DD- Topical Therapeutics in Dermatology Flashcards Preview

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Flashcards in DD- Topical Therapeutics in Dermatology Deck (37):
1

To be effective, topical medications need to gain entry into the skin through the _______ and reach the site of action in desired concentrations

stratum corneum

2

1- Meds move across the stratum corneum by passive diffusion.
2- the agents can be transported through channels or pores within a lacunar system in the stratum corneum.
3- Meds may be transported via _________ such as sweat glands or hair follicles.

appendageal structures

3

Factors Influencing Absorption of Topical Medications

(a) drug factors and (b) patient factors.

4

Drug factors affecting percutaneous absorption include

• Active drug concentration
• Composition of the vehicle
• Molecular size of the drug or prodrug
• Lipophilicity of the drug

5

Molecular size of the drug affects its absorption at the site______

of action.

6

1- Meds move across the stratum corneum by passive diffusion.
2- the agents can be transported through channels or pores within ______ system in the stratum corneum.
3- Meds may be transported via appendageal structures, such as sweat glands or hair follicles.

a lacunar

7

Patient factors affecting percutaneous absorption of topical medications include:

• Presence of barrier disruption
• Anatomic location (including thickness of the stratum corneum)
• Skin hydration
• Occlusion

8

________of the skin often leads to markedly increased skin hydration.

Why does this matter?

Occlusion

active ingredients delivered in the form of an ointment, tape, or to the skin folds, reach much higher [ ] because occlusion prevents loss of medication by evaporation, friction, or exfoliation.

9

In general absorption is lower in anatomic regions where the_______ is thicker,

stratum corneum

10

1- Meds move across the stratum corneum by ________
2- the agents can be transported through channels or pores within a lacunar system in the stratum corneum.
3- Meds may be transported via appendageal structures, such as sweat glands or hair follicles.

passive diffusion.

11

Typically, the diffusion of a compound is
inversely proportional to the?

molecular size of the drug.

12

• Ointments: Water in oil emulsion

• Creams: Oil in water emulsion

• Gels: Semisolid emulsion in alcohol base

• Lotions/Solutions: Powder in water (some oil in water)

• Foams: pressurized collections of gaseous bubbles in a matrix of liquid film

These are examples of?

Classification of Vehicles

13

strong potency

hydrating, with very low sensitization risk or irritation risk

use are non-intertreginous sites

Ointments Vehicles

14

moderate potency

some hydration

significant sensitization risk and a low irritation risk.

Creams Vehicles

15

strong potency

drying

significant sensitization risk and a relatively high irritation risk

oral mucosal surfaces and the scalp

Gels Vehicles

16

matrix is stable at room temperature but
readily melts at body temperature.

supersaturated active ingredients to interact with lipids of the stratum corneum.

Foams Vehicles

17

When selecting an appropriate vehicle, three factors are of particular importance?

anatomic location, contact allergy/sensitization, and irritancy

18

What is an FTU?

FTU=Fingertip Unit

19

• 1 gram of cream covers approximately ______ area of skin

10 cm x 10cm

20

• 1 gram of ointment spreads ____ further than the same amount of cream.

10%

21

• Approximately _____ are necessary to treat the entire body of an adult man

20 g

22

binding of glucocorticosteroids is associated with the following downstream molecular events:

Alteration of transcription rate--> inflammatory proteins

Inhibition of nuclear factor-κB pathway

interacts with other tx factors that play a role in the inflammatory response.

23

Easy to apply/remove, non-toxic, non-irritating, stable, cosmetically acceptable, good at
delivering the drug, and inert

The ideal vehicle

24

Water-based vehicles (__________) contain preservatives that may increase the risk of contact allergy and sensitization.

such as creams, lotions, and solutions

25

_______ is associated with high concentrations of propylene glycol, other types of alcohols, and certain acidic vehicle ingredients.

Irritancy

26

glucocorticoids inhibit.....

inflammatory cytokines.

27

Seven classes have been proposed based on potency.

These classes were developed based on
vasoconstrictor assays.

superpotent topical glucocorticosteroids
belong to class 1

very low-potency topical glucocorticosteroids belong to class 7

28

Class 7 (low-potency)

Efficacious for mild eczema in children and
adults

Treatment of inflammatory dermatoses
involving anatomic regions such as the face,
intertriginous areas, or groin.

Hydrocortisone 2.5%

29

Class 4 (cream formulation, mid-potency)

Effective against most moderate spongiotic
dermatoses (including eczematous dermatitis, atopic dermatitis, allergic contact dermatitis, arthropod bite)

Use on trunk and extremities

Long-term use not recommended for facial,
intertriginous, and groin regions.

Triamcinolone Acetonide 0.1%

30

Class 1 (high-potency)

Rx for acute eruptions that necessitate relatively rapid amelioration, such as contact dermatitis or acute drug eruptions.

Avoid use on the face, intertriginous
areas, or the groin.

Longer-term use of requires monitoring of development of adverse effects.

The Clobetasol Propionate 0.05%

31

More potent topical steroids are associated with greater ______

adverse effects

32

______ most commonly associated with long-term use of potent to super-potent topical steroids

Skin atrophy:

33

The Clobetasol Propionate 0.05%

Class 1 (high-potency)

Rx for acute eruptions that necessitate relatively rapid amelioration, such as contact dermatitis or acute drug eruptions.

Avoid use on the face, intertriginous
areas, or the groin.

Longer-term use of requires monitoring of development of adverse effects.

34

Extensive and long-term use of potent or super-potent topical steroids have been associated with _______

systemic side effects.

Potential systemic side effects include adrenal suppression, Cushing’s syndrome, and growth retardation in children

35

Triamcinolone Acetonide 0.1%

Class 4 (cream formulation, mid-potency)

Effective against most moderate spongiotic
dermatoses (including eczematous dermatitis, atopic dermatitis, allergic contact dermatitis, arthropod bite)

Use on trunk and extremities

Long-term use not recommended for facial,
intertriginous, and groin regions.

36

systemic side effects of GCs may include?

adrenal suppression, Cushing’s syndrome, and growth retardation in children

37

Hydrocortisone 2.5%

Class 7 (low-potency)

Efficacious for mild eczema in children and
adults

Treatment of inflammatory dermatoses
involving anatomic regions such as the face,
intertriginous areas, or groin.