Drugs Affecting the Integumentary System Flashcards
(184 cards)
1
Q
most common pathogens seen in bacterial skin infections
A
staph aureus
strep pyogenes
2
Q
first-line therapy for impetigo
A
Mupirocin (Centany) or retapamulin (Altabax)
3
Q
if MRSA is suspected…
A
appropriate systemic antibiotics should be used:
Trimethoprim/sulfamethoxazole (TMP/SMZ)
Doxycycline
Minocycline
Clindamycin
4
Q
mupirocin pharmacodynamics
A
o Has a wide range of coverage against gram-positive bacteria
o Limited coverage against gram negative bacteria
o Acts by binding to bacterial isoleucyl-tRNA synthetase
5
Q
retapamulin pharmacodynamics
A
Bacteriostatic against S. aureus and S. pyogenes by inhibiting protein synthesis
6
Q
bacitracin pharmacodynamics
A
Bacteriostatic, but may also be bactericidal
- Depending on the antibiotic concentration and the susceptibility of the organism
Primarily active against gram-positive organisms
- Inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall
7
Q
neomycin pharmacodynamics
A
o An aminoglycoside
o Bactericidal
o Binds to the 30s subunit of the bacterial ribosome to inhibit protein synthesis
8
Q
polymyxin pharmacodynamics
A
Acts as a surfactant that disrupts bacterial membranes
- has bactericidal activity against some gram-negative organisms, including:
P. aeruginosa
E. coli
Enterobacter spp
Klebsiella spp.
9
Q
what is impetigo?
A
a contagious superficial skin infection caused by S. aureus and/or s. pyogenes
10
Q
decision on how to treat impetigo is based on
A
# of lesions
The location
The need to limit spread of infection to others
11
Q
first-line topical agents for impetigo
A
Mupirocin
Retapamulin
If the patient has up to five singular lesions, topical mupirocin or retapamulin may be applied 2 times a day for 5 days
* Only available by prescription
12
Q
impetigo - Pt who have numerous lesions or who are not responding to topical agents should receive oral antimicrobials that are effective against S. aureus and S. pyogenes
A
Cephalexin (Keflex)
Dicloxacillin
13
Q
impetigo - if MRSA is suspected
A
Clindamycin
TMP/SMZ
Doxycycline
14
Q
impetigo - if pt has a PCN allergy and MRSA is not suspected
A
Erythromycin
Clarithromycin
15
Q
duration of systemic abx for impetigo
A
7 days
16
Q
what are furuncles?
A
o Commonly known as boils
o Infections of the hair follicle
o Usually caused by S. aureus
17
Q
first line therapy for furuncles
A
small –> warm, moist compress
large –> incision and drainage
18
Q
when should abx be used for tx of furuncles?
A
Systemic antibiotics should be reserved for abscesses larger than 2 cm or when symptoms of infection are present:
Temp > 38C
Tachypnea > 24 bpm
Tachycardia > 90 bpm
WBC > 12,000/mL
19
Q
recurrent skin abscesses treatment
A
o Treatment as above for initial abscess
A 5-day recolonization regimen:
- Twice daily nasal mupirocin
- Daily chlorhexidine washes
- Dilute bleach baths
* 1 teaspoon per gallon of water
* ¼ cup per ¼ tub
- Daily washing of personal towels, sheets, and clothing
20
Q
nasal MRSA carrier
A
Eradication of nasal MRSA may be achieved with intranasal mupirocin
o 1-gram, single-use tubes administered twice daily = Half the tube per nostril
o Treatment for 5 days in combination with a skin antiseptic body wash (chlorhexidine)
21
Q
what are fungal infections caused by?
A
dermophytes and yeasts
22
Q
topical antifungals are used to tx
A
superficial fungal infections caused by dermatophytic fungi and yeasts
23
Q
when are oral antifungals necessary?
