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Pharmacology- Exam #4 > Derm > Flashcards

Derm Flashcards

1
Q

Palm area rule

A

2 palm areas x2/day needs 30g for 1 month

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2
Q

Fingertip Units (FTU’s)

A

2 FTU=1 g of Topical Steroid

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3
Q

How can we enhance absorption/efficacy with topical agents?

A

Occlusion-Apply plastic wrap

10x increase with topical steroid agents

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4
Q

What is the role of dressings?

A
  1. Protect open lesions
  2. Facilitate healing
  3. Increase drug absorption
  4. Protect patient’s clothing
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5
Q

What is the MC Nonocclusive dressing?

A

Gauze dressings

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6
Q

Purpose of Nonocclusive dressing?

A
  1. Maximally allow air to reach wound

2. Allow lesion to dry

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7
Q

Purpose of wet-to-dry dressings

A

Cleanse and Debride thickened/crusted lesions

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8
Q

How do you apply wet-to-dry dressings?

A 
Applied Wet (saline solution) 
Removed after solution has evaporated
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9
Q

What conditions increase penetration in topical steroids?

A
  1. Inflamed skin-Atopic dermatitis

2. Exfoliative disease

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10
Q

Class I Potency and areas of application

A 
Super High Potency steroid 
Severe dermatoses over nonfacial and nonintertriginous:
1. Scalp
2. Palms 
3. Soles
4. Thick plaques on extensor surfaces
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11
Q

Class I length of treatment

A

<3 weeks

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12
Q

Class II-V Potency and areas of application

A

Medium-to-High Potency Steroid

Mild-to-Moderate nonfacial and nonintertriginous

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13
Q

Class II-V length of treatment

A

<6-8 weeks

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14
Q

Class VI-VII Potency and areas of application

A 
Low Potency Steroid 
Large Areas and thinner skin:
1. Face
2. Eyelid
3. Genital
4. Intertriginous areas
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15
Q

Class VI-VII length of treatment

A

1-2 weeks

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16
Q

Low potency steroids SE’s?

A
  1. Skin atrophy
  2. Telangiectasia
  3. Steroid induced acne
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17
Q

Systemic SE’s of Topical Glucocorticoids

A
  1. HPA Axis suppression
  2. Cushings
  3. Growth retardation
  4. Edema
  5. Sodium retention
  6. Pseudotumor cerebri
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18
Q

Ocular SE’s Topical Glucocorticoids

A
  1. Cataracts
  2. Glaucoma
  3. Retarded healing of corneal abrasion
  4. Extension of herpetic infection
  5. Increased susceptibility to bacterial and fungal infections
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19
Q

Cutaneous SE’s of Topical Glucocorticoids

A
  1. Skin atrophy
  2. Striae
  3. Telengiectasis, purpura, echymosis
  4. Retardation of wound healing
  5. Contact allergic dermatitis: Vehicle induced=common
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20
Q

What organisms does Bacitracin cover?

A

Gram +

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21
Q

Bacitracin Vehicle

A

Compound ointment base:
Alone OR
Combo with Neomycin/polymyxin B OR
Both

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22
Q

Most frequent SE of Bacitracin ?

A

Allergic contact dermatitis

Most likely from Neomycin

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23
Q

What organism does Mupirocin (Bactroban) cover?

A
  1. Gram +

2. MRSA

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24
Q

What is the preferred vehicle of Mupirocin? What is covered by insurance?

