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Clinical Pharmacology > 2) Topicals and Dermatologicals > Flashcards

2) Topicals and Dermatologicals Flashcards

1
Q

General principles

A
  • Thicker plantar skin needs higher dose/concentration

- Occlusion needs lower dose and concentration (saran wrap increased percutaneous penetration by 10 X)

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2
Q

Percutaneous absorption is determined by many factors

A
  • Vehicle
  • Integrity of epidermis
  • Use of occlusion/plastic film
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3
Q

Ointments and gels provide increased

A
  • Potency
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4
Q

Lotions and creams are preferred on

A
  • Hairy areas
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5
Q

With higher doses and concentration, must watch for

A
  • Systemic effects
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6
Q

Cortisone vs hydrocortisone

A
  • Cortisone = no topical activity

- Hydrocortisone = the prototype of all topical corticosteroids

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7
Q

Actions of topical corticosteroids

A
  • Anti-inflammatory
  • Anti-pruritic
  • Vasoconstriction
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8
Q

Topical corticosteroid mechanism of action

A
  • Diffuses across cell membranes, binds to cell receptors
  • Induces phospholipase A2 inhibitory proteins, inhibiting arachidonic acid pathway
  • Result in decreased formation of endogenous mediators of inflammation
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9
Q

Endogenous mediators of inflammation

A
  • Prostaglandins
  • Leukotrienes
  • Histamine
  • Kinins
  • Lysozomal enzymes
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10
Q

Topical corticosteroids anti-mitotic effect

A
  • Anti-mitotic on epithelial cells

- Good for psoriasis

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11
Q

Topical corticosteroids indications

A
  • Treatment of the inflammatory and pruritic manifestations of corticosteroid responsive dermatoses
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12
Q

Goal of topical corticosteroids

A
  • Inhibition of the inflammatory or exudative phase of wound healing
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13
Q

Eczema

A
  • Generic name for a group of inflammatory skin diseases characterized by a erythematous, weeping, vesicular, and scaley appearance
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14
Q

Topical corticosteroids contraindications

A
  • Hypersensitivity to corticosteroids, or other components.
  • Cutaneous viral infections
  • HPA axis suppression occurs anywhere from 2-14 grams/day
  • Warning: cutaneous atrophy
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15
Q

Topical corticosteroids dose

A
  • Higher doses and concentration: watch for systemic effects (ie. H-P-A axis suppression: weakness, nausea, loss of appetite, fever.
  • Response to treatment: decrease the dose
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16
Q

Highest potency topical corticosteroid (I)

A
  • Betamethason dipropionate augmented: 0.05% cr., gel, lot, oint qd-bid (Diprolene)
  • Clobetasol 0.05% crm, foam, gel, lot, shmp, sol (Temovate, Cormax, Clobex)
  • Fluconide 0.05% crm, gel, oint, sol; 0.1% crm (Lidex)
  • Halobetasol 0.05% crm, oint (Ultravate $82.63) generic $30.99
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17
Q

High potency topical corticosteroid (II) example

A
  • Triamcinolone 0.025, 0.1, 0.5% crm, oint, lot; bid-qid (Kenalog)
  • Desoximetasone 0.05, 0.25% crm, gel, oint (Topicort)
  • Mometasone 0.1% crm, lot, oint, q d dosing (Elocon)
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18
Q

High-medium potency topical corticosteroid (III) example

A
  • Triamcinolone 0.5% crm
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19
Q

Medium potency topical corticosteroid (IV) example

A
  • Triamcinolone 0.1% oint
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20
Q

Medium-low potency topical corticosteroid (V) example

A
  • Triamcinolone 0.1% crm, lot, 0.025% oint
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21
Q

Low potency topical corticosteroid (VI) example

A
  • Triamcinolone 0.025% crm, lot
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22
Q

Lowest potency topical corticosteroid (VII) example

A
  • Hydrocortisone 1% (often OTC)
  • Cortaid, Cortisone 10
  • Rx 2.5% crm
  • Apply bid-qid
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23
Q