A
treatment of disease that:
Is extensive
Affects hair and nails
Does not respond to topical agents
24
Q
categories of topical antifungals
A
o allylamine/benzylamine
o azole
o polyene
o other
25
allylamine/benzylamine medications
- terbinafine (Lamisil AT)
- naftifine (Naftin)
- butenafine (Mentax, Lotrimin Ultra)
26
terbafine (Lamisil AT)
a topical allylamine antifungal
indicated for:
* tinea capitis
* tinea corporis
* tinea pedis
27
naftitine (Naftin)
topical allylamine antifungal
indicated for:
* tinea cruris
* tinea corporis
* tinea pedis
28
butenafine (Mentax, Lotrimin Ultra)
a benzylamine antifungal
indicated for the topical treatment of:
interdigital tinea pedis
tinea corporis
tinea cruris due to:
* Epidermophyton floccosum
* Trichophyton mentagrophytes
* Trichophyton rubrum
* Trichophyton tonsurans
29
azole medications
Clotrimazole
econazole (Ecoza; Zolpak)
* also has some antibacterial activity
efinaconazole (Jublia)
ketoconazole (Extina; Ketodan)
luliconazole (Luzu)
miconazole (Cavilon; Lotrimin)
oxiconazole (Oxistat), sertaconazole (Ertaczo)
sulconazole (Exelderm)
30
polyene antifungals
nystatin
- not effective against dermatophytes
31
other antifungals
- ciclopirox olamine (Loprox)
- tolnaftate (Tinactin)
32
ciclopirox (Loprox)
A broad-spectrum N-hydroxypryidinone antifungal
Used in the treatment of:
Tinea corporis
Tinea cruris
Tinea pedis
33
tolnaftate (Tinactin)
o an OTC product
o used to treat superficial fungal infections
34
tinea capitis (scalp ringworm) tx
first line drugs
oral griseofulvin
oral terbinafine
35
onychomycosis tx
topical
* ciclopirox (Penlac)
* efinaconazole (Jublia)
* avaborole (Kerydin)
systemic
* itraconazole
* terbinafine
36
nystatin pharmacodynamics
a topical polyene antifungal antibiotic
effective against most oral, mucosal, and cutaneous infections caused by Candida species
binds to sterols in the cell membranes of both fungal and human cells
* causes a change in membrane permeability that allows leakage of intracellular components
37
topical azole antifungals pharmacodynamics
alter the fungal cell membrane by inhibiting ergosterol synthesis through interacting with 14-alpha-demthylase (an essential component of the membrane)
- causes leakage of cellular contents
38
allylamine antifungals pharmacodynamics
terbinafine and naftifine
* exert their antifungal effectiveness by inhibiting squalene epoxidase (a key enzyme in sterol biosynthesis in fungi)
* results in the accumulation of squalene within the fungal cell and causes fungal cell death
39
tolnaftate pharmacodynamics
distorts hyphae and stunts mycelial growth in susceptible fungi
40
butenafine pharmacodynamics
the first of a newer class of topical antifungal agents, the benzylamines
effective against a wide variety of pathogenic fungi
inhibits fungal ergosterol biosynthesis by interfering with the conversion of squalene into 2,3-oxidosqualene
41
ciclopirox pharmacodynamics
a broad-spectrum antifungal agent
acts on the cell membrane to block transmembrane transport of amino acids into the fungal cell
* causing intracellular depletion of essential substrates and/or ions
42
ciclopirox uses
used to treat tinea corporis, tinea cruris, or tinea pedis
43
ciclopirox nail lacquer
ciclopirox nail lacquer penetrates the nail to be fungicidal to most organisms responsible for onychomycosis
44
efinaconazole pharmacodynamics
inhibits lanosterol 14 alpha-demethylase, which is needed in the synthesis of ergosterol
- resulting in cell death
45
tavaborole pharmacodynamics
inhibits fungal protein synthesis
46
systemic antifungals used in the treatment of fungal skin infections
griseofulvin
the azoles
* itraconazole
* fluconazole
oral allylamine terbinafine
47
griseofulvin pharmacodynamics
