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Block 2 Flashcards

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1
Q

What is the MOA of anti-allergy medications for the eye?

A

H1 receptor blocker

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2
Q

Anti-Cholinergic MOA + eye?

A

Inhibits glandular secretions

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3
Q

Beta blocker MOA + eye?

Non-selective MOA?

A

Reduces lysozyme lvls and IgA

Non-selective = reduces IOP by decreasing aqueous formation by ciliary body

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4
Q

What Rx causes band keratopathy?

A

Diuretics

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5
Q

What Rx causes vortex keratopathy?

A

Amiodarone + Chloroquine/Hydroxychloroquine

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6
Q

What are the side effects of Amiodarone + eye?

A
  1. Vision loss
  2. Pseudotumor cerebri
  3. Haloes
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7
Q

What is pseudotumor cerebri and what causes it?

A

Increased intracranial pressure leading to optic nerve swelling and eventually vision loss

  • Amiodarone
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8
Q

What are the side effects of Digoxin + eye?

A
  1. Red/Green color defect
  2. Xanthopsia
  3. Flashes of light
  4. Reduces IOP
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9
Q

Digoxin MOA + eye?

A

Inhibits Na-K ATPase pump

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10
Q

What are some side effects of anticoagulants and antiplatelets and eye?

A

Subconjunctival and retinal hemorrhage

Chronic use = yellowing of vision

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11
Q

What are the side effects of Accutane + eye?

A
  1. Blepharoconjunctivitis
  2. Night blindness
  3. Contact lens intolerance
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12
Q

What drugs cause hyperpigmentation and dark deposits in palpebral conjunctiva?

A

Tetracyclines

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13
Q

Tetracyclines can cause what to the eye?

A

Hyperpigmentation and dark deposits in palpebral conjunctiva

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14
Q

What is blepharoconjunctivitis and what causes it?

A

Swelling of lids and conjunctiva

  • Accutane
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15
Q

How would you manage tetracycline + eye issues?

A

d/c Rx

Oral steroids and/or diamox to reduce intracranial pressure

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16
Q

How would you manage amiodarone + eye issues?

A

Frequent eye exams (q6months), decrease dose or d/c Rx

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17
Q

What drugs have irreversible damages to the eye?

A

Chloroquine and Hydroxychloroquine

Maybe…Anti-tuberculosis Rx…?

Phosphodiesterase agents

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18
Q

How would you manage chloroquine/hydroxychloroquine + eye?

A
  1. Baseline testing before starting Rx, then annual exam

2. If toxicity is found, immediately d/c

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19
Q

Chloroquine/Hydroxychloroquine can cause what to the eye?

A
  1. Bulls-eye maculopathy
  2. Vortex keratopathy
  3. Ptosis
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20
Q

What specifically do chloroquine and hydroxychloroquine target in the eye?

A

High affinity to melanin and toxic to retina

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21
Q

What specifically do anti-tuberculosis Rx target in the eye?

A

Chelates copper

Decreased levels impair mitochondrial activity and leads to optic neuropathy

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22
Q

What specifically do anti-hyperglycemics target in the eye?

A

Activate PPAR-gamma which leads to fluid retention in retinal vasculature

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23
Q

Corticosteroids can cause what to the eye?

A

Cataracts (posterior lens opacity)
Increased IOP
+ Glaucoma

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24
Q

What drugs can cause macular edema?

