Derm 2

Question 1

Corticosteroid - inceases in concentration

Answer 1

Increases in concentration of a particular corticosteroid within a finite range in a defined vehicle enhance potency

Question 2

Corticosteroid - Occlusive dressings

Answer 2

Occlusive dressings promote cutaneous hydration and significantly increase absorption and potency.

Question 3

Corticosteroid - Occlusion can enhance

Answer 3

Occlusion can enhance topical corticosteroid potency by as much as 100-fold.

Question 4

Corticosteroid ointment preperations

Answer 4

preparations generally allow better percutaneous drug absorption and are therefore more potent than creams and lotions. One exception is the super-potent topical corticosteroid (e.g.,betamethasonedipropionate) that may be packaged in “optimized” cream vehicles.

Question 5

Daily use of super high potency topical corticosteroids – do not exceed

Answer 5

3 weeks (persistent lesions on small areas could be treated longer)

Question 6

Corticosteroids - High potency and medium strengths – rarely cause cutaneous side

Answer 6

effects if used for less than 6 to 8 weeks; could occur with shorter courses, especially on the face and intertriginous areas

Question 7

Corticosteroids - Intermittent therapy

Answer 7

Intermittent therapy – maintaining long-term control

Question 8

Corticosteroids - Discontinue when

Answer 8

Discontinue when skin condition has resolved

Question 9

Corticosteroids Rebound

Answer 9

Rebound flares – avoid by tapering topical therapy with a gradual reduction in both potency and dosing frequency at two-weeks intervals

Question 10

Topical Glucocorticoids - SE

Answer 10

SE are rate with low potency

Question 11

Topical Glucocorticoids facial

Answer 11

Facial, intertriginous, genital dermatoses – treat short 1 to 2 weeks intervals – most susceptible to corticoids-induced atrophy, telangiectasia, and acneiform eruption

Question 12

Topical Glucocorticoids ADR

Answer 12

Local reactions
Thinning of the skin
Stretch marks
Purpura
Telangiectasia
Hypertrichosis
Atrophy

Question 13

Topical Glucocorticoids - Saver than

Answer 13

Safer than systemic glucocorticoids

Question 14

Topical Glucocorticoids - Tachy

Answer 14

Tachyphylasix

Question 15

Topical Glucocorticoids - ADR Systemic

Answer 15

Systemic toxicity
More likely with higher doses and long-term therapy
Growth retardation in children
Adrenal suppression

Question 16

Topical Glucocorticoids - Administration

Answer 16

Apply in a thin film and gently rub into the skin

Do not use occlusive bandages (or tight-fitting diapers and plastic pants)

Question 17

Pediatrics - Safe

Answer 17

use of lower potency (groups 4 to 7) – short durations, appropriate inflammatory conditions

Question 18

Pediatrics - require

Answer 18

Require less - infants be given one-fifth of the adult dose, children be given two-fifths of the adult dose, and adolescents be given two-thirds of adult doses

Question 19

Pregnant women - mild or moderate

Answer 19

Pregnant women - mild or moderate

Question 20

pregnancy if potent or

Answer 20

potent or super potent topical corticosteroids are needed, the amount used should be kept to a minimum; monitor fetal growth.

Question 21

Pregnancy it is not known

Answer 21

whether topical corticosteroids are secreted in breast milk; no adverse effects have been noted in lactating women.

Question 22

How much to dispense?

Answer 22

Considering the amount used per application
The number of applications to be given daily,
The duration of therapy
The Fingertip Unit (FTU)

Question 23

The Fingertip Unit (FTU)

Answer 23

Approximately equivalent to 0.5 and 0.4 grams of ointment in men and women,respectively.
Head and neck = 4.5; trunk (front or back) = 7; one arm = 3; one hand = 1; one leg = 6; and one foot = 2.

Question 24

For 3 times daily applications – 9 grams of cream covers

Answer 24

9% of skin area daily

Question 25

Quantity of cream to dispense for complete coverage of area for 3x daily applications for 10 days

Answer 25

Face: 45g
Chest or back: 180g
1 arm: 90g
1 forearm: 45g
1 hand or foot: 45g
1 leg: 180g

Question 26

Avoiding under and

Answer 26

over dispensing.

Question 27

Consider the amount used per

Answer 27

application, the number of applications to be given daily, and the duration of therapy.

Question 28

For a three times a day application, 9 grams of cream will cover

Answer 28

9% of the skin area daily.

Question 29

Example OF RULE OF NINE

Answer 29

Entire right leg, you take 9 (front of leg) and 9 (back of leg) which equal 18. Take 18 x 10 = 180grams. This is for a three times a day application to the entire right leg for 10 days.
Front of the forearm – it would be half of 9 = 4.5 x 10 = dispense a 45 grams tube.

Question 30

Pediatrics: greater surface

Answer 30

greater surface area-to-weight ratio, permeability of skin increased in very young, avoid high potency corticosteroids, and avoid occlusive dressings.

Question 31

Pregnant – alterations in hormonal

Answer 31

alterations in hormonal balance result in skin changes. Many dermatological products are not recommended in pregnancy.

Question 32

Geriatrics – skin is less

Answer 32

permeable to drugs due to an altered lipid content and loss of subcutaneous tissues; changes in CNS alter perception of itching and pain; atrophy of the reticuloendothelial system may impair the immune system; progressive impairment of peripheral vascular symptom decreases sensation.

Question 33

Combination anti-fungal/topical corticosteroid products – consider

Answer 33

doing a KOH scraping to help determine if its is fungal

Question 34

Topical Corticosteroids - Other SE

Answer 34

Other side effects that can occur with topical corticosteroid use include acneiform eruptions, purpura, hypopigmentation, glaucoma, and suppression of the hypothalamic-pituitary axis

Question 35

Topical Corticosteroids - Intermitent therpay

Answer 35

Intermittent therapy with topical corticosteroids can be effective for long-term maintenance therapy in some conditions (e.g., twice-weekly application in well-controlled atopic dermatitis to reduce risk of relapse).

Question 36

Topical Corticosteroids Pulse therapy

Answer 36

Pulse therapy – 2 weeks on and 2 weeks off.

Question 37

Topical Corticosteroids facial

Answer 37

intertriginous, and genital dermatoses should be treated for short one to two-week intervals. These areas are more susceptible to corticosteroid-induced atrophy, telangiectasia, and acneiform eruption.