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Pharmacology - Exam 3 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How long does it take for a cell to fully keratinze?

A
  • 30d
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2
Q

What are the pharmacological variables?

A
  • variation in drug penetration (i.e. thin skin)
  • conc. gradient
  • dosing schedule
  • vehicles & occlusion
  • allergies/sensitivities
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3
Q

What is the relationship between concentration of drug and absorption?

A
  • directly, [high], high absorption
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4
Q

What are the two types of topical drugs?

A
  • moisturizing

- drying

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5
Q

Patient has xerosis, lichenification, or scaling - what type of topical drug should you rx?

A
  • moisturizing
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6
Q

Patient has a weeping, oozing, vesicular lesion with crusting - what type of topical drug should you rx?

A
  • drying
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7
Q

What must you take into consideration when administering topical rxs?

A
  • hairy areas

- cosmetic feel/look

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8
Q

What are the general uses for topical steroids?

A
  • nonspecific anti-infalm

- reduces itching

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9
Q

What do low/medium dose topical steroids tx?

A
  • eczema
  • irritant dermatitis
  • seborrhea
  • atopic dermatitis
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10
Q

What do high dose topical steroids tx?

A
  • psoriasis
  • lichen planus
  • allergic contact dermatitis
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11
Q

What is the MOA of topical steroids?

A
  • decrease migration of PMNs & fibroblasts
  • reverses cap permeability
  • controls rate of protein synthesis
  • lysosomal stabilization
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12
Q

What must you remember about using ultra high potency steroids?

A
  • should not be used >3w
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13
Q

What must you remember about using low, medium, or high potency steroids?

A
  • should not be used >3m
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14
Q

What should be taken into considerations when using topical steroids?

A
  • chronic use effects
  • low doses used on areas of increased absorption
  • caution with occlusive dressings
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15
Q

What type of topical steroid has the highest effects?

A
  • ointments
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16
Q

What is the ADME of topical steroids?

A
  • A: minimal systemic
  • D: highly protein bound
  • M: hepatic
  • E: urine
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17
Q

What is the 1/2 life of topical steroids?

A
  • 6.5h
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18
Q

What does the A (administration) depend on for topical steroids?

A
  • potency
  • formulation
  • extent of use
  • area of use
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19
Q

What is the common ADE (adverse drug effect) of topical steroids?

A
  • cutaneous atrophy, can have teleangiectases & purpura, resolves
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20
Q

What are the other/serious ADEs of topical steroids?

A
  • striae
  • acne
  • refractory rosacea
  • hypopigmentation
  • alopecia
  • glaucoma
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21
Q

Describe the relationship between topical steroids & adrenal suppression/iatrogenic Cushings

A
  • specific ADE of topical steroids

- increased with dose/duration and in children

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22
Q

What are the drug interactions of topical steroids?

A
  • none when topical
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23
Q

What are the contraindications of topical steroids?

A
  • systemic fungal infection

- hypersensitivity

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24
Q

What patient populations should use caution with topical steroids?

A
  • preggers

- children < 12y/o

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25
Q

What is the next step in a patient who is on topical steroids but continues to have worsening symptoms?

A
  • ? fungal
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26
Q

What improves cutaneous absorption of topical steroids?

A
  • hydration

i. e. apply s/p shower or cold compress

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27
Q

What is the fingertip method?

A
  • 1 fingertip amount will cover 2 palms
  • fingertip = 0.5g
    ( 2 palms divided by 1 fingertip = 1/2 g)
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28
Q

Where is psoriasis mostly located?

A
  • elbows
  • knees
  • back
  • scalp
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29
Q

Define mild-moderate psoriasis

A
  • <5%BSA
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30
Q

Define moderate-severe psoriasis

A
  • > 5% BSA
    OR
  • hand, feet, face or genitals
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31
Q

What is the MOA of corticosteroids?

A
  • inhibits inflammation
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32
Q

What are the topical medications for psoriasis?