A

Hyperglycemics

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25
What drugs for the eye can cause cataracts and increased IOP?
Corticosteroids
26
Tamsulosin can cause what to the eye?
Floppy Iris Syndrome
27
How would you manage Tamsulosin + eye?
D/c Rx prior to cataract surgery otherwise no harm
28
What drugs can cause Non-Arteritic Anterior Ischemic Optic Neuropathy?
Phosphodiesterase agents
29
Phosphodiesterase agents can cause what to the eye?
Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) | Changes in color perception
30
Which glaucoma is considered an emergency if it were to happen?
Primary angle closure glaucoma; vision loss can occur within hours
31
How does primary open angle glaucoma present?
Bilateral but asymmetric (one eye is more severely affected vs the other)
32
What is glaucoma?
Progressive structural and/or functional damage to optic nerve fibers
33
What is a normal IOP?
10 to 21
34
What is the post-cataract surgery Tx plan for cataracts?
1. Abx 2. Steroids 3. NSAIDs (best for reducing retinal inflammation)
35
What is the primary Tx option for cataracts?
Surgery
36
What is the pathophysiology of cataract formation?
Swelling of lens + liquefaction of collagen fiber cells, leads to opacification of cells and color of lens change
37
Where are corticosteroids synthesized?
Adrenal cortex
38
When is the production of cortisol the greatest? Least?
Greatest - early morning or during food intake, stress, emotion Least - during the night
39
(Glucocorticoids/Mineralocorticoids) have anti-inflammatory potency
Glucocorticoids
40
(Glucocorticoids/Mineralocorticoids) have Sodium-retaining potency
Mineralocorticoids
41
All natural corticosteroids are derived from _______ and have a __-ring structure
Cholesterol 4
42
Where does metabolism of corticosteroids occur?
Liver
43
When should cortisone or prednisone not be prescribe to someone?
Severe hepatic failure or with rare condition of cortisone reductase deficiency
44
Severe hepatic failure is contraindicated for which corticosteroid?
Prednisone and cortisone
45
C11B-OH is found in which corticosteroid?
Prednisone and cortisone
46
Introduction of an additional C1=C2 double bond does what to corticosteroids?
Increases glucocorticoid activity only
47
What does alpha-fluorination at C9 do for corticosteroids?
Increases both glucocorticoid and mineralocorticoid activity
48
What does substitution at C16 do for corticosteroids?
Increases glucocorticoid activity only; completely takes away mineralocorticoid activity
49
What hormone does the hypothalamus release?
Corticotropin releasing hormone
50
What hormone does the pituitary gland release?
Adrenocorticotropic hormone
51
Cortisol is a (glucocorticoid/mineralocorticoid)
Glucocorticoid
52
Aldosterone is a (glucocorticoid/mineralocorticoid)
Mineralocorticoid
53
What are the negative effects of the HPA axis?
Adrenocorticotropic hormone on hypothalamus Cortisol on both anterior and hypothalamus
54
Prolonged use of glucocorticoids produces _______ wasting
muscle
55
How long do intranasal glucocorticoids takes to become effective?
Several days to one week
56
How long do intranasal glucocorticoids take to reach maximal efficacy?
2 - 3 weeks
57
What are some advantages of using intranasal glucocorticoids vs antihistamines
Reduce rhinorrhea and congestion
58
What kind of infections are common with inhaled corticosteroids for asthma?
Candida albicans
59
What are some side effects of intranasal glucocorticoids?
Sore throat Epistaxis (nose bleed) Headache
60
What is the most potent topical glucocorticoid?
Betamethasone Diflorasone Clobetasol
61
How often are topical glucocorticoids applied?
Twice daily
62
Which glucocorticoids should you avoid putting on the face?
Fluorinated glucocorticoids Triamcinolone Betamethasone Next 2 are not topical: Fludrocortisone Dexamethasone
63
Most drug allergies are Type ___ mediated
I
64
Serum sickness is a type ____ hypersensitivity
III
65
What drugs are associated with serum sickness?
Antitoxin and anti-venom serums
66
Drug rash with eosinophilia and systemic symptoms is composed of a triad of:
