
-DRY
-redness, inflammation
-hist of allergic disease
-risk of 2nd infection

35
Q

Atopic dermatitis in infants

A

-cheeks
-neck, trunk, groin

36
Q

Atopic dermatitis in children

A

-face, neck, creases of arms and legs

37
Q

Atopic dermatitis in adult

A

-hands and neck
-arms and legs

38
Q

Atopic dermatitis triggers

A

-detergents
-infections

39
Q

Nonpharma tx of atopic dermatitis

A

-baths
-emollients
-avoid trggers
-trim nails
-comfy clothes

39
Q

Stepwise tx of atopic dermatitis

A
  1. nonpharm
  2. topical
  3. systemic
  4. Acute flares
  5. Refractory
  6. Maintenance
40
Q

Topical tx of atopic dermatitis

A

-corticosteroids
-calcineurin inhibitor therapy
-JAK inhibitor

-strength/duration based on severity

41
Q

Systemic tx of atopic dermatitis

A
  1. phototherapy
  2. oral immunosuppresants
  3. oral JAK inhibitors
  4. injectable biologic agents
42
Q

Acute flares tx of atopic dermatitis

A

-mod to severe
-medium-potency corticosteroid BID for up to 3 days beyond clearance of lesions

43
Q

Refractory tx of atopic dermatitis

A
  1. phototherapy or oral immunosuppresives
  2. consider biologics
44
Q

Maintenance therapy of mod to severe atopic dermatitis

A

-low topical corticosteroid qd
-OR TCS + anti-inflammatory 2-3x weekly
-written action plan

45
Q

Chose TCS based on:

A

-location
-type
-severity
-degree of skin penetration desired

46
Q

TCS potency

A

-very high - low (I-VII)
-vehicle impacts delivery AND potency
-only 2% absorbed into skin

47
Q

Occlusion

A

-enhances penetration of TCS upto 10%

48
Q

Side effects of TCS

A

-thinning of skin
-dilated blood vessels
-bruising
-skin coloring changes
-risk of HPA suppression w long-term use
-tolerance development (tachyphaylaxis)

49
Q

Very high potency TCS Class 1

A
50
Q

Betamethasone potency

A

-very high as ointment
-high as cream
-mod as lotion

51
Q

slide48 maybe

A
52
Q

Topical calcineurin inhibitors

A

-MOA: blocks pro-inflammatory cytokine genes
-can be used on any area
-equiv to mid potency TCS
-no risk of atrophy
-burning sensation
-$$$
-pimecrolimus and tacrolimues

53
Q

Pimecrolimus and Tacrolimus

A

-topical calcineurin inhibitors
-2nd line tx of atopic dermatitis
-intermittent use only
-risk of malignancies
-risk infection in kids under 2

54
Q

Crisaborole 2% ointment

A

-Phosphodiesterase-4 inhibitor (non steroidal)
-alt to TCS and TCI
-mild or mod AD
-BID for 28 days
-expensive

55
Q

Ruxolitinib (Opzelura 1.5% cream)

A

-mild to mod atopic derm
-JAK inhibitor
-thin layer BID upto 20% BSA
-short term use
-max 60g/week
-AVOID in immunocompromised pts

56
Q

Upadacitinib (Rinvoq)

A

-mod-severe atopic dermatitis
-JAK inhibitor
-15-30mg PO qd
-well tolerated
-higher rates of CV/thrombosis

57
Q

Dipilumab (Dupixent)

A

-biologic for mod-severe atopic derm
-mAb against IL-4 a
-600mg then 300mg SC q 2 weeks
-expenziveee

therapeutics (78 decks)

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