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Pharmacology Test 1 > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

Etiology of diaper rash

A

Yeast: most common cause – Mostly due to candida albicans species Bacterial: 2nd most common cause - Mostly due to S. aureus, group A S. pyogenes

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2
Q

How can we PREVENT diaper rash?

A

Keep area clean and as dry as possible Powder or cornstarch Frequent diaper changes Diaper should be loose fitting, ventilated Change to cloth if needed Remove diaper and leave off as time permits Protective barrier (A+D ointment, vaseline) Wash with water or mild cleanser like Cetaphil Use cool air to dry buttocks

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3
Q

Anti-fungals for Diaper Rash

A

Nystatin (Mycolog) – powder, cream, oint Nystatin + triamcinolone (Mycolog II) – cream , oint Clotrimazole (Lotrimin) - cream Clotrimazole + betamethasone (Lotrisone) – cream NEW combination product Zinc oxide, petrolatum & 0.25% miconazole (Vusion) (expensive)

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4
Q

Treating Bacterial Diaper Rash

A

Rash caused by bacteria (usually staph or strep) – “yellowish, fluid-filled pustules, honey-colored, crusty” Mild infections – may benefit from topical product like bacitracin or mupirocin More severe infections – Must treat with appropriate systemic (PO) antibiotics (beta-lactams are very effective) Combination therapy (Topical AND PO) is most effective and is often utilized in clinical practice

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5
Q

butt paste

A

Includes the following ingredients Zinc oxide Aquaphor, A&D oint or petrolatum Cholestyramine (Questran) Cholestyramine binds uric acid, keeps pH at normal levels, zinc and A&D provide protective barrier. NOT for prevention. For treatment only

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6
Q

Rhus Dermatitis

A

delayed hypersensitivity rxn occurring 12 – 72 hrs after exposure Urushiol – chemical secreted by bruised plants Primary exposure – direct contact to bruised portion of plant that exudes urushiol Secondary exposure – contact with exposed pets, contaminated clothing, smoke from burning plants Not transmitted via fluid vesicles/blisters The condition is self-limiting 14-20 d Symptoms include: Severe itching Burning sensation Secondary infection can occur Caused by scratching – bacteria enter broken skin

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7
Q

Topical preparations to treat poisonous plant lesions

A

Calamine (calamine, Fe oxide, Zn oxide) Local anesthetics (ie. Caladryl = calamine + pramoxine) Antihistamines (Benadryl cream) (Generally not effective – diphenhydramine does not penetrate skin & may irritate further, may sensitize skin) Camphor, menthol, phenol, EtOH Promotes drying of vesicles Camphor & menthol - “cooling” effect Phenol & EtOH - Antibacterial Aluminum acetate solutions Steroids Do NOT use ointments while vesicles are present and/or weeping b/c they can form a barrier and seal moisture in - the vesicles need to dry

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8
Q

Treatments for poison plant exposure

A

Soaks, baths, mild dressings Topical preparations to treat lesions Oral Antihistamines - anti-itch (for severe cases or cases involving eye only) Oral Glucocorticosteroids – anti-inflammatory Oral Antibiotics - If infections occurs

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9
Q

Soaks, baths, mild dressings for poison plant exposure

A

for treatment of mild cases Colloidal oatmeal (Aveeno) – bath, transient relief Aluminum acetate (Burrow’s soln) – moist/wet dressings, reduce itch, mild astringent If there are facial lesions – Use moist/wet dressings – NOT lotions (difficult and painful to remove once dry)

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10
Q

Oral Antihistamines for poison plant exposure

A

for severe cases or eye involvement only anti-itch Diphenhydramine – 25-50mg PO qid prn ADR: sedation, dry mouth

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11
Q

Oral Glucocorticosteroids for poison plant exposure

A

anti-inflammatory Common dose: Prednisone PO 7-21 d, taper off Some practitioners might use in moderate cases

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12
Q

Oral Antibiotics for poison plant exposure

A

If infections occurs Treat for staph (most common in skin infections) – cephalosporins and penicillins mainstay,

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13
Q

Causes Acne

A

stimulated by testosterone and its metabolite - dihydrotestosterone Pathogenesis is multifactorial Bacterial - P. acnes Irritants Touching your face Makeup (lanolin and emollients trap dirt) Foods (certain individuals)

