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Derm Pharm Flashcards

(101 cards)

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1
Q

Describe creams

A

half water half oil

emulsifier

spread easily (good for large areas)

well absorbed, wash off with water

too thick to pump so in tube

OOZING/WET skin conditions

lotions similar but less viscous

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2
Q

Describe ointments

A

20% water in 80% oil

greasy, occlusive, stay on surface–> more complete absorption

DRY SKIN, traps moisture

less likely to cause allergic rxn because creams have preservative

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3
Q

What are gels made of?

A

polyionic colloids expanded with water

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4
Q

What are pastes mixtures of?

A

oil, powder, water

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5
Q

When is alcohol-based disinfectants not indicated?

A

Not effective against C Diff–> must use soap and water

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6
Q

What are components of moisturizers?

A

emollients–> form oily layer on top of skin to trap water

humectants–> draw water into outer layer of skin

keratin softeners–> loosen bonds to help dead skin cells fall off, retain water, smoother skin feeling

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7
Q

What are common emollients?

A

petrolatum

lanolin

mineral oil

dimethicone

–>form oily layer on top of skin to trap water

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8
Q

What are common humectants?

A

glycerin

lecithin

propylene glycol

–>osmotic agents that draw water to outer layer of skin

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9
Q

What are common keratin/ horny substance softeners?

A

urea

alpha hydroxy acids

allantoin

–>loosen bonds b/t top layer cells to get rid of dead cells, retain water for softer and smoother skin

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10
Q

What kind of moisturizer for normal skin?

A

water=based, lightweight, non-greasy feel

silicone-derived (cyclomethicone)

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11
Q

What kind of moisturizer for dry skin?

A

heavier, oil based

antioxidants (dimethicone or grape seed oil) to keep skin hydrated

petrolatum-based products for cracked skin->keep water from evaporating

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12
Q

What kind of moisturizer for oily skin?

A

water-based, noncomedogenic

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13
Q

What kind of moisturizer for sensitive skin?

A

soothing ingredients (chamomile, aloe)

no allergens (dyes, fragrances)

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14
Q

What kind of moisturizer for mature skin?

A

oil-based with petrolatum

antioxidants or alpha hydroxy acids to combat wrinkles

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15
Q

Which radiation causes erythema/sunburns, skin aging and photocarcinogenesis?

A

UVB

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16
Q

Which radiation causes skin aging and cancer?

A

UVA

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17
Q

What is the function of sunscreens?

A

absorb UV light

  • -> PABA in UVB
  • -> dibenzoylmethanes in UVA
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18
Q

What ingredient in sunscreen is used for drug-induced photosensitivity and lupus

A

dibenzoylmethanes (UVA)

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19
Q

What is an opaque material that reflects light and contains titanium dioxide?

A

sunshade

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20
Q

What is SPF

A

ration of minimal erythema dose with sunscreen to without

~50 by FDA

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21
Q

What is the difference between antiseptics and disinfectants?

A

antiseptics are for skin

disinfectants are for surfaces

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22
Q

What is glutaraldehyde?

A

targets cell envelope and macromolecules

cross-linking of proteins to disinfect

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23
Q

What are quaternary amines?

A

disinfect via inner cytoplasmic membrane

generalized membrane damage involving phospholipid bilayers

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24
Q

What is chlorhexidine?

A

broad-spectrum antimicrobial used in homes and hospitals (both disinfectant and antiseptic)

low irritability

works on bac spores, mycobacteria, yeasts, viruses (not many), protozoa (not cystic)