* Maculopapular rash (with facial/neck edema) * Eosinophilia (>1500 or atypical lymphocytes) * Internal/systemic organ involvement
67
What drugs are associated with Drug rash with eosinophilia and systemic symptoms?
Phenytoin Allopurinol Lamotrigine Sulfonamides
68
Drug rash with eosinophilia and systemic symptoms is a type _____ hypersensitivity
IV
69
What drugs are associated with drug fever?
Tetracycline Sulfonamides Phenytoin Carbamazepine
70
What drugs are associated with vasculitis?
Beta lactams Sulfonamides Thiazide Phenytoin
71
What is the most common medication allergy reported?
PCN allergy
72
Which allergy can cause all type I - IV hypersensitivity?
PCN allergy
73
Who are not candidates for skin testing or drug challenges?
Non-IgE mediated rxn
74
Can you diagnose based on reaction for a skin allergy test?
Nope, poor predictor
75
What are some pros and cons of PCN skin allergy testing (Pre-Pen)?
Good- * Antimicrobial stewardship * Less deviation from guidelines * Negative predictive power (97-99%) Bad - * Tests only IgE rxn * Pre-pen contraindicated (hypersensitivity, etc) * Minor determinants is recommended
76
NSAIDs can cause type _____ hypersensitivity
I and IV I - urticaria, angioedema, anaphylaxis IV - delayed hypersensitivity
77
Insulin can cause type ____ hypersensitivity
I, III, and IV I - most common III - SQ nodule at site IV - rxn to additives
78
How long does Drug Rash with Eosinophilia and Systemic Symptoms take to develop?
Delay; 3 - 8 weeks
79
How long does a drug fever take to develop?
7 to 10 days
80
Allergy to penicillin is due to what?
R1 side chain
81
If someone has a true IgE mediated allergy and they conduct a PCN allergy test with a positive result and no alternative, what do you do?
PCN desensitization
82
If someone has a true IgE mediated allergy and they conduct a PCN allergy test with a positive result and an alternative is available, what do you do?
Administer alternative
83
If someone has a true IgE mediated allergy and they conduct a PCN allergy test with a negative result, what do you do?
Administer PCN
84
If someone has a true IgE mediated allergy, should you do a PCN allergy test?
Yes
85
If someone has a urticarial skin reaction to an aminopenicillin, should you do a PCN allergy test?
Yes
86
If someone has a non IgE mediated allergy, should you do a PCN allergy test?
No, administer PCN No testing involved
87
If someone has a non-immediate reaction, should you do a PCN allergy test?
No, do not administer PCN nor test
88
Pre-pen, what is the major and minor determinant?
Major - Benzylpenicilloyl polylysine Minor - Pen G
89
When would you desensitize a patient with an alternative Rx besides PCN?
True IgE mediated allergy Positive PCN test No alternative available
90
When would you administer an alternative Rx besides PCN?
True IgE mediated allergy Positive PCN test Alternative available
91
When would you not administer Rx test nor drug for PCN allergy?
Non-immediate rxn
92
When would you administer Rx without a skin test?
No suggestion of IgE mediated allergy
93
What types of Rx would interfere with skin allergy testing?
Antihistamines
94
Which enzyme via NSAIDs potentially causes hypersensitivity?
Inhibition of COX-1
95
Dermatologic effects via sulfonamides are higher in what population group?
HIV/AIDS
96
Sulfonamides present _____ hypersensitivity
delayed
97
What is anaphylactic shock?
Vasodilation and reduction in effective plasma volume
98
Is anaphylactoid reaction immune mediated?
Nope
99
How does anaphylaxis present?
Slow heart rate Wheezing NVD Swelling
100
How would you treat anaphylaxis?
IM or SC epinephrine 0.01mg/kg up to 0.5mg Repeat every 5 to 20 mim Should be given within 20 min Also give fluids to restore intravascular volume
101
How does urticaria present?
Edema in superficial dermas Red raised rash w/ wheal and flare lesions
102
How would you treat urticaria?
2nd gen antihistamine for 2 weeks. May increase dose if symptoms exist by 4x it If symptoms still exist, add leukotriene antagonist and/or change antihistamine
103
What is the last line treatment for urticaria after youve tried everything?
``` Cyclosporine 1st gen antihistamine MMF Azathioprine Omalizumab ```
