Derm

Question 1

How does regional variation determine the potency you choose in dermatology?

Answer 1

lighter potency in more sensitive areas like skin and groin, and heavier potency in areas like forearm and palm

Question 2

When someone displays resistance to your first line therapy, what do you do?

Answer 2

increase concentration

Question 3

What is a vehicle?

Answer 3

substance that carries a drug to the skin to help treat skin conditions. ointment, cream, lotion, gels, powders, pastes

Question 4

What helps maximize efficacy?

Answer 4

occlusion – plastic wrap, mittens/socks

Question 5

What are low potency topical corticosteroids?

Answer 5

hydrocortisone (hytone, cortizone), hydrocortisone acetate (cortaid), triamcinolone acetonide (aristocort, kenalog)

Question 6

What are medium potency topical corticosteroids?

Answer 6

hydrocortisone valerate (westcort), mometasone furoate (elocon), betamethasone valerate (valisone), triamcinolone acetonide (aristocort, kenalog)

Question 7

What are high potency topical corticosteroids?

Answer 7

fluocinonide (lidex), betamethasone dipropionate (diprosone, maxivate), triamcinolone acetonide (aristocort, kenalog)

Question 8

What are very high potency topical corticosteroids?

Answer 8

betamethasone dipropionate (diprolene) ointment, clobetasol propionate (temovate, olux)

Question 9

What are low potency topical steroids used for?

Answer 9

face and groin, children

Question 10

What are medium potency topical steroids used for?

Answer 10

most adults for majority of areas

Question 11

What are high potency topical steroids used for?

Answer 11

thick plaques not responding to treatment, palms and soles

Question 12

When are topical steroids recommended?

Answer 12

atopic dermatitis, eczema, seborrheic dermatitis, contact dermatitis, psoriasis
“inflammation”

Question 13

What’s the MOA of corticosteroids?

Answer 13

depress formation, release, and activity of chemical mediators of inflammation (induction of ph.A), decreases leukocytes, suppresses cytokines , vasoconstrictive…

Question 14

Why do topical steroids only work on inflammation?

Answer 14

absorption markedly increased in inflamed skin

Question 15

What are ADRs of topical steroids?

Answer 15

tachyphylaxis, rapid tolerance, can do one week on, one week off. skin atrophy, striae, common skin conditions caused by steroidal use

Question 16

What are ADRs of topical corticosteroids that are systemic?

Answer 16

iatrogenic cushing’s syndrome – weight gain, “Buffalo hump” “moon face”, HTN, hypokalemia, hyperglycemia, osteoporosis, ulcers, muscle weakness, cataracts or glaucoma

Question 17

What is preferred for infants and elderly patients?

Answer 17

low potency agents

Question 18

When should you use topical steroid ointments?

Answer 18

for thick, lichenified lesions to enhance penetration

Question 19

When should you use topical steroid cream?

Answer 19

acute and subacute dermatoses; moist skin, intertriginous areas

Question 20

When should you use topical steroid gels, solutions, or sprays?

Answer 20

scalp or non-oil based vehicles needed

Question 21

How long should very high potency steroid agents be used?

Answer 21

no longer than 2-3 weeks

Question 22

What is acne vulgaris treatment for mild non-inflam disease?

Answer 22

topical retinoid or salicyclic acid

without improvement, can add topical antibiotic

Question 23

What is acne vulgaris treatment for mild inflammatory disease?

Answer 23

topical retinoid (adapalene) + BPO in AM or topical abx +BPO
no improvement, add oral abx

Question 24

What is acne vulgaris for moderate disease?

Answer 24

topical retinoid + topical abx in AM + oral abx + BPO

Question 25

What should you consider for hormone-related acne?

Answer 25

combined oral contraceptive and topical retinoid + oral abx + BPO for longer term

Question 26

What should you do about severe acne vulgaris?

Answer 26

refer to derm Oral abx + topical therapy oral retinoid if all else fails

Question 27

What is the MOA of salicylic acid?

Answer 27

Keralytic —- dissolve cell surface proteins that keep outermost epidermal layer intact, applied to whole treatment area

Question 28

What are ADRs of salicylic acid?

Answer 28

skin irritation (limit area), photosensitivity, allergic reaction (note: not good for any aspirin allergies)

Question 29

What is the MOA of topical retinoids?

Answer 29

Keratolytic: allowing treatment in, opens up comedones, aids in extraction

Question 30

How are topical retinoids used?