Highest potency corticosteroid dosing

A
  • 45-50 gm/week

- 2 weeks max

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24
Q

Topical corticosteroid potency from lowest to highest

A
  • Hydrocortisone 1%(OTC) ; 2.5% (Rx) (Hytone)
  • Triamcinolone acetonide 0.1% (Kenalog, Artistocort)
  • Fluocinoline acetonide 0.025% (Synalar)
  • Mometasone furoate 0.1% (Elocon)
  • Betamethasone valerate 0.1% (Valisone)
  • Betametasone dipropionate (Diprosone) 0.05%
  • Fluocinonide 0.05% (Lidex)
  • Flumethasone pivalate 0.03% (Locorten)
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25
Q

Topical anti-inflammatory immunomodulators (non-corticosteroids)

A
  • Pimecrolimus (Elidel - Novartis) Rx 1% cream (10 mg/g. of cr.); 15, 30, 100 g tubes.
  • Tacrolimus (Protopic- Fujisawa) Rx 0.03%; 0.1% ointment 30, 60 g. tubes
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26
Q

Topical anti-inflammatory immunomodulators (non-corticosteroids)

A
  • Topical calcineurin inhibitors - Microbial-derived macrolides - Mechanism similar to cyclosporine (Sandimmune, and others)
  • Non-steroidal (non-cortisone) anti-inflammatory
  • Macrolide immunosuppressant produced by streptomyces species
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27
Q

Atopic dermatitis (type of eczema)

A
  • Inflammatory, chronically relapsing, non-contagious and pruritic skin disorder
  • Skin reacts abnormally and easily to irritants, food, and environmental allergens
  • Becomes red, flaky and very itchy
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28
Q

Other names for atopic dermatitis

A
  • Neurodermatitis
  • Endogenous eczema
  • Flexural eczema
  • Infantile eczema
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29
Q

Immunomodulators MOA

A
  • Inhibits T lymphocyte activation by binding to the intracellular protein macrophilin-12
  • Complex inhibits calcium-dependent phosphatase
  • Blocks dephosphorylation of nuclear factor (NF-AT) of activated T-cells
  • Inhibits the formation of lymphokines
  • Interleukins (IL-2,3,4,5, GM-CSF, and TNF-α) and gamma interferon
  • Inhibits release of inflammatory cytokines from mast cells after stimulation by antigen/IgE
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30
Q

Pimecrolimus (Elidel) and tacrolimus (Protopic) topical immunomodulators indications

A
  • Short term and intermittent long term Tx of mild to mod atopic dermatitis
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31
Q

Pimecrolimus (Elidel) and tacrolimus (Protopic) topical immunomodulators contraindications

A
  • Preg cat c
  • No use in children or immunocompromised
  • Hypersensitivity
  • Rx may predispose to severe skin viral infections (HSV 1 or 2; verruca; VZV) or skin malignancies
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32
Q

Pimecrolimus (Elidel) and tacrolimus (Protopic) topical immunomodulators other uses

A
  • Lichen Planus (shin, nails)

- Vitiligo

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33
Q

crisaborole topical (Eucrisa) Rx 2% topical oint indications

A
  • Mild to moderate atopic dermatitis
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34
Q

crisaborole topical (Eucrisa) Rx 2% topical oint actions

A
  • Phosphodiesterase (PDE)-4 inhibitor
  • Results in increased intracellular cyclic adenosine monophosphate (cAMP) levels
  • cAMP is thought to decrease the proinflammatory response (eg, cytokine release) associated with atopic dermatitis
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35
Q

crisaborole topical (Eucrisa) Rx 2% topical oint sig

A
  • Apply a thin layer topically to affected area(s) BID
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36
Q

doxepin (Zonalon) Rx 5% cream

A
  • Local anesthetic effects
  • Itch relief
  • Potent H1 and H2 receptor blocking activity
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37
Q

