Lecture 5 - Dermatology 2 Flashcards

Question

Tazarotene clinical pearls

Answer 1

used with TCS for inc efficacy and tolerability use lower strength cream and combo with moisturizer alternate days to reduce irritation used QD

Answer 2

Anthralin = V irritating, have to do short contact regimen Coal Tar = stain and small, used at night Salicylic Acid = avoid combo w/ calcipqotriol, phototherapy, > 20% BSA, renal impairment, children

Answer 3

not FDA approved Not as effective so not really used

Answer 4

Faster responses Can cause tanned spots on skin high doses of UVA light to certain spots

Answer 5

moderate to severe plaque type good short/long term

Answer 6

Approved for PsA and moderate to severe psoriasis Give 50mg SQ BIW for 1st 12weeks, then 25/50mg QW efficacious children 4-17 dosed 0.8mg/kg (50mg max) QW

Answer 7

rapid and efficacious control of psoriasis and PsA, can see improvement in 1st week dose: 80mg SQ once, then 40mg SQ QOW effective alternative for pts who fail to respond to Enbrel

Answer 8

more efficacious than Entanercept Given Iv infusion over 6 weeks, then every 8 weeks Rapid response Rare but serious ADE = highest risk for TB, Bacterial/viral/invasive fungal infection, Fatal cases of hepatosplenic T-cell lymphomas

Answer 9

Dosed QOW Mild ADR = nasopharyngitis & URI $$$ relatively safe in pregnancy

Answer 10

Adalimumab = dec after 12 weeks Etanercept = going from BIW -> QIW = less therapeutic effect Infiximab = greatest dec symptoms shortest time

Answer 11

combo w/ methotrexate = lower likelihood of resistnace $$$$$ Dont sue w/ live vaccines as immune response can be compromised

Answer 12

PDE-4 inhibitor, inhibit TNF-a production ADR mental = depression, suicidial ideation, mood changes = probs dont use Titrate up to 30mg BID, reduce dose if CrCl < 30

Answer 13

appears to be less effective than TNF-a inhibitor Oral admin w/ minimal DI and ADR GI concern

Answer 14

Cosentyx (Secukinumab) Taltz (Ixekizumab) Siliq (Brodalumab)

Answer 15

Stelara (Ustekinumab) Tremfya (Guselkumab) Illumya (Tildrakizumab) Skyrizi (Risankizumab)

Answer 16

Possible anaphylaxis and inc in infection rate Greater efficacy for mod/severe plaque psoriasis than ustekinumab Less long-term efficacy than guselkumab Dosed: QW for 4 weeks, then Q monthly

Answer 17

Dosed Q2 wks for 12 wks, then Q4wks SE: neutropenia More efficacy than etanercept

Answer 18

Dosed: QWkly X 3, then Q2weeks REMS for suicidal ideation & Box warning** higher likelihood of complete remission than ustekinumab SE: arthralgia, suicidal ideation, cryptococcal meningitis, candida infections

Answer 19

efficacy persistent over time May worsen PsA for some pts More major CV events reported**

Answer 20

SE: tinea, HSV infection effective pts who had inadequate responses to ustekinumab

Answer 21

Dosed: week 0/4 nd then every 12 superior to etanercept antibody development w/ minimal impact on efficacy

Answer 22

Dosed week 0/4 and then every 12 greater efficacy than ustekinumab and adalimumab higher likelihood of antibody development effecting efficacy

Answer 23

All shown efficacy over etanercept but $$

Answer 24

oral retinoid utilized for sever psoriasis can be used with UVB or PUVA therapy or topical calcipqotriol Less effective used alone Efficacy dose dependent, 50mg optimal Bunch of ADRs, BW

Answer 25

Category X pregnancy contraindicated for 3 years after D/c No blood donations from men/women for atleast 3 years after

Answer 26

two negative preg test repeat test monthly during therapy, Q3 months 3yrs after therapy 2 forms of Birth control starting 1 month before and 3 years after therapy cant drink during therapy and 2 months after D/c

Answer 27

two negative preg test repeat test monthly during therapy, Q3 months 3yrs after therapy 2 forms of Birth control starting 1 month before and 3 years after therapy cant drink during therapy and 2 months after D/cMethotrexate info

Answer 28

Should be given with folic acid sup daily** more effective than acitretin, similar to cyclosporine w/ less ADR given Weekly BW, Preg X, and 6 months females and 3 months before conception...both have to use contraception CI in Breastfeeding too

Answer 29

1. Mild to mod TCS 2. trial of topical Vit D analog or retinoid alone or w/ TCS..combo recommended 3. Trial of phototherapy or oral systemic agent 4. consider moderate-severe disease therapy Step down therapy to lowest therapy that maintains control of symptoms