A

Ointment=preferred

Cream=covered by insurance

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25
Mupirocin ADE's
1. Stinging/Burning 2. Pruritis 3. HA
26
List the Triple ABx Ointment
1. Polymyxin B 2. Neomycin 3. Bacitracin
27
What organisms does Polymyxin B cover?
``` Gram - 1. P. aeruginosa 2. Enterobacter 3. E.coli ALL gram + are resistant ```
28
What organism does Neomycin cover?
1. Gram - (E.coli) | 2. Gram + (S. aureus)
29
Neomycin SE
Sensitization (contact dermatoses) | = 30%
30
What is the main benefit of Gentamcin?
More active against Pseudomonas than Neomycin
31
Mild inflammatory acne treatment
Topical Retinoid OR Topical Benzoyl Peroxide AND/OR Topical Abx
32
Moderate acne treatment
Retinoid + Benzoyl Peroxide | +/- Topical Abx
33
What should you consider for moderate acne treatment in females?
Oral Abx Derm referral Hormal therapy
34
Severe acne treatment t
Retinoid + Benzoyl Peroxide+ Oral Abx | +/- Topical Abx
35
What should you consider for severe acne treatment in females?
Oral Isotretinoin Derma Referral Normal therapy
36
Comedone treatment
Topical Tretinoin (Retin A)
37
Cystic Acne treatment
Intralesional Triamcinolone
38
List Topical Abx for use in mild-to-moderate cases of inflammatory acne
1. Clindamycin (water-based gel) | 2. Erythromycin (water-based gel)
39
What can you combine both. Topical Clindaymycin and Erythromycin with?
Benzoyl Peroxide
40
Who is Retinoic Acid beneficial in?
1. Tx of Acne Vulgaris 2. Photodamaged skin 3. Thickened skin (psoriasis) 4. Atrophic areas
41
What is the best Retinoic Acids (acid form of Vitamin A)
Tretinoin (Retin A)
42
Retinoic Acid application
Every night at bedtime to dry skin only x4-6 weeks
43
What should you educate your patients about with the use of Retinoic acid?
1. Avoid contact with: corner of nose, eyes, mouth, mucous membranes 2. Can look worse initially 3. Avoid sun exposure and wear SPF
44
Who is Retinoic acid NOT recommended in?
Pregnant patients
45
Benzoyl Peroxide PK/Mechanism
1. Converted to Benzoic acid within epidermis and dermis | 2. Bacteriostatic against P.acnes
46
What is the OVERALL recommendation in Acne?
COMBO THERAPY 1. Topical Retinoid +Abx (when inflammatory lesions are present) 2. Benzoyl Peroxide +/- ABx
47
When should you discontinue Abx therapy in acne?
Inflammatory lesions resolve
48
Tetracycline ADE's
1. Slate gray hyperpigmentation 2. Drug-Induced lupus 3. Tetragenic 4. Dizzines (Minocycline)
49
Erythromycin ADE
Pro-kinetic= Increases GI motility=GI upset
50
Management of Isotretinoin (Accutane) to prevent Teratogenic
1. 2 effective forms of contraception: 1 month before, throughout, and 1 menstrual cycle after Tx ends 2. Serum pregnancy test 2 weeks PRIOR to initiating tx
51
What labs must you obtain monthly with the use of Isotretinoin (Accutane)
1. Serum Pregnancy test | 2. Fasting lipids
52
List the Topical abx used in treatment of Rosacea
1. Clindamycin 1% cream/lotion/gel 2 Erythromycin 2% solution 3. Metronidazole (Metrogel, Metro cream, Metrolotion) 4. Sodium Sulfacetamide 4%
53
Who is Metronidazole NOT recommended in?
Pregnancy Nursing Kids
54
List the ORAL abx used in treatment of Rosacea
Tetracyclines: 1. Doxycycline 2. Minocycline
55
Stage III rosacea with rhinopehyma and rosacea flumicans treatment
Isotretinoin (accurate)
56
What type of rosacea is Isotretinoin (accurate) NOT recommended in?
Ophthalmic rosacea
57
List Topical Imidazoles
1. Ketoconazole 2. Miconazole 3. Fluconazole
58
