Dermatologic

Question 1

Which area of the skin will have the most permeation and absorption?

Answer 1

#1 groin 
#2 face

Question 2

Bacitracin-Neomycin-Polymyxin B (Neosporin) class

Answer 2

Topical antimicrobial

Question 3

Bacitracin-Neomycin-Polymyxin B (Neosporin) indications

Answer 3

Superficial bacterial skin infx, eyes and external ear infx

can be used prophylactically against bacterial contamination of abrasions, burns, skin grafts or incisions

Question 4

Bacitracin-Neomycin-Polymyxin B (Neosporin) MOA

Answer 4

polymyxin disrupts the structure of the bacterial cell membrane by interacting with phospholipids; bacitracin interferes with the peptidoglycans of the bacterial cell wall

Question 5

Do not use Bacitracin-Neomycin-Polymyxin B (Neosporin) is __________

Answer 5

allergic to systemic aminoglycosides

Question 6

Drugs of choice to tx impetigo

Answer 6

Mupirocin (Bactroban)

Question 7

When to use topical therapy with tx impetigo

Answer 7

only if there is a limited # of lesions

Question 8

Mupirocin (Bactroban) class

Answer 8

topical antibiotic

Question 9

Mupirocin (Bactroban) MOA

Answer 9

inhibits bacterial protein synthesis

Question 10

T/F: Mupirocin (Bactroban) can be used to tx MRSA colonization

Answer 10

TRUE

should be applied to nares to eradicate nasal carriage of infx

Question 11

Mupirocin (Bactroban) local s/e

Answer 11

irritation

Question 12

What is the MC type of Tinea?

Answer 12

Tinea pedis

Question 13

Drug of choice to tx Tinea

Answer 13

Ketoconazole (Nizoral)

Question 14

Ketoconazole (Nizoral) class

Answer 14

topical antifungal

Question 15

Ketoconazole (Nizoral) MOA

Answer 15

inhibits sterol synthesis, a component of fungal cell membranes

Question 16

Ketoconazole (Nizoral) local s/e

Answer 16

skin irritation

Question 17

Commonly encountered conditions in which topical corticosteroids are used?

Answer 17

1) Atopic dermatitis/Eczema
2) Contact/allergic dermatitis - environmental exposure
3) Psoriasis

Question 18

Potency of topical corticosteroids is based on

Answer 18

vasoconstriction effects (not on the anti-inflammatory effects)

Question 19

Very high potency (Class I) corticosteroid considerations

Answer 19

1) do not discontinue abruptly - switch to lower potency agent
2) tx duration should not exceed 2-4 wks

Question 20

High potency (Class II-III) corticosteroid considerations

Answer 20

avoid occlusive dressings with betamethasone dipropionate, use with caution in other high potency agents

Question 21

Low potency (Class VI-VII) corticosteroid considerations

Answer 21

1) consider these agents for children, pregnant women, elderly, and pt. w/ large areas to be treated
2) preferred agents for face, groin, armpits, or skinfolds

Question 22

potency classes of topical corticosteroids

Answer 22

Very high = Class I
High = Class II-III
Medium = Class IV-V
Low = Class VI-VII

Question 23

cutaneous adverse rxn to topical corticosteroids

Answer 23

skin atrophy (thinning), telangiectasia, hypopigmentation, steroid acne, increased hair growth

Question 24

________ topical corticosteroids can be systemically absorbed

Answer 24

Very high (Class I) and High (Class II-III) potency

Question 25

systemic/LT s/e of topical corticosteroids

Answer 25

insomnia, hyperglycemia, osteoporosis, impaired wound healing

Question 26

last line therapy for tx of atopic dermatitis/eczema, used if pt. have failed to respond to topical corticosteroids

Answer 26

Topical Calcineurin Inhibitors

Question 27

Tacrolimus (Protopic) ointment class

Answer 27

Topical Calcineurin Inhibitors

Question 28

Pimecrolimus (Elidel) cream class

Answer 28

Topical Calcineurin Inhibitors

Question 29

Topical Calcineurin Inhibitors local s/e

Answer 29

local stinging, burning

Question 30

Treat pruritis/hives with

Answer 30

systemic antihistamines

Question 31

Loratadine (Claritin) class

Answer 31

systemic antihistamines

Question 32

Cetirizine (Zyrtec) class

Answer 32

systemic antihistamines

Question 33

T/F: topical antihistamines can be used to treat pruritus/hives

Answer 33

FALSE they are ineffective & topical doxepin carries risk of local contact dermatitis

Question 34

What are pharmacologic options for tx acne?

