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Stage 3 Block 2 > Skin > Flashcards

Flashcards in Skin Deck (66):
1

What are the symptoms of eczema?

Pruritus
Blisters
Scaling plaques
Infection may result

2

Describe the pathophysiology of eczema

Dermal oedema and inflammatory cell infiltration
Spongiosis and fluid filled vesicles
Scales
Epidermal hyperplasia and hyperkeratosis

3

What are the different types of dermatitis?

Primary irritant dermatitis
Allergic contact dermatitis
Atopic dermatitis
Drug-related eczematous dermatitis
Photoeczematous dermatitis

4

Describe the mechanism of the sensitisation phase of contact dermatitis

Antigen gets recognised by Langerhans cells
These are antigen presenting cells which present the antigen to naive T cells
The T cells then differentiate to form memory and effector T cells which elicit an immune response

5

Describe the mechanism of the re-exposure phase of contact dermatitis

Antigen gets recognised by Langerhans cells and activated T memory cells
Cytokines are released and an immune response elicited

6

Describe the mechanism of action of tacrolimus and pimecrolimus

Forms a complex with FKBP12 to inhibit calcineurin
Prevents phosphorylation of NFAT
Inhibiting the translocation of NFAT and thus the production of interleukins

7

What are the indications of tacrolimus and pimecrolimus?

Pimecrolimus - mild-to-moderate eczema
Tacrolimus - moderate-to-severe eczema

8

What ADRs are associated with tacrolimus and pimecrolimus?

Burning
Pruritus

9

What cautions surround the use of tacrolimus and pimecrolimus?

Increased risk of skin infection
Increased risk of skin cancer
Avoid exposure to UV light

10

What are the contraindications for the use of tacrolimus and pimecrolimus?

Hypersensitivity (including other macrolides e.g. erythromycin, sirolimus)
Skin barrier defects
Immunodeficiency

11

What interactions are associated with tacrolimus and pimecrolimus?

Immunosuppressants

12

What class of drug is ciclosporin?

A calcineurin inhibitor

13

Describe the mechanism of action of ciclosporin

Forms a complex with cyclophilin, inhibiting calcineurin which inhibits the phosphorylation of NFAT, inhibiting the translocation of NFAT to the nucleus and inhibiting the production/release of interleukins

14

What ADRs are associated with ciclosporin?

Nephrotoxicity, HTN, neurotoxicity, hepatotoxicity, hyperlipidaemia, neoplasms, infection

15

What cautions surround the use of ciclosporin?

Avoid UV light
Monitor renal function
Existing infection

16

What are the contraindications for the use of ciclosporin?

Hypersensitivity
Poor renal function
HTN
Uncontrolled infection
Cancer

17

What interactions are associated with ciclosporin?

Immunosuppressants
CYP3A4

18

Describe the mechanism of action of methotrexate

Inhibits dihydrofolate reductase
- decreased nucleotide synthesis
- increased apoptosis of T cells
- increase in adenosine is anti-inflammatory

19

What ADRs are associated with methotrexate?

Bone marrow suppression and blood dyscrasia
Hepatotoxicity
Nephrotoxicity
GI ulceration
Risk of infection

20

What cautions surround the use of methotrexate?

Impaired liver function
Blood disorder
GI ulceration
Impaired renal function

21

What are the contraindications for the use of methotrexate?

Severe renal or hepatic impairment
Pregnancy and lactation

22

What interactions are associated with methotrexate?

NSAIDs - inhibit tubular secretion, both compete for OAT3
Antifolate antibiotics - both inhibit folate synthesis

23

How is methotrexate secreted?

Tubular secretion by OAT3

24

Describe the mechanism of action of glucocorticoids

Bind with GR to promote translocation to nucleus, increasing production of anti-inflammatory cytokines and decreasing the production of pro-inflammatory cytokines

- inhibition of inflammatory gene expression
- induction of anti-inflammatory gene expression
- inhibition of leukocyte migration and activity
- inhibition of prostanoid/leukotriene synthesis
- inhibition of T lymphocyte proliferation

25

What ADRs are associated with glucocorticoids?

Inhibition of hypothalamic/pituitary/adrenal axis
Weight gain and DM
Redistribution of fat
Broad anti-inflammatory effects
HTN
Euphoria
Buffalo hump
Moon face
Easy bruising
Poor wound healing

26

What cautions surround the use of glucocorticoids?

Short term use only
Avoid potent glucocorticoids in psoriasis

27

What are the contraindications for the use of glucocorticoids?