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14
Q

Pharmacological Treatment of Acne

A

Topical Benzoyl Peroxide Topical Salicylic Acid Topical Retinoids Miscellaneous topicals Topical antibiotics Oral Antibiotics Oral isotretinoin (Accutane) Oral contraceptives

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15
Q

Benzoyl Peroxide

A

(Benzac, Benzagel, Clearasil, Stridex) (C) (2.5 - 10%) MOA - Causes desquamation – ↑ turnover of epithelial cells, promotes healing, May be bacteriostatic or bacteriocidal Precautions - Do not use around mouth, eyes or lips. Some pts are hypersensitive. ADRs Drying, Peeling, Stinging May bleach clothing or linens (use white pillow cases)

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16
Q

Salicylic Acid

A

(clearisil pads) (0.5-2%) MOA - Keratolytics – helps remove upper layer of dead cells ADRs Drying, peeling Other indications: higher concentrations of salicyclic acid (10-15%) are used for wart removal

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17
Q

Topical Retinoids

A

Vit A derivatives MOA - ↑s epithelial cell proliferation, reduces comedo formation Precautions - AVOID sun – use SPF 30-45 – minimize exposure. Do not use too close to eyes, mouths, lips. ADRs – erythema, dryness , peeling, scaling,, itching, crusting, photosensitivity, pigmentation changes (bleaching). Examples: Tretinoin (Retin-A, Renova, Avita) (D) gel and cream Tazarotene (Tazorac) (X) gel and cream

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18
Q

Adapalene

A

(Differin 1% gel) (C) MOA - Retinoid-like compound, binds to different retinoid type receptors ADRs – similar to other retinoids, local skin irritation, not shown to be teratogenic in rodents, but no human studies

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19
Q

Azelaic acid

A

(Azelex) (C) MOA - not fully determined, but may have antimicrobial activity against P. acnes and blocks conversion of testosterone to dihydrotestosterone ADRs - erythema, dryness

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20
Q

Topical Antibiotics for acne treatment

A

MOA - antimicrobial activity against causative organisms ADRs - Burning stinging, drying, peeling, erythema Dosed – 2-6xd – resistance rare due to minimal systemic absorption Examples: Erythromycin (Eryderm) (B) Erythromycin + benzoyl peroxide (Benzamycin) (C) Sodium Sulfacetamide (Klaron, Ovace) (C) Clindamycin (cleocin T) (B) gel, cream, lotion, soln, disposable pads Combo w/ benzoyl peroxide (Duac Gel)

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21
Q

Oral Antibiotics for acne treatment

A

MOA - antimicrobial activity against causative organisms Precaution - May ↑ risk of resistance due to chronic usage ADRs include Nausea, vomiting, diarrhea and many others (more detail to be provided in antimicrobial lecture) Vertigo (primarily with minocycline) Contraceptive failure of BC pills (use alternate form of BC) Examples Tetracyclines Doxycycline (D) Minocycline (D) Macrolides Erythromycin (B)

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22
Q

Isotretinoin

A

(Accutane) (X) (oral retinoid) MOA - reduce sebaceous gland size, regulates cell proliferation and differentiation DOSE: 0.5 – 1 mg/kg/day divided BID for 15-20 weeks. May repeat x 1 after 2 months off ADR’s - dryness & itching of skin and mucous membrane, HA, depression, hyperlipidemia, increase LFT’s, alopecia, myalgia, hematologic ADRs, ocular ADRs, photosensitivity, increase suicide risk Used only for severe cases – best treatment Need to sign informed patient consent prior to receiving and cannot be pregnant or get pregnant

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23
Q

Oral Contraceptives –

A

females only MOA - Increased estrogen helps counterbalance the high testosterone levels which cause acne Estrogen alone or Estrogen / Progesterone combo With combo want high estrogenic activity and low androgenic activity (tricycline brands are good) ADRs – PMS like symptoms, bloating, weight gain Use for women >18yo, not planning pregnancy

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24
Q

Drugs that CAUSE Acne

A

Hormones- Gonadotropins, Anabolic steroids, Corticosteroids Anti-epileptic drugs TB drugs- INH, Rifampin Miscellaneous - Lithium, Cyclopsorine, Iodine

