Chapter 16: Skin disorders Flashcards Preview

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Flashcards in Chapter 16: Skin disorders Deck (78):
1

 

 

purpose of topical corticosteroids

 

 

decrease inflammation, reduce itching, acute and chronic dermatitis

2

 

 

delivery types of topical corticosteroids

 

 

ointments, gels, aerosols, cream and lotions

3

 

 

low potency topical corticosteroids used for

 

 

eczema, iritant dermatitis, seborrhea, atopic dermatitis

4

 

 

high potency topical corticosteroids are used for

 

 

psoriasis, lichen planus, allergic contact dermatitis

5

 

 

are cream or ointments generally preferred

 

 

creams because they are nonocclusive and less greasy

6

 

 

when are aerosols preferred

 

 

weeping lesions or lesions on scalp

7

 

 

what is the drawback of lotions

 

 

often contain alcohol and sting

8

 

 

what is the advantage of gels

 

 

spread easily and can be used on scalp and hairy areas

9

 

 

most common adverse effect

 of topical corticosteroids

 

 

cutaneous atrophy

(thinning of skin accompanied by telangiectasia)

10

 

 

other adverse effects of topical corticosteroids

 

 

striae, acne, hypopigmentation, alopecia, glaucoma,

adrenal suppression (may be life threatening)

11

 

 

conscientiou prescribing of topical steroids

 

 

drug absoprtion enhanced by increased skin temp, skin hydration, application to denuded areas

cannot be used extended periods in women who are or may become pregnant

12

 

 

what is the most commonly used topical corticosteroid

 

 

1% hydrocortisone

13

 

 

topical corticosteroid patient teaching

 

 

effects are short term, agents cannot be used frequently

symptoms may reappear after effects wear off

14

 

 

mechanism of action for topical corticosteroids

 

controls protein synthesis rate

depresses migration of polymorphonucleic leukocytes

reverses capillary permeability

reverses lysosomal stablization

prevents or controls inflammation

15

 

 

topical corticosteroid pharmacokinetics

 

absorption: no systemic absorption

distribution: 2/3 protein bound if systemically absorbed

metabolism: hepatic if absorbed

excretion: urine

half-life: 6.5 hours

16

 

 

clinical uses for topical corticosteroids

 

 

17

 

 

contraindication to topical corticosteroids

 

 

hypersensitivity

systemic fungal infection

18

 

 

dosage and application of topical corticosteroids

 

 

Page 295

19

 

 

topical corticosteroid patient education

 

avoid occlusive dressings

avoid with diapers (occlusive)

caution with pregnancy

20

 

 

etiologic agent of acne

 

 

propionibacterium acnes

21

 

 

mild acne

 

 

few to several papules and pustules but no nodules

22

 

 

moderate acne

 

 

several papules and pustules with a few nodule

23

 

 

severe acne

 

 

several papules, pustules, and nodules

24

 

 

drugs used to treat acne

 

 

keratolytics, antibiotics, vitamin A derivatives

25

 

 

names of mild keratolytics

 

 

benzoyl peroxide

salicylic acid

26

 

 

mild keratolytics mechanism of action

 

 

causes epidermis cells to shed faster to prevent pore clogging

 

27

 

 

how does benoyl peroxide decrease anaerobic bacteris in follicles

 

 

convert benzoic acid in skin and releases free-radical oxygen that oxidizes bacteria proteins

28

 

 

what can happen with high concentration formulations of benzoyl peroxide

 

 

hyperpigmentation and increased risk of skin irritation

29

 

 

antiobitc mechanism of action

 

 

decreases bacterial load and inflammation and infection that results from bacteria presence

30

 

 

Administration of antibiotics for acne

 

 

may be topical or oral

31

 

 

why are ABT and benzoyl peroxide often prescribed together for acne treatment

 

 

provides better results than either agent alone

32

 

 

side effects of ABT

 

 

light sensitivity, gastric upset, diarrhea

33

 

 

tetracyclines after expiration date

 

 

become more potent

don't use

34

 

 

caution with ABT prescribing

 

 

children under 10

pregnant women

to avoid blue-gray discoloration of teeth

35

 

 

what infection may clindamycin lead to

 

 

c-diff

36

 

 

mechanism of action: vitamin A

 

 

retinoids prevent the formation of comedones by normalizing the desquamation of follicular epithelium

37

 

 

major side effects of retinoids

 

 

excessive drying, burning, skin inflammation

38

 

 

examples of retinoids

 

 

tretinoin (retin A), adapalene, tazoarotene

39

 