104
How does angioedema present?
Non-pitting edema Affects deep layers of epidermis, and hypodermis Hereditary or drug induced
105
What drugs can cause angioedema?
ACEi, ARBs, NSAIDs during 1st month of initiation
106
What causes drugs to inflict angioedema?
Elevated levels of bradykinin
107
How would you treat angioedema?
Depends if it's mast cell mediated or bradykinin mediated Mast cell - high dose antihistamine, corticosteroid, epi Bradykinin - frozen plasma, C1 inhibitor (ecallantide)
108
Abrasions vs incisions, which is more likely to get infected and why?
Abrasions; rubbed off
109
What is the general wound healing process?
Coagulation/hemostasis Inflammation Proliferation/repair Maturation/remodeling
110
What happens in the coagulation/hemostasis wound healing process?
1. Vascular response to injury which releases epi 2. Vasoconstriction and platelet aggregation 3. Platelet plug forms and releases growth factor to begin healing
111
What happens in the inflammatory wound healing process?
1. Leukocytes and macrophages go to wound 2. Remove bacteria and releases proteases and cytokines 3. Degrade damaged portions of matric and release more growth factor
112
What happens in the proliferation/repair wound healing process?
1. Dermal regeneration via angiogenesis, epithelialization, fibroblast formation, wound contraction
113
What happens in the maturation/remodeling wound healing process?
1. Collagen reorganizes and remodels | 2. Strengthens wound tissue within 3 months
114
How long is the inflammatory phase of wound healing?
4 to 6 days
115
How long is the proliferation/repair phase of wound healing?
4 to 60 days
116
How long is the maturation/remodeling phase of wound healing?
60 days to 2 years
117
What are the goals of wound care?
1. Facilitate hemostasis 2. Decrease tissue loss 3. Promote wound healing 4. Minimize scar formation 5. Minimize complications
118
What medications slow down wound healing?
Systemic glucocorticoids, NSAIDs, and chemo
119
How does necrotic tissue impede wound healing?
Delays development of granulation tissue and re-epithelialization Increases bacterial growth`
120
Why is it important for a moisture balance for wound healing?
Moist wounds heal 2-3x faster Facilitates autolytic debridement Promotes cell growth Too much moisture can lead to surrounding tissue damage though :/
121
When is an absorbent dressing used?
Soak up drainage May cause damage to surrounding skin upon removal
122
When is a foam dressing used?
Soak up drainage on partial or full thickness wounds Packs in deep cavity wounds to prevent premature closure
123
When is hydrogel used?
Minimal or no drainage, painful and dry wounds, burns
124
When is a hydrocolloid used?
Light draining wounds, DO NOT use in dry wounds or in wounds with bone or muscle
125
When is an alginate used?
High drainage, but requires a secondary dressing
126
When is a film dressing used?
Dry superficial wounds
127
When are compression dressings used?
Apply compression to treat venous ulcerations
128
When is a protease modulating dressing used?
Associated with angiogenesis and cleanses wound Degrades collagen which assist in tissue remodeling
129
When is a negative pressure wound therapy used?
Enhance blood flow, reduce edema, limit bacterial proliferation, acceleration granulation
130
What are the cutaneous red flag signs from drug reactions?
BUMP CF Blisters Ulcers Mucosal involvement Palpable purpura Confluent erythema Facial edema
131
What are the systemic red flag signs from drug reactions?
SLASH F ``` SOB, wheezing Lymphadenopathy Arthralgias Skin tenderness Hypotension ``` Fever
132
What are the red flag laboratory findings from drug reactions?
LFT>3x ULN Eosinophilia Neutropenia
133
What Rx causes skin pigmentation?
Amiodarone
134
Which cutaneous drug reaction does amiodarone cause?
Skin pigmentation (blue-grey color)
135
What is the physiology behind skin pigmentation?
Either increased melanin activity or increased deposition of Rx
136
Which hair cycle phase is affected by drug induced hair disorders like hair loss?
Telagen, Anagen
137
What Rx causes onycholysis?