an antifungal antibiotic produced by certain species of Penicillium
fungistatic
disrupts the mitotic spindle structure of the fungal cell
* arrests metaphase cell division
48
fluconazole pharmacodynamics
a synthetic, broad spectrum triazole antifungal agent
alters the fungal cell membrane
a highly selective inhibitor of fungal CYP450 and sterol 14-alpha-demethylase
* results in increased cellular permeability -> causes leakage of cellular contents
49
itraconazole pharmacodynamics
a synthetic triazole antifungal
alters the fungal cell membrane
inhibits the CYP450-dependent synthesis of ergosterol
* increases cellular permeability -> causes leakage of cellular contents
50
oral terbinafine pharmacodynamics
an allylamine antifungal
interferes w/ fungal sterol biosynthesis by inhibiting the enzyme squalene monooxygenase
* causes accumulation of squalene weakens the cell membrane in sensitive fungi
51
ciclopirox nail lacquer precautions
should not be used in patients who are immunocompromised or have DM
52
griseofulvin can have CNS effects
o Headache
o Fatigue
o Dizziness
o Insomnia
o Confusion
o Impaired performance of routine activities
53
rare effects w/ prolonged use or high doses of griseofulvin
- granulocytopenia
- leukopenia
54
oral terbinafine rare but serious RXNs
- steven-johnson syndrome
- toxic epidermal neurolysis
55
oral terbafine - rare cases of blood dyscrasias
o Neutropenia
o Lymphopenia
o Thrombocytopenia
o Agranulocytosis
56
most common sites for mucocutaneous candidiasis
* Mouth: stomatitis or thrush
* Esophagus: esophagitis
* Vagina: yeast vaginitis
57
first line treatment for cutaneous candida infections
OTC azoles -> miconazole and clotrimazole
applied twice daily to the affected skin area until clear
58
tx of thrush in patients older than 3 y/o
10mg clotrimazole troche
- Slowly and completely dissolved in the mouth, 5 times per day for 14 days
59
tx for candida infections if pt cannot tolerate azole antifungals
nystatin
* Cream, ointment, or powder can be applied to the affected area two-three times per day until clear
60
second-line treatment for cutaneous Candida infections
other prescription azole antifungals
- Econazole -> Applied to the affected area twice daily for at least 2 weeks
- Ketoconazole -> Applied once daily for at least 2 weeks
- Oxiconazole -> Applied to the affected area and the immediately surrounding areas once or twice daily until clear
- Sulconazole -> Gently massaged into the affected areas and surrounding skin once daily until clear
61
first line treatment for thrush
4-6mL of nystatin suspension
- Swished around mouth and swallowed four times per day
- Treatment should be continued until s/s have been resolved for 48 hours
62
second-line treatment for thrush
systemic fluconazole
* 200 mg PO on day one, then 100-200 mg once daily for 7-14 days
63
tinea capitis is known as:
ringworm of the scalp
64
causative organism for tinea capitis
Trichophyton tonsurans
65
tinea capitis tx
* Oral antifungal therapy w/ griseofulvin
* Biweekly shampooing w/ sporicidal shampoo
- such as selenium sulfide 2.5% or ketoconazole 2%
66
tinea corporis is commonly called:
ringworm
67
causative organisms for tinea corporis
* T. rubrum
* M. canis
* T. interdigitale
* T. violaceum
* M. audouinii
* M. gypseum
68
tinea corporis presentation
* Annular lesion with raised borders and center clearing
* May be scaling and some erythema
69
tx for tinea corporis (limited disease involvement)
topical antifungal cream
* Miconazole
* Tolnaftate
* Clotrimazole
70
tx for tinea corporis (extensive disease involvement or failure of topical antifungals)
systemic tx should be initiated
71
what is tinea cruris known as?
jock itch
72
what is tinea cruris?