Percutaneous absorption of doxepin (Zonalon) Rx 5% cream

A
  • May produce systemic side effects: somnolence, sedation, drowsiness
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38
Q

doexpin (Zonalon) indications

A
  • short term Tx of pruritis from eczematous dermatitis: atopic, lichen chronicus simplex
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39
Q

doxepin (Zonalon) contraindications

A
  • Break in the epidermis
  • Narrow angle glaucoma
  • Urinary retention (doxepin has anti-cholinergic effect)
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40
Q

doexpin (Zonalon) sig

A
  • Apply thin layer qid

- Not longer than 8 days

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41
Q

Topical antihistamine indications

A
  • Pruritis due to minor skin disorder
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42
Q

diphenhydramine (Benedryl) OTC forms (topical)

A
  • 1% and 2% in cream, lotion, spray
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43
Q

Caladryl

A
  • 1% diphenhydraqmine, 8% calamine; camphor
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44
Q

Benedryl Itch Relief

A
  • 2% diphenhydramine, 0.1% zinc acetate, 73% alcohol, aloe vera
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45
Q

diphenhydramine (Benadryl) MOA

A
  • Competes with histamine for H1-receptor sites on effector cells in GI tract, blood vessels, and respiratory tract
  • Anticholinergic and sedative effects
  • May be used alone or in combination with centrally acting anticholinergic agents
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46
Q

diphenhydramine (Benadryl) indications

A
  • for IM, IV, PO symptomatic relief of allergic symptoms caused by histamine release, including nasal allergies and allergic dermatosis
  • Insomnia, occasiona
  • Prevention or treatment of motion sickness
  • Antitussive
  • Management of Parkinsonian syndrome including drug-induced extrapyramidal symptoms (dystonic reactions)
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47
Q

diphenhydramine (Benadryl) adjunct indications

A
  • Adjunct to epinephrine in the treatment of anaphylaxis
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48
Q

Psoriasis

A
  • Chronic papulosquamous disease
  • Characterized by reddened plaques covered by thick dry silvery scales that are the result of excessive development of epithelial cells
  • Autoimmune skin disease in which activation of T lymphocytes results in the release of cytokines and the proliferation of keratinocytes.
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49
Q

Psoriasis signs/presentation

A
  • Red scaley papules
  • Plaques
  • White, silvery scales
  • Auspitz Sign
  • Koebner’s Phenomenon
  • Scalp, palms, and soles
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50
Q

Anti-psoriatics

A
  • Vitamin D analogues, tazarotene, corticosteroids alone, or w/ vitamin D analogue or tazarotene;
  • Pimecrolimus
  • Topical anti-inflammatory (steroids)
  • PUVA (phototherapy combination of Psoralen and UVA)
  • UVB and coal tar preparations
  • Salicylic acid
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51
Q

Psoriasis Tx

A
  • Slowing the growth of skin
  • Controlling the immune response that causes psoriasis
  • Both
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52
Q

calcipotriene (Devonex) 0.005% cr, foam, oint, solution

A
  • Anti-psoriatic 1st line Tx

- 7-dehydrocholesterol-UV-cholecalciferol

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53
Q

calcipotriene (Devonex) action

A
  • Synthetic vitamin D3 analog

- Bind to cell receptors in the skin (kertinocytes) and regulates cell production

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54
Q

calcipotriene (Devonex) indications

A
  • Psoriasis
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55
Q

calcipotriene (Devonex) contraindications

A
  • Pts with hypercalcemia or evidence of vitamin D toxicity
  • Use on the face (cream, ointment)
  • Pts with acute psoriatic eruptions (scalp solution)
  • Preg cat C
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56
Q

calcipotriene (Devonex) preparations

A
  • Devonex ointment 0.005%
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57
Q

tazarotene (Tazaroac; Avage)

