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PAM Semester 4 > Pharm Derm Exam 1 > Flashcards

Pharm Derm Exam 1 Flashcards

1
Q

ABCDE

A

For Any Neoplasm

Asymmetry
Borders
Color
Diameter
Evolving / elevation
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2
Q

Types of benign tumors

A 
Dermal tumors - acrochordon
Cysts
Vascular tumors (cherry hemangioma)
Tumors of subcutaneous fat (lipoma)
Hyperkeratotic reactions to chronic friction (callus/corn)
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3
Q

Premalignant neoplasms

A

Actinic keratosis appear over the exposed areas of the body as a result of actinic radiation

(solar)

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4
Q

Actinic Keratoses Treatments

A

Fluorouracil
imiquimod
ingenol mebutate

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5
Q

5 fluorouracil

A

Efudex (5%)
(Antimetabolite)

Cream or solution
a topical chemotherapy
most common treatment of most common precancer
(actinic keratoses)

Superficial basal cell carcinoma when conventional therapy is impractical

Preg Cat X

Adverse
Pain or burning at application site, pruritis, irritation, hyperpigmentation

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6
Q

5 fluorouracil MOA

A

Inhibits thymidylate synthetase and incorporates into DNA as an abnormal nucleotide

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7
Q

imiquimod

A

Aldara (5%) Cream
Actinic keratoses on face or scalp

Immune response modifier that is a Toll like receptor 7 agonist that activates immune cells

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8
Q

ingenol mebutate

A

Picato
Actinic Keratoses

Cell Death inducer

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9
Q

Actinic Keratoses Treatment options

A

Lesion directed
Surgery
Cryotherapy
Dermabrasion

Field directed
Topical
Fluorouracil
imiquimod
ingenol mebutate

or photodynamic therapy

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10
Q

Bowens disease Treatment

A 
Surgical excision
curettage
electrodessication
Photodynamic therapy
Cryotherapy
Topical fluorouracil
Topical imiquimod
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11
Q

Keratoacanthomas

A

Conventional surgical excision is the treatment of choice for solitary Keratoacanthomas

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12
Q

Basal cell carcinoma topical treatment

A

Fluorouracil

imiquimod

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13
Q

Squamous cell carcinoma
If Low recurrence
Treatment

A 
If low risk of recurrence
Treatment
Surgical excision
Mohs surgery
Curettage and electrodessication
Cryotherapy
Photodynamic therapy
Radiation therapy (non surgical candidates)
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14
Q

pembrolizumab

A

Keytruda
Human programmed death receptor 1
PD -1 Blocking antibody

for unresectable metastatic melanoma

Embyro Fetal toxicity

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15
Q

pembrolizumab

MOA

A

releases the “brake” allowing T cells to act

protein receptor is the “brake”

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16
Q

pembrolizumab (keytruda)

Warnings and precautions
Immune mediated adverse reactions

A

Immune mediated adverse reactions

Pneumonitis, colitis, hepatitis, hypophysis, nephritis, hyperthyroidism, hypothyroidism

Administer corticosteroids based on severity of reaction

Withhold or discontinue keytruda depending upon severity of reaction

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17
Q

pembrolizumab (keytruda)

Warnings and precautions
Embryofetal toxicity

A

Keytruda may cause fetal harm

Advise females of reproductive potential to use highly effective birth control during treatment with keytruda and for 4 months after the last dose.

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18
Q

Acne treatments Based on MOA

Inflammation

A

Oral isotretinoin
Oral tetracycline
Topical retinoids
Azelaic Acid

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19
Q

Acne treatments Based on MOA

C. Acnes proliferation

A

Benzoyl peroxide
Topical and oral antibiotics
Azelaic acid

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20
Q

Acne treatments Based on MOA

Increased sebum production

A

Oral isotretinoin

Hormonal therapies

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21
Q

Acne treatments Based on MOA

Follicular Hyperproliferation and abnormal desquamation

A 
Topical retinoids
Oral Retinoids
Azelaic acid
Salicylic acid
hormonal therapies
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22
Q

Retinoic acid

most common adverse effects

A

The most common adverse effects of topical retinoic acid are erythema and dryness that occur in the first few weeks of use

But these can be expected to resolve with continued therapy

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23
Q

Isotretinoin

A

Accutane

Sever recalcitrant nodular acne unresponsive to conventional therapy (eg. systemic ABX)

Not for children
Preg Cat X
Severe birth defects

Must register patients in Ipledge

Avoid tetracyclines (increased risk of pseudomotor cerebri)