Tetracyclines, NSAIDs
138
What is the physiology behind warfarin-induced skin necrosis?
Reduction in protein C
139
How do you treat warfarin-induced skin necrosis?
Vit. K, heparin, surgical debridement, wound care
140
How do you treat red man syndrome?
Antihistamines, baths, antipyretics, short course of corticosteroids, plasmapheresis, IVIG, immunomodulatory RX
141
How do you treat maculopapular eruptions?
Antihistamines, baths, short course of topical glucocorticoids
142
How do you treat pustular eruptions?
Moisturizers, topical corticosteroids, antihistamines, analgesics
143
Where do fixed drug eruptions occur?
Lips, hands, legs, genitalia, oral mucosa
144
What are the signs/symptoms of vasculitis?
SOB/cough Numbness in hands/feet Red spots, lumps, sores
145
Vasculitis is a type ____ hypersensitivity
III
146
How do you treat serum sickness?
IV corticosteroids x 3 days then oral corticosteroids If no response; then plasmapheresis or IVIG
147
How does serum sickness present?
Triad of fever, rash, and joint pain
148
What is the physiology behind Steven Johnsons Syndrome or Toxic epidermal necrolysis?
Drug metabolisms trigger T cell cytotoxic rxn to drug stimulus Genetic predisposition
149
How do you treat SJS or TEN?
No specific treatment Supportive care, cyclosporine, plasmapheresis, IVIG
150
What is the universal sign of anaphylaxis?
Scratching Itching of throat, mouth, lips
151
Allopurinol can cause what cutaneous drug reaction?
Maculopapular eruptions Can cause DRESS, SJS, TEN Pts with HLA B*5801 are highly susceptible
152
Which HIV Rx can cause maculopapular eruptions?
Nevirapine
153
Nevirapine can cause what cutaneous drug reaction?
Maculopapular eruptions Can cause SJS or TEN To minimize effect, slowly titrate dose
154
Which Rx reactions correlates with HLA B*5701?
Abacavir
155
Which Rx reactions correlates with HLA B*5801?
Allopurinol
156
What kind of contrast causes cutaneous drug reactions?
High osmolality
157
How do you treat high osmolality contrast reactions?
Pre treat with prednisone and diphenhydramine
158
Which anticonvulsants are of concern for cutaneous drug reactions?
Phenobarbital Phenytoin Carbamazepine Lamotrigine Pseudolymphoma syndrome and gingival hyperplasia risk with aromatic anticonvulsants
159
Which specific anticonvulsant is the biggest concern?
Lamotrigine Unclear if rxn is diminished with slow titration in dose Valproate + lamotrigine increases risk
160
(T/F) Fixed drug eruptions ALWAYS are drug-induced
True
161
What is composed of the atopic triad?
Allergic rhinitis Asthma Atopic dermatitis
162
What are some climate factors for dermatitis?
Dry, humid
163
What are some infection factors for dermatitis?
Steroid, ABx can disturb the skin
164
What are some genetic factors for dermatitis?
Interleukins mutation
165
What are some environmental factors for dermatitis?
Anything that increases allergen response like dust
166
What are some food item factors for dermatitis?
Anything that increases allergen response
167
How is dermatitis presented in infants/children?
Facial, neck, arms, dorsum of hands/feet
168
How is dermatitis presented in adolescents?
Face, neck palms, soles
169
How is dermatitis presented in adults?
Flexural creases and dorsum of hands/feet
170
What features are found in moderate to severe dermatitis?
Involved in >10% BSA Involved in highly visible areas Reduced QoL (interferes sleep or daily activities)
171
What are some major non-pharmacological therapies for dermatitis?
Skin care Avoid triggers Antiseptic measures Extra stuff
172
What non-pharmacological therapies are involved in skin care + dermatitis?
Warm bath QD w/o soap Apply moisturizer after bath "Soak and seal" w/ Cetaphil
173
What non-pharmacological therapies are involved in antiseptic measures + dermatitis?
Dilute bleach bath or ABx if needed
174
Which severity of dermatitis should you apply topical corticosteroids?
Any severity needs topical corticosteroids, non-lesional to mild requires low to medium potency. Moderate to severe requires medium to high potency
175
Which severity of dermatitis should you avoid trigger?
Non-lesional to mild
176
