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

2) Topicals and Dermatologicals (Part 2) Flashcards

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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
Sodium hypchlorite (NaOCL, Dakin's Solution) cautions
- May cause bleaching and chemical burns
26
Burrow's Solution
- Astringent used for wet dressings - 23 % aluminum acetate - Don't confuse with Dakin's Solution (sodium hypochlorite)
27
Benzalkonium Chloride actions
- Bactericidal (spores are resisitant) - Fungicidal - Viricidal and kills protozoa - Deodorant - Wetting - Detergent - Keratolytic
28
Benzalkonium Chloride indications
- Antisepsis of skin, mucous membrane, abrasions and wounds - Pre-op surgical skin prep - Opthalmic solutions - Eye/ body cavity irrigations
29
Benzalkonium Chloride warnings
- Incompatible with iodine | - AgNO3, aluminum, zinc
30
Benzalkonium Chloride examples
- Zephiran solution or tincture | - Both 1:750 conc
31
Sulfamylon (Mafenide - Winthrop)
- Alpha amino toluenesulfonamide | - A soft, white cream
32
Sulfamylon (Mafenide - Winthrop) actions
- Bacteriostatic Gr +/Gr -/ pseudomonas/some anaerobes
33
Sulfamylon (Mafenide - Winthrop) indications
- Burns, 2nd and 3rd degree
34
Sulfamylon (Mafenide - Winthrop) contraindications
- Hypersensitivity to sulfonamides | - Pts. w/ glucose-6-phosphatase deficiency (causes severe and possibly fatal hemolytic anemia)
35
Topical Sulfa Rx antibacterials
- Silver Sulfasiazine (Silvadene) - Sulfamylon (Mafenide) - Sulfacetamide
36
Silvadene (silver sulfadiazene) Cr actions
- 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
37
Silvadene (silver sulfadiazene) Cr indications
- Burns, 2nd and 3rd degree
38
Silvadene (silver sulfadiazene) Cr contraindications
- Hypersensitivity to sulfonamides | - Pts w/ gluc-6-dehydrogenase deficiency
39
Sulfamylon (Mafenide) alpha-amino-toluenesulfonamide actions
- Bacteriostatic Gr +/Gr - pseudomonas/some anaerobes
40
Sulfamylon (Mafenide) alpha-amino-toluenesulfonamide indications
- Burns, 2nd and 3rd degree
41
Sulfamylon (Mafenide) alpha-amino-toluenesulfonamide contraindications
- Hypersensitivity to sulfonamides | - Pts. w/ glucose-6-phosphatase deficiency (causes severe/fatal hemolytic anemia)
42
sulfacetamide 10% topical lotion or wash action
- Bacteriostatic | - Competes with p-amino-benzoic acid (PABA) inhibiting folic acid synthesis
43
sulfacetamide 10% topical lotion or wash indications
- Acne | - Seborrheic dermatitis
44
sulfacetamide 10% topical lotion or wash disp
- 188 ml bottle | - Sig: apply lotion bid
45
Tetracycline HCI Achromycin (Lederle)
- OTC: 3% oint | - Rx: 1% opthalmic oint and susp
46
Tetracycline HCI Achromycin (Lederle) actions
- Antibiotic derived from streptomyces aureofaciens | - Bacteriostatic
47
Tetracycline HCI Achromycin (Lederle) indications
- Staph, strep, E. coli | - Used for opthalmic neonatorum effective against Clamydia or Neisseria
48
Tetracycline HCI Achromycin (Lederle) contraindications
- Pregnancy | - Children (teeth forming years < 8 yrs old: Ca+ chelation)
49
Chloramphenicol (Chloromycetin 1% cr, oint, solut) actions
- Bacteriostatic | - Protein sysnthesis inhibitor
50
Chloramphenicol (Chloromycetin 1% cr, oint, solut) indications
- Tx of skin infections caused by organisms susceptable to chloramphenicol (eg. E. coli; Haemophillus; Staph/Strep, Moraxella, Neisseria)
51
chloramphenicol (Chloromycetin 1% cr, oint, solut) contraindications
- Hypersensitivity to chloramphenicol
52
chloramphenicol (Chloromycetin 1% cr, oint, solut) warning
- Bone marrow suppression | - Aplastic anemia even with local application of chloramphenicol (is DOC for Salmonella)
53
Corticosporin (Monarch Pharm) cream Rx
- Polymixin B sulfate 10,000 units; - Neomycin sulfate 3.5 g - Hydrocortisone acetate 0.5 (5 mg)
54
Corticosporin (Monarch Pharm) ointment Rx
- Polymixin B sulfate 5,000 un%its - Zinc bactracin 400 units; - Neomycin sulfate 3.5 g - Hydrocortisone 1.0 % (10 mg)
55
Corticosporin (Monarch Pharm) actions
- Topical antibacterial/anti-inflammatory
56
Corticosporin (Monarch Pharm) indications
- Steroid responsive dermatoses with secondary bacterial infection
57
Corticosporin (Monarch Pharm) contraindications
- Lesions TB viral, or fungal of the skin
58
Corticosporin (Monarch Pharm) forms
- cr/oint/opthalmic oint and suspen | - Otic solution/suspension
59
Erythromycin solution 2%, USP (topical antibacterial-antibiotic)
- Eryderm (Abbott); Erycette swabs - Erymax-2% top solut in 2,4 oz bottles - Erygel (Allergan) 2% gel in 30, 60 g. tubes
60
Erythromycin solution 2%, USP actions
- Binds the 50s component of the ribosome therefore inhibiting protein synthesis
61
Erythromycin solution 2%, USP indications