A
  • corticosteroids
  • vit D analogues
  • tazarotene
  • calcineurin inhibitors
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33
Q

What is the MOA of vit D analogues?

A
  • bind to Vit D receptor

- promotes differentiation of keratinocytes

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34
Q

What ADE can vit D analogues cause?

A
  • photosensitivity
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35
Q

What is the MOA of tazarotene?

A
  • binds to retinoic acid receptors

- normalizes epidermal differentiation

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36
Q

side note of tazarotene?

A
  • photosensitivity

- pregnancy category X

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37
Q

What is the MOA of calcineurin?

A
  • inhibits transcription of cytokines including IL-2
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38
Q

What can calcineurin be used for specifically?

A
  • facial or intertriginous psoriasis
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39
Q

When are topical medications used in psoriasis?

A
  • mainly mild disease
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40
Q

What is the first line tx for psoriasis?

A
  • corticosteroids (generally)
41
Q

_______ + _______ more effective than _______

A
  • calcipotriene
  • corticosteroid
  • monotherapy
42
Q

What are the oral non-biologics for psoriasis?

A
  • methotrexate
  • cyclosprorine
  • acitretin
  • fumaric acid esters
  • apremilast
43
Q

In general, what do many non-biologics have?

A
  • many contraindications (CI)
44
Q

What is the MOA of methotrexate?

A
  • blocks dihydrofolate ==> blocks DNA synthesis
45
Q

What is the MOA of cyclosporine?

A
  • inhibits IL-2 & other cytokines
46
Q

When a patient is being treated with oral non-biologics, what must be watched?

A
  • frequent lab monitoring
47
Q

When should patients with psoriasis be referred?

A
  • once oral therapy is indicated
48
Q

What is the stratum corneum also known as & what is its function?

A
  • drug reservoir

- extends 1/2 life

49
Q

What are the concentrations/potencie of topical steroids?

A
  • lowest
  • low
  • medium
  • high
  • highest
50
Q

What are the biologics for psoriasis?

A
  • adalimumab (Humira)
  • etanercept (Enbrel)
  • infliximamb (Rmicade)
  • alefacept (Amevive)
  • ustekinumab (Stelara)
51
Q

What is a concern for psoriatic biologics?

A
  • serious infection
52
Q

What must be obtained prior to biologics?

A
  • neg. PPD
53
Q

Who manages biologic rx’s?

A
  • specialist
54
Q

What is a non-pharmacologic tx for psoriasis?

A
  • UVB from phototherapy
55
Q

What is the 1st line tx for mild (grade I) acne?

A
  • topical retinoids consider with antimicrobial (i.e. benzoyl peroxide)
56
Q

What is the 1st line tx for moderate (grade II & III) acne?

A
  • topical retinoid + oral abx w/ or w/o antimicrobial (i.e. benzoyl peroxide)
57
Q

What is the 1st line tx for severe (grade IV) acne?

A
  • oral isotretinoin
58
Q

What is the MOA of topical retinoids?

A
  • prevents formation of comedones & inflam lesions

- does not contribute to bacteria resistance

59
Q

T/F: There are concerns surrounding topical retinoids and long-term use.

A
  • false
60
Q

How are topical retinoids available?

A
  • gel
  • cream
  • sol’n
  • lotion
  • ointment
  • compress
61
Q

What are the ADEs of topical retinoids?

A
  • skin peeling
  • redness
  • dryness
  • burning
  • puritis
62
Q

What patient population should topical retinoids be avoided in?

A
  • preggers
63
Q

What other product should be used with topical retinoids?

A
  • daily moisturizer with sunscreen
64
Q

What are examples of topical keratolytics?

A
  • benzoyl peroxide

- salicyclic acid

65
Q

What is the MOA of topical keratolytics?

A
  • rapid shedding of epidermis to prevent clogging & formation of comedones
  • topical antimicrobial, not associated with resistance
66
Q

What is the optimal preparation of topical keratoylitcs?