Which severity of dermatitis should you use antiseptic measures?
Mild
177
Which severity of dermatitis should you refer to atopic dermatitis specialist?
Severe
178
Which severity of dermatitis should you apply topical anti-inflammatory medication?
Moderate
179
Which severity of dermatitis should you use phototherapy?
Severe
180
Which severity of dermatitis should you apply topical anti-inflammatory medication?
Moderate
181
Which severity of dermatitis should you use phototherapy?
Severe
182
What is the least potent corticosteroids?
Hydrocortisone
183
Which severity of dermatitis should you apply for moderate to severe dermatitis? List the calcineurin inhibitor
Tacrolimus
184
Ointments are generally better for absorption compared to creams (T/F)
True
185
Which Rx is first line for dermatitis of the face?
Calcineurin inhibitors
186
Which severity of dermatitis should you apply for mild to moderate dermatitis? List the calcineurin inhibitor
Pimecrolimus
187
What are the AE of calcineurin inhibitors for dermatitis?
* Local burning sensation * Increase risk of viral infections * Malignancy has been reported
188
What are some counseling points for calcineurin inhibitors for dermatitis?
Use sunscreen
189
What are some characteristics of calcineurin inhibitors for dermatitis?
* Indicated for <2yrs * Reduces pruritus within days * first line for facial disease
190
What are the directions of use for crisaborole (Eucrisa)?
Apply to affected area BID
191
What is the MOA of crisaborole (Eucrisa)?
Inhibits PDE-4, which increases cAMP, decrease cytokine production
192
Who is approved to use crisaborole (Eucrisa)?
Kids aged 2 and above
193
Crisaborole (Eucrisa) AE?
Local burning sensation
194
Crisaborole (Eucrisa) AE?
Local burning sensation
195
Dupilumab MOA?
AB against IL-4 receptor subunit alpha
196
Dupilumab place in therapy?
Moderate to severe atopic dermatitis for pt >12yrs old. Can be used w/ or w/o topical steroids
197
Cyclosporine MOA?
Inhibits T cell activity and IL-2 production
198
Cyclosporine place in therapy?
Rapid improvement Short to intermediate term use due to AE
199
Azathioprine MOA?
Purine synthesis inhibitor; decreased leukocyte proliferation
200
Azathioprine place in therapy?
Modest benefits in trials Take 2-3 months to see effects
201
Methotrexate MOA?
Decreases allergen specific T-cell activity
202
Methotrexate place in therapy?
For refractory cases
203
MMF MOA?
Inhibits de novo pathway of purine synthesis; suppresses lymphocyte function
204
MMF place in therapy?
For recalcitrant cases; takes 2-3 months to see effect
205
Systemic corticosteroid MOA?
Inhibits inflammation and immune response
206
Systemic corticosteroids place in therapy?
continuous/chronic use is not recommended Steroid bursts can be used for flares
207
What are the major etiologic factors of acne?
1. Increase in keratinization 2. Increase sebum 3. P. acnes colonization 4. Inflammation
208
Open comedone are known as (black/white) heads
blackheads
209
Closed comedones are known as (black/white) heads
whiteheads
210
(open/closed) comedones are known as blackheads
Open
211
(open/closed) comedones are known as whiteheads
Closed
212
Open vs closed comedones Which is smaller?
Open
213
Open vs closed comedones Which is larger?
Closed
214
Open vs closed comedones Which one will likely rupture?
Open
215
Open vs closed comedones Which one is the first sign of acne?
Open
216
A pustule acne is a superficial aggregation of what?
Neutrophils
217
Benzoyl peroxide MOA?
Releases free-radical oxygen which oxidizes bacterial proteins which decreases anaerobic bacteria and irritating-type free FA
218
Salicylic acid MOA?
Produces desquamation of hyperkeratotic epithelium
219
What are the types of light used for acne?
Blue - acne | Red - inflammation
220
What are the 4 groups of targets for acne?
1. Against P. acnes proliferation 2. Inflammatory 3. Sebum 4. Keratinization of follicles
221
Which Rx go against P. acnes proliferation?
Benzoyl peroxide ABx Isotretinoin
222
Which Rx go against keratinization of follicles (for acne)?
Benzoyl peroxide Isotretinoin Salicylic acid Topical retinoids
223