superficial fungal infection of the groin, upper thighs, and intertriginous folds
73
lesions in tinea cruris
* Pruritic
* Erythematous
* Scaly
* Well-demarcated patches w/ central clearing
74
treatment for tinea cruris
same as for tinea corporis w/ the same dosing schedule
75
tinea pedis
superficial fungal infection of the skin of the feet
commonly called "athlete's foot"
76
clinical presentation of tinea pedis
Scaling, maceration, fissuring, and inflammation on the feet
* Especially on the inner digital areas
77
treatment of tinea pedis
same topical agents used for tinea corporis
* Often 4 weeks of treatment is needed
78
tinea versicolor
A superficial fungal infection of the skin caused by yeasts in the genus Malassezia
- Appears as hyperpigmented or hypopigmented, coalescing, scaly macules on the trunk and upper arms
79
treatment for tinea versicolor
Treatment consists of topical application of selenium sulfide shampoo or a topical antifungal
80
selenium sulfide shampoo for tinea versicolor
Applied to the tinea versicolor patch, left on for 10-15 minutes every day for 1 week
81
topical azoles for tinea versicolor
Miconazole, clotrimazole, and econazole
o Used twice daily for 2-4 weeks
82
onychomycosis (tinea unguium)
a fungal infection of the nail, either fingernail or toenail
Treatment usually involves months of treatment w/ a systemic antifungal
* Terbinafine and itraconazole appear to have higher rates of cure than griseofulvin
83
topical treatment options for onychomycosis
* Ciclopirox nail lacquer
* Efinaconazole 10% solution (Jublia)
* Tavaborole (Kerydin)
84
first line treatment for onychomycosis
systemic terbinafine
* Fingernail -> 250 mg daily for 6 weeks
* Toenail -> 250 mg daily for 12 weeks
85
monitoring during terbinafine tx for onychomycosis
Liver enzymes and CBC should be monitored every 6 weeks if treatments lasts longer than 6 weeks
86
tx for onychomycosis if the patient cannot tolerate terbinafine
itraconazole can be used
* Can be dosed either daily dosing or pulse dosing
87
daily dosing itraconazole for onychomycosis
200 mg daily for 12 weeks
88
pulse dosing for itraconazole for onychomycosis
200 mg/day for 1 week per month for 3 consecutive months
89
second line therapy for onychomycosis
griseofulvin
- fingernail: 4 months
- toenail: 6 months
90
monitoring for griseofulvin therapy for onychomycosis
Renal, liver, and hematopoietic functions should be measured at least every 8 weeks during therapy
91
ciclopirox indications for onychomycosis
o Superficial white onychomycosis
o When there is distal subungual onychomycosis that affects less than 50% of the nail surface
o When four or fewer nails are infected
o For children w/ thin, fast-growing nails
92
how to use ciclopirox nail lacquer
o Applied to entire nailbed and surround 5 mm of skin
o Must remain on the nail for 8 hrs before bathing
o Once a week, previous coats of lacquer are removed with alcohol and excess nail is trimmed and filed
o This routine is repeated for 24-48 weeks
93
prescription azoles for onychomycosis
if OTC products are not effective
- efinaconazole and tavaborole
- topical antifungals
- applied once daily to clean, dry nail for 48 weeks
94
HSV-1
nongenital infection
95
HSV-2
genital infections
96
three topical antiviral medications
o acyclovir (Zovirax)
o penciclovir (Denavir)
o the OTC product docosanol (Abreva)
97
both acyclovir and penciclovir must be phosphorylated to be active against HSV
both medications are converted to monophosphate forms by viral thymidine kinases, then further converted to diphosphate, and finally to triphosphate by various cellular enzymes
98
acyclovir triphosphate pharmacodynamics
- competes with deoxyguanosine triphosphate for a position in the DNA chain of the herpes virus
- once incorporated in the DNA chain -> it terminates DNA synthesis
99
penciclovir triphosphate
selectively inhibits viral DNA polymerase by competing with deoxyguanosine triphosphate
* this inhibits viral replication
100
topical acyclovir indications for herpes simplex
- recurrent herpes labialis (cold sores)
- herpes genitalis
- in limited, non-life-threatening, mucocutaneous HSV infections in immunocompromised patients
- topical acyclovir is applied to cover all lesions 5 times a day for 4 days
101
penciclovir 1% cream
- indicated in the treatment of recurrent herpes labialis on the lips and face
- application to mucous membrane is not recommended
- applied q2 hr while awake for 4 days
102
docosanol (Abreva) for herpes simplex
- the only OTC product available for the treatment of herpes labialis
