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pharmacology exam 3 > Dermatological Conditions > Flashcards

Dermatological Conditions Flashcards

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1
Q

four common forms of dermatitis seen in primary care

A
  • atopic dermatitis (eczema)
  • contact dermatitis
  • diaper dermatitis (diaper rash)
  • seborrheic dermatitis
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2
Q

rash pattern on infants with atopic dermatitis

A
  • Rash on the face, scalp, trunk, and the extensor surface of extremities
  • Usually acute or subacute, red, and vesicular
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3
Q

rash pattern on adolescents and adults with atopic dermatitis

A

o Usually chronic
o w/ scaling, dryness, and lichenification
o located on flexure surfaces of the extremities, face, neck, hands, and upper chest
o tends to worsen in the winter

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4
Q

what is contact dermatitis?

A
  • An acute inflammatory reaction of the skin to an irritant or allergen
  • Generally, not chronic or recurring
  • Usually distributed on exposed skin
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5
Q

what is seborrheic dermatitis?

A

A common inflammatory dermatitis characterized by erythematous, eczematous patches with yellow, greasy scaling
- Usually localized to hairy areas and to areas with high concentrations of sebaceous glands

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6
Q

medications to treat acute exacerbations of eczema

A
  • topical corticosteroids
  • oral corticosteroids
  • immunomodulators
  • antipruritics
  • emollients
  • antibiotics
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7
Q

topical corticosteroids for acute exacerbations of eczema

A

Anti-inflammatory effect
- Suppresses the release of proinflammatory cytokines
- Inhibit the formation, release, and activity of the endogenous mediators of inflammation

When applied to skin -> inhibit the migration of macrophages and leukocytes into the area by reversing vascular dilation and permeability
- Decreases edema, erythema, and pruritus

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8
Q

topical low-potency steroids

A

1% hydrocortisone - available OTC

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9
Q

medium-potency topical steroids

A
  • hydrocortisone butyrate 0.1% (Locoid)
  • triamcinolone acetonide 0.1% (Kenalog cream)
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10
Q

high-potency topical steroids

A
  • betamethasone dipropionate
  • augmented 0.05% (Diprolene lotion)
  • triamcinolone acetonide 0.5% (Triderm)
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11
Q

very-high potency topical steroids

A
  • betamethasone dipropionate
  • augmented 0.05% (Diprolene ointment)
  • halobetasol propionate 0.05% (Ultravate)
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12
Q

oral corticosteroids for acute exacerbations of eczema

A

occasionally used to treat severe eczema
- d/t major adverse effects associated w/ prolonged use of corticosteroid therapy -> routine use of oral steroids for eczema is contraindicated
- consult w/ dermatology specialist is indicated

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13
Q

immunomodulators for acute exacerbations of eczema

A

a class of topical medications used in the short-term or intermittent long-term treatment of atopic dermatitis
- second-line therapy after topical corticosteroid treatment failure for atopic dermatitis

medications: pimecrolimus and tacrolimus

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14
Q

antipruritic for acute exacerbations of eczema

A

used to control itching associated with eczema to break the itch-scratch-itch cycle

oral agents
- the antihistamines (diphenhydramine and hydroxyzine)
- cetirizine (Zyrtec)

topical agents
- doxepin cream (Prudoxin, Zonalon)
- Aveeno cream (colloidal oatmeal-based)
- Moisture emollient cream or lotion (petrolatum, glycerine-based)

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15
Q

antihistamines for acute eczema exacerbations

A

have sedative actions
- may be beneficial for nocturnal itching that disrupts sleep

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16
Q

cetirizine (Zyrec) for acute eczema exacerbations

A
  • does not have sedative effects
  • can be used during the day
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17
Q

doxepin cream for acute eczema exacerbations

A

for moderate to severe pruritus
can be absorbed systemically if used over 10% of the body
- may cause drowsiness

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18
Q

antibiotics for acute eczema exacerbations

A

Antibiotics may be necessary to treat secondary infections of Staphylococcus aureus or beta-hemolytic streptococci

Effective abx
- Cephalexin
- amoxicillin/clavulanate (Augmentin)
- cefprozil (Cefzil)

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19
Q

long-term therapy for eczema

A

patients must continue to care for their skin to prevent further exacerbations

  • keys to long-term therapy
    o adequate hydration
    o avoidance of agents that cause exacerbations
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20
Q

nonpharmacological measures for long-term therapy of eczema

A

o Hydrating baths
o Avoiding skin irritations and offending agents

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21
Q

treatment for contact dermatitis

A
  • For a small area of skin affected -> a topical corticosteroid cream
  • More than 10% of the skin surface affected or if the allergic contact dermatitis is severe -> oral corticosteroids