Uncontrolled infections

28

Describe the mechanism of action of retinoids

Form a complex with RAR and RXR to promote translocation to the nucleus and production of the genes regulating differentiation and proliferation, and genes that regulate apoptosis

29

Give examples of retinoids and their indications

Alitretinoin - eczema
Tazoretene - psoriasis
Acitretin - severe psoriasis

30

What ADRs are associated with the use of retinoids?

Burning, erythema
Teratogenic

31

What are the contraindications for the use of retinoids?

Pregnancy
Hyperlipidaemia
Hepatic and renal impairment

32

Give examples of vitamin D analogues

Calcipotriol, calcitriol, tacalcitol

33

Describe the mechanism of action of vitamin D analogues

Inhibit epidermal cell proliferation
Induce keratinocyte differentiation
Anti-inflammatory (inhibit T cell proliferation and cytokine production)

34

What ADRs are associated with vitamin D analogues?

Burning
Erythema
Pruritus
Paraesthesia
Hypercalcaemia

35

What are the contraindications for the use of vitamin D analogues?

Calcium metabolism disorders

36

Give examples of TNF-alpha inhibitors

Etanercept
Infliximab
Adalimumab

37

What ADRs are associated with TNF-alpha inhibitors?

Increased risk of infection

38

What cautions surround the use of TNF-alpha inhibitors?

Predisposition to infection

39

What are the contraindications for the use of TNF-alpha inhibitors?

Uncontrolled infection

40

What interactions are associated with TNF-alpha inhibitors?

Live vaccines

41

What class of drug is ustekinumab?

IL12/IL23 inhibitor

42

What ADRs are associated with the use of ustekinumab?

Increased risk of infection

43

What cautions surround the use of ustekinumab?

Predisposition to infection

44

What are the contraindications for the use of ustekinumab?

Uncontrolled infection

45

What interactions are associated with ustekinumab?

Live vaccines

46

What are the functions of the skin?

Regulate body temperature
Store blood
Protect body from external environment
Detect cutaneous sensations
Excretion and absorption
Synthesis of vitamin D

47

What is the function of keratinocytes?

Produce keratin and lamellar granules to decrease water loss from skin and protect skin from heat, microbes and chemicals

48

Name the 5 layers of the epidermis

Stratum basale
Stratum spinousum
Stratum granulosum
Stratum lucidum
Stratum corneum

49

Outline the process of keratinisation

Keratinocytes accumulate keratin, and are pushed up from the stratum basale, and undergo apoptosis at the stratum granulosum and are sloughed off when they reach the stratum corneum.

50

Describe atopic dermatitis

Most commonly affects flexures
Type IgE mediated
FH of atopy

51

What type of dermatitis is type IgE mediated?

Atopic dermatitis

52

What patient groups get gravitational dermatitis?

Those with varicose veins

53

What type of dermatitis is type IV mediated?

Allergic contact dermatitis

54

What are the 4 Ps of lichen planus?

Pruritic
Purple
Polygonal
Papules

55

Describe the process of healing by primary intention

Acute inflammation
Platelets
Thromboplastin
Vasodilation
Neutrophils and macrophages
Fibroblasts
Scab
Epithelial cells
Healed 2-3w

56

Outline the process of healing by secondary intention

Necrosis
- debridement

Granulation
- inflammation
- infiltration with erythrocytes, leukocytes and platelets
- endothelial cells
- growth factors

Epithelialisation

57

Which part of a hydrocolloid dressing is hydrophilic?

Granules

58

Which part of a hydrocolloid dressing is hydrophobic?

Adhesive matrix

59

How do hydrocolloid dressings work?

Slowly absorb fluid from wound, forming cohesive or hydrophilic gel

60

What are the components of foams?

Absorbent polyurethane with other components:
- hydrocellular foams
- hydropolymer foams
- soft silicone foams
- foam and silver
- foam and charcoal

61

What component of an alginate dressing forms a soft flexible gel?

Mannuronic acid

62

What component of alginate dressings form a firm gel?

Guluronic acid

63

What types of dressing can be used in a low granulating wound?

Foams
hydrogels

64

What types of dressings can be used in a wound with light to medium exudate?

Foams
Alginates
Thin hydrocolloids
Hydrogels

65

What types of dressings can be used in a wound with medium to heavy exudate?

Alginates
Hydrocolloids
Foams

66

What types of dressings can be used in a wound with heavy exudate?

Alginates
Hydrocolloids
Foams