- applied to lesion 5 times a day until healed
- d/c treatment if lesion is not healed within 10 days
103
topical agents in tx of acne
retinoids
abx (against P. acnes)
104
topical retinoids
- tretinoin (Retin-A, Atralin)
- adapalene (Differin)
- tazarotene (Tazorac, Arazlo)
- trifarotene (Akleif)
105
oral medications for systemic use for acne tx
- oral antibiotics
* prescribed for moderate to severe acne
- hormonal therapy
- isotretinoin (an oral retinoid)
* prescribed for severe nodulocystic acne
106
tritinoin (Retin-A, Atralin) pharmacodymanics
a naturally occurring derivative of vitamin A
- reduces the cohesion between keratinized cells
- act specifically on microcomedones causing:
* fragmentation and expulsion of the microplug
* expulsion of comedones
* conversion of closed comedones to open comedones
- new comedone formation is prevented by continued use
- does not affect the bacteria found in P. acnes
- enhance the penetration of other topical agents such as topical abx and benzoyl peroxide
107
tretinoin (Retin-A, Atralin) is used in the treatment of:
* fine wrinkling
* mottled hyperpigmentation
* roughness of the skin associated with sun damage
108
adapalene (Differin) pharmacodynamics
a topical retinoid-like drug used for the treatment of mild to moderate acne vulgaris
- binds to specific retinoic acid nuclear receptors but does not bind to the cytosolic receptor protein
- normalizes the differentiation of follicular epithelial cells -> resulting in decreased microcomedone formation
a modulator of cellular differentiation, keratinization, and inflammatory process
109
tazarotene (Tazorac, Arazlo) pharmacodynamics
- a retinoid
- normalizes epidermal differentiation
- reduces the influx of inflammatory cells into the skin
110
trifarotene (Akleif) pharmacodynamics
a fourth-generation selective retinoic acid receptor (RAR) agonist
- RAR stimulation results in modulation of target genes associated with medication of inflammation and differentiation of cells
111
topical antibiotic medications
o Benzoyl peroxide (PanOxyl, Benziq)
o Erythromycin (Erygel)
o Topical clindamycin (Cleocin, Clindacin)
o Metronidazole (Metrocream, Nuvessa)
o Azelaic acid (Azelex, Finacea)
o Topical minocycline 4% foam (Amzeep, Zilxi)
112
benzoyl peroxide pharmacodynamics
Has antibacterial activity against P. acnes
* Due to the release of active or free-radical oxygen capable of oxidizing bacterial proteins
Has a drying effect, removes excess sebum, causes mild desquamation, and a sebostatic effect
113
erythromycin (Erygel) pharmacodynamics
A bacteriostatic macrolide antibiotic
- Binds to the P site of the 50S ribosomal subunit interfering with protein synthesis
114
topical clindamycin (Cleocin, Clindcin) pharmacodynamics
Reversibly binds to 50S ribosomal subunit
- Prevents peptide bond formation and thus inhibiting bacterial protein synthesis
115
metronidazole (Metrocream, Nuvessa) pharmacodynamics
Classified as an antiprotozoal and antibacterial agent
- Acts in reducing the inflammatory lesions, is thought to be disruption of bacterial and protozoal DNA, inhibiting nucleic acid synthesis
116
azelaic acid (Azelex, Finacea) pharmacodynamics
Antimicrobial against P. acnes and S. epidermis
- Inhibits microbial cellular protein synthesis
- Decreases the inflammation associated with acne lesions by reducing the concentration of bacteria present in the skin
- May also cause normalization of keratinization -> leading to an anticomedonal effect
- May also decrease microcomedone formation by reducing the number and size of keratohyalin granulaes and the amount and distribution of filaggrin in the epidermal layers
- Does not affect sebum excretion
117
topical minocycline 4% foam (Amzeep, Zilxi) uses
approved for moderate to severe acne
118
systemic retinoid for acne -> isotreinoin (Absorica, Claravis)
An isomer of all-trans retinoic acid, a metabolic of retinol (vitamin A)
- Reduces sebum production by reducing sebaceous gland size, normalizing follicular keratinization, and indirectly reducing P. acne and its inflammatory sequalae
119
contraindications for systemic retinoids
- psychiatric disorders (may cause major depression, psychosis, and suicidal ideation)
pregnancy
- May cause severe malformations of the fetal craniofacial, cardiac, thymic, and CNS structures
- Spontaneous abortions and premature births have been reported
120
topical retinoids for acne vulgaris
applied once daily as tolerated
- Apply a thin film of medication in the evening after washing with a gentle cleanser