A
  • Anti-acne, keratolytic agent; 0.05% and 0.1% cr.; foam
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58
Q

tazarotene (Tazaroac; Avage) actions

A
  • Synthetic retinoid
  • Modulates differentiation and proliferation of epithelial tissue
  • Some degree of anti-inflammatory and immunological activity
  • Decreases cohesiveness of follicular epithelial cells
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59
Q

tazarotene (Tazaroac; Avage) mitotic activity

A
  • Stimulates mitotic activity and increased turnover of follicular epithelial cells causing extrusion of the comedones
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60
Q

tazarotene (retinoid) indications

A
  • Palliation of fine facial wrinkles
  • Facial mottled hyper-/hypopigmentation
  • Benign facial lentigines: psoriasis
61
Q

tazarotene (retinoid) contraindications

A
  • Pregnancy
62
Q

tazarotene (retinoid) sig for psoriasis

A
  • Apply once daily to psoriatic lesions using enough (2 mg/cm2) to cover only the lesion with a thin film
  • May increase strength to 0.1%
63
Q

methoxsalen (Psoralens; 8-MOP; Uvadex; Oxsalen) forms

A
  • oral and 1% lotion 1% (29.57 mL)
  • $929.69
  • Po and topical drug combined with UVA phototherapy (PUVA)
64
Q

methoxsalen (Psoralens; 8-MOP; Uvadex; Oxsalen) effects

A
  • Cause skin inflammation, increased melanin production, and thickening of the stratum corneum
  • Results in photodamage and decreased cell proliferation
  • Causes photosensitivity (i.e. sunburn)
65
Q

methoxsalen (Psoralens; 8-MOP; Uvadex; Oxsalen) MOA

A
  • Bonds covalently to pyrimidine bases in DNA
  • Inhibits the synthesis of DNA
  • Suppresses cell division and epidermal turnover
66
Q

PUVA Tx indications

A
  • Psoriasis
  • cut T cell lymphoma
  • Vitiligo
67
Q

PUVA Tx contraindications

A
  • Preg C/D

- Fetal toxicity has ben observed in animal studies

68
Q

PUVA Tx dosing

A
  • 10 to 70 mg 1.5 to 2 hours (Oxsoralen Ultra) or 2 hours (8-MOP) before exposure to UVA light
  • Dose may be repeated 2-3 times per week
69
Q

Crude coal tar

A
  • Antipsoriatic prototype
  • Coal tar 5%, U.S.P. in bases such as propylene glycol, sorbitol, alcohol and water
  • Bath oils, ointment, creams, and lotion
70
Q

Crude coal tar actions

A
  • Cytostatic agent (inhibits mitosis)
  • Antipruritic
  • Anti-eczematous
  • Keratoplastic
  • Antiseptic
71
Q

Crude coal tar indications

A
  • Psoriasis
  • Atopic dermatitis
  • Lichen chronicus simplex
  • Nummular eczema
  • Etc.
72
Q

Crude coal tar 5% USP contraindications

A
  • Hypersensitivity to coal tar preparations

- Acutely inflamed lesions and open wounds

73
Q

Crude coal tar warnings

A
  • May cause allergic irritation

- Photosensitivity (avoid exposure to sunlight)

74
Q

Systemic Tx of Psoriasis (po; IM; IV)

A
  • Methotrexate
  • Retinoids (acitretoin)
  • TNF inhibitors
  • IL-17 inhibitors
  • IL-12/23 inhibitors
  • IL-4/13 inhibitors
  • Selective phosphodiesterase 4 inhibitors (PDE-4)
  • Cyclosporine
75
Q

Methotrexate

A
  • Folate antagonist used in Tx of cancers, RA, Psoriasis
76
Q

Retinoids (acitretoin)

A
  • Indicated for severe psoriasis

- Not in females of child bearing age

77
Q

TNF inhibitors

A
  • Often also indic for Crohns, UC, RA, psoriasis, ankylosing spondylitis
  • Certolizumab, etanercept, adalimumab, infliximab, golimumab
78
Q

