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Clinical Pharmacology > 2) Topicals and Dermatologicals (Part 2) > Flashcards

2) Topicals and Dermatologicals (Part 2) Flashcards

1
Q

Cutaneous bacterial infections - pyoderma

A
  • Impetigo
  • Folliculitis
  • Ecthyma
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2
Q

Impetigo

A
  • superficial skin infection usually caused by S. aureus and occasionally by S. pyogenes.
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3
Q

Folliculitis

A
  • Superficial infection of the hair follicles often caused by Pseudomonas
  • Characterized by erythematous, follicular-based papules and pustules
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4
Q

Furuncles (folliculitis)

A
  • Deeper infections of the hair follicle
  • Characterized by inflammatory nodules with pustular drainage
  • Can coalesce to form larger draining nodules (carbuncles)
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5
Q

Ecthyma

A
  • Cutaneous infection characterized by thickly crusted erosions or ulcerations
  • S. aureus or S. pyogenes is the usual pathogen of ecthyma
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6
Q

Erysipelas

A
  • Superficial cutaneous infection of the skin involving dermal lymphatic vessels
  • Cellulitis is a deeper process that extends to the subcutis
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7
Q

Most common pathogen responsible for erysipelas

A
  • Group A β-hemolytic streptococcus

- S. aureus is by far the most common pathogen for cellulitis

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8
Q

7 major groups of antibacterials

A
  • Alcohols
  • Aldehydes
  • Halogens
  • Oxidizers
  • Heavy metals
  • Phenols
  • Cationic surface active agents
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9
Q

Antiseptics

A
  • Iodine solution and tincture

- Iodophors

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10
Q

Iodine tincture

A
  • Iodine 2%, sodium iodide 2.4%, in 50% ethanol
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11
Q

Halogen (elemental iodine)

A
  • 1% tincture will kill 90% of bacterial on the skin in 1.5 minutes
  • Toxicity and iodine burns due to older 7% tinctures
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12
Q

Betadine (provodone-iodine)

A
  • Combination of iodine with a carrier or solublizing agent (eg polyvinylpyrrolidone)
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13
Q

Betadine action (iodophore)

A
  • Microbiocidal

- Fungal, yeasts, Gr+/Gr, viruses, trichomonas, and candidiasis

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14
Q

Betadine (iodophor) indications

A
  • Burns
  • Abrasions
  • Open wounds
  • Ulcers
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15
Q

Betadine (iodophor) contraindications

A
  • Hypersensitivity to iodine
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16
Q

hexachlorophene, U.S.P. (antibacterial)

A
  • Phenolic compound; (polyclorinate bis-phenol)

- Rx: pHisohex 3% (Winthrop)

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17
Q

hexachlorophene, U.S.P. (antibacterial) actions

A
  • Bacteriostatic skin cleansing agent (Gr + and Staph)
  • gr+ and gr- (no effect on spores)
  • Good for staph but not proprionbacterium (a gr. neg anaerobe) therefore not for acne
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18
Q

hexachlorophene, U.S.P. (antibacterial) indications

A
  • Pre-op surgical scrub
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19
Q

hexachlorophene, U.S.P. (antibacterial) contraindications

A
  • not to be used on burns, open wounds, mucous membranes
  • Caution with infants
  • Systemic toxicity causes cerebral irritation and excitation, myoclonic seizures, clonus and brain stem lesions
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20
Q

Chlorhexidine (Hibiclens; Peridex) actions

A
  • Halogen
  • Breaks plasma membrane of bact
  • Cell Surgical Scrub (47% Soap) better than Iodophor or 4% Solution to Tx/disinfect
  • Wounds: used if allergic to iodine
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21
Q

Chlorhexidine (Hibiclens; Peridex) indications

A
  • Pre-op srugical scrub or bacteriocidal skin cleanser

- Gr+ and gr-

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22
Q

Chlorhexidine (Hibiclens; Peridex) preparations

A
  • 2% or 4% solution

- Surgical scrub

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23
Q

Sodium hypchlorite (NaOCL, Dakin’s Solution)

A
  • Bleach = 5.25% NaOCI

- Two strengths 0.25% and 0.5%

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24
Q

Sodium hypchlorite (NaOCL, Dakin’s Solution) indications

A
  • Active against bacterial, fungi, and viruses

- Deodorizes wounds

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25
Q

Sodium hypchlorite (NaOCL, Dakin’s Solution) cautions

A
  • May cause bleaching and chemical burns
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26
Q

Burrow’s Solution

A
  • Astringent used for wet dressings
  • 23 % aluminum acetate
  • Don’t confuse with Dakin’s Solution (sodium hypochlorite)
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27
Q