Adverse
Dry skin, eyes, nose, mouth, lips

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24
Q

REMS

A

To inform patients about the serious risks associated with drug X

To minimize potential drug drug and disease drug interactions

To prevent the risk of fetal exposures to drug X

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25
Q

Isotretinoin (what is does)

A

Used for acne vulgaris

improve through reducing sebum production inhibiting growth of cutibacterium acnes and inhibiting comedogensis

Multiple side effects include
tetragenicity, mucocutaneous disorders, myalgia

Not for use with pregnancy
Not for use with tetracyclines
(Idiopathic intracranial hypertension (pseudo cerebri)

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26
Q

Oral ABX for acne

A 
Tetra
Doxy
minocycline
Sarecycline
Erythromycin
Bactrim
Azithro
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27
Q

Topical combination Med

A

Benzoyl peroxide 5% / clindamycin 1%

Local ski irritation, may bleach skin or clothing

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28
Q

Hormonal agents for acne

A

Spironolactone

contraindicated in pregnancy

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29
Q

Azelaic acid

A

Azelex

Antibacterial / anti keratinizing agent

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30
Q

Sulfacetamide Topical 10%

A

Wash or lotion

Contra
sulfa allergy

Adverse
SJS
Erythema multiforme (HSV) (target lesions)

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31
Q

Folliculitis

A

Most common pathogen S. aureus

Other common pathogens Pseudo, malassezia, demodex mites

Mild s. aureus folliculitis usually resolves on its own

persistent S. aureus folliculitis = topical ABX

Topical mupirocin, clinda are preferred

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32
Q

Mupirocin MOA

A

inhibits bacterial protein synthesis by reversible binding and inhibiting isoleucyl transfer RNA synthetase

with subsequent inhibition of the incorporation of isoleucine into bacterial proteins

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33
Q

Brimonidine

A

Topical Mirvaso 0.33% gel

for persistent (non transient) facial erythema of rosacea

Pregnancy Cat B

Alpha 2 agonist (direct vasoconstriction of vessels)

Interactions
Caution with Beta blocker, antihypertensives and cardio glycosides

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34
Q

Topicals for rosacea

A

Topical Metronidazole
(metrogel, metrocream, metrolotion, noritate)

Topical doxy = Oracea

Topical Ivermectin = Soolantra

Topical azelaic acid = Finacea

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35
Q

Rosacea Patient Education

A

Avoidance of triggers of flushing
gentle skin care,
sun protection

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36
Q

Rosacea and tetracycline

A

Not to be used in children under nine

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37
Q

Erythema infectiosum

5th disease

A

There is no specific therapy and usually no indication for symptomatic treatment

Human parvovirus B19 infections

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38
Q

Hand foot and mouth Disease

A

clinical syndrome with
oral enanthem
macular, maculopapular, vesicular rash on
hands and feet

children and adults

coxsackie b

First seen in 1957 - toronto

Management is supportive

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39
Q

Measels

A

Prevention is key MMR vaccine

There is a role for Vitamin A

Supportive therapy includes antipyretics, fluids, treatment of bacterial super infections
(pneumonia, otitis)

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40
Q

When to use ribavirin in Measles

A

under 12

over 12 with pneumonia on vent

immuno suppressed patients

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41
Q

Alopecia areata

A

chronic, relapsing, immune mediated inflammatory disorder affecting hair follicle resulting in non scarring hair loss

Tx: topical, intralesional, systemic agents, devices

few clinical trials so response varies widely

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42
Q

Alopecia areata treatment

A

scalp intralesional injections of corticosteroids

topical corticosteroids in children or those unable to tolerate intralesional injection

with extensive alopecia areata or alopecia totalis who don’t respond to treatment
use topical immunotherapy

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43
Q

Number of potency categories of topical steroids

A

7

Group 1 is highest potency

Group 7 is lowest potency
(hydrocortisone 2%)

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44
Q

Topical steoirds in skin disease

A

anti inflammatory
anti mitotic
immunosuppressive

topical is safer than systemic

side effects can still occur especially with super potent

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45
Q

Side effects of higher potency topical corticosteroids

A

Cutaneous atrophy
telangiectasias
striae

others
acneiform eruptions
purpura
hypopigmentation
glaucoma
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46
Q

Onychomycosis causes

A

Dermatophytes
particular trichophyton rubrum is most common cause

Yeast (candida) and non dermatophyte molds can also cause onychomycosis

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47
Q

First line for mild to moderate dermatophyte onychomycosis

A

Terbinafine (lamisil)