IL-17 inhibitors

A
  • Indic for psoriasis and ankylosing spondylitis

- Secukinumab (Cosentyx), ixekizumab (Taltz)

79
Q

IL-12/23 inhibitors

A
  • Ustekinumab (Stelara)

- Guselkumab (Tremfya)

80
Q

Il-4/13 inhibitors

A
  • Duplimab (Dupixent) indic for the oral Tx of atopic dermatitis and eosinophilic asthma
81
Q

Selective Phosphodiesterase 4 inhibitors (PDE-4)

A
  • Causes increased levels of cAMP

- Apremilast (Otezla)

82
Q

Cyclosporine

A
  • Also indic for organ transplant rejection prophylaxis

- RA, severe psoriasis

83
Q

Seborrhea other names

A
  • Seborrheic dermatitis
  • Seborrheic eczema
  • Dandruff
  • Pityriasis capitis
84
Q

Seborrhea

A
  • A chronic, relapsing mild dermatitis

- In infants aka, cradle cap; inflammatory skin disorder affecting the scalp, face, and torso

85
Q

Seborrhea presentation

A
  • Presents with scaly, flaky, itchy, and red skin
  • Etiology unknown, possibly weakened immune system or deficiency of biotin, Vit B2, or vit B6
  • Possibly due to Malassezia fufur infection (a yeast)
86
Q

Seborrheic dermatitis Rx Tx

A
  • Antifungals, topical corticosteroids, keratolytics such as topical urea
  • Antihistamines are used to reduce itching
87
Q

Isotretinoin

A
  • Sebosuppressive agent
  • Last resort Tx in refractory disease
  • May be used to reduce sebaceous gland activity
88
Q

Selenium sulfide (anti-seborrheic)

A
  • Used in head and shoulders
  • Cytostatic effect on epidermis and follicular epithelium
  • Reduces corneocyte production
89
Q

Selenium sulfide indications

A
  • Dandruff
  • Seborrheic dermatitis of the scalp
  • Tinea versicolor
90
Q

Selenium sulfide contraindications

A
  • Allergy
91
Q

Selenium sulfide warnings

A
  • Use with caution in children

- Preg Cat C

92
Q

Tar derivatives

A
  • Tegrin medicated shampoo

- Anti-seborrheic agent

93
Q

Pyrithion zinc

A
  • Anti-seborrheic agent

- Head and shoulders, sebulon

94
Q

Pyrithion zinc actions

A
  • Cytostatic agent

- Binds to hair and skin, reducing cell turnover rate

95
Q

Pyrithion zinc administration

A
  • Apply as shampoo, rinse

- Use twice weekly

96
Q

Acne (definition)

A
  • Dermatological condition characterized by comedones (plugs in duct), papules, pustules, nodules, and/or cysts
  • As a result sebaceous overactivity, obstruction and inflammation of the pilosebaceous units (hair follicle and accompanying sebaceous gland.)
  • Treatment is trough a variety of systemic and topical agents intended to reduce sebum production, infection, and normalize keratinization
97
Q

Desquamtors (anti-acne)

A
  • Benzoyl peroxide

- Tretinoin (Retin-A)

98
Q

Benzoyl peroxide (2.5, 5, 10%) Rx/OTC actions

A
  • Antibacterial (predominate organism of sebaceous follicles is propionibacterium acnes)
  • An oxidizer, releases oxygen
  • Mild desquamation of skin surface, reduction of skin surfaces lipids
99
Q

Benzoyl peroxide indications

A
  • Acne vulgaris
100
Q

Benzoyl peroxide contraindications

A
  • Hypersensitivity
101
Q

Benzoyl peroxide forms

A
  • Desquam-X (Westwood)
102
Q

Tretinoin (Retin-A)

A
  • Retinoic acid 0.025%; 0.05 and .1% cr.; gel
103
Q

Tretinoin (Retin-A) action

A
  • Decreases cohesiveness of follicular epithelial cells

- Increases mitotic activity and increased cell turnover of follicular epithelium

104
Q

Tretinoin (Retin-A) indications

A
  • Acne Vulgaris/cutan.