Which Rx go against the inflammatory response for acne?
Intralesional or oral corticosteroids Topical or oral ABx
224
Which Rx go against sebum production of acne?
``` Topical or oral ABx Isotretinoin Corticosteroids Estrogen Antiandrogens ```
225
Which acne product is a vitamin A derivative
Retinoids
226
What are some key patient counseling points when using topical retinoids?
* avoid in pregnant/breastfeeding individuals * may sunburn easily * NO occlusive dressings * wash area and dry, wait 20-30 min then apply Rx
227
Which dosage form of acne treatment causes mood disorders?
Oral retinoids
228
Which dosage form of acne treatment causes initial flare-ups?
Topical retinoids
229
What are some general side effects of oral retinoids?
Anticholinergic effects TG lvls increase Mood disorders
230
Who is required to sign up for the iPledge program for oral retinoids?
Men and women
231
What are some counseling points to give to patients on oral retinoids?
For females, two forms of birth control required (1 month prior and 4 months after Monthly pregnancy test Moisturizer
232
Which dosage form for acne causes psuedomembraneous colitis?
Topical antibacterials
233
Topical antibiotics for acne can cause what?
Diarrhea or pseudomembranous colitis
234
Tetracycline AE?
Tooth discoloration
235
Doxycycline AE?
Photosensitivity?
236
Minocycline AE?
Drug induced lupus
237
What are some counseling points for tetracycline?
Women of child-bearing age must use contraception Increase % of vuvlovaginal infections
238
Is having an oral and topical ABx allowed?
Nope
239
Which topical treatment for acne is useful for women who are wanting to be pregnant/or are pregnant?
Azelaic acid
240
Using BSA, how would you classify the severity level of psoriasis?
``` <3% = mild 3-10% = moderate >10% = severe ```
241
Using PSI, how would you classify the severity level of psoriasis?
``` <10 = mild ≥10 = moderate or severe ```
242
How is PSI for psoriasis calculated?
BSA + lesion severity Score = 0 to 72
243
For effective response of psoriasis treatment, how is that assessed?
Reduction of PASI by ≥75% Reduction of PASI by 50-75% = now impact of QoL
244
How is the maintenance phase of psoriasis evaluated?
Reassessed every 8 weeks
245
What is the initial topical therapy for psoriasis?
Mid to high potency topical agents
246
Which potency level of topical agents should be limited to 2 to 4 weeks?
High potency (<50g/week)
247
Tazarotene MOA
Binds to RAR-B and RAR-y and inhibits psoriasis-associated differentiation
248
When is Tazarotene used?
Mild to moderate psoriasis w/ topical steroids
249
Tazarotene is pregnancy category __
X
250
Which Rx for psoriasis is applied for about 30 min then wiped off?
Anthralin
251
Which Rx for psoriasis were on the lower end of efficacy?
Anthralin, Acitretin (compared to methotrexate/cyclosporine), and coal tar
252
Why is adherence for coal tar use on psoriasis low?
Stains clothes and the odar of tar
253
If a systemic agent w/ or w/o phototherapy or topical agent is ineffective in treating moderate-severe psoriasis, what can you do? What happens if that answer doesnt work?
Give a more potent systemic agent or give 2+ systemic agents in rotation If no success, give a biologic response modifier
254
Regardless of how you treat moderate-severe psoriasis, what could you always do regardless of efficacy?
Moisturize
255
Methotrexate is pregnancy category ___
X
256
What is the dose of methotrexate for psoriasis?
7.5 to 25mg once weekly
257
What is the place in therapy for methotrexate on psoriasis?
For moderate-severe psoriasis Safer than cyclosporine
258
What should you monitor if taking methotrexate?
CBC + LFT
259
Cyclosporine is pregnancy category ___
C
260
What should you monitor if taking cyclosporine?
SCr, BUN, BP, Lipid profile
261
Which Rx for psoriasis can take up to 3 years for the med to be eliminated from the body?
Acitretin
262
Acitretin is pregnancy category ___
X
263
Acitretin is contraindicated in who?
Women who fail to use contraception for 3 years after d/c
264
What should you monitor if taking Acitretin?
Blood, glucose, lipid panel, LFTs
265
Which Rx for psoriasis can cause brittle nails, hair loss, or sticky skin?