A
  • gel
67
Q

What are the ADEs of topical keratolytics?

A

~local effects~

  • skin irritation
  • contact dermatitis
  • dryness erythema
  • peeling
  • stinging
68
Q

What are examples of antimicrobial therapy for acne?

A
  • dapsone
  • erythromycin
  • clindamycin
  • tetracycline
  • minocycline
69
Q

What is the MOA of antimicrobial therapy for acne?

A
  • decrease bacterial load

- reduce inflammation

70
Q

When can antimicrobials be used PO?

A
  • severe
71
Q

How are antimicrobials used?

A
  • combo with benzoyl peroxide
72
Q

What is the ideal length for antimicrobials PO?

A
  • 3mo
73
Q

What should be avoided with topical antimicrobials?

A
  • combining with oral

- switching abx w/o justification

74
Q

How does isotretinoin tx acne?

A
  • reduces sebum production
  • reduces comedone formation by decreasing keratinization
  • reduces P. acnes
  • reduces inflmmation
75
Q

What are the ADEs of isotretinoin?

A
  • excessive drying, burning, & skin inflam
  • mild lip inflam
  • dyslipidemia
  • arthralgias/musculoskeletal pain
76
Q

What must be avoided with isotretinoin?

A
  • pregnancy
77
Q

What is the preferred route of rx admin for urticaria?

A
  • PO
78
Q

Which type of anithistamines is preferred and why?

A
  • 2nd generation: effective with no/minimal drowsiness
79
Q

What is the 1st line tx for urticaria?

A
  • 2md generation antihistamines
80
Q

What is the 1st line tx for impetigo?

A
  • prevention
81
Q

What is the rx tx for impetigo?

A
  • broad spectrum abx

- topical is usually sufficient

82
Q

What is the treatment for topical fungal infections?

A
  • suffix: -azole
  • allylamines
  • others rare: ciclopirox, griseofulvin
83
Q

What is the MOA of -azoles?

A
  • inhibits conversion of lanosterol to ergosterol via CYP P450 (prevents fungal cell wall synthesis)
  • also affects human steroid synthesis
84
Q

What is the MOA of allylamines?

A
  • inhibit squalene oxidase, required for ergosterol synthesis
  • less effect on human steroid synthesis
85
Q

What is the MOA of griseofulvin?

A
  • binds to fungal microtubules & inhibits mitosis
86
Q

What is the MOA of ciclopirox?

A
  • not well understood

- blocks cell membrane transport, depeleting cells of substrates and ions

87
Q

What is a major concern with -azoles?

A
  • CYP P450 drug interactions
88
Q

What type of ADEs are seen with the topical fungal rxs?

A
  • mainly local
89
Q

When is topical tx used for viral infections (HSV)?

A
  • mild lesions such as cold sores
90
Q

When is oral tx used for viral infections (HSV)?

A
  • genital lesions
  • severe
  • suppression (prophylaxis of breakouts)
91
Q

What is the group of rxs used as common antivirals?

A
  • suffix: -clovir

i. e. acyclovir, famciclovir, valacyclovir

92
Q

What is the MOA of antiviral rxs?

A
  • inhibit viral DNA synthesis

- should resolve sx in 7d

93
Q

What must be avoided with antiviral rx tx & why?

A
  • OTC creams, delay healing & increase transmission of disease
94
Q

What are the side effects of topical antivirals?

A
  • urticaria
95
Q

What are the side effects of oral antivirals?

A
  • GI irritation
  • elevated LFTs
  • disorientation
  • hallucinations
  • H/A
96
Q

What is an antiviral safety concern?

A
  • drug & vaccine interactions
97
Q

What are the ‘top’ 4 types of moisturizing topicals?

A
  • ointments
  • foams
  • creams
  • pastes
98
Q

What are the ‘top’ 4 types of drying topicals?

A
  • tinctures
  • wet dressings
  • lotions
  • gels

Pharmacology - Exam 3 (4 decks)

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