- Acne | - Corynebacterium intertrigo
62
Erythromycin solution 2%, USP contraindications
- Known hypersensitivity to erythromycin
63
Gentamicin sulfate
- 0.1% Cr./Oint., U.S.P.; also opthalmic solution and ointment (Garamycin) Rx
64
Gentamicin sulfate actions
- Binds the 30s component of the ribosome | - Inhibits protein synthesis
65
Gentamicin sulfate indications
- Ecthyma, impetigo, or any primary or secondary skin infection caused by the organisms: Staph, Strep; Gr- : Klebsiella, E. Coli, Aerobactor
66
Gentamicin sulfate contraindications
- Sensitivity to gentamycin | - Ottotoxicity/nephrotoxicity
67
Neosporin ointment (Burroughs-Wellcome) OTC
- Polymixin B sulfate 5,000 units - Neomycin 3.5 g - Bacitracin 400 units
68
Neosporin ointment (Burroughs-Wellcome) OTC actions
- Topical antibiotic (OTC)
69
Neosporin ointment (Burroughs-Wellcome) OTC indications
- First aid, cuts, burns, abrasions
70
Neosporin ointment (Burroughs-Wellcome) OTC hypersensitivity warning
- Aminoglycoside and a sensitizer (ie: allergic sensitization induced allergic reaction)
71
Neosporin ointment (Burroughs-Wellcome) OTC forms
- GU irrigant | - Opthalmic ointment and solution (Rx)
72
Mupirocin (Bactroban)
- 2% cr/oint.(20 mg. mupirocin/mg cr.) chemically - Naturally occuring antibiotic - Fermentat by Pseudomonas florescens
73
Mupirocin (Bactroban) actions
- Inhib. bact. protein synthesis by binding to isoleucyl transfer-RNA synthetase
74
Mupirocin (Bactroban) indications
- For bacterial skin infections by: - Staph aureus (inclu. MRSA; b-lactamase producers;) - Staph. epi. & saprophyticus - Beta-hemolytic Strept. and S. pyogenenes
75
Mupirocin (Bactroban) contraindications
- Ophthalmic use
76
Mupirocin (Bactroban) warnings
- Burning, stinging, pain, itch 1%
77
Mupirocin (Bactroban) dose
- Small amount to affected area t.i.d | - 15% 30g tube
78
Types of antifungals and how they work
- 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
Cutaneous mycotic infections
- Common fungal infections of the skin: cause the “tineas” or "ringworm" - Tinea corporis, pedis, cruris, ungium, manis, corporis, capitus, faciei, barbae, nigra, versicolor)
80
Onychomycosis (OM) aka Tinea Ungium
- Accounts for 30% of all superficial fungal infections | - 50% of all dystrophic appearing nails are due to fungal infection (OM)
81
There are only three topical preparations for the Tx of OM
- ciclopirox 8% lacquer, (Penlac) - efinaconazole 10% soln (Jublia) - tabvaborole 5% soln (Kerydin) - PO-itraconazole and po (Lamisil)
82
Common dermatophytes
- Tricophyton: rubrum, mentagrophytes, tonsurans Epidermophyton floccosum - Microsporum: canis, audouini, gypseum
83
Non-dermatophytic fungi
- Yeast - Aspergillis - Cladosporum - Pityrosporum ovale, Pityrosporum orbicularis - Scopulariopsis brevicaulis
84
Rx for Tx of cutaneous fungal infections
- Imidazoles - Synthetic allylamines - Anti-yeast - Others
85
Imidazoles
- Triazole-antifungals - End in the suffix "-conazole" e. g. miconazole, clotrimazole
86
Synthetic allylamines (anti-fungals)
- naftifine (Naftin) - butenifine (Mentax) - terbinafine(Lamisil)
87
Tri-azole antifungals (imidazoles)
- Oral, injectable & many topical preparations | - All have similar chem structure
88
Tri-azole antifungals (imidazoles) actions
- Penetrates the cell wall, inhibits 14-alpha demethylase necessary for ergosterol synthesis - Thus, weakening cell membrane - Decreases integrity and permeability of cell membrane
89
Tri-azole antifungals (imidazoles) indications
- 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
Miconazole Rx and OTC
- Micatin, Breezee Mist, LotriminAF - Rx : Monistat-Derm, Fungoid tincture) 2% cr.,powder, solut - 80-96% effective against T. pedis and cut candidiasis
91
clotrimazole OTC/Rx (Lotrimin; Lotrisone; Mycelex)
- 1% top. cr.; solut.; lotion - Same spectrum as miconazole - Also effective against Corynebacterium - DOC for candida (more effective than nystatin)
92
ketoconazole 2% (Nizoral) Rx
- 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
Econazole 1% (topical Rx only)
- 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
Oxiconazole (Oxistat) topical only Rx 1% cr; lotion; chem
- 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
sulconazole (Exelderm) topical only Rx
- 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
efinaconazole (Jublia) 10% topical only, solution for nails
- Indications: onychomycosis - Dose: apply q d to the nails and nail edges x 48 weeks. - Supplied: 4 and 8 ml bottles w/brush
97
itraconazole- 100 mg. caps po only
- 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
Synthetic allyamines
- 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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