48
Q

Terbinafine

A

Lamisil
Allylamine antifungal

Onychomycosis of toenail or fingernail due to tinea unguium

Contra
Chronic or active liver disease

LFT’s prior to start and during treatment
Discontinue if Liver injury

Preg Cat B

Adverse
Liver enzyme abnormalities
Hepatotoxicity

49
Q

Acute paronychia causes

A

S. Aureus, Strep pyogenes are most common

periungal tissues

minor mechanical or chemical trauma that disrupt the nail fold barrier

50
Q

Acute paronychia treatment

A

without abscess
topical ABX and warm water/antiseptic soak (eg iodine)
multiple times a day

usually an anti-staph antibiotic like mupirocin or triple antibiotic ointment

Soaks should be 15 mins

With abscess
I&D with culture and cover MRSA

51
Q

Melasma Tx

A

There is no standard therapy for melasma

Photoprotection (prevention)
strict photoprotection, 
sun avoidance, 
sun protective clothing, 
sunscreens
52
Q

vitiligo tx

A

No cure

Treatments can stop progression
and help repigmentation

for rapidly progressing non-segmental vitiligo oral glucocorticoids rather than ultraviolet is first line

53
Q

Vitiligo goals of treatment

A

Stabilization of active disease
repigmentation

treatment is slow and variable

54
Q

Tacrolimus

A

Protopic (immunomodulator)
Atopic derm

Warning
Long term safety of topical calcineurin inhibitors has not been established

Black box
Skin malignancies, lymphoma

55
Q

Tacrolimus MOA

A

Calcineurin inhibitor

Inhibits T lymphocytes and pro inflammatory cytokines in inflamed dermis

56
Q

Seborrhic keratosis

A

Well demarcated, round or oval lesions with a dull

verrucous surface and typical stuck on appearance

57
Q

Seborrhic keratosis treatments

A

Cryotherapy = most common
flat fair lesions

Curettage / shave excision
submit specimen to pathology
(no 15 scalpel, 1% lido)

Electrodessication
use with 1% lido

58
Q

Cherry hemangioma

A

only treat if patient is bothered by them
cosmetic

new lesions may appear
no way to prevent this

59
Q

Telangiectasias

A

Lasers provide quick effective therapy
particularly for multiple telangiectasias
large areas with telangiectasias
or lesions that have failed to resolve after electrocautery

60
Q

CREST

A

Calcinosis (deposits on hand)

Raynauds

Esophageal dysfunction

Sclerodactyly (thick skin on fingers)

Telangiectasias

61
Q

Bullous pemphigoid treatment

A

Decrease blister formation and pruritis

Promote healing of blisters and erosions

Improve quality of life

Topical steroids
Systemic steroids
Doxy

62
Q

pemphigus vulgaris treatment

A

systemic glucocorticoids

rituximab

63
Q

Rituximb

A

rituxan
CD20 directed cytolytic monoclonal antibody

moderate to severe pemphigus vulgaris

Warning
Fatal infusion related reactions
severe mucutaneous reactions
Hep B reactivation
Progressive multifocal leukoencephalopathy

Interaction
Live vaccine

64
Q

Erythema multiforme

A

target like lesions
commonly from infection (HSV)

If HSV oral antivirals don’t work

Topical corticosteroids and oral antihistamines

65
Q

SJS / TEN

A

Sever mucocutaneous adverse reactions
most commonly triggered by medications

Fever, extensive necrosis and detachment of dermis

SJS = 10% BSA
TEN >30% BSA
SJS / TEN = 10-30% BSA

Supportive care is tx = nutrition ,eyes, electorlytes, fluids, temp, pain control etc

66
Q

Common drugs of SJS

A 
SATAN
Sulfa
Allopurinol
Tetracycline
Anticonvulsants
NSAIDS

Antiepileptics =
carbamazepine lamictal, phenytoin, phenobarb

67
Q

Widow bite treatment

A

usually respond to narcotics, benzos
and hen necessary, antivenom

wound care
tetanus
opioids (pain)
benzos (muscle spasms)
Antiemetic (N/V)
68
Q

Recluse bite Treatment

A

Symptomatic and supportive care
wound care

Causes dermal necrolysis

no antivenom

dont use dapsone

69
Q

Rocky mountain spotted fever bacteria

A

Rickettsia Rickettsi

70
Q

Ehrlichiosis

A

Rash is uncommon

Doxy for all ages

71
Q

Lyme disease bacteria

A

Borrelia burgdorferi

72
Q

Lyme disease treatment

A

doxy 100mg BID 10-14 days

Erythema migrans

73
Q

Misc insect bite treatment

A

antihistamines

if severe, can use prednisone

74
Q

Empiric MRSA coverage

A

IV Vanc

PO Bactrim

75
Q

Non purulent cellulitis treatment

A

Empiric therapy for
beta hemolytic strep
MSSA
Possibly for MRSA

Use cefazolin IV
or Cephalexin PO

5 days of treatment for uncomplicated infection
can be extended to 14 days if severe