Oral antihistamines may help control pruritic

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22
Q

treatment for plant dermatitis

A

intermediate- or high-potency creams should be used for poison ivy or poison oak

Medium potency
- Hydrocortisone valerate 0.2%
- triamcinolone acetonide 0.1% cream

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23
Q

oral corticosteroids for contact dermatitis

A

Used if the contact dermatitis is severe or if a large skin surface area is involved
- Prednisone or methylprednisolone
- A 2- to 3-week course of therapy may be needed for severe cases
- 2 weeks is the minimum length of therapy required for severe poison oak or poison ivy dermatitis

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24
Q

drug therapy for diaper dermatitis is aimed at

A

o Protecting the skin
o Decreasing inflammation
o Treating Candida infection

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25
barrier medications for diaper dermatitis
Used to protect the skin from the irritant effects of contact with urine and feces Plain white petrolatum - Effective and inexpensive barrier agent A&D ointment - Vitamin A and D added to petrolatum Zinc oxide -> has a drying effect as well - Promotes wound healing when added to other agents
26
anti-inflammatory medications used for diaper dermatitis
Used to decrease the inflammation associated w/ diaper dermatitis - Low-dose hydrocortisone (0.5% or 1%) can be used safely in the diaper area for 2 to 3 days, two to three times a day
27
why can't you use higher potency steroids in the diaper area?
diapers act as an occlusive dressing that increases the potency of the medication
28
antifungal medications for diaper dermatitis
 nystatin (Nyamyc, Nystop)  miconazole (Cruex)  clotrimazole (Desenex)
29
topical corticosteroid use for seborrheic dermatitis
may be used for nonhairy areas (such as the face) - low-potency steroid lotion or gel
30
what is psorasis?
characterized by sharply defined, symmetrical, erythematous patches with distinctive silver scales
31
pathophysiology of psoriasis
there is a significant decrease in the amount of time that it takes for a psoriatic epidermal cell to travel to the skin surface and be cast off - does not allow normal cell maturation to take place lesions of active psoriasis can develop in areas of epidermal trauma - EX: surgical incisions, sunburn, scratch marks -> leave psoriatic lesions in their place
32
management of psoriasis
1. Topical medication 2. Phototherapy - For mild to moderate psoriasis - Less than 5% of the body involved 3. Systemic medications - For severe psoriasis - More than 5-10% of the body involved - Only prescribed by dermatology specialists - systemic immunosuppressants -> cyclosporine retinoids, methotrexate, and apremilast
33
topical steroids for psoriasis
anti-inflammatory effects on the plaques -Moderate- to high-potency steroids are used because the lesions are resistant to steroids - Applied 2-3 times per day - If topical corticosteroids are used in the intertriginous areas or on the face, a low-potency medication should be chosen - 2-3 weeks of continuous use is the limit - With gradual reduction in frequency of application to prevent rebound - Topical corticosteroids should be reserved for psoriasis flare-ups
34
anthralin (Zithranol) for psoriasis
An antimitotic agent that is used for chronic psoriasis - Has an antiproliferative effect - Disadvantages --> Irritation --> Stains skin and clothing
35
calcipotriene (Dovonex) for psoriasis
 Regulates cell differentiation and proliferation  Suppresses lymphocyte activity
36
topical calcitriol (Vectical Ointment) for psoriasis
 a vitamin D3 derivative  inhibits keratinocyte proliferation  inhibits T-cell proliferation and other inflammatory mediators
37
phototherapy for psoriasis
o with ultraviolet B (UVB) light o effective in managing psoriasis by reducing DNA synthesis of epidermal cells
38
management goals that will control acne
- Controlling the inflammatory process associated with acne by altering the bacterial flora - Decreasing the obstruction of the sebaceous ducts
39
treatment for acne
should be approached in a stepwise manner
40
tx for mild to moderate acne
Initial therapy -> topical retinoids and/or topical antibiotics If after 6-8 weeks that is not effective -> oral antibiotics or a change in topical therapy
41
tx for moderate to somewhat severe acne
Initial therapy -> oral antibiotic and topical preparations
42
tx for severe, recalcitrant, nodular acne
Isotretinoin (Accutane)
43
topical retinoids for acne
- alter the abnormal keratinization process of acne that leads to microcomedone formation - stimulate mitotic activity - increase the turnover of follicular epithelial cells -> causes extrusion of the comedones - causes an initial worsening of acne -> face will clear after approximately 6-8 weeks of treatment - will also cause some skin irritation
44
topical antibiotics for acne
