Topical Therapeutics in Derm (complete) Flashcards

1
Q

What are common types of vehicles for topical medications?

A

A mixture of powder, liquid, and/or grease

1) Ointments
2) Creams
3) Gels
4) Lotions/Solutions
5) Foams
6) Pastes
7) Shake lotions/suspension

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2
Q

What are factors you should consider when selecting an appropriate vehicle?

A

1) Anatomic location
2) Contact allergy/intimacy
3) Irritancy

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3
Q

What is the definition of an FTU? Describe it.

A

Finger Tip Units = 0.5g

Amount of ointment that’s dispensed from a 5mm diameter nozzle and applied to distal third of index finger

BUT I HAVE TINY FINGERS!

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4
Q

Estimate the amount of topical medication necessary to treat different body areas

A

Face/neck: 2.5FTU

Trunk, front, back: 7 FTU

One arm: 3 FTU

One hand (front/back): 1 FTU

One leg: 6 FTU

One foot: 2 FTU

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5
Q

What is the classification system for topical corticosteroids?

A

7 classes:

  • Class 1 = most potent
  • Class 7 = weakest

Developed based on vasoconstrictor assays

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6
Q

What are prototypical topical corticosteroids?

A

1) The Gentle Touch: Hydrocortisone 2.5%
2) The Almost All-Purpose Weapon: Triamcinolone 0.1%
3) Hercules: Clobetasol Propionate 0.05%

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7
Q

What are common adverse effects associated with topical corticosteroid usage?

A
  • Most potent => greater adverse effects
  • Skin atrophy

Extensive/long-term use => Systemic side effects

  • Adrenal suppression
  • Cushing’s syndrome
  • growth retardation in kids
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8
Q

What are drug factors that affect absorption?

A

1) Active drug concentration
2) Molecular size of drug/prodrug
3) Lipophilicity of the drug
4) Composition of the vehicle

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9
Q

What are patient factors that affect absorption?

A

1) Presence of barrier disruption
2) Anatomical location
3) Skin hydration
4) Occlusion

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10
Q

Describe an ideal vehicle

A

Easy to apply/remove

Non-toxic

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11
Q

What is the composition of ointments?

A

Water in oil emulsion

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12
Q

What is the composition of creams?

A

Oil in water emulsion

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13
Q

What is the composition of gels?

A

Semisolid emulsion in alcohol base

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14
Q

What is the composition of lotions/solutions?

A

Powder in water (some oil in water)

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15
Q

What is the composition of foams?

A

Special vehicle!!

Pressurized collections of gaseous bubbles in a matrix of liquid film

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16
Q

What type of vehicle is least likely to cause contact allergy?

A

Ointments!

17
Q

What type of vehicle would you use for the scalp?

A

Gel
Foam
Spray/solution

18
Q

Describe hydrocortisone 2.5%

A

The Gentle Touch!!

  • Cream/ointment
  • Class 7
  • Efficacious mild eczema in kids/adults
  • Tx of inflammatory dermatoses involving face, intertriginous areas, groin
19
Q

Describe Triamcinolone Acetonide 0.1%

A

The Almost All-Purpose Weapon

  • Class 4
  • Effective against most moderate spongiotic dermatoses (eczematic, atopic, and allergic dermatitis and arthropod bite)
  • Use on trunk and extremities
  • Long term use not recommended for facial, intertriginous, groin
20
Q

Describe clobetasol propionate 0.05%

A

Hercules!!

  • Cream/ointment
  • CLASS 1
  • Tx for acute eruptions that need rapid tx including contact dermatitis or acute drug eruptions
  • Avoid use on face, intertriginous areas, groin
  • Long term use requires monitoring for adverse rxns