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Pharm - Sam > pharm: derm > Flashcards

pharm: derm Flashcards

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1
Q

most common causes of diaper rash? (1 & 2)

A
  1. yeast

2. bacteria – mostly staph and group A strep. pyogenes

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2
Q

protective barrier meds for diaper rash?

A

A&D ointment
petroleum
zinc oxide
Desitin (contains zinc oxide and emollient)
some contain protectant + drying agent + anti-microbial + vitamins

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3
Q

topical steroids for diaper rash?

A

do little to treat rash - they are beneficial for their anti-inflammatory effect

caution b/c they can cause adrenal suppression if too much gets absorbed

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4
Q

what does a diaper rash caused by yeast look like?

A

“red satellite lesions”

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5
Q

treatment of diaper rash caused by YEAST?

A

Topical antifungal:

  • Nystatin
  • Nystatin + triamcinolone
  • Clotrimazole
  • Clotrimazone + betamethasone

New combo product: zinc oxide, petrolatum, % 0.25% miconazole

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6
Q

what does a diaper rash caused by bacteria look like?

A

“yellowish, fluid filled pustules, honey-colored, crusty”

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7
Q

treatment of diaper rash caused by BACTERIA?

A 
antibiotics 
-mild infections = topical product 
     Bacitracin or Mupirocin
-severe infections = PO antibiotics
     Beta-lactams = very effective
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8
Q

what is in “butt paste?”

is it for prevention or treatment?

A

zinc oxide
aquaphor, A&D oint, or petrolatum
Cholestyramine – binds uric acid, keeps pH at normal levels

zinc & A+D = provide protective barrier

treatment only!

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9
Q

what does cholestyramine do?

A

binds uric acid, keeps pH at normal levels

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10
Q

Rhus dermatitis?

A

name of delayed hypersensitivity rxn occurring 12-72 hours after exposure to poison ivy, oak, or sumac

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11
Q

Urushiol?

A

chemical secreted by bruised poison ivy, oak, or sumac plants

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12
Q

how is poison ivy, oak, and sumac transmitted?

A

primary or secondary exposure
NOT transmitted via fluid vesicles/blisters

can develop secondary infection from scratching (bacteria can enter broken skin)

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13
Q

what is Bentoquatum?

A

Ivy Block - barrier product to prevent poison ivy

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14
Q

what is Zanfel?

A

OTC wash - barrier product for poison ivy (NOT RECOMMENDED THOUGH)

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15
Q

Tx of mild & moderate cases of poison ivy, oak, and sumac?

A
  1. soaks, baths, mild dressings
    • Colloidal oatmeal
    • Aluminum acetate
  2. topical preparations to treat lesions
    • Calamine
    • Local anesthetics (ie. Caladryl = calamine + pramoxine)
    • Antihistamines (generally not effective)
    • Campor, menthol, phenol, EtOH
    • Aluminum acetate solutions
    • Steroids
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16
Q

what is colloidal oatmeal?

A

aveeno

oatmeal bath

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17
Q

what is aluminum acetate?

A

Burrow’s solution - moist/wet dressings, reduce itch, mild astringent for poison ivy, oak, and sumac

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18
Q

what is caladryl?

A

calamine + pramoxine (topical anesthetic)

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19
Q

why aren’t antihistamines effective to treat poison ivy?

A

diphenhydramine does not penetrate skin & may irritate further

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20
Q

what do camphor, menthol, phenol, and EtOH do for poison ivy?

A

promote drying of vesicles
camphor & menthol -> “cooling” effect
phenol & EtOH –> antibacterial

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21
Q

why shouldn’t you use ointments while vesicles are present and/or weeping in poison ivy pts?

A

b/c they can form a barrier and seal moisture in – the vesicles need to dry

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22
Q

Tx. of severe cases of poison ivy, oak, and sumac - widespread or eye involvement?

A
  1. oral antihistamines - anti-itch
    Diphenhydramine - 20-50 mg PO qid prn
  2. oral glucocorticosteroids
    Prednisone - PO 7-21d, taper off
  3. oral antibiotics - if infections occur
    Treat for staph (most common skin infections) - cephalosporins and penicillins
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23
Q

what causes acne?

A

stimulated by testosterone and its metabolite – DIHYDROTESTOSTERONE

Pathogenesis is multifactorial

  • Bacterial - P.acnes (propionibacterium)
  • Irritants
    • touching your face
    • makeup
    • foods
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24
Q

what is dihydrotestosterone?