- Wrinkles

105
Q

Tretinoin (Retin-A) contraindications

A
  • Hypersensitivity to retinoic acid

- Warning: sunlight exposure/sunlamp therapy due to increase sensitivity

106
Q

Isotretinoin (Accutane)

A
  • Oral vitamin A
  • Suppresses the activity of the sebaceous glands
  • Very effective
107
Q

Isotretinoin (Accutane) indications

A
  • Recalcitrant nodulocytic form of acne
108
Q

Isotretinoin (Accutane) adverse reactions

A
  • Cheilosis, dry skin, alopecia, hypertriglyceridemia, hepatitis, pancreatitis, musculoskeletal pain, skeletal hyperostosis - all characteristic of excessive vitamin A)
  • Preg Cat X- Birth defects and restrictions in Rx
  • May also cause depression and psychosis
109
Q

Anti-acne topical antibiotics

A
  • Clindamycin (Cleosin)
  • Erythromycin
  • Metronidazole
  • Sulfacetamide
110
Q

Keratolytics

A
  • Salicylic acid
  • Podophyllin
  • Cantharidin
111
Q

Salicylic acid

A
  • 6% USP
  • 17% in film vehicle
  • 40% in plaster vehicle
112
Q

Salicylic acid actions

A
  • Dissolution of intercellular cement- mechanical removal of epidermal cells
  • Cornified (horny layer only) epidermis swells, softens, macerates and desquamates
  • Keratolytic at 2-6%
113
Q

Salicylic acid indications

A
  • Removal of excess hyperkeratotic skin
114
Q

Verruca vs Hyperkeratosis

A
  • Differentiate between corns, callouses, the hereditary hperkeratoses, and verruca
115
Q

Verruca (warts)

A
  • Benign epithelial tumors caused by human papilloma virus (HPV) a DNA virus
  • 130 different strains which affect different parts of the body
116
Q

Types of verruca

A
  • Type 1 (verruca plantaris)
  • Types 2, 4 (most common- verruca vulgaris)
  • Anogenital warts; types 6, 11 or 63
117
Q

Verruca virus attack mechanism

A
  • Virus attacks compromised skin through direct contact

- Enters through possibly tiny cuts and abrasions in the stratum corneum

118
Q

Salicylic acid contraindications

A
  • Hypersensitivity to salicylates

- Moles, birth marks, mucous membranes

119
Q

Salicylic acid preparations

A
  • OTC or Rx depends upon the strength

- Solutions, gels, plasters, and patches

120
Q

Rx strength salicylic acid preparations

A
  • Salacid 25% and 60% in petrolatum base
  • Sal-Acid 40% in collodion
  • Clear-Away Plantar 40% in rubber based vehicle
  • Mediplast 40% 2” X 3” patches
121
Q

OTC strength salicylic acid preparations

A
  • Freezone 13.5% in collodion vehicle
  • Occlusal-HP 17% in polyacrylic vehicle
  • Compound W 17% in collodion vehicle
  • Duofilm 17% in flexible collodion
122
Q

Podophyllin 25% actions

A
  • Resin is a powdered mixture from the May apple or Mandrake plants (Podophyllum)
  • Cytotoxic agent
  • Arrests mitosis
123
Q

Podophyllin 25% indications

A
  • Removal of genital warts (condyloma acuminata) and other papillomas
124
Q

Podophyllin 25% contraindications

A
  • Diabetes
  • Poor circulation
  • Bleeding warts and lesions
  • Birthmarks and moles
125
Q

Podophyllin 25% preparations

A
  • Applied only by physician and not dispensed to patient
126
Q

Cantharidin, 0.7%

A
  • Chemical secreted by many species of blister beetle, poisonous acting as a blister agent
127
Q