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25
What are halogens?
target oxidizing agents oxidate thiol groups to disulfides
26
What are peroxygens?
target oxidizing agents creates hydrogen peroxide that oxidizes thiol group to peracetic acid (disrupts them)
27
Does chlorhexidine inhibit spore outgrowth?
yes, but not germination not sporicidal but prevents development
28
What agent is mycobacteriostatic and not cidal?
chlorhexidine
29
Give examples of resistance to antiseptics and disinfectants
prions, coccidia (D in HIV patients), spores (c diff), etc
30
Why are biofilms important to consider when giving drugs?
abx resistance via persistent nonreplicative cells, neutralize abx, limited penetration, slow growth
31
Are antiseptic wash solutions necessary in wound healing?
NO minimal action against bacteria, impede wound healing ex: dilute iodine, chlorhexidine, hydrogen peroxide
32
When should abx therapy be given in wound healing?
only if appear clinically infected --> no evidence for use as prophylaxis --> don't need to put neosporin on every cut
33
What agents are exceptions to the rule of antiseptic use in wound healing?
cadexomer iodine: reduces bacterial load while providing moist wound environment silver (silvadene): toxic to bacteria, decreases surface contamination, doesn't improve rate of wound healing -->used widely by clinicians
34
What clinical exception exists where you would want to use antiseptic/abx use in wound healing?
patients with poor glycemic control have increased morbidity/mortality with wound healing --> priority
35
What are important considerations in dealing with wound healing?
needs adequate oxygenation and nutrition --> poor outcomes with malnutrition (impaired intake) and symp activity (vasoconstriction d/t less oxygen caused by decreased blood volume, unrelieved pain, hypothermia)
36
When to use low pressure irrigation with normal saline in wound debridement
routine since flushes bacteria and removes loose material
37
When to use surgical wound debridement
removing large areas of necrotic or infected tissue
38
When to use enzymatic wound debridement
mixed results collagenase promote endothelial cell and keratinocyte migration
39
When to use biologic wound debridement
maggot therapy liquefaction of necrotic tissue -->pressure ulcer healing time not consistently reduced
40
What is the only agent approved for treatment of chronic diabetic foot ulcers?
becaplermine -->platelet derived GF, promotes prolif and angio increased malignancy with increased use
41
Does epidermal GF significantly improve epithelialization in wound healing?
no
42
How to dress wounds
kept moist, not exposed to air -->occluded wounds heal 40% faster, less scarrig
43
What dressing to use for debridement stage?
hydrogels
44
What dressing to use for granulation stage?
foam and low-adherence dressings
45
What dressing to use for epithelialization stage?
hydrocolloid and low-adherence dressings
46
What topical antibacterial agents is a peptide, gram +, poorly absorbed through skin (rare toxicity) and causes allergic contact dermatitis?
bacitracin
47
What topical antibacterial agents is an aminoglycoside, gram -, poorly absorbed through skin (rare toxicity) and causes allergic contact dermatitis?
neomycin
48
What topical antibacterial agents is a peptide, gram -, and rarely causes allergic reactions?
polymixin B
49
What are topical imidazoles?
antifungals that block ergosterol synthesis, wide range of activity against dermatophytes and yeasts ex: miconazole, clotrimazole, efinaconazole, ketoconazole
50
What antifungal could you use for vulvovaginal candidiasis?
miconazole | clotrimazole
51
What antifungal could you use for nail fungal inf?
efinaconazole given for 48 weeks
52
What antifungal could you use for dandriff
ketoconazole
53
What antifungal is a broad spectrum (disrupts macromolecular synthesis), has low incidence of adverse rxn/dermatitis and is used against dermatophytes, Candida and Malassezia?
ciclopirox
54
What antifungal is allylamine (inhibits epoxidase), can cause local irritation wit mucous membranes and has high activity against dermatophytes but less against yeasts?
terbinafine
55
What antifungal is synthetic, effective topically except against Candida and tolerated well?
tolnaftate
56
What antifungal alters membrane permeability and used to treat cutaneous and mucosal candida inf (especially in mouth)?
nystatin
57
What antifungal alters membrane permeability, treats topical cutaneous candida and can cause yellow staining of skin?
amphotericin B
58
What is a topical antiviral that treats recurrent orolabial HSV in immunocompetent adults?
acyclovir -->guanine analog for HSV 1 and 2
59
What is the difference between local and neuropathic pruritis?
localized d/t yeast, dandriff, lice, etc neuropathic d/t compression or defen of nerves
60
How to treat pruritis?
keep skin moist, cooling lotions, avoid skin irritants, stress reduction (especially with systemic pruritis), dress areas to break cycle
61
How to use topical steroids as clinical
start with high potency to gain control then titrate down EXCEPT use low potency on face, genitals, skin folds
62
When to use local anesthetics (ex: lidocaine patch) for pruritis?
neuropathic pruritis pruritis on face d/t CKD
63
When to use capsaicin for pruritis?
neuropathic itch
64
When to use topical calcineurin inhibitors for pruritis?
anogenital pruritis
65