Answer 34

1) salicylic acid 2) benzoyl peroxide 3) topical retinoids 4) antibacterial agents 5) antisebum agents

Question 35

Which antibacterial agents are used to tx acne?

Answer 35

1) Erythromycin, clindamycin 2) azelaic acid 3) dapsone

Question 36

Which antisebum agents are used to tx acne?

Answer 36

1) oral contraceptives 2) spironolactone 3) isotretinoin

Question 37

Isotretinoin (Accutane) class

Answer 37

Vitamin A derivative

Question 38

Isotretinoin (Accutane) indications

Answer 38

acne, acne rosacea, and hidradenitis supperativa

Question 39

Isotretinoin (Accutane) MOA

Answer 39

1) reduction of hyperkeratinization 2) reduction in # of sebaceous glands and sebum production 3) reduction of Propionbacterium acne, the organism believed to contribute to acne-associated inflammation

Question 40

Isotretinoin (Accutane) ADRs

Answer 40

1) **Teratogenicity (1' in first 3 wks) 2) Depression 3) Psychosis 4) Myalgias 5) Hyperlipidemia

Question 41

What is the iPLEDGE program?

Answer 41

that Isotretinoin (Accutane) Rx requires registration from: physician, patient, pharmacy, and wholesaler goals: no female pt. starts Isotretinoin (Accutane) if pregnant and no female pt. on Isotretinoin (Accutane) becomes pregnant

Question 42

T/F: LT use of topical corticosteroids can cause systemic s/e such as insomnia, hyperglycemia, osteoporosis, and impaired wound healing

Answer 42

False | although depends on potency of steroid

Question 43

Treatment options for psoriasis

Answer 43

1) topical corticosteroids 2) topical vitamin D analog 3) topical vitamin A analog/retinoid (i.e. tazarotene) 4) phototherapy 5) systemic therapy

Question 44

Which systemic therapies are used to tx psoriasis?

Answer 44

1) oral steroids, 2) chemotherapy agents (methotrexate) 3) TNF-a inhibitors (Infliximab/Remicade and Etanercept/Enbrel)

Question 45

Cacipotriene (Dovonex) class

Answer 45

Vitamin D analog

Question 46

Cacipotriene (Dovonex) MOA

Answer 46

inhibits epidermal proliferation and stimulation of differentiation

Question 47

Cacipotriene (Dovonex) indications

Answer 47

plaque psoriasis, scalp psoriasis

Question 48

T/F: the vitamin D analog, Cacipotriene (Dovonex, is as effective as topical corticosteroids but has more frequent adverse effects

Answer 48

TRUE

Question 49

Cacipotriene (Dovonex) s/e

Answer 49

- photosensitivity - hypercalcemia - may worsen psoriasis - skin irritation

Question 50

Cacipotriene (Dovonex) is potentially more effective in tx psoriasis when used with _________

Answer 50

Betamethasone

Question 51

Tazarotene (Tazorac) class

Answer 51

topical retinoid

Question 52

Tazarotene (Tazorac) indications

Answer 52

plaque psoriasis, acne

Question 53

Tazarotene (Tazorac) s/e

Answer 53

skin burning, irritation, stringing

Question 54

Tazarotene (Tazorac) is recommended to use with _______ for improved efficacy and tolerability when tx psoriasis

Answer 54

topical corticosteroids

Question 55

What is phototherapy?

Answer 55

use of UVA & UVB as therapeutic agents

Question 56

What is photochemotherapy?

Answer 56

adding an agent such as a psoralen drug (e.g. methoxsalen) to phototherapy tx

Question 57

PUVA

Answer 57

psoralen (P) + UVA

Question 58

phototherapy s/e

Answer 58

- nausea - painful erythema and blistering - chronic use associated w/ incr. risk of skin cancer