- Apply oil-free moisturizer to the face before the application of topical retinoid
121
topical abx for acne vulgaris
Applied in a thin film to affected acne areas twice daily as tolerated
- Benzoyl peroxide cream or gel is applied once or twice a day to acne-affected areas
- Benzoyl peroxide cleanser may be used once or twice daily
- Clindamycin should be applied to all of the affected areas twice daily
- Dapasone gel should be applied twice a day to skin that has been washed and patted dry
122
first line tx of mild acne rosacea
Metronidazole 0.75% cream (MetroCream) or gel (MetroGel) or 1% emollient cream is applied in a thin film twice a day (for cream) or once a day (for gel)
- Significant therapeutic results should be noticed within 3 weeks
123
topical ivermectin (Soolantra) for acne rosacea
- May be used for the papules and pustules of rosacea
- Applied to affected areas once daily
124
Topical azelaic acid (finacea 15% gel, finasea 15% foam) for acne rosacea
Applied twice a day
- Causes more facial sensitivity
125
second-line therapy for acne rosacea
combination products that combine an antibacterial w/ a keratolytic
sulfacetamide 10% and sulfur 5% (Plexion)
- applied one to three times a day to clean skin
Sulfacetamide and sulfur washes (AVAR)
- used once or twice a day
azelaic acid 15% gel (Finacea)
- an antibacterial/antikeratinizing agent
126
noninflammatory comedonal acne treatment
topical retinoids and/or benzoyl peroxide products
o abx are not considered for this type of acne
o azelaic acid can also be effective
127
antibiotics (oral or topical) may be used in the treatment of inflammatory papulopustular acne
- benzoyl peroxide is an effective antimicrobial and comedolytic agent for treating inflammatory and noninflammatory acne
- topical dapsone and topical metronidazole may be useful for mild inflammatory acne
- adding a topical retinoid or azelaic acid to improve follicular keratinization can also be helpful
128
treatment for papulopustular or nodulocystic acne w/ severe inflammation
a topical antibiotic
benzoyl peroxide
an oral abx
129
indications for oral isotretinoin
- when acne is not responsive to other tx
- severe nodulocystic acne
- moderate noncystic inflammatory acne with the potential for scarring
130
psoriasis tx
Topical corticosteroids are used to treat psoriasis b/c of their anti-inflammatory effects on the plaques
- Moderate- to high-potency steroids are used
- Psoriasis lesions are generally resistant to steroids
131
general rules for topical corticosteroid potency use
- in children -> low- to moderate-potency
- on the face or other areas w/ thin skin -> low-potency agents
high potency agents should be reserved for:
* brief periods (up to 2 weeks)
* in areas that are resistant to lower-potency treatment
132
vehicle affects potency of topical medications
ointments
* more occlusive
* effective for dry or scaly lesions
creams
* may be used more frequently on oozing lesions on intertriginous areas
gels, aerosols, lotions, and solutions
* used on hair-bearing areas
steroid-impregnated tape (Cordran)
* useful for occlusive therapy in small areas
133
topical calcineurin inhibitors
a class of topical medications used in short-term or intermittent long-term treatment of atopic dermatitis
- nonsteroidal options for atopic dermatitis when it is not responsive to conventional therapy, or when conventional therapy is not appropriate
134
topical calcineurin inhibitor examples
o Pimecrolimus (Elidel)
o tacrolimus (Protopic)
135
topical calcineurin inhibitor pharmacodynamics
work through inhibition of phosphorylase activity of the calcium-dependent serine/threonine phosphatase calcineurin and the dephosphorylase activity of the nuclear factor of activated T-cell protein (NF-ATp)
o NF-ATp is a factor necessary for the cytokines interleukin-2 (IL-2), IL-4, and IL-5
o Might also inhibit the transcription and release of other T-cell proteins
- Can contribute to allergic inflammation
136
topical tacrolimus has been found to inhibit:
T cells
Langerhans cells
Mast cells
Keratinocytes
137
pimecrolimus pharmacodynamics
Was specifically developed to treat inflammatory conditions
- Active by binding to FKBP/macrophilin 12 and interfering with calcineurin action
- inhibits the release of inflammatory cytokines and mediators from mast cells
138
boxed warning for topical calcineurin inhibitors
Long-term safety of topical immunosuppressant calcineurin inhibitors b/c of rare cases of malignancy (skin and lymphoma) that have been reported