Cantharidin, 0.7% actions

A
  • Can cause severe chemical burns
  • Disintegration of desmosomes leading to detachment of tonofilaments that hold cells together
  • Leads to the loss of cellular connections (acantholysis) and ultimately blistering and exfoliation due to acantholytic action in the epidermis
  • Destruction limited to epidermis, with minimal effect on the dermis thus no scarring
128
Q

Cantharone indications

A
  • Removal of benign epidermal growths; eg. warts.
129
Q

Cantharone contraindications

A
  • Diabetes
  • Poor circulation
  • Bleeding warts and lesions
  • Birthmarks and moles
130
Q

Cantharone preparations

A
  • Applied by physician; not dispensed to patient
131
Q

Cantherone examples

A
  • Verr-Canth 0.7% in adherent film-forming base

- Cantherone Plus 30% sal acid; 10% podophylline; 1% cantherone

132
Q

Immunomodulators action

A
  • Topically applied activates the B- and T-lymphocytes, NKC, macrophages and Langerhans cells
  • Activates the toll-like receptor 7 (TLR7) which causes T cells to secrete cytokines (primarily interferon-α (INF-α), IL-6 and TNF-α 2
133
Q

Immunomodulators indications (Imiquimod 5% cream/Aldara)

A
  • Genital and peri-anal warts (condyloma acuminata)
  • Basal cell carcinoma and actinic keratosis
  • No contraindications
134
Q

Imiquimod 5% cream (Aldara) sig

A
  • Immunomodulator
  • Patient applies a thin layer of the cream to each wart and leave in place for 6-10 hrs; 3 x per week ; supplied in 12 single-use packets
135
Q

Fluorouracil (Efudex) 5% cr. ; solution (2% or 5%) actions

A
  • Inhibits synthesis of DNA and RNA particularly on rapidly growing cells which absorb FU rapidly
  • Causes inflammation, erosion, ulceration, necrosis, crusting and re-epithelialization
136
Q

Fluorouracil (Efudex) 5% cr. ; solution (2% or 5%) indications

A
  • Actinic or solar keratoses
  • Superficial basal cell CA
  • Condyloma acuminata
137
Q

Fluorouracil (Efudex) 5% cr. ; solution (2% or 5%) contraindications

A
  • Allergy

- Pregnancy

138
Q

Fluorouracil (Efudex) 5% cr. ; solution (2% or 5%) sig

A
  • Apply to lesion bid and cover with bandaid

- Discontinue when inflammation and erosion begins

139
Q

Cauterizing agents

A
  • Chloroacetic acids 80%

- Silver nitrate

140
Q

Chloroacetic acids 80% actions

A
  • Rapidly penetrates and cauterizes skin and keratin

- Monchloroacetic is more deeply destructive than trichloroacetic acid

141
Q

Chloroacetic acids 80% indications

A
  • Verruca, callouses, corns, seborrheic keratoses

- Epistaxis (as a cautery)

142
Q

Chloroacetic acids 80% contraindications

A
  • Malignant or premalignant lesions of the skin
143
Q

Chloroacetic acids 80% warnings

A
  • These acids are powerful keratolytics

- May cause burning, inflammation, and pain

144
Q

Chloroacetic acids 80% preparations

A
  • mono, di, and tri chloroacetric acids
145
Q

Silver nitrate actions

A
  • Dose dependent actions
  • Strong caustic, escharotic providing antiseptic, astringent, germicidal, epithelial stimulant
  • Inorganic silver salts are very bacteriocidal
146
Q

Silver nitrate indications

A
  • Vary with concentration
  • Styptic action
  • Cautery
  • Gonorrheal opthalmia neonatorum
147
Q

Silver nitrate contraindications

A
  • Wounds, cuts, broken skin
148
Q

Silver nitrate sticks

A
  • 10%, 25%, 50% ointment and solution are antiseptics

- 75% applicators is a cautery agent

Clinical Pharmacology (4 decks)

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