A

metabolite of testosterone that’s involved in stimulating acne formation

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25
what bacteria causes acne?
Propionibacterium | P. acne
26
general acne treatment guidelines?
1. cleanse skin BID w/ mild cleanser and pat dry 2. use coarse cloth or other sponges to exfoliate skin 3. astringent - closes pores helps prevent dirt from entering 4. medication as necessary
27
pharmacological treatment of acne? (8 options)
1. topical benzoyl peroxide 2. topical salicylic acid 3. topical retinoids (based off Vit. A - category X) 4. miscellaneous topicals 5. topical antibiotics 6. oral antibiotics 7. oral isotretinoin (Accutane) -- category X 8. oral contraceptives
28
Benzoyl peroxide (ACNE) MOA? ADRs? category & percent used?
MOA: causes desquamation - increases turnover of epithelial cells, promotes healing, may be bacteriostatic or bacteriocidal ADRs: drying, peeling, stinging C 2.5-10%
29
Salicylic Acid (ACNE) MOA? ADRs? percent used? other indications?
MOA: keratolytics -- helps remove upper layer of dead cells ADRs: drying, peeling 0.5 - 2% other indications: higher conc (10-15%) used for wart removal - 10% = warts on hand/body - 15% = plantar warts (foot)
30
Topical retinoids - Vit A derivatives (ACNE) MOA? Precautions? ADRs? Examples & their categories?
MOA: increases epithelial cell proliferation (growth/production), reduces comedo (blackhead) formation Precautions: MUST AVOID SUN - can get 2nd degree burns ADRs: erythema, dryness, peeling, scaling, itching, crusting, photosensitivity, pigment changes (bleaching) Ex: Trentinoin (retin-a)-- D Tazarotene (tazorac) -- X
31
what are 2 examples of miscellaneous topical acne treatments?
Adapalene (Differin) -- C MOA: retinoid-like compound, binds to different retinoid type receptors ADRs: similar to other retinoid, local skin irritation, not shown to be teratogenic in rodents (no human studies) Azelic acid -- C MOA: not fully determined, but may have antimicrobial activity against P.acnes and blocks conversion of testosterone to dihydrotestosterone ADRs: erythema, dryness
32
Topical antibiotics (ACNE) MOAs? ADRs? Examples?
MOA: antimicrobial activity against causative organisms (underlying organisms causing acne) Dosed 2-6x day -- resistance rare due to minimal systemic absorption ADRs: burning, stinging, drying, peeling, erythema ``` Ex: Erythromycin (B) Erythromycin + benzoyl peroxide (C) Sodium Sulfacetamine (C) Clindamycin (B) when combined with benzoyl peroxide - Duac gel ```
33
Oral antibiotics (ACNE) MOA? Precautions? ADRs? Examples?
MOA: antimicrobial activity against causative organisms Precautions: chronic use may increase risk of resistance and/or can negatively affect residual bacteria levels ADRs: nausea, vomiting, diarrhea, vertigo, and contraceptive failure of BC pills ``` Ex: Tetracyclines Doxycycline (D) Minocycline (D) Macrolides Erythromycin (B) ```
34
Oral retinoid (Isotretinoin) -- Accutane (ACNE) MOA? Dose? ADRs? Category and risks?
MOA: reduce sebaceous gland size, regulates cell proliferation and differentiation Dose: 0.5-1 mg/kg/day divided BID for 15-20 wks. may repeat x1 after 2 months off (NEED BREAK) ADRs: dryness, itching of skin & mucous membranes, headache, depression, hyperlipidemia, increase LFTs, alopecia, myalgia, hematologic ADRs, ocular ADRs, photosensitivity, increase suicide risk? CATEGORY X -- cant be or get pregnant ***USED ONLY FOR SEVERE CASES -- BEST TREATMENT
35
Oral contraceptives (ACNE) MOA? ADRs?
MOA: increased estrogen helps counterbalance high testosterone levels which cause acne - estrogen alone or estrogen/progesterone combo -- want high estrogenic activity and low androgenic activity (tricycline brands are good) ADRs: PMS like symptoms, bloating, weight gain only women (>18 yo) not planning pregnancy
36
Drugs that CAUSE acne:
hormones gonadotropins, anabolic steroids, corticosteroids anti-epileptic drugs TB drugs - INH, Rifampin Miscellaneous - Lithium, Cyclopsorine, Iodine
37
Treatment of ACUTE psoriasis?
