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Pharmacology > Unit 2: Skin > Flashcards

Unit 2: Skin Flashcards

1
Q

Dermatitis

A

Alteration in skin reactivity caused by exposure to external agent
Usually appears as inflammatory process
Irritant or allergic

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2
Q

Allergic contact dermatitis

A

Exposure to antigen that causes immunologic response
During initial sensitization phase, host is immunized to allergen
On re-exposure, more rapid and potent secondary immune response occurs
T cells involved

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3
Q

Characteristics of dermatitis

A

linear streaks of papules, vesicles and blisters that are very pruritic

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4
Q

Ointments and gels for dermatitis

A

Offer best delivery and protection barrier

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5
Q

Topical corticosteroids for dermatitis

A

Effective for smaller outbreaks
Anti inflammatory and antimitotic
Should be avoided if infection present
Start with lowest potency

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6
Q

Prolonged use of topical corticosteroids can cause

A

Atrophy on face and acne like eruptions

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7
Q

Systemic corticosteroids for dermatitis

A

Use if widespread or resistant to topical

Prescribed in tapering dose for 2-3 weeks

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8
Q

Topical immunosuppressants for dermatitis

A

Pimecrolimus, tacrolimus
Acts on T cells by decreasing cytokine transcription
For moderate to severe dermatitis if can not tolerate steroids

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9
Q

Antihistamines for dermatitis

A

Used to relieve itching associated with contact dermatitis

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10
Q

First line agent for dermatitis

A

Low potency topical corticosteroid 2x a day with antihistamine for relief

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11
Q

2nd line agent for dermatitis

A

Increase potency of topical corticosteroid

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12
Q

Third line agent for dermatitis

A

Oral corticosteroid

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13
Q

Tinea

A

Fungi infection of skin

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14
Q

Tinea capitis

A

Head

Affects mostly 3-9 years old

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15
Q

Tinea corporis

A

Body

Ringworm when on face, limbs, trunk

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16
Q

Tinea Manus

A

Hands

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17
Q

Tinea Cruris

A

groin

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18
Q

Tina unguium

A

Nails

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19
Q

Predisposing factors for tinea

A

Warm, moist, occluded environments, compromised immune system

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20
Q

What can you use to diagnose fungal infection

A

10% KOH, Fungal culture, wood lamp

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21
Q

Topical azole antifungals

A

Impair synthesis of ergosterol; fungicidal
Effective for tinea corporis, tinea cruris, tinea pedis
2-4 weeks of tx; continue for 1 week after lesions disappear

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22
Q

Topical allylamine antifungals

A

Naftifine, terbinafine
Effective against dermatophyte infections but limited against yeast
Shorter treatment than azoles

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23
Q

Griseofulvin

A

Oral fungistatic agent that deposits in keratin precursor cells
May aggravate SLE and cause N/V, diarrhea, HA

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24
Q

Systemic allylamine antifungals

A

Terbinafine
Inhibits key enzyme in fungal biosynthesis
Treatment for nail fungus

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25
Systemic azole antifungals
Itrazonazole, flucanazole Inhibit P450 enzymes Inhibit synthesis of ergosterol Treatment for tinea capitis and tinea uriguium
26
First line agent for tinea capitis
Griseofulvin (8 weeks)
27
2nd line agent for tinea capitis
Terbinafine or itraconazole
28
First line agent for tinea corporis, cruris, and pedis
Topical azoles
29
First line agent for tinea uriguium
Itrazonazole or terbinafine (12 weeks)
30
Tinea versicolor
Opportunisitc superficial yeast infection Chronic Asymptomatic Well-demarcated scaling patches of varied colors
31
DOC for tinea versicolor
Selenium sulfide | CI in pregnancy and breastfeeding
32
Candidiasis
Superficial fungal infection of skin and mucus membranes | Commonly found in diaper area, oral cavity, nails, vagina, penis
33
Intertrigo
Armpits, under breasts, groin
34
Balanitis
Glans penis
35
Candidal folliculitis
Follicular pustules
36
Candidal paronychia
Nail folds
37
Nystatin
Fungicide that binds to sterols in cell membrane of fungus | Used for thrush--placed inside of mouth 3x . day for 10-14 days
38
First line agents for candidiasis
Cool soaks with Burow solution Topical azole for skin Oral nystatin for mouth
39
Second line agents for candidiasis
Itracanazole or fluconazole
40
HSV-1
Involves face and skin above waist
41
HSV-2
genitals
42
Herpes Zoster
Shingles and varicella
43
EBV
Causes mono
44
HHV-6
Causes roseola
45
HHV-8
Causes kaposi sarcoma
46
Topical antiviral agents for HSV-1
Acyclovir and Penciclovir
47
Systemic antiviral agents for HSV-1
Acyclovir, Famciclovir, Valacycolvir | Recommended for adolescents, adults + high risk patients
48
First line tx for HSV-1
Topical therapy with acyclovir or penciclovir
49
Second line tx for HSV-1
Systemic acyclovir, famciclovir, valacyclovir
50
First line treatment for herpes zoster
Systemic antiviral if outbreak <72 hours in duration, patient is >50 or patient is immunocompromised
51
Warts
Caused by HPV
52
Salicyclic acid
Can treat warts Keratolytic peeling agent