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25
psoriasis
No cure for psoriasis Treatment can be defined as acute or chronic Factors influencing treatment selection Age of patient Type of psoriasis Site and extent of involvement Previous treatment Coexisting diseases
26
non-medicated topicals for psoriasis
Aquaphor Cold cream Lac-hydrin Eucerin
27
ADRs of Topical Corticosteroids
Thinning Tearing (due to thinning) Bruising of skin Acne Hypopigmentation -blanching due to vasoconstriction Infection (immune system suppressed) Contact dermatitis Super potent – do not use on children or elderly due to increased systemic absorption (children: skin not keratinized, elderly: skin is thin) Super Potent - Avoid use in flexural areas: groin, axilla, popliteal and antecubital fossa (areas tend to be warm and moist – added absorption) – if used minimize to less than 2wks, switch to lower potency Super potent – may inhibit HPA axis
28
Topical Corticosteroids
Anti-inflammatory Antipruritic Vasoconstrictor Immunosuppressive
29
Coal Tar (Zetar, Neutragena T) (C)
Available as ointment, lotion, soap, shampoo Use alone or w/ Low Potency steroids Applied HS and washed off in AM May be used with UVB light therapy Non-compliance problems Cosmetically non-appealing – staining of clothes, bedding, hair Treatment of Chronic Psoriasis
30
ADRs of Coal Tar
Folliculitis Photosensitivity Irritation Scaling Itching Inflammation
31
Psoralens
Methoxsalen (oxsoralen) (PO, lotion) (C) Follow with UVA light tx 2 hrs post Combo referred to as PUVA ADRs Pruritis, dry skin, loss of pigmentation Nausea Blistering Painful erythema Drug-food interaction: Avoid furocoumarin-containing foods
32
Retinoids for psoriasis
Etretinate (Tegison) (PO) (X) Normalizes expression of keratin Suppresses chemotaxis Decreases stratum corneum cohesiveness Half life = 100 days (can be found in plasma 2-3 years after discontinuation)
33
ADRs of retinoids
LFT abnormalities Alopecia Exfoliation Hyperlipidemia (cholesterol and TG) Myalgia Arthralgia Birth Control- Should be utilized 1 month pre and during therapy; must use BC for 3 years post
34
Methotrexate (PO) (D) – chemo drug
Antimetabolite for psoriasis
35
Cyclosporine A (Neoral) (PO) (C)
Immunosuppressant for psoriasis
36
Tacrolimus (Protropic) (topical) (C) Pimecrolimus (Elidel) (topical) (C)
Topical immune modulators for psoriasis
37
Calciprotriene (Dovonex) (C) – topical
for psoriasis Effects equal to class II or III steroids Vit D analog, therefore no steroid SE SE’s: Local irritation Skin reactions Do NOT use on face, eyelids, perineum or skin folds
38
Anthralin (Drithocreme) (C) - topical
Use for short term treatment of psoriasis Apply for 1 hr or \<, then wash off SE’s: Staining Irritation of un-involved skin Permanent brown color staining of clothing and bathroom fixtures
39
Keratolytics
psoriasis treatment Softens keratin layer of skin Enhance absorption of other agents Phenol and Salicylic acid used – mixed with Aquaphor, cold cream, emollients, coal tar
40
Phototherapy
Sunlight Photochemotherapy PUVA = psoralens + UVA light UVB light therapy
41
Non-FDA approved agents used to treat psoriasis
IV Immune Modulators Etanercept (enbrel) (IV) (B) Usually used for RA and JRA Immunosuppresants Sirolimus (rapamune) (PO) (C) Usually for organ transplant
42
Rosacea Treatment
Topicals – Creams, lotions, oint and gels Antibiotics Azelaic acid Sulfur lotions Benzoyl peroxide – limited data on effectiveness
43
Metronidazole (topical)
Treatment of choice for Rosacea Also an antiprotozoal agent
44
Clindamycin and Erythromycin
Not as effective as other topical antibiotics or azelaic acid for treating Rosacea
45
Sulfur products
Novacet, Sulfacet-R) Avoid in sulfa allergy Rosacea treatment
46
Topical Azelaic Acid
Antibacterial, comedolytic, anti-inflammatory One small study – as effective as Metrogel Products: Finacea Gel 15% - for rosacea Azelex or Finevin Cream 20% - for acne ADRs – local skin irritation
47