What drugs are not directly antipruritis but can be useful d/t inflammatory skin dermatoses?
topical corticosteroids
66
What channels does capsaicin activate?
TRPV1 (heat) induces lasting desensistization of neurons chronic pain and pruritis
67
What channels does menthol activates?
TRPM8 (cooling)
68
Describe salicylic acid
COX inhibitor, natural anti-inflamm acne and dandruff products: causes epidermal cells to shead readily, antibac properties, opens clogged pores need protection from sun prolonged use--> salicylate toxicity especially in children
69
What drug to use for cholestatic pruritis
sertraline (SSRI)
70
What drug to use for nocturnal pruritis
mirtazapien (NaSSA)
71
What drugs to use for cholestatic and CKD-associated pruritis
naltrexone (mu-opioid receptor antagonists)
72
What drugs to use for nocturnal and intractable pruritis
butorphanol (kappa opioid agoinist, mu antagoinst)
73
What drugs to use for neuropathic pruritis
gabapentin, pregabalin (anticonvulsants)
74
What drug to treat rosacea is an a2 adrenergic agonist
brimodinine topical gel that vasoconstricts to decrease redness
75
What drug to treat rosacea is a mixed a1/a2 agonist
oxymetazoline topical cream
76
What drugs to treat red eyes
adrenergic agoinsts naphazoline, tetrahydrozoline, phenylephrine, oxymetazoline
77
What drugs to kill ectoparasites
malathion (topical organophos cholin inhibitor) permethrin (blocks repol) ivermectin (oral, hyperpol nerve and muscle cells) lindane (topical, disrupts GABA transmission, LAST RESORT)
78
Topical antimicrobials to treat acne
benzoyl peroxide (antiseptic) clindamycin and erythromycin
79
What is azaleic acid?
dicarboxylic acid (from plants) that kills acne bacteria, decreases production of keratin treats mild-mod, post-inflamm hyperpig
80
What oral abx for acne cause photosensitivity, GI and shouldn't be used in pregnant or young children?
tetracycline, doxycycline
81
What oral abx for acne can cause drug-induced lupus, skin discoloration and dizziness (no preg or children)
minocycline
82
What is the MOA of retinoid acne meds?
normalizes follicular keratin, decreased cohesiveness of keratinocytes--> reduced occlusion and microcomedone formation
83
Home skin care recs for acne tmt
synthetic detergent cleanser twice daily (cetaphil or dove) gently massage skin with fingertips (aggressive is inflammatory) don't use antimicrobial soaps (no data) water-based lotions, hair products, cosmetics (less comedogenic vs oil)
84
What is proactive
benzoyl peroxide in certain steps
85
What is the initial choice for mild-mod psoriasis?
emollients | corticosteroids
86
What is the function of topical vitamin D analogs in tmt of psoriasis?
calcipotriene and calcitrol unknown MOA but reduces keratinocyte proliferation
87
What has anti-prolif effects, is ancient and largely displaced by less messy and odorous choices?
tar
88
What is a good initial choice for moderate-severe psoriasis tmt
UV light therapy --> UBV to point of redness 3x per week with tar --> PUVA using UVA closely supervised (need to ingest psoralen plant 2hrs before tmt)
89
Briefly list systemic therapies for psoriasis
``` methotrexate apremilst retinoids systemic calcineurin - biologic agents ```
90
What drug inhibits PDE4 to increase camp levels, decreases NO synthase and !L-23/TNFa, and increases IL-10?
apremilast for psoriasis for mod-severe and active psoriatic arthritis oral, good results
91
What is another PDE4 inhibitor recently approved for topical dermatitis therapy?
crisaborole
92
What targets proinflammcytokines (IL-22 and 23), blunts IL-12 and 23 effects to decrease inflammation?
ustekinumab -->plaque psoriasis, psoriatic arthritis, crohn disease increased risk for inf, subQ
93
What targets proinflamm cytokine IL-17A, blunts its effects to induce production of other proinflamm signaling molecules?
secukinumab --> ankylosing spondylitis, plaque psoriasis, psoriatic arthritis hella expensive increased risk for inf, subQ
94
What is a humanized monoclonal Ab against IL-17A with similar indications c/t secukinumab?
ixekuzumab
95
Describe treatment options for actinic keratosis
``` liquited N cryotherapy surgical pharm ---> topical 5FU ---> imiquimod (local cytokine +) ---> ingenol mebutate ---> topical diclofenac (NSAID) ---> retinoids ``` dermabrasion chemical peels red light therapy
96
Describe topical 5FU in tmt of actinic keratosis
- thymidylate synthetase (DNA synth) prevents cell prolif-->death good success if tolerated causes inflammation and destruction of lesions (erythema--> necrosis-->re-epithelialization in 4-6 weeks)
97
Tmt of basal or squamous cell carcinoma
surgery topical meds (imiquimod, 5FU) vismodegib or sonidegib if advanced (oral hedgehod inhibitors)
98
Tmt of melanoma
surgery w/n 1-2cm margins dacarbaine (chemo) MAP kinase inhibitors (vemurafenib)
99
Drugs to treat male pattern baldness
minoxidil (vasodilates via K+ channel opening, promotes hair growth and enlarges follicles) finasteride (inhibits DHT, sexual dysfunction)
100
Drugs to treat female pattern baldness
minoxidil first line anti-androgens second line - >spironolactone (androgen partial agonist) - -> finasteride (blocks DHT) - -> flutamine (androgen antag)-
101
Management of alopecia areata
chronic immune-mediated inflamm--> nonscarring hair loss corticosteroids topical immunotherapy (DPCP causes contact dermatitis--> causes hair growth)

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