Answer 30

1. high-V high potency TCS + vitamin D analog/retinoid 2. Add systemic agent ( IL/TNF-a I) to topical therapy or consider trial of phototherapy 3. inc systemic agent potency or use 2 systemic agents in addition to topical therapy 4. use BRM an other agents as needed Step down therapy to lowest therapy that maintains control of symptoms

Answer 31

Biologic Response modifiers Acitretin, Methotrexate, Cyclosporine

Answer 32

Dermatophytes Candida albicans

Answer 33

prolonged exposure to sweat maceration intertriginous folds sharing personal belongings occlusion of the skin close living quarters immunodeficiency and suppresion diabetes obesity poor hygiene trauma warm or humid climate

Answer 34

Athletes foot usually 3/4 or 4/5th toes usually seen in 1 foot and respond to topical therapy

Answer 35

cream generally Terbinafine better than azaleas Treat for 1-6 weeks avoid nystatin**

Answer 36

oral treatments terbinafine 250 QD for 2 weeks Itraconazole 200mg BID X 1 week fluconazole 150mg weekly for 2-6 weeks

Answer 37

aka onychomycosis fungal infection of nail, more common toe nails

Answer 38

> 40yrs old Family history Immunodeficiency Psoriasis Diabetes PVD Tinea pedis Sporting activities

Answer 39

most common T.rubum common cause nail plate, bed and maybe matrix effected white, yellowish or brown discoloration

Answer 40

t.metagrophytes most common cause localized to surface of nail place

Answer 41

invades nail through proximal nail fold and spreads to nail plate and matrix uncommon in general pop, mostly immunocompromised patients

Answer 42

Jublia Kerydan Penlac

Answer 43

mild-moderate onychomycosis Early stages of DSO Treatment for 1yr only superficial Limited to 3-4 nails used if Systemic therapy is CI

Answer 44

Terbinafine or itraconazole generally 3 months 12 weeks for toenails or 6 weeks for fingernails

Answer 45

jock itch scaly, erythematous margin more common males source of infection is almost always patients feet

Answer 46

topical therapy is recommended for 1-2 weeks after system resolution severe/resistn require oral therapy relief of itching/burning can be facilitated by using short-term topical steroids

Answer 47

ringworm of the body commonly in obese, adults in warmer climates, day care kids

Answer 48

small, circular, erythematous scaly areas may have pustules may be itchy

Answer 49

topical agents usually systemic for severely immunocompromised, griseofulvin preferred in children (has penicillin so if allergic cant use)

Answer 50

Typically occurs in childhood one or more patches of partial hair loss more common in black females

Answer 51

depends on causative organism PO therapy for 4-12 wks depending on agent used

Answer 52

1st = Griseofulvin (6-12weeks) 2nd = Terbinafine, itraconazole, fluconazole

Answer 53

1st = Terbinafine (2-4wks), 6 weeks if granule formation 2nd = Griseofulvin, itraconazole, fluconazole Family members maybe asymptomatic = use antifungal shampoo for at least 5 min, 3 times per week

Answer 54

Also called tines versicolor more common in adults and those in tropical temps

Answer 55

1st line = Ketoconazole or selenium sulfide Topical Terbinafine maybe used Hypopigmented areas take longer to regiment

Answer 56

Usually 2-3 weeks Ketoconazole = QD 2-3weeks, let sit for 5min then wash off Selenium sulfide = apply 10min, wash off for 7 days

Answer 57

itraconazole and fluconazole are effective and preferred keto works but dont want to work terbinafine and griseofulvin not effective

Answer 58

Reduce and or relieve symptoms Eradicate fungus Prevent future infections Prevent spreading of infections

Answer 59

reduce moisture to affected area avoid tight fitting clothing keep areas clean dry areas completely wash infected clothing separately avoid walking barefoot in communal areas keep nails short and clean avoid sharing personal items use separate towels to dry off affected area

Answer 60

Tinea unguium or Capitis uncealer etiology signs of 2ndary infection involvement of face, genitalia, or mucous membranes if topical doesn't work diabetes, systemic infection or immunodeficiency

Answer 61

better coverage because rubbed into skin product needs to be dried before putting socks on

Answer 62

good for excessive wetness good for skin folds where moisture accumulates

Answer 63

better coverage of affected areas like creams dries more rapidly but more expensive

Answer 64

easy to apply, especially hard to reach Not as effective due to no rubbing

Lecture 5 - Dermatology 2 Flashcards

(88 cards)