Flashcards in Therapeutics Deck (16):
How medications bind to receptors and signal intended response
5 actions of corticosteroids
1) stabilizes cell and lysosomal membranes
2) reduces vascular smooth muscle sensitivity to histamine
3) inhibits histamine release
4) decreases neutrophil migration / adherence
5) decreases production of IL-1
Effect of the body on a medication. Depends on absorption, distribution, bioavailability, metabolism (hepatic), and excretion (renal).
4 key topical steroids
UP: Clobetasol proprionate .05% (class I). Usually limited to 2 weeks unless on palms or soles. Do not use occlusion (dangerous potency).
HP: Fluocinonide .05% (class II)
MP: Triamcinolone acetonide (class IV)
LP: Hydrocoritoone 1% (class VII)
Combination of clobetasol and clotrimazole (antifungal). Don’t use due to risk of side effects.
Where / what are gels used for?
Used for mucosal sites (mouth for pemphigus vulgaris) and face (acne). Contain alcohol, so may burn and dry skin.
What is typical dosage for oral steroids?
1 mg / kg / day
6 components of a prescription
Full name of medication, potency, vehicle, quantity, directions (freq and site), and refills.
Side effects of topical steroids
Acne, rosacea, perioral dermatitis, atrophy (thinning / stretch marks), contact / irritant dermatitis (more often due to the vehicle), infection, cataracts, glaucoma, purpura (bleeding may be due to thinning), rebound, tachyphylaxis (continued application → lower effect, common in psoriasis), or telangiectasias.
Continued application leads to less effect. Common in psoriasis
Which vehicles commonly cause side effects?
Formalin, preservatives, lanolin, etc.
Propylene glycol is a humectant and solvent. May cause irritant contact dermatitis.
Formaledhyde may cause allergic contact dermatitis
Calcineurin Inhibitors (types, use, population, mechanism, side effects)
Tacrolimus .1% ointment and Pimecrolimus 1% cream.
Topical substitute for MP steroids.
Supposed to be used for atopic dermatitis in age 2+, but often also used for seborrheic dermatitis, contact dermatitis, psoriasis, vitligo, etc.
Act by inhibiting transcription of pro-inflammatory cytokine IL-2.
Do not cause atrophy. Rare burning effects or lymphoma.
Avoid prolonged use. Good alternative when rebound occurs in eyelid dermatitis.
When are systemic corticosteroids used? How are they delivered?
Used for severe or systemic diseases, such as pemphigus vulgaris, severe atopic dermatitis, poison ivy, or acne fulminans.
May be delivered orally (po, Prednisone most common), injected (IV, intralesional [IL], or intramuscular [IM]), or inhaled.
Injections are good for diseases w/ fibrosis / thickenings.
IV / oral good for pemphigus vulgaris w/ lots of pain / lesions.
Intralesional injections (type, use, side effects)
Include triamcinolone. Good for localized disease such as alopecia areata and keloids. Side effect includes epidermal / dermal atrophy.
Side effects of systemic corticosteroids
Osteoporosis (long-term), osteonecrosis (may occur quickly, often in hip), HPA suppression (must taper steroids if used for more than 3 weeks), infection (due to immunosuppresion).