Derma Abx Flashcards
what variables determine topical drug penetration
lichenification thickness (palms/soles) solubility location (thick skin is harder ) duration of exposure frequency of application allergies/sensitives
what are the general uses of topical steroids?
non specific antiinflammatory reduces itching mainstay of tx : acute or chronic derm low/medium dose--> eczema, irritant term, atopic derm high dose--> psoriasis, allergic derm
MOA of topical steroids
decrease migration of PMS and fibroblasts
reverse capillary permeability
control rate of protein synthesis
- gene regulation of inflammatory response
lysosomal stabilization
Low strength corticosteroids
Alclometasone dipropionate
Desonide
intermediate strength
fluticasone propionate
mometasone furoate
hydrocortisone valerate
high strength
amcinonide
Very high strength
clobetasol propionate
halobetasol
Commons Adverse drug effects of topical/corticosteroids
cutaneous atrophy
- telangiectasia, purpura
other/serious
- striae, acne, refractory rosacea, hypo pigmentation,
adrenal suppression and iatrogenic cushings:
- Increase dose/duration
- Increase with children
What are safety considerations
drug interactions
- minimal if topical
contraindications
- systemic or fungal infection
- hypersensitivity
caution in pregnant women
caution in children < 12 (avoid or use low dose)
caution if symptoms worsenTreatment considerations for Corticosteroids
chronic use effects (ADE, tolerance, tachyphylaxis)
use low doses on areas with increase absorption
occlusive dressings
- caution with low to mid potency
- do not recommend with high very high potency corticosteroids
- do not use in diaper area
ointments have highest effects
What is remember 3?
ultra high potency steroids
- should not be use for > 3 weeks (usually 2-4 weeks)
Low –> high potency steroids
should not be used for > 3 months
what are prescribing consideration of topicals?
hydration improves absorption
- consider applying after a shower
most are once or twice daily
finertip method
What is the fingertip method?
1/2 fingertip covers area of hand
fingertip 0.5g covers 2 hands surface area
1g–> cover 4 hands surface area (4%)
What are topical meds for treating psoriasis?
coticosteroids
vitamind d analogues (calcipotriene, calcitriol)
retinoids (tazarotene) (NO PREGNANT)
calcineruin inhibitors (Tacrolimus, pimecrolimus) consider for facial
- cortico steroids are generally a first line
- calcipotrience and corticosteroids are more effective than mono therapy (no longer term effects)
What are oral nonbiologics for treating psoriasis?
methotrexate (NOT WITH PREGNANT, hepatotoxic)
cyclosporine (NOT with grapefruit juice, renal pt, hypertension, many drug interactions).
oral retinoid –> acitretin (soriatane) (AVOID PREGNANCY 3 years)
apremilast –> suppress immune system
what are clinical acknowledges for nonbiologics?
frequent lab monitoring–> baseline and follow up, CBC, BUN, pregnancy tests
concern for drug interactions–> methotrexate and cyclosporine
potential for ADE
Consider referring to specialist once oral therapy is indicated
What are biologic agents for treating psoriasis?
ends in “-MAB” –> its a biologic
injectable
Most are subcutaneous
EXPENSIVE!!!
BBW!! –> concern for serious infection
PPD
Increased risk for infection
Suppress immune system
considerations for phototherapy for psoriasis?
benefit from UVB exposure
Clinic and home treatments
Can use natural sunlight, 30 min at noon, avoid over exposure
What are drugs for treating urticaria?
Urticaria is a histamine response
- PO or Topical
treat with antihistamine
1st generation
- diphenhydramine, doxylamine
- drowsiness! BPH, dry mouth
2nd generation –>
- cetirizine, levocetirizine
- almost no drowsiness - not getting into skin/tissue or CNS