 

pregnancy category of retinoids

 

tretinoin - class C

tazarotene and isotrentinion - class X

 

Never use in pregnant women

40

 

 

treatment of urticaria

 

 

antihistamines

41

 

 

antihistamine mechanism of action

 

 

act on histamine receptor to decrease release of histamine from mast cells

42

 

 

first generation antihistamines

 

 

diphenhydramine

lead to drowsiness

43

 

 

second generation antihistamines

 

 

loratidine, fexofenadine, cetirizine

cause very little drowsiness if used at commonly prescribed doses

44

 

 

treatment of superficial bacterial infection

 

 

usually topical agents are sufficient

if not, oral agents are used

45

 

 

impetigo characterisitics

 

 

lesions with a honey colored crust

highly contagious

46

 

 

mupirocin

 

 

topical antibiotic that is effective against gram+ bacteria including MRSA

47

 

 

examples of oral agents utilized when topicals are insufficient

 

 

dicloxacillin, erythromycin, and amoxicillin with clavulanate

48

 

 

imidazole and triazole

 

 

antifungals  that inhibit p450 system to stop conversion of lanosterol to ergosterol

(which is necessary for cell wall synthesis)

49

 

 

allylamines

 

 

antifungals inhibits epoxidase

(which is required for ergosterol)

50

 

 

griseofulvin

 

 

antifungal that binds to microtubules, stopping fungal mitosis

51

 

 

patient education on drugs treating superficial bacterial infections

 

wash with soap and water before applying

 

52

 

 

drugs used to treat superficial fungal infections

 

 

imidazole, triazoe, allylamines, griseofluvin

53

 

 

treatment of tinea cruris

 

topical treatment with any antifungal agentunless it has spread to lower thighs and buttocks, then use itraconazole or terbinafine

54

 

 

treatment of tinea capitis

 

 

oral griseofulvin usually used cause topical agents do not clear infection very well

55

 

 

treatment of tinea corporis

 

 

topically id 1-2 lesions present, otherwise orally.  fluconazole once weekly x 4 weeks

56

 

 

treatment of tinea pedis

 

 

topical agent in most cases but highly kerototic lesion may require oral therapy

57

 

 

treatment of onchyomycosis and candiasis

 

 

Page 299

58

 

 

Topical conditions that are viral

 

shingles

chicken pox

herpes simplex

herpes zoster

59

 

 

antiviral agents mechanism of action

 

 

inhibits DNA synthesis to decrease viral replication

60

 

 

antiviral pharmacokinetics

 

metabolism: liver

excretion: urine

half-life: 8-10 hours

61

 

 

antiviral agents drug interactions

 

 

probenecid will increase drug levels

risk of toxicity when adinistered with theophylline

62

 

 

agents used for cleansing and disinfecting skin

 

 

NS, isopropyl alcohol, phenol derivatives, chlorhexidine, cationic surfactants, povidone-iodine, hydrogen peroxide

63

 

 

purpose of topical cleansing/disinfecting agents

 

 

decrease risk of infection by decreasing bacterial load

usually for intact skin

64

 

 

first degree burn

 

 

exhibit pain and erythema only

65

 

 

second degree burn

 

 

exhibits blisters and pain

66

 

 

third degree burns

 

 

full thickness that are insensate and usually require more than outpatient treatment

67

 

 

treatment of 2nd degree burns

 

 

silver sulfadiazine and covered with guaze.  CHange twice daily

68

 

 

pressure ulcers

 

 

page 302

69

 

 

topical drugs used for reatment of psoriasis

 

corticosteroids

vitamin D analogues

emollients

keratolytics

tazarotene

calcineurin inhibitors

page 303

70

 

 

oral drugs for treatment of psoriasis

 

 

cyclosporin A

methotrexate

acitretin

fumaric acid esters

page 303-304

71

 

 

IV/injectable meds for psoriasis

 

 

 

page 304-305

72

 

 

drugs to treat seborrhea

 

mild strength corticosteroids

shampoos containing selenium

mineral oil pretreatment for debridement

73

 

 

example of drugs used to treat seborrhea

 

 

page 305-306

74

 

 

mechanism of action for topical anethestics

 

 

blocks sodium channels, slowing conduction along nerves and disrupting the action potential

75

 

 

examples of topical anesthetics

 

lidocaine

benzocaine

prilocaine

76

 

 

application of topical anesthetics

 

 

only to intact skin

77

 

 

pregnancy, pediatric, geriatric implications

 

 

page 308

78