Rosacea Oral Antibiotics
Tetracyclines (D) Most commonly used Erythromycin (B) Clarithromycin (Biaxin) (C) Sulfamethoxazole/Trimethoprim (Bactrim, Septra) Metronidazole (Flagyl)-not usually taken due to adverse reaction
48
Glycolic acid
Miscellaneous rosacea treatment Peels - q2-4 weeks Washes and creams
49
Topical tretinoin (Retin-A)
Miscellaneous rosacea treatment
50
Isotretinoin (Accutane)
Miscellaneous rosacea treatment severe cases off label use
51
Doxycycline - PO
Traetment for Rosacea Eye problems
52
Minocycline - PO
Traetment for Rosacea Eye problems
53
Tetracycline - PO
Traetment for Rosacea Eye problems
54
Rosacea Treatment For Redness and Flushing
Anti-inflammatory meds – steroid creams Electrosurgery Intense light therapy Vascular lasers
55
Treatment for Rhinophyma
Dermabrasion Electrosurgery Laser surgery
56
Overall Treatment Approaches for Rosacea
Overall Goal – minimize flare ups Avoid rubbing, scrubbing, massaging face – irritates Use mild cleansers, moisturizers and sun screen Avoid triggers – hot drinks, spicy foods and EtOH SPF 15 or \> and protective clothing Protect skin form extreme heat or cold – irritate = flare up Avoid cosmetics, soaps, moisturizers, etc which contain EtOH and fragrances Medication use as appropriate
57
Eczema Symptoms
Most common symptoms Dry, red, extremely itchy patches on skin Occurs on any part of body Usually appears during infancy
58
Eczema PREVENTION
Moisturize Avoid rapid temperature changes Reduce stress Avoid scratchy materials (wool) Avoid harsh soaps, detergents Avoid triggers – allergens Be aware for foods that cause outbreak and avoid them
59
Eczema TREATMENT
Topical Corticosteroids - OTC or Rx Anti-inflammatory Topical and PO antibiotics Only if infected skin Oral Antihistamines – OTC or Rx Reduce itch Prevent scratching Creams and lotions to moisturize Cold compresses
60
Cyclosporine A (PO) (C)
TREATMENT of Eczema (Neoral, Sandimune, Restasis) – only for resistant eczema Immune modulator - immunosuppressant
61
Tacrolimus (Protropic) (topical) (C)
Topical Immune Modulators Eczema
62
Pimecrolimus (Elidel) (topical) (C)
Topical Immune Modulators Eczema
63
Prevention and Treatment of eczema in kids
Moisturize Avoid temp changes Keep bedroom and play area – dust free Mild soaps – cetaphil Breathable clothing – cotton Topical Hydrocortisone - low potency Topical Immune Modulators PO steroids PO Antihistamines – OTC or Rx PO or topical Antibiotics
64
Actinic Keratoses
Early beginning of skin cancer Common lesions of epidermis Caused by long sun exposure (most common) Appear approx 40-50yo – chronic sun exposure FL, southern CA – teens to 20’s Increased risk in fair skin individuals Definition – cutaneous dysplasia of epidermis
65
5-Fluoruracil (Efudex, Fluoroplex) (topical) (X)
Topical Chemotherapy Actinic Keratosis treatment 1, 2 and 5%
66
Actinic Keratosis treatment
Cryosurgery - most common treatment Surgical excision and biopsy-Suspect squamous cell carcinoma Retinoids – topical and PO Chemical Peels Dermabrasion Laser skin resurfacing Electrosurgical skin resurfacing
67
Melanoma
Skin CA in melanocytes Melanin – cells produce brown pigmentation Potentially lethal skin CA
68
Melanoma treatment
Localized - surgical excision Higher stages Interferon injection Interleukin injection Combination chemotherapy
69
Ectoparasites
Parasite that lives outside the body Includes lice (head, body or pubic) and mites (scabies)
70
Ectoparasites Tx
Eradicate the causative organism and provide symptomatic relief to patients
71
permethrin (B)
TREATMENT OF CHOICE for all Ectoparasites * MOA/kinetics - pediculicide, scabicide * Derived form flowers of Chrysanthemum cinerariifolium plant * Available in different dosage forms and strengths for treatment of lice/scabies. Also used as pesticide * Precaution – pts w/ ragweed or Chrysanthemum allergy * ADRs – local itching, burning, stinging and tingling
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Treatment of Lice & Scabies