Indications for Topical Imidazoles treatment
Dermatophyte and Candida infections of: 1. Stratum Corneum 2. Mucosa 3. Cornea
59
What is Topical Imidazoles treatment NOT indicated in?
1. Nail infections 2. Hair infections 3. SubQ infections
60
Seborrheic dermatitis treatment
Ketoconazole
61
What is Nystatin NOT effective against?
Dermatophytes
62
Atopic Dermatitis Treatment
Immunomodulators: 1. Tacrolimus 2. Pimecrolimus
63
Tacrolimus, Pimecrolimus MOA
1. Calcineruin inhibitors | 2. Inhibit T-lymphocyte activation: Prevents degranulation of mast cells by antigen-IgE complexes
64
Tacrolimus, Pimecrolimus Black Box warning
1. Malignancy 2. Avoid continuous use 3. Limit application to areas of involvement 3. Not indicated in kids under 2
65
What low pH cleanser would you recommend for general pruritus?
CeraVe
66
Topical Doxepin: What is it? Used for? CI in?
Potent H1/H2 receptor antagonist Tx Pruritis CI: Urinary retention, narrow angle glaucoma
67
List the Ectoparasiticides in the treatment of head lice/scabies
1. Permethrin 2. Lindane 3. Crotamition 4. Sulfar
68
Lindane ADE
Concentrated in fatty tissues, including brain: Neurotoxic-Seizures
69
List agents that reduce hyper pigmentation. MOA?
Hydroquinone + Mequinol | Interferes with biosynthesis of melanin
70
Vitiligo treatment
Psoralens: 1. Trioxsalen 2. Methoxypsoralen
71
Psoralens MOA
Repigmentation of depigmented macule in Vitiligo
72
Risks of psoralen photochemotherapy
1. Cataracts | 2. Skin CA
73
Define Sunscreen
Chemical compounds that absorb UV light
74
Define Sunblock
Contain opaque materials that reflect light | Doesn't need a chemical reaction to work= can go out immediately
75
Sunscreen instructions
Apply 20 minutes before going out | Replace every 2 hours
76
What do we use Salicylic Acid to treat?
Keratolytic agent to tx: 1. Acne 2. Psoriasis 3. Warts
77
Who do you want to caution Salicylic Acid use in?
1. Diabetics | 2. PAD
78
Effects of Urea?
Softening and moisturizing effect on stratum corneal
79
Humectant (urea agent) effects
Increases water content of stratum corneum
80
What do we use Podophyllum Resin and Podophyllotoxin to treat?
Condyloma acuminatum
81
Actinic Keratoses treatment
Fluorouracil
82
What do we use Imiquimod to treat?
1. Warts (FDA approved) 2. Actinic Keratosis 3. Basal cell carcinoma 4. Squamous cell carcinoma 5. Lentigo maligna melanoma
83
What is a disadvantage of Minodixil (Rogaine)?
Effects are not Permanent: Stop tx, hair loss in 4-6 months
84
What do we use Finasteride (trcichogenic agent) to treat? How long?
Promotes hair growth: Prevent further hair loss in men with Androgenic alopecia Tx for 3-6 months
85
Finasteride (trcichogenic agent) ADE's
1. Decreased libido 2. Ejaculation disorder 3. Erectile dysfunction
86
What is initial treatment for Psoriasis?
High potency topical steroid + Phototherapy
87
What is Acitretin (soriatane) a metabolite of? Treatment for?
Retinoid Metabolite | Treatment of Psoriasis
88
What is the treatment regimen/management/limitatinos of Acitretin (soriatane)?
1. Must not be used in pregnancy/looking to become pregnant years after tx 2. NO alcohol during tx and 2 years after tx 3. CANT donate blood during tx AND for 3 years after tx
89
Methotrexate PK
Folate antagonist
90
Who is Methotrexate NOT indicated in?
Pregnancy and breastfeeding=Category X
91
What is a rare ADE with the use of biologic agents in the treatment of Psoriasis?
Lymphoma

Pharmacology- Exam #4 (6 decks)

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