Benzalkonium Chloride actions

A
  • Bactericidal (spores are resisitant)
  • Fungicidal
  • Viricidal and kills protozoa
  • Deodorant
  • Wetting
  • Detergent
  • Keratolytic
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28
Q

Benzalkonium Chloride indications

A
  • Antisepsis of skin, mucous membrane, abrasions and wounds
  • Pre-op surgical skin prep
  • Opthalmic solutions
  • Eye/ body cavity irrigations
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29
Q

Benzalkonium Chloride warnings

A
  • Incompatible with iodine

- AgNO3, aluminum, zinc

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30
Q

Benzalkonium Chloride examples

A
  • Zephiran solution or tincture

- Both 1:750 conc

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31
Q

Sulfamylon (Mafenide - Winthrop)

A
  • Alpha amino toluenesulfonamide

- A soft, white cream

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32
Q

Sulfamylon (Mafenide - Winthrop) actions

A
  • Bacteriostatic Gr +/Gr -/ pseudomonas/some anaerobes
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33
Q

Sulfamylon (Mafenide - Winthrop) indications

A
  • Burns, 2nd and 3rd degree
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34
Q

Sulfamylon (Mafenide - Winthrop) contraindications

A
  • Hypersensitivity to sulfonamides

- Pts. w/ glucose-6-phosphatase deficiency (causes severe and possibly fatal hemolytic anemia)

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35
Q

Topical Sulfa Rx antibacterials

A
  • Silver Sulfasiazine (Silvadene)
  • Sulfamylon (Mafenide)
  • Sulfacetamide
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36
Q

Silvadene (silver sulfadiazene) Cr actions

A
  • Silver ion precipitates proteins and interferes with bact. cell metabolism
  • All sulfa Rx competes with p-amino-benzoic acid (PABA) inhibiting folic acid synthesis
  • Bacteriocidal: Gr+/Gr-/yeast/pseudomonas
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37
Q

Silvadene (silver sulfadiazene) Cr indications

A
  • Burns, 2nd and 3rd degree
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38
Q

Silvadene (silver sulfadiazene) Cr contraindications

A
  • Hypersensitivity to sulfonamides

- Pts w/ gluc-6-dehydrogenase deficiency

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39
Q

Sulfamylon (Mafenide) alpha-amino-toluenesulfonamide actions

A
  • Bacteriostatic Gr +/Gr - pseudomonas/some anaerobes
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40
Q

Sulfamylon (Mafenide) alpha-amino-toluenesulfonamide indications

A
  • Burns, 2nd and 3rd degree
41
Q

Sulfamylon (Mafenide) alpha-amino-toluenesulfonamide contraindications

A
  • Hypersensitivity to sulfonamides

- Pts. w/ glucose-6-phosphatase deficiency (causes severe/fatal hemolytic anemia)

42
Q

sulfacetamide 10% topical lotion or wash action

A
  • Bacteriostatic

- Competes with p-amino-benzoic acid (PABA) inhibiting folic acid synthesis

43
Q

sulfacetamide 10% topical lotion or wash indications

A
  • Acne

- Seborrheic dermatitis

44
Q

sulfacetamide 10% topical lotion or wash disp

A
  • 188 ml bottle

- Sig: apply lotion bid

45
Q

Tetracycline HCI Achromycin (Lederle)

A
  • OTC: 3% oint

- Rx: 1% opthalmic oint and susp

46
Q

Tetracycline HCI Achromycin (Lederle) actions

A
  • Antibiotic derived from streptomyces aureofaciens

- Bacteriostatic

47
Q

Tetracycline HCI Achromycin (Lederle) indications

A
  • Staph, strep, E. coli

- Used for opthalmic neonatorum effective against Clamydia or Neisseria

48
Q

Tetracycline HCI Achromycin (Lederle) contraindications

A
  • Pregnancy

- Children (teeth forming years < 8 yrs old: Ca+ chelation)

49
Q

Chloramphenicol (Chloromycetin 1% cr, oint, solut) actions

A
  • Bacteriostatic

- Protein sysnthesis inhibitor

50
Q

Chloramphenicol (Chloromycetin 1% cr, oint, solut) indications

A
  • Tx of skin infections caused by organisms susceptable to chloramphenicol (eg. E. coli; Haemophillus; Staph/Strep, Moraxella, Neisseria)
51
Q

chloramphenicol (Chloromycetin 1% cr, oint, solut) contraindications

A
  • Hypersensitivity to chloramphenicol
52
Q

chloramphenicol (Chloromycetin 1% cr, oint, solut) warning

A
  • Bone marrow suppression

- Aplastic anemia even with local application of chloramphenicol (is DOC for Salmonella)