139
clinical use of topical pimecrolimus (Elidel)
Used as second-line drug in the short-term or intermittent long-term treatment of mild to moderate atopic dermatitis in immunocompetent patients older than 2 years
140
clinical use of topical tacrolimus (protopic)
Used for short-term or intermittent long-term treatment of moderate to severe atopic dermatitis in children older than 2 years
- Pt should be reevaluated 6 weeks after therapy is started
141
tx recommendation for mild to moderate psoriasis (less than 20% of the body involved)
topical medication and phototherapy
142
tx recommendation for severe psoriasis (more than 20% of the body involved)
o Systemic medications are added
o Referral to dermatologist
143
topical therapy recommendations for psoriasis by the American Academy of Dermatology
o Nonmedicated topical moisturizers
o Coal tar
o Topical corticosteroids
o Vitamin D analogs
o Calcineurin inhibitors
o Tazarotene
144
calcipotriene (Calcitrene, Dovonex) pharmacodynamics
o Vitamin D3 derivative
o Regulates cell differentiation and proliferation
o Suppressed lymphocyte activity
145
coal tar pharmacodynamics
affects psorasis by enzyme inhibition and antimitotic action
146
tazarotene pharmacodynamics
A topical retinoid prodrug that is used in treatment of psoriasis
- After topical application -> undergoes esterase hydrolysis in skin to form its active metabolite, tazarotenic acid
- Tazarotenic acid is further metabolized in the skin
- Works by normalizing epidermal differentiation, reducing hyperproliferation and reducing the influx of inflammatory cells into the skin
147
anthralin pharmacodynamics
Inhibits DNA synthesis in epidermal cells -> leads to decreased proliferation of epidermal cells
148
use of calcipotriene for psoriasis
- applied in a thin film to affected psoriasis plaques and rubbed into the skin gently and completely
- pt should be reevaluated after 6-8 weeks
- may be used in combo with topical steroids
149
use of tazarotene for psoriasis
- applied to clean, dry skin
- 0.05% or 0.1% gel is applied once daily in the evening for psoriatic lesions for 12 weeks
- No more than 20% of the body surface area should be covered
150
seborrhea definition
an inflammatory dermatitis that produces greasy-looking, yellowish scales distributed on areas rich in sebaceous glands such as the scalp, the external ear, the center of the face, the upper part of the trunk, and the intertriginous areas
151
mildest, most common form of seborrhea
scalp seborrheic dermatitis, AKA "dandruff"
152
treatment of seborrhea
mainstay -> topical antifungals
- antiseborrheic shampoos and topical steroid preparations can be used additionally
153
commonly used seborrhea shampoos
o Selenium sulfide
o Pyrithione zinc
o Coal tar
o Salicyclic acid
154
selenium sulfide (Selsun) pharmacodynamics
Has a cytostatic effect on the cell of the epidermis and follicular epithelium
- Leading to reduced corneocyte production
155
Pyrithione zinc (Head & Shoulders) pharmacodynamics
o Cytostatic agent that reduces the cell turnover rate
o Also exhibits antifungal and antibacterial properties
o A nonspecific toxic effect on the epidermal cells
156
tar derivatives for seborrhea pharmacodynamics
- Treat seborrhea by correcting abnormal keratinization and by decreasing epidermal proliferation and dermal infiltration
- Also have antiseptic, astringent, antifungal, vasoconstrictive, and photosensitizing properties
157
ketoconazole (Nizoral) and ciclopirox pharmacodynamics for seborrhea
* the antifungals
Work against dandruff and seborrheic dermatitis by altering the fungal cell membrane
- Particularly of P. ovale (a pathogen implicated in seborrhea)
158
patient education for seborrhea
seborrheic dermatitis cannot be cured, only controlled
- continued use of the medication will be necessary to maintain control
159
topical antihistamines and antipruritics
benadryl and doxepin (Prudoxin, Zonalon)
160
topical diphenhydramine pharmacodynamics
Provides local relief from pruritus and edema
- b/c of local effect on the H1-receptors
- suppresses the formation of edema, flare, and pruritus
may also provide local anesthetic activity
- decreases the permeability of the nerve cell membrane to sodium ions -> blocking the transmission of nerve impulses
161
doxepin pharmacodynamics
Topical MOA is unclear
H1- and H2-receptor blocking action
- Histamine blocking drugs appear to compete at histamine receptor sites
* Inhibit the activation of histamine receptors
162
topical diphenhydramine precautions