thought to control acne by their bacteriostatic or bactericidal activity against P. acnes - control the inflammatory process - decrease the free fatty acids that P. acnes produces
45
oral antibiotics for acne
do not affect existing lesions - prevent future lesions by decreasing sebaceous fatty acids by decreasing P. acnes colonization
46
oral abx for acne medications
 Tetracycline  Doxycycline *  Minocycline *  Erythromycin  trimethoprim-sulfamethoxazole  trimethoprim  azithromycin
47
isotretinoin (Accutane)
- Most potent agent for treating acne - Reserved for severe, recalcitrant cystic acne or moderate acne that is treatment-resistant or produces physical scarring - usually on prescribed by a dermatologist
48
isotretinoin (Accutane) mechanism of action
Exact mechanism of action is unknown - Decreased sebum production - Decrease abnormal keratinization
49
what is acne rosacea?
commonly referred to as rosacea - a chronic inflammatory disorder that affects the blood vessels and pilosebaceous units of the face
50
hallmark sign of rosacea
Easy facial flushing and blushing associated w/ ingestion of: - Alcohol - Spicy foods - Caffeine-containing beverages
51
causes of rosacea
- Papules and pustules superimposed on diffuse erythema and telangiectasia over the central portion of the face - Hyperplasia of the sebaceous glands, connective tissue, and vascular bed - Can lead to a large, bulbous red nose, called rhinophyma
52
FDA-approved treatment for rosacea
 Topical metronidazole (MetroGel, Noritate) * Antibacterial  azelaic acid (Finacea)  topical ivermectin (Soolantra)
53
what is impetigo?
a bacterial infection of the superficial layers of the skin, which begins as vesicles rupture, leaving a hallmark golden or honey-colored crust - causative organism: S. aureus or Str. Pyogenous
54
tx for mild impetigo (up to 5 singular lesion)
topical mupirocin ointment (Centany) or retapamulin (Altabax) is used for 5 days
55
oral abx for impetigo
indicated if the patient has more than five lesions or ecthyma, or if the lesions continue to worsen after 2 to 3 days of topical therapy - such as cephalexin or dicloxacillin
56
tx for impetigo if MRSA is confirmed
treat with doxycycline, clindamycin, or sulfamethoxazole-trimethoprim (SMZ/TMP) based on local resistance patterns
57
treatment for large boil (furuncle) or abscess
1. incision and drainage 2. Systemic abx - first-line antibiotic would be cephalexin or dicloxacillin (while waiting for gram stain of the drainage)
58
special precaution with malathion (Ovide)
is flammable! * Should not be exposed to open flames or electric heat sources * Do not smoke while apply lotion * Allow hair to dry naturally and to remain uncovered after application
59
pyrethrins
o Applied to dry hair - Left on for 10-20 min o Patient should be retreated in 1 week regardless of whether there is evidence of infestation
60
permethrin use
o A cream rinse that is applied after shampooing, left in for 10 minutes, and then rinsed out o Should be retreated in 1 week regardless of whether there is evidence of infestation
61
lindane use for head lice
- Applied to dry hair, working in small quantities of water to create a good lather - Left on for 4 minutes, then rinsed well - Retreatment should be avoided
62
lindane precaution
Neurotoxic - Should not be used in pregnancy - Used in caution in children, older adults, and patients weighing less than 110lbs
63
malathion (Ovide) use
Applied to dry hair in an amount sufficient to wet the hair and scalp - Allow hair to dry naturally - Left on for 8-12 hours and then shampooed out - May be repeated in 7 days if lice are still present
64
benzyl alcohol use
- Applied to dry hair, completely saturating the hair and scalp - Left on for 10 min, then rinsed off well with water - Treatment should be repeated in 7 days
65
first nonneurotoxic treatment for head lice
benzyl alcohol - Active ingredient stuns the respiratory mechanism of the lice open, enabling the vehicle to penetrate -> leading to asphyxiation
66
ivermectin use
- Applied to dry hair, and left on for 10 min, then rinsed off with water - Retreatment is not usually necessary
67
spinosad use
- Applied to dry hair, left on for 10 min, then rinsed with warm water - Retreatment is not usually needed
68
crotamiton 10% cream or lotion (Crotan, Eurax) use
Approved to treat adults with scabies Applied to entire body, including under the fingernails - Second dose to be applied 24 hours later - Washed off 48 hours after first application
69
lindane use for pubic lice
Cream and lotion - Thin later is applied to the hair and skin surrounding the pubic area - Left on for 12 hours Shampoo - Massaged into dry pubic hair - Left on for 5-10 min
70
pyrethrins for pubic lice
o Permethrin 1%, pyrethrin lotion, or shampoo o Thoroughly saturate hair with lice medication o Leave on for 10 min o Rinse off with water o Dry with clean towel o Reapply in 7 days if there is evidence of live lice

pharmacology exam 3 (14 decks)

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