53
Q

Corticosporin (Monarch Pharm) cream Rx

A
  • Polymixin B sulfate 10,000 units;
  • Neomycin sulfate 3.5 g
  • Hydrocortisone acetate 0.5 (5 mg)
54
Q

Corticosporin (Monarch Pharm) ointment Rx

A
  • Polymixin B sulfate 5,000 un%its
  • Zinc bactracin 400 units;
  • Neomycin sulfate 3.5 g
  • Hydrocortisone 1.0 % (10 mg)
55
Q

Corticosporin (Monarch Pharm) actions

A
  • Topical antibacterial/anti-inflammatory
56
Q

Corticosporin (Monarch Pharm) indications

A
  • Steroid responsive dermatoses with secondary bacterial infection
57
Q

Corticosporin (Monarch Pharm) contraindications

A
  • Lesions TB viral, or fungal of the skin
58
Q

Corticosporin (Monarch Pharm) forms

A
  • cr/oint/opthalmic oint and suspen

- Otic solution/suspension

59
Q

Erythromycin solution 2%, USP (topical antibacterial-antibiotic)

A
  • Eryderm (Abbott); Erycette swabs
  • Erymax-2% top solut in 2,4 oz bottles
  • Erygel (Allergan) 2% gel in 30, 60 g. tubes
60
Q

Erythromycin solution 2%, USP actions

A
  • Binds the 50s component of the ribosome therefore inhibiting protein synthesis
61
Q

Erythromycin solution 2%, USP indications

A
  • Acne

- Corynebacterium intertrigo

62
Q

Erythromycin solution 2%, USP contraindications

A
  • Known hypersensitivity to erythromycin
63
Q

Gentamicin sulfate

A
  • 0.1% Cr./Oint., U.S.P.; also opthalmic solution and ointment (Garamycin) Rx
64
Q

Gentamicin sulfate actions

A
  • Binds the 30s component of the ribosome

- Inhibits protein synthesis

65
Q

Gentamicin sulfate indications

A
  • Ecthyma, impetigo, or any primary or secondary skin infection caused by the organisms: Staph, Strep; Gr- : Klebsiella, E. Coli, Aerobactor
66
Q

Gentamicin sulfate contraindications

A
  • Sensitivity to gentamycin

- Ottotoxicity/nephrotoxicity

67
Q

Neosporin ointment (Burroughs-Wellcome) OTC

A
  • Polymixin B sulfate 5,000 units
  • Neomycin 3.5 g
  • Bacitracin 400 units
68
Q

Neosporin ointment (Burroughs-Wellcome) OTC actions

A
  • Topical antibiotic (OTC)
69
Q

Neosporin ointment (Burroughs-Wellcome) OTC indications

A
  • First aid, cuts, burns, abrasions
70
Q

Neosporin ointment (Burroughs-Wellcome) OTC hypersensitivity warning

A
  • Aminoglycoside and a sensitizer (ie: allergic sensitization induced allergic reaction)
71
Q

Neosporin ointment (Burroughs-Wellcome) OTC forms

A
  • GU irrigant

- Opthalmic ointment and solution (Rx)

72
Q

Mupirocin (Bactroban)

A
  • 2% cr/oint.(20 mg. mupirocin/mg cr.) chemically
  • Naturally occuring antibiotic
  • Fermentat by Pseudomonas florescens
73
Q

Mupirocin (Bactroban) actions

A
  • Inhib. bact. protein synthesis by binding to isoleucyl transfer-RNA synthetase
74
Q

Mupirocin (Bactroban) indications

A
  • For bacterial skin infections by:
  • Staph aureus (inclu. MRSA; b-lactamase producers;)
  • Staph. epi. & saprophyticus
  • Beta-hemolytic Strept. and S. pyogenenes
75
Q

Mupirocin (Bactroban) contraindications

A
  • Ophthalmic use
76
Q

Mupirocin (Bactroban) warnings

A
  • Burning, stinging, pain, itch 1%
77
Q

Mupirocin (Bactroban) dose

A
  • Small amount to affected area t.i.d

- 15% 30g tube

78
Q

Types of antifungals and how they work

A
  • Antiseptics and disinfectants
  • Astringents (eg. bactine)
  • Keratolytic agents: promote desquammation of the S. Corneum and therefore removes the offending fungus
  • Drugs that prevent hyperhydrosis: retard proliferation of fungi-by altering the conditions for growth
79
Q

Cutaneous mycotic infections

A
  • Common fungal infections of the skin: cause the “tineas” or “ringworm”
  • Tinea corporis, pedis, cruris, ungium, manis, corporis, capitus, faciei, barbae, nigra, versicolor)
80
Q

