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Pharmacology > Skin > Flashcards

Skin Flashcards

1
Q

Atopic Dermatitis (Eczema)

A

form of allergic dermatitis

pruritic chronic inflammatory condition

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2
Q

pathogenesis of atopic dermatitis

A

involves genetic factors, skin barrier defects, and immune dysregulation

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3
Q

treatments for contact dermatitis

A

topical corticosteroids
systemic corticosteroids
topical immunosuppressives
antihistamines

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4
Q

dosage of topical corticosteroids for contact dermatitis

A

short term therapy with more potent steroids is preferable to long term therapy with less potent

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5
Q

how do you enhance the penetrance of topical corticosteroids

A

hydrate the skin

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6
Q

prolonged use of topical corticosteroids on the face

A

atrophy and acne-like eruptions

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7
Q

prolonged use of topical corticosteroids in the elderly

A

ecchymosis on arms and legs

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8
Q

prolonged use of topical corticosteroids: epidermal atrophy manifestations

A

striae
shiny, thin skin
telangiectases

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9
Q

when would you use systemic corticosteroids for contact dermatitis

A

if it is widespread or resistant to treatment

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10
Q

contraindications to systemic corticosteroids

A

systemic mycoses

patients receiving a vaccination

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11
Q

when would you use topical immunosuppressives for contact dermatitis

A

mod-severe atopic dermatitis that cannot tolerate topical steroids, not responsive to other treatments, or there is concern for topical steroid-induced atrophy

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12
Q

available topical immunosuppressives

A

Tacrolimus

Pimecrolimus

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13
Q

contraindications to topical immunosuppressives

A

Do not use under occlusive dressings

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14
Q

1st line therapy for contact dermatitis

A

topical corticosteroid low-intermediate potency applied BID
low potency are used on the face
oral antihistamines relieve itching

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15
Q

2nd line therapy for contact dermatitis

A

more potent topical steroids or topical immunosuppressives

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16
Q

3rd line therapy for contact dermatitis

A

systemic corticosteroids

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17
Q

topical steroids in pediatrics

A

should only be used for 7 days in children <6 and at the lowest potency

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18
Q

tinea capitis presentations

A

inflamed scaly alopecia patches (especially in infants)
tender pustular nodules
“gray patch” white scaly plaques with hair broken off clos to skin

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19
Q

tinea corporis

A

ringworm

affects face, limbs, trunk

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20
Q

tinea cruris

A

jock itch
infection of groin and inguinal folds
often accompanying infection of feet

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21
Q

tinea pedis

A

athletes foot

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22
Q

tinea manus

A

dermatophyte infection of the hand

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23
Q

tinea unguium

A

fungal infection of the nail

also called onychomycosis

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24
Q

treatment modalities for fungal infections

A

topical and systemic azoles
topical and systemic allylamine antifungals
griseofulvin

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25
Q

topical azole antifungals

A

effective against tinea corporis, tinea cruris, and tinea pedis as well as cutaneous candidiasis
apply 1-2xs daily for 2-4wks
continue use for 1 week after lesions clear

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26
Q

contraindications to topical azole antifungals

A

not recommended during pregnancy/lactation
caution with hepatocellular failure
avoid ketoconazole with sulfite sensitivity

27
Q

Topical agents for tineas

A

effective for most but not tinea capitis or tinea unguium

28
Q

1st line therapy for fungal infections

A

topical therapy for tinea corporis, pedis, cruris, manus when lesions affect a specific area
tinea capitis is griseofulvin admin with milk or food
tinea unguium (onychomycosis) is systemic therapy with itraconazole

29
Q

2nd line therapy for tinea corporis, pedis, cruris, manus

A

if failure to respond to therapy, multiple lesions, or area is repeatedly shaved
terbinafine or fluconazole

30
Q

2nd line therapy for tinea capitis

A

itraconazole, terbinafine, or fluconazole

31
Q

tinea versicolor

A

superficial yeast infection that typically chronic and characterized by well demarcated scaling patches of varied color

32
Q

therapy for tinea versicolor

A

1st line: topical selenium sulfide with a topical antifungal (terbinafine, ketoconazole, or sulconazole)
2nd line: systemic itraconazole