76
Q

purulent cellulitis treatment

A

I&D

Cover with ABX for MRSA

77
Q

Erysipelas vs cellulitis

A

treat empirically for beta hemolytic strep

will have more delineated borders compared to cellulitis
superficial dermis
superficial lymphatics

(Cellulitis is deeper)

78
Q

Erysipelas treatment

A

Mild = oral penicillin or amoxicillin

if allergic

use cephalexin

if cant tolerate

use clinda, Bactrim or linezolid

79
Q

Impetigo

A

Usually from S. Aureus

Topical Mupirocin TID x 5 days
and
Retapamulin BID x 5 days

If numerous lesions, use oral ABX
dicloxacillin and cephalexin x 7 days

If MRSA suspected, use Bactrim, clinda, doxy

80
Q

Candidiasis

A

Intertrigo or intertriginous dermatitis
common inflammatory condition in the skin folds

Moist erythema, malodor, weeping, pruritis, tender

81
Q

Candidiasis treatment

A

Daily cleaning with mild cleanser, hair dyer to dry (cool)

treat for DM if appropriate

82
Q

Dermatophyte infections

A

Tinea pedis
tinea corporis
tinea cruris
tinea capitis

Tinea versicolor is not a dermatophyte
It is a yeast

83
Q

Ketoconazole

A

Nizoral shampoo

Tinea versicolor

Azole antifungal

84
Q

Tinea pedis
Tinea corporis
Tine Cruris

Treatment

A 
Topicals
azoles
allyamines
butenafine
ciclopirox
tolnaftate
Severe: use oral:
terbinafine
itraconazole
fluconazole
griseofluvin
85
Q

Tinea pedis
Tinea corporis
Tine Cruris

Severe
Treatment

A

Severe: use oral:

terbinafine
itraconazole
fluconazole
griseofluvin

86
Q

Tinea capitus treatment

A

Griseofulvin
terbinafine
both are first line

87
Q

Do nots for anti fungals

A

Nystatin doesn’t work (only for candida)

Dont use ketoconazole for tinea infections
(box warning, hepatotoxicity)

Dont treat without confirming first
KOH, Culture, acid schiff test for onychomycosis

Dont use topicals only on tinea capitus
can use in combo

88
Q

Lindane toxicity (kwell)

A

Lindaneis an organochlorine insecticide that inhibits neurotransmission in parasitic arthropods.

Neurologic toxicity resulting in seizures and death has been reported in humans following topical lindane therapy.

Most of these events have occurred after prolonged or repeated application of lindane but, in rare cases, have followed a single application.

89
Q

Lindane

A

Kwell

Only use as last resort for lice

Black box
lindane shampoo should only be used as a second-line treatment in patients who cannot tolerate or have failed other therapies for the treatment of scabies or lice.

Lindane is contraindicated in patients with skin disorders that may lead to increased systemic absorption (eg, atopic dermatitis, psoriasis).

90
Q

Scabies treatment

A

Topical permethrin

cure rate over 90%

91
Q

Vulvo vaginal warts

A

40% will resolve without treatment

92
Q

Herpes simples treatment

A

Anitvirals
Acyclovir
Valcyclovir
Famciclovir

93
Q

Herpes simples treatment

Acyclovir dose

A

400mg 3-5 x day

children 12-15mg/kg/day divided in 2 doses

prophylactic
400mg BID

94
Q

Herpes simples treatment

Valcyclovir dose

A

500mg TID

prophylactic
500mg QD

95
Q

Herpes simples treatment

Famciclovir dose

A

250mg TID

Prophylactic
250mg QD or 125 BID

96
Q

Acyclovir Class

A

Nucleoside analogue

Zovirax cream

97
Q

Varicella Zoster

A

fever
vesicular rash

antihistamine
cut fingernails
Tylenol
(not ASA - Reyes)

if under 12, no antivirals (self Limiting)

If antivirals are needed, valcyclovir (fewer doses)

98
Q

The goals of antiviral therapy

for varicella zoster

A

Promote more rapid healing of skin lesions,

Lessen the severity and duration of pain associated with acute neuritis,

and potentially reduce the incidence or severity of chronic pain,

referred to as post herpetic neuralgia.