o Prolonged use (more than 7 days) should be avoided
o should not be used to treat chickenpox, or measles, or used on blistered or oozing skin
o applying diphenhydramine to denuded skin or to large surface areas increases the potential for toxic psychosis, especially in children
163
topical doxepin precautions
o Drowsiness
o Patients who should not use (d/t anticholinergic effects):
- Untreated narrow-angle glaucoma
- Urinary retention
164
clinical use for topical diphenhydramine
Local reactions to insect bites, stings, and minor skin disorders (poison ivy, sumac, and oak)
- Applied to affected area 3-4 times a day for up to 7 days
165
treatment of severe pruritus
Doxepin cream (Prudoxin, Zonalon)
- applied in a thin layer four times a day in 3- to 4-hour intervals for up to 8 days
other available topical antipruritics are safer
- Aveeno cream (colloidal oatmeal-based)
- Sarna anti-itch lotion
166
treatment of burns in primary care
- silver sulfadiazine (Silvadene)
- bacitracin (a topical antibiotic)
167
silver sulfadiazine pharmacodynamics
a topical anti-infective
- active against both yeast and bacteria
- bactericidal
- acts on the cell membrane and wall to produce a toxic effect on bacteria
- reduction of bacterial growth after a partial thickness burn promotes spontaneous healing by preventing conversion of partial thickness burns to full thickness by sepsis
168
pharmacological management of scabies and lice consists of ectoparasiticides
o OTC products (Nix and RID)
o Benzoyl alcohol (the first nonneurotoxin for head lice)
o Topical ivermectin
o Malathion (Ovide)
o Spinosad 0.9% topical suspension (Natroba)
o Permethrin
o Crotamiton (Crotan)
169
pyrethrins pharmacodynamics
- OTC preparation: RID
- Absorbed through the chitinous exoskeleton of arthropods
- Block sodium channel repolarization of the arthropod neuron -> leads to paralysis and death
- Are pediculicidal, not ovicidal
- Have no residual activity are rinsing
- Application should be repeated 7 days later to ensure resolution
170
permethrin pharmacodynamics
acts on the arthropod nerve cell membrane to disrupt the sodium channel current
- disrupts sodium channel polarization leading to paralysis
- cream rinse has residual activity against lice for up to 10 days
171
lindane pharmacodynamics
o absorbed through exoskeleton of parasites
o causes CNS excitation -> leads convulsions and death
o resistance has been documented worldwide
172
malathion pharmacodynamics
- acts on a pediculicide by inhibiting cholinesterase activity in vivo
- ovicidal and pediculicidal
- 96% mortality in 30 min
- Some residual activity for 7 days
173
ivermectin pharmacodynamics
Interferes with the function of invertebrate nerve and muscle cells by binding to glutamate-gated chloride channels
- Results in parasite paralysis and death
174
spinosad pharmacodynamics
- Causes fatal neuronal excitation in insects
- Both pediculicidal and ovicidal
175
pyrethrin shampoo for head lice
* Applied to dry hair and left on for 10-20 min
* Pt should be retreated in 1 week
176
permethrin cream rinse for head lice
* Applied after shampooing, left in for 10 min, then rinsed out
* Should be retreated in 1 week
177
lindane for head lice
* Applied to dry hair and left on for 4 min
* Small amount of warm water is used to lather the shampoo, then the hair is rinsed well w/ water
178
malathion (Ovide) for head lice
* Applied to dry hair in an amount sufficient to wet the hair and scalp
* Left on for 8-12 hours, and then shampooed out
* May be repeated in 7 days if lice are still present
179
benzoyl alcohol for head lice
* Applied to dry hair, completely saturating the hair and scalp
* Left on for 10 min, then rinsed off well with water
* Can be repeated in 7 days if live lice are seen
180
topical ivermectin for head lice
* Applied to dry hair to coat the hair and scalp and left on for 10 min
* Rinsed off well with water
181
treatment for body lice
Body lice live on clothing and underwear and only come to the skin to feed
- Wash all clothing and bedding in hot water to kill lice and nits
- Treat body with a pediculicide (Permethrin 5% or lindane)
182
treatment for pubic lice
Treated with the same medications used to treat pediculosis capitis (head lice)
* Permethrin 1% or pyrethrin
183
scabies drug of choice for tx
Massaged into skin and should be left on for 8-14 hours before being washed off in the shower
184
other treatment options for scabies
Lindane 1% cream
- Left on for 8-12 hours before being washed off
Crotamiton (Crotan) is approved for use in adults