``` treat the severely erythematous lesions soothe irritation w/ non-medicated topicals: - aquaphor - cold cream - lac-hydrin - eucerin may also use topical steroids ```
38
Treatment of CHRONIC psoriasis? | ***SEE NOTES ABOUT EACH ONE***
1. Topical corticosteroids 2. Coal tar (topical) 3. Psoralens (PO) 4. Retinoids (PO) 5. Antimetabolites (PO) 6. Immunosuppressants (PO) 7. Immunomodulators (topical) 8. Calciprotriene (topical) 9. Anthralin (topical) 10. Keratolytics (topical) 11. phototherapy
39
Chronic psoriasis - topical steroid uses:
1. anti-inflammatory 2. antipruritic 3 vasoconstrictor 4. immunosuppressive
40
psoriasis treatment with topical corticosteroids?
- start w super high potency (class 1 or 2) BID x 2-3 weeks - after high potency treatment switch to Pulse treatment (2 days on 5 days off) OR change to lower potency steroid - halogenated/ fluorinated steroids vs. non-fluorinated steroids
41
halogenated or fluorinated steroids?
improve absorption - DO NOT use on face, perineum, or mucus membranes
42
non-fluorinated steroids?
can be used on face, eyelids, perineum, and mucous membranes
43
ADRs of topical corticosteroids for psoriasis?
- thinning of skin - tearing (due to thinning) - bruising of skin - acne - hypopigmentation - infection (immune system suppressed) - contact dermatitis
44
problems with super potent corticosteroids?
- do not use on children/ elderly - increased systemic absorption (children: skin not keratinized, elderly: skin is thin) - 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 2 wks, switch to lower potency - may inhibit HPA axis (hypothalamic-pituitary-adrenal axis)
45
Coal Tar
tx for chronic psoriasis
46
ADRs of Coal Tar
``` folliculitis photosensitivity irritation scaling itching inflammation ```
47
Psoralen?
tx for chronic psoriasis follow w/ UVA light for tx 2 hours post - PUVA
48
example of Psoralen?
Methoxsalen - PO, lotion
49
ADRs of Psoralen?
``` pruritis, dry skin, loss of pigmentation nausea blistering painful erythema drug-food interaction: avoid furocoumarin-containing foods ```
50
Examples of Retinoids (chronic psoriasis)?
Etretinate Acitretin Tazarotene
51
Etretinate? MOA?
retinoid used for chronic psoriasis tx normalizes expression of keratin suppresses chemotaxis decreases stratum corneum cohesiveness half life = 100 days when combined with PUVA = RE-PUVA
52
Etretinate ADRs?
``` LFT abnormalities Alopecia exfoliation hyperlipidemia myalgia arthralgia ```
53
Acitretin?
retinoid used for chronic psoriasis tx same precautions and ADRs as etretinate half life = 49 hrs
54
Tazarotene?
retinoid used for chronic psoriasis tx
55
Examples of miscellaneous agents used to tx chronic psoriasis? (6)
1. Antimetabolites 2. Immunosuppressants 3. Topical Immune modulators 4. Calciprotriene 5. Anthralin 6. Keratolytics
56
Example of antimetabolite used to tx chronic psoriasis?
methotrexate (PO) - chemo drug
57
example of immunosuppressant used to tx chronic psoriasis?
cyclosporine A
58
2 examples of topical immune modulators used to tx chronic psoriasis?
Tacrolimus | Pimecrolimus
59
Calciprotriene? - MOA and SE
tx of chronic psoriasis ``` effects equal to class II or III steroids Vit D analog, therefore no steroid SE ``` SEs: local irritation, skin reactions DO NOT USE on face, eyelids, perineum, or skin folds
60
Anthralin? - MOA and SE
tx of chronic psoriasis use for short term treatment apply for 1 hr or <, then wash off SEs: staining, irritation of un-involved skin, permenant brown color staining of clothing and bathroom fixtures
61
Keratolytics?
tx of chronic psoriasis soften keratin layer of skin enhance absorption of other agents phenol and salicylic acid used -- mixed with aquaphor, cold cream, emollients, coal tar
62
Rosacea tx?
topicals - cream, lotions, oint, and gels antibiotics azelaic acid sulfur lotions benzoyl peroxide -- limited data on effectiveness
63
rosacea topical antibiotic examples?
Metronidazole (Metrogel)-- TREATMENT OF CHOICE! -- also an antiprotozoal agent ``` Sulfur products (Novacet, Sulfacet-R) Clindamycin & erythromycin -- not as effective as other topical antibiotics or azelaic acid ```