33
Q

1st line tx for candidiasis

A

cutaneous cool wet soaks with Burow solution
keep areas dry by powdering or keeping OTA
can apply AF cream 1-2x daily x 10days

34
Q

2nd line therapy for candidiasis

A

systemic itraconazole for adults only

35
Q

follow up for fungal infections

A

Reassess in 2 weeks

for chronic systemic therapy monitor monthly to check liver function

36
Q

treatment of herpes varicella (chicken pox)

A

systemic therapy only recommended for complicated cases

37
Q

when should you treat for herpes zoster

A

if the rash has been present fewer than 72 hours or if new lesions are still developing

38
Q

topical antiviral agents for herpes infections

A

Acyclovir (q3h, 6x/day x7 days)

Penciclovir (q2h while awake x4d)

39
Q

systemic antiviral therapy is not recommended for who

A

healthy children <12

40
Q

contraindications for systemic antiviral therapy

A

renal disease
CHF
lactation

41
Q

disadvantage of oral acyclovir

A

reduced bioavailability of only 10-20%

42
Q

1st line therapy herpes type 1 (face/skin above waist)

A

topical acyclovir or penciclovir

43
Q

warts are caused by what

A

HPV

44
Q

1st line therapy for filiform or flat warts

A

removed by dermatologist

45
Q

1st line therapy for common warts

A

17% salicyclic acid at hs x8wks

46
Q

1st line therapy for plantar warts

A

40% salicyclic acid at hs x8weeks or until wart is gone

on for 24-48 h then rub with pumice stone

47
Q

initiating drug therapy for cutaneous HPV infection

A

aggressive therapy typically not needed unless there is report of pain as they will often spontaneously resolve in a few months-years

48
Q

contraindications for topical treatment of cutaneous HPV infection

A

DM, impaired circulation, on moles, birthmarks, or unusual warts with hair growth

49
Q

impetigo

A

highly contagious bacterial skin infection frequently on face, scalp, extremities
macules that develop into vesicles/pustules that ooze purulent liquid that, once dried, has a characteristic honey-colored crust

50
Q

bullous impetigo

A

superficial, flaccid bullae on the skin

brownish gray lesions sometimes are crusted or have an erythematous halo

51
Q

Ecthyma

A

impetigo that worsens and spreads deeply into the dermis
usually affects debilitated and the elderly
lesions are usually painful and may persist for weeks to months

52
Q

what do red streaks signify in cellulitis

A

lymphatic spread or lymphangitis

53
Q

erysipelas

A

cellulitis in the superficial layers of skin

most common in children (especially infants) and the elderly

54
Q

pustular bacterial infections

A 
folliculitis
furuncle
carbuncle
paronychia
felon
55
Q

folliculitis

A

superficial infection of the hair follicle

erythematous papules that turn into small pustules in approx 48h

56
Q

furuncle

A

painful pus-filled nodule that circles a follicle (develops from folliculitis)

57
Q

carbuncle

A

confluence of several furuncles that forms deep within the dermis
frequently accompanied by systemic s/s such as fever, malaise, and HA

58
Q

paronychia

A

infection of the tissue surrounding the nail bed

59
Q

felon

A

infection that involves the pulp space in the tip of a digit

60
Q

necrotizing fascitis

A

typically appears like cellulitis but there is severe pain, edema, and erythema
subQ tissue has a wood hard feel
typically accompanied by high fever
drainage usually present that looks like dishwater pus
severely ill requiring intensive care and tx by specialists

61
Q

1st line therapy impetigo and ecthyma

A

minor impetigo can be tx with topical mupirocin for 7-10 days
bullous impetigo usually an oral broad-spectrum PCN (Augmentin or dicloxacillin) or 1st gen cephalosporin (Keflex)
Clindamycin is a good alternative for PCN allergy
Ecthyma needs oral agents such as dicloxacillin or keflx

62
Q

2nd line therapy for impetigo and ecthyma

A

severe cases of ecthyma may need IV nafcillin

63
Q

1st line treatment of cellulitis

A

systemic tx is always needed

see p.191

64
Q

secondary infections with carbunculosis

A

osteomyelitis and endocarditis are risks therefore systemic abt are always given after lesions are drained

Pharmacology (11 decks)

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