Answer 30

entire affected area, do not use with alcohol or astringents

Question 31

What are ADRs of topical retinoids?

Answer 31

skin irritation, photosensitivity (wear sunscreen), teratogenicity

Question 32

What is the MOA of BPO?

Answer 32

lipophilic oxidizing agent -- oxidizes bacterial proteins, active against p. acnes

Question 33

When should you use BPO?

Answer 33

adjunct to topical and oral abx, more effective than either alone! also acne rosacea

Question 34

What are ADRs for BPO?

Answer 34

skin irritation, allergic contact dermatitis, inactivation of topical retinoids (apply at different times), bleaching agent

Question 35

What is the MOA of azelaic acid (azelex)?

Answer 35

inhibits effect of conversion of testosterone to dihydrotesterone

Question 36

When do you use azelaic acid (azelex)?

Answer 36

alternative to topical abx or BPO, less irritating but less effective

Question 37

What are ADRs of azelaic acid?

Answer 37

skin irritation, hypopigmentation, vitiligo depigmentation, hypertrichosis

Question 38

What are indications for topical antibacterials?

Answer 38

prevention in a clean wound, early treatment, reduce staph colonization, acne, combo with corticosteroids

Question 39

What is bacitracin?

Answer 39

gram+, most anaerobes, Neisseriae, tetanus, diptheria, can be Neosporin or PolymyxinB

Question 40

What is polymyxin B sulfate?

Answer 40

gram- (pseudomonas, e.coli, enterobacter, klebsiella), resistant to proteus and serratia and g+, avoid with sulfa allergy

Question 41

What is neomycin?

Answer 41

gram-, generally avoid up to 25% have allergic reaction (redness in wound), found with polymyxin in Neosporin

Question 42

What is mupirocin?

Answer 42

most g+ including MRSA, treats impetigo, intranasal, can be irritating

Question 43

What is clindamycin?

Answer 43

fights p.acnes, mild to moderate cases, foam can be drying, lotion/gel is better tolerated systemic reactions are rare

Question 44

What is erythromycin?

Answer 44

mild to moderate cases of acne, unknown MOA, but can see resistance so stop and treat with oral abx water based gel is less irritating

Question 45

What is metronidazole?

Answer 45

anti-inflamm action common for rosacea, but maybe carcinogen. ADR=dryness, burning, cream is better

Question 46

What do you use topical antifungals for?

Answer 46

treat superficial fungal infections, mostly candida

Question 47

What are miconazole and clotrimazole?

Answer 47

miconazole (monistat) - cream, lotion, or suppositories clotrimazole (lotrimin) - cream, lotion, vaginal cream/tablets *stronger than niastatin*

Question 48

What is ketoconazole (nizoral)?

Answer 48

cream for dermatophytosis and candidiasis , shampoo for seborrheic dermatitis

Question 49

What is clotrimazole-betamethasone dipropionate cream?

Answer 49

antifungal + corticosteroid = rapid symptomatic relief, very strong, "fungus on steroids"

Question 50

What is nystatin?

Answer 50

prescription, narrow spectrum, swallowing treatment, may cause GI issues

Question 51

What is imiquimod (aldara)?

Answer 51

genital and perianal warts, BCC on trunk/neck/extremities max 16 week use

Question 52

What is permethrin?

Answer 52

Nix = lice, apply for 10 minutes and rinse or Elimite = scabies (leave on for 8-14 hours)

Question 53

What is ivermectin?

Answer 53

sklice -- 6 months and older, apply for 10 minutes then rinse

Question 54

where is tinea corporis?

Answer 54

body

Question 55

Where is tinea capitis?

Answer 55

head

Question 56

Where is tinea cruris?

Answer 56

groin

Question 57

Where is tinea pedis?

Answer 57

feet

Question 58

Where is tinea unguium?

Answer 58

nail

Question 59

What do you treat dermatophytes with?

Answer 59

-azoles, except nails -- need stronger

Question 60

What is the yeast that causes pityriasis/tinea versicolor?

Answer 60

malassezia furfur

Question 61

What is the treatment for tinea versicolor?

Answer 61

selenium sulfide (selsun blue)

Question 62

What is pruritus ani?

Answer 62

perianal itching and discomfort, from cycle of scratching, treat with high potency topical corticosteroids

Question 63

What are treatments for breastfeeding?

Answer 63

lanolin (oil that is emollient action to condition skin), nipple fissure --> mupirocin, betamethasone, clotrimazole