64
what is the treatment of choice for rosacea?
Metronidazole (Metrogel) (topical antibiotic) | -- also an antiprotozoal agent
65
topical azelaic acid?
tx for rosacea (also acne) antibacterial, comedolytic, anti-inflammatory one small study -- as effective as Metronidazole (Metrogel) ADRs- local skin irritation
66
azelaic acid products?
Finacea Gel 15% - for rosacea | Azelex or Finevin Cream 20% - for acne
67
oral antibiotic examples for rosacea?
``` Tetracyclines --> most commonly used! Erythromycin Clarithromycin Sulfamethoxazole/ Trimethoprim (Bactrim, Septra) Metronidazole ```
68
which oral antibiotic is most commonly used to tx rosacea?
Tetracyclines
69
Miscellaneous tx for rosacea?
``` glycolic acid peels q2-4 weeks washes and creams topical tretinoin isotretinoin ```
70
tx for eye problems associated with rosacea?
Doxycycline Minocycline Tetracycline
71
tx for redness and flushing associated with rosacea?
anti-inflammatory meds - steroid creams electrosurgery intense light therapy vascular lasers
72
tx for rhinophyma (large, bulbous, ruddy nose) associated with rosacea?
dermabrasion electrosurgery laser surgery
73
tx of eczema?
``` prevent scratching creams and lotions to moisturize cold compresses topical corticosteroids topical and PO antibiotics oral antihistamines coal tar phototherapy cyclosporine A -- only for resistant eczema (immunosuppressant) topical immune modulators - tacrolimus - pimecrolimus ```
74
what is actinic keratoses?
early beginning stage of skin cancer common lesions of epidermis caused by long sun exposure (most common) appear approx 40-50 yo (teens - 20s in sunny places) definition- cutaneous dysplasia (abnormal development) of epidermis
75
tx of actinic keratoses?
cryosurgery (application of extreme cold) surgical incision and biopsy suspect squamous cell carcinoma retinoids - topical and PO topical chemotherapy 5-fluoruracil (X) chemical peels - dermabrasion, laser skin resurfacing, and electrosurgical skin resurfacing
76
melanoma - higher stages tx
interferon injection interleukin injection combination chemotherapy
77
treatment of choice of ectoparasites?
Permethrin
78
Pernethrin?
treatment of choice for lice/scabies MOA- pediculicide, scabicide derived from Chrysanthemum plant
79
Malathion?
tx for lice/scabies MOA - pediculicide, scabicide **ORGANOPHOSPHATE cholinesterase inhibitor -- 2nd line agent
80
Lindane?
tx for lice/scabies MOA- pediculicide, scabicide can be absorbed and concentrate in fatty tissues, especially brain 2nd or 3rd line -- CNS hematological toxicity DO NOT use in premature infants or pts with known seizure disorders
81
Crotamiton?
tx for lice/scabies MOA - not fully understood, may also have some antiprutitic properties 2nd or 3rd line
82
Ivermectin PO?
tx for lice/scabies MOA: antihelminthic agent -- drugs that expel parasitic worms (helminthes) from the body, by either stunning or killing them 2nd or 3rd line precautions: Mazzoti rxn in pts with onchocercisis (allergic and inflammatory response due to death of the microfilariae - often affects eyes)
83
topical antibiotic preparations for lice/scabies?
``` bacitracin gramicidin mupirocin polymyxin B neomycin/ gentamycin ```
84
miscellaneous topical agents for lice/scabies?
topical antibiotics doxepin hydrochloride - antipruritic pramoxine - topical anesthetic
85
what drugs cause drug-induced photosensitivity?
``` benzocaine coal tar hexachlorophene isotretinoin methoxsalen tacrolimus tazarotene retinoin sunscreen agents: PABA, cinnamates, benzyphenones ```
86
2 types of photosensitivity?
1. photoallergy | 2. phototoxicity
87
what is a photoallergy?
rare, immunological response light causes the drug to act as a hapten - triggering a hypersensitivity response leads to pruritis, eczematous rxn
88
what is phototoxicity?
more common | chemically-induced rxns when drug absorbs UVA light and causes cellular damage

Pharm - Sam (3 decks)

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