99
Q

Valcyclovir dose vs acyclovir

Zoster

A

1000mg TID
x 7 days
vs
800mg 5 times a day for 7 days

100
Q

Zoster transmission

A

Patients with herpes zoster can transmit VZV to individuals who have not had varicella and have not received thevaricella vaccine.

Until the rash has crusted, patients should be advised to keep the rash covered, if feasible, and to wash their hands often to prevent the spread of virus to others.

They should also avoid contact with pregnant women who have never had chickenpox or the varicella vaccine, premature or low birth weight infants, and immunocompromised individuals.

101
Q

Molluscum contagiosum Tx

A

Cryotherapy
curettage
cantharidin

102
Q

Verrucae

A

Warts

HPV 6 and 11 = Anogenital warts

Common, plantar or flat warts (verrucae ….)

topical salicylic acid
cryotherapy
most common treatments

plantar warts less likely to respond

103
Q

Contact dermatitis treatment

A

avoid offending agent
treat skin inflammation
restore epidermal barrier function
prevent further exposure

Dorsum of hands, finger tips, finger webs
common sites

Emollients and topical corticosteroids used empirically
Used in combo

104
Q

Exanthematous drug eruptions

treatment

A

stop drug
topical corticosteroids (high potency-grp 1-3)
BID x 1 week

oral antihistamines PRN for pruritis

don’t use systemic corticosteroids for uncomplicated reaction

105
Q

Eczema Treatment

A

The goals of treatment are

to reduce symptoms (pruritus and dermatitis),

prevent exacerbations,

and minimize therapeutic risks.

106
Q

Atopic Dermatitis Treatment

A

mild to moderate atopic dermatitis
topical corticosteroids and emollients.

For patients with mild atopic dermatitis, we suggest a low-potency (groups 5, 6,7) corticosteroid cream or ointment (eg,desonide0.05%,hydrocortisone2.5%).

Topical corticosteroids can be applied once or twice daily for two to four weeks.

We suggest that patients with atopic dermatitis involving the face or skin folds that is not controlled with topical corticosteroids be treated with a topical calcineurin inhibitor (ie,tacrolimusorpimecrolimus)

107
Q

Lichen planus treatment

A

We suggest high potency or super high potency topical corticosteroids as initial treatment of localized cutaneous lichen planus on the trunk or extremities

Intralesional corticosteroids can be useful in patients with hypertrophic lichen planus.

108
Q

Pityriasis rosea

A

In 50 to 90 percent of cases, the eruption begins with a “herald” or “mother” patch,
a single round or oval, sharply delimited, pink or salmon-colored lesion on the chest, neck, or back.

mild itching = medium-potency topical corticosteroids.

Severe PR who desire treatment to accelerate improvement of the skin manifestations

oralacyclovirrather than oralerythromycin.

109
Q

Psoriasis

A

limited plaque psoriasis
topical corticosteroids and emollients

moderate to severe plaque psoriasis
phototherapy if feasible and practical.

110
Q

Coal tar

A

Scytera
To relieve symptoms of psoriasis

Inhibits excessive skin cell proliferation
keratolytic
anti itchy
anti inflammatory

111
Q

Biologics and psoriasis

A

The drugs block certain cells or proteins that play a role in psoriasis.

They keep them from going into overdrive.

While that helps with inflammation and other issues, it also lowers your body’s defenses.

112
Q

TNF concerns

Tumor necrosis factor blockers

A

There is a concern that all TNF-alpha inhibitors have the potential to activate latent infections such as tuberculosis, and increased rates of infection have been seen in patients with rheumatoid arthritis treated withetanercept,infliximab, andadalimumab.

113
Q

Etanercept

A

Enbrel
Tumor Necrosis Factor Blocker

Mod - severe plaque psoriasis

not for under 4

Contra
Sepsis

114
Q

IL 23 blocker

A

Ustekinumab
Guselkumab
Risankizumab
Tidrakizumab

115
Q

IL 17 blocker

A

Secukinumab
Ixekizumab
Bimekizumab

116
Q

IL 17A blocker

A

Brodalumab

117
Q

Biologics for psoriasis Drugs and class

A 
TNF alpha blockers
Etanercept (enbrel)
Adalimumab (Humira)
Infliximab (Remicade)
Certolizumab

PAM Semester 4 (7 decks)

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