73
Permethrin (B) directions for use
* Topical lotion for lice: Wash hair w/ shampoo, towel dry. Saturate hair and scalp with lotion or crème rinse, leave on for 10 minutes then rinse. Remove remaining nits. May repeat in in 9 days x 2 more times if lice or nits still present. (total = 3 doses) Cure rate 90-97% * Cream for scabies: Wash and scrub body. Apply cream from head to toe, leave on for 8-14 hours before washing off with water. Cure rate 90%
74
Malathion
* MOA/kinetics – pediculicide, scabicide. Organophosphate cholinesterase inhibitor. Must be activated in body by conversion to oxygen analogs. This occurs rapidly in insects and vertebrates. Then they are rapidly metabolized to inactive products in birds and mammals but NOT in insects * nPrecautions. 2nd line agent. Organophosphate. * nDirections for use for lice: Apply to dry hair and leave on for 8-12 hours. Then shampoo hair. Repeat in 7-9 days if necessary
75
Lindane
* MOA/kinetics - pediculicide, scabicide. Can be absorbed and concentrate in fatty tissues, especially the brain * Precautions – 2nd or 3rd line. CNS and hematological toxicity. Do not use in premature infants or in pts with known seizure disorders. * Directions for use: * Shampoo for lice: Apply to clean, dry hair. Massage into hair for 4 minutes. Rinse hair then remove nits w/ comb. Use 30-60 ml. * Lotion for scabies: Apply thin layer on body, bathe and remove the drug after 8-12 hours
76
Crotamiton
* MOA – not fully understood, may also have some antipruritic properties. * 2nd or 3rd line agent * Directions for use for scabies: Apply to body in two applications (24 hours apart). Take a cleansing bath 48 hours after last application.
77
Ivermectin PO
* * MOA – antihelminthic agent * 2nd or 3rd line agent * Precautions: Mazzoti reaction in pts with onchocerciasis (allergic and inflammatory response due to the death of the microfilariae – often affects eyes) * Dose: 200mcg/kg x 1 dose
78
Topical Antibacterial Preparations
* Uses: * Preventing infection in clean wounds (cuts, scrapes) * Early treatment of infected dermatoses and wounds * Reducing colonization of staph in nares * Efficacy: * Varies amongst agent * Spectrum: * Varies amongst agent * Combo products with broader spectrum to cover for mixed infections or infections due to undetermined pathogen
79
bacitracin
Topical Antibacterial Preparation Mostly gram + coverage. Available alone or in combo w/ neomycin and polymyxin
80
gramicidin
Topical Antibacterial Preparation Mostly gram + coverage. Available in combo w/ neomycin, polymyxin, bacitracin and nystatin
81
mupirocin
Topical Antibacterial Preparation (Bactroban): Effective against MRSA. Preferred agent for impetigo and to eliminate nasal carriage of S. aureus.
82
Polymyxin B
Topical Antibacterial Preparation Mostly gram – coverage. Available as combo product
83
eomycin/gentamcin
Topical Antibacterial Preparation Topical aminoglycosides w/ gram – coverage, incl pseudomonas. Neomycin available in combo products, gentamicin in combo or alone
84
Doxepin hydrochloride (Zonalon)
Miscellaneous Topical Agents Topical antipruritic used to treat pruritus associated with atopic dermatitis or lichen simplex chronicus MOA - blocks H1 and H2 receptors ADRs - local burning and stinging, sedation, anticholinergic side effects
85
Pramoxine (Tronolane)
Miscellaneous Topical Agents Topical anesthetic available alone or in combo with hydrocortisone. Used to provide temporary relief form pruritus associated with mild eczematous dermatoses and hemorrhoids (for external use only) ADRs - local burning and stinging
86
Drug-induced photosensitivity
* benzocaine (Americaine) * coal tar * hexachlorophene (PHisoHex) * isotretinoin (Accutane) * methoxsalen (Uvadex, Oxsoralen) * tacrolimus (Prograf, Protopic) * tazarotene (Tazorac) * retinoin (Retin-A) * Sunscreen agents: PABA, cinnamates, benzyphenones

Pharmacology Test 1 (5 decks)

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