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Flashcards in Dermatological Agents Deck (51):
1

how are drugs deliver in dermatological diseases

Concentration gradient
Partition coefficient
Diffusion coefficient

2

what are the physiological factors of drug delivery in dermatological diseases

-thickness of stratum corneum
-degree of hydration
-temperature

3

what is the equation for Percutaneous Absorption

J=Cveh x K x D/x

4

what are most dermatological drugs incorporated into

vehicles

5

what are vehicles

vehicles bring the drug into contact with the skin

6

the type of vehicle used greatly influences what

drug's absorption
-vehicles themselves can have a beneficial or harmful effect on the skin

7

see slide 5

see slide 5

8

what are the general guidelines for topical therapy

-dosage
-regional anatomic variation
altered barrier function
-hydration
-vehicle

9

what are topical glucocorticoids

-are grouped into 4-7 classes in order for decreasing potency

10

modifications of topical glucocorticoids are based on what

hydroxylation, methylation, fluorination or esterificaition are made to increase lipid solubility and potency, and decrease mineralcorticoid effect

11

relative potency of topical glucocortioics are based on what

vasoconstrictor assay, psoriasis bioassy, or relief of experimentally induced-erythema or inflammation

12

what is the mechanism of action of steroids

-penetrate cell membrane and bind to a cytoplasmic receptor- heat shock protein complex
-the heat shock protein is released and the hormone receptor complex is transported to the nucleus

13

steroids interact with ---- and regulate their expression

glucocorticoid response elements on various genes and other regulatory proteins

14

what type of therapeutic use do topical steroids have

anti-inflammatory and immunosuppressive effects

15

MOA of topical steroids

-decrease adhesion, migration and function of macrophages, PMS and other lymphocytes

16

topical steroids block production and release of what

-various cytokines and acute phase reactants
-suppress growth factor induced DNA synthesis and fibroblast proliferation

17

describe the anti-inflammatory effects of topical steroids

-antimitotic; anti-inflammatory; reduce capillary permeability; local vasoconstriction; secondary anti-pruitic effects

18

how do you choose a topical steroid

ask yourself the following
1. what condition are you trying to treat? (acute vs. chronic)
2. what potentcy do youw ant to use?
3. what part of the body are you treating? (thin vs. thick skin)
4. minimize the risk of the SE
5. what vehicle/Formulation do you want to use? (ointment, cream, gel, lotion, or foam?)

19

how are topical steroids strengths classified

classified into 4-7 potency groups
Group 1 = ultra high potency
Group 7 = lowest potency

20

absorption and potency of topical steroids are increased with what

fluorination, occlusion and application of thinner skin

21

lower potency are used for

infants, young children; elderly
high skin penetration areas
long-term/chronic therapy

22

higher potency are used for

Acute lesions/flare-ups
skin penetration poor
short-term control

23

where can steroids be applied from thickest to thinnest areas

palmar, plantar, nails
dorsum of hands & feet
lower arms & legs
upper arms & legs
eyelids*, face*, chest, & back
mucous membranes*, scrotum*, submammary area*, axillary & perineal flexures*


*Fluorinated steroids generally avoided on these areas

24

what are ointments more potent

bc they tend to be more occlusive

25

what are ointments used for

-dry, fissured & lichenfied skin due to moisturizing effect
-palms and soles

26

what are creams used for

-weeping lesions due to drying nature
-used in intertriginous areas due to high moisture in these areas

27

what are gels, locations and foams used for

-suitable for scalp or regions with hair
-little moisturizing benefit
-penetration enhancers (eg. propylene glycol) often used which can be irritating

28

what is the purpose of occlusive dressings

-increase hydration of skin thus enhancing drug penetration
-increasing drug penetration increases risk of systemic adverse effects

29

what are occlusive dressings

wrapping medicated areas with occlusive dressings

30

what are the occlusive dressings commonly used

Saran Wrap, vinyl gloves, cotten gloves

31

what are the different types of skin infections

-bacterial, fingal, viral or parasitic in origin
-systemic therapy may be required

32

what drugs are used against surface bacterial infections

topical antibiotics are used

33

what are the therapeutic uses of topical antibiotics

-prevent infections in clean wounds
-for early treatment of infected dermatoses and wounds
-reduce colonization of the nares by Staphylococci
-to treat acne

34

what are the different OTC Topical Antibiotics

Bacitracin: Gram (+)
Neomycin: Gram (-), some Gram (+)
Polymixin: Gram (-)

Polysporin® (bacitracin + polymixin)
Neosporin® (all three)

35

what is the MOA of mupirocin

-inhibits bacterial enzymes necessary for protein and RNA synthesis

36

what is the spectrum of activity of Mupirocin

-effects gram (+) and some gram (-) bacteria
-broader spectrum of activity that OTC products

37

what is the functional role of Retinoids

-vision
-cell proliferation and differentiation
-bone growth
-immunity; tumor suppression

38

what is the MAO of Retinoids

-effects gene expression via 2 families of receptors (RARs; RXRs)

39

what are the different types of Retinoids

Tretinoin* (acne; photodamaged skin)
Isotretinoin# (acne vulgaris)
Alitretinoin* (Kaposi’s sarcoma)
Acitretin# (psoriasis)
Adapalene* (acne)
Tazarotene* (acne; psoriasis; photoaging)
Bexarotene*# (cutaneous T-cell lymphoma)

40

Retinoid Toxicity

-acute toxicity similar to Vit. A intoxication
-dry skin, nosebleeds, conjunctivitis, reduced night vision, hair loss, MSK pain, mucocutaneous abnormalities, "retinoid dermatitis" and mood alterations
-oral retinoids are potent teratogens

41

what is the goal of acne treatment

1. correct abnormalities of follicular maturation (unplug pores)
2. decrease sebum production
3. decrease P.acnes colonization
4. decrease inflammation

42

see slide 28-31

see slide 28-31

43

what are the Atopic Dermatitis

Glucocorticoids
Antihistamines
Immunosuppressants

44

what topical agents can be used to treat Pruritus

antihistamines
emollient creams and lotions
menthol
camphor pramoxine; doxepin; capsaicin; tar

45

what systemic agents are used to treat pruritus

antihistamines; doxepinl glucocorticoids

46

what physical modalities are used to treat Pruritus

PUVA; acupuncture, electrical stimulation

47

what immunosuppressants are used for Eczema

Tacrolimus and Pimecrolimus

48

what is the MOA of Tacrolimus and Pimecrolimus

-inhibits production of interleukins, interferons, other antigen-stimulated products in T cells
-inhibit release of pre-formed mediators from skin mast cells and basophils, breastfeeding

49

how long should Tacrolimus and Pimecrolimus be used for

short term and intermittent long-term therapy for eczema

50

what topical agents are used for Psoriasis

Glucocorticoids
Calcipotriene (Vit D analog)
Tazarotene (retinoid)
Anthralin
Coal tar

51

what systemic agents are used to treat Psoriasis

Methotexate
Acitretin
Immunosuppressants (cyclosporine; mycophenlate)
Biologic agents (alefacept; efalizumab; etanercept, adalimumab; infliximab)