Onychomycosis (OM) aka Tinea Ungium

A
  • Accounts for 30% of all superficial fungal infections

- 50% of all dystrophic appearing nails are due to fungal infection (OM)

81
Q

There are only three topical preparations for the Tx of OM

A
  • ciclopirox 8% lacquer, (Penlac)
  • efinaconazole 10% soln (Jublia)
  • tabvaborole 5% soln (Kerydin)
  • PO-itraconazole and po (Lamisil)
82
Q

Common dermatophytes

A
  • Tricophyton: rubrum, mentagrophytes, tonsurans
    Epidermophyton floccosum
  • Microsporum: canis, audouini, gypseum
83
Q

Non-dermatophytic fungi

A
  • Yeast
  • Aspergillis
  • Cladosporum
  • Pityrosporum ovale, Pityrosporum orbicularis
  • Scopulariopsis brevicaulis
84
Q

Rx for Tx of cutaneous fungal infections

A
  • Imidazoles
  • Synthetic allylamines
  • Anti-yeast
  • Others
85
Q

Imidazoles

A
  • Triazole-antifungals
  • End in the suffix “-conazole”
    e. g. miconazole, clotrimazole
86
Q

Synthetic allylamines (anti-fungals)

A
  • naftifine (Naftin)
  • butenifine (Mentax)
  • terbinafine(Lamisil)
87
Q

Tri-azole antifungals (imidazoles)

A
  • Oral, injectable & many topical preparations

- All have similar chem structure

88
Q

Tri-azole antifungals (imidazoles) actions

A
  • Penetrates the cell wall, inhibits 14-alpha demethylase necessary for ergosterol synthesis
  • Thus, weakening cell membrane
  • Decreases integrity and permeability of cell membrane
89
Q

Tri-azole antifungals (imidazoles) indications

A
  • Broad spectrum all dermatophytes
  • Also: candida, Cryptococcus, Aspergillus, Coccidioides, Paracoccidioides, Cladosporium, Madurella, Blastomyces, histoplasma, Phialophora
  • Oral agents in this class are itraconazole, ketoconazole, fluconazole
90
Q

Miconazole Rx and OTC

A
  • Micatin, Breezee Mist, LotriminAF
  • Rx : Monistat-Derm, Fungoid tincture) 2% cr.,powder, solut
  • 80-96% effective against T. pedis and cut candidiasis
91
Q

clotrimazole OTC/Rx (Lotrimin; Lotrisone; Mycelex)

A
  • 1% top. cr.; solut.; lotion
  • Same spectrum as miconazole
  • Also effective against Corynebacterium
  • DOC for candida (more effective than nystatin)
92
Q

ketoconazole 2% (Nizoral) Rx

A
  • Topical cr, foam; shampoo and po tabs
  • indic: dermatophytes, candida; malasezia furfur; seb. dermatitits;
  • Rx: q d X 2 wks
  • po 1:10,000 toxic hepatitis
93
Q

Econazole 1% (topical Rx only)

A
  • 1% cr and foam
  • 5,30,85 gm tubes
  • Good for the common dermatophytes, yeast, and pityrosporporum orbiculare (t. Versicolor) and some gr. positive bact
  • 80% cure rate; Sig: q d x 2- 4 wks; for yeast use bid
94
Q

Oxiconazole (Oxistat) topical only Rx 1% cr; lotion; chem

A
  • Similar to econazole
  • Not effective for Candida, Microsporum sp. and Malassezia
  • Indicated for Tricophyton and Epidermophyton sp.
  • Rx: bid X two weeks at best 67-77% cure
95
Q

sulconazole (Exelderm) topical only Rx

A
  • 1% cr. (10 mg/g.); solut 15,30,60 gmtubes and 30 ml bottle
  • Chemically: 1-(2,4-dichloro(p-chlorobenzylthiaphenethel)
  • Not as good as the others, not effective against all dermatophytes and not proven effective for yeast
96
Q

efinaconazole (Jublia) 10% topical only, solution for nails

A
  • Indications: onychomycosis
  • Dose: apply q d to the nails and nail edges x 48 weeks.
  • Supplied: 4 and 8 ml bottles w/brush
97
Q

itraconazole- 100 mg. caps po only

A
  • Indic: life threatening fungal infections; onychomycosis of finger and toenails; superficial mycoses; coccidiomycosis; coccidioidal meningitis; cut and lymphocutaneous sporotrichosis
  • Dose: toenails 200 mg po q d x 12 wks
98
Q

Synthetic allyamines

A
  • nafitine (Naftin): 1-2% cr, gel; 2-4 wks
  • terbinafine (Lamisil) 1% cr, spray; bid x 2wks
  • butenifine (Mentax) 1% cr bid x 1-2 wks

Clinical Pharmacology (4 decks)

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