Acitretin
266
What are the major components that cause psoriasis?
DC + T cells TNF-alpha IFN-gamma IL-12,17,23
267
If a topical agent is ineffective for mild-moderate psoriasis, what can you do? What if the answer doesnt work?
Add phototherapy Add a systemic agent if phototherapy doesnt work
268
What are some AE of topical corticosteroids?
Systemic (medium-superpotent) can cause HPA axis suppression, cataracts, glaucoma
269
Intermittent allergic rhinitis is defined as...
<4 days/week OR <4 weeks
270
Persistent allergic rhinitis is defined as...
>4 days/week AND!!! >4 weeks
271
Mild allergic rhinitis is defined as...
Normal sleep, no impairment of activities, work, school, no troublesome symptoms
272
Moderate-severe allergic rhinitis is defined as...
One of more of the following Abnormal sleep, impairment of activities, work, school, troublesome symptoms
273
What is the main cause of allergies during the springtime?
Tree pollen
274
What is the main cause of allergies during the summer?
Summer grass
275
What is the main cause of allergies during the fall?
Ragweed
276
Calcipotriol (Calcipotriene) MOA?
Synthetic Vit. D3 analog Binds to Vit. D receptors by inhibiting keratinocyte proliferation
277
When is Calcipotriol (Calcipotriene) used?
Combined w/ betamethasone for mild to severe disease Used at night only because it will become deactivated
278
``` Sneezing Itching Rhinorrhea Congestion Ocular ``` Oral antihistamine targets include...
All but congestion
279
``` Sneezing Itching Rhinorrhea Congestion Ocular ``` Intranasal antihistamine targets include....
Only itching and rhinorrhea
280
``` Sneezing Itching Rhinorrhea Congestion Ocular ``` Oral decongestant targets include...
Only congestion
281
``` Sneezing Itching Rhinorrhea Congestion Ocular ``` Intranasal steroid targets include...
All but ocular
282
Cromolyn targets include...
Sneezing, itching, rhinorrhea
283
Of the topical treatments for psoriasis, what is the most efficacious to least efficacious?
Corticosteroids Tazarotene (Tazorac®) Anthralin
284
Intranasal ipratropium targets include...
Rhinorrhea only
285
Which 2nd Gen antihistamine can cause drowsiness?
Cetirizine and levocetirizine
286
What are the short-acting intranasal decongestant?
Naphazoline – Privine® | Phenylephrine
287
What are the long-acting intranasal decongestant?
Oxymetazoline–Afrin®
288
What are the oral decongestants?
Pseudoephedrine (PSE) -Sudafed® Phenylephrine (PE) - Sudafed PE®
289
Decongestant MOA?
Acts on alpha-1 adrenergic receptors (vasoconstriction)
290
Which is more efficacious, PSE or PE?
PSE aka Pseudoephedrine | (PSE) -Sudafed®
291
Oral decongestants are metabolized by what enzyme?
monoamine oxidase
292
Rebound congestion is found in what drug class?
Only intranasal + ocular decongestants, not oral
293
What is an ocular decongestant and what are they used for? AE?
Naphazoline (Naphcon, Clear Eyes, AK-Con) Allergic conjunctivitis Increases IOP
294
``` What is the most effective medication class for allergic rhinitis? a) Oral antihistamines b) Oral decongestants c) Intranasal antihistamines d) Intranasal steroids ```
d) Intranasal steroids
295
What is the last line therapy for allergic rhinitis? What does it treat?
Leukotriene receptor antagonist (Monetelukast) Treats only nasal symptoms
296
TNF-alpha inhibitors should not be given to who?
Patients with MS or serious infections
297
Which monoclonal AB has a off-label use for allergic rhinitis?
Omalizumab
298
What should be avoided in pregnant women suffering from allergic rhinitis?
Oral steroids Immunotherapy should not be initiated during pregnancy, but can be continued.
299
What is the first line Tx for psoriasis + pediatrics (mild-moderate)?
Calcipotriol +/- mild-moderate topical steroid • May add tacrolimus
300
What is the first line Tx for psoriasis + pediatrics (moderate-severe)?
First-line: Methotrexate • Second-line: Cyclosporine • Third-line: Etanercept (age≥4) and ustekinumab (age≥12)
301
What are the systemic Rx for psoriasis?
Methotrexate Cyclosporine Acitretin

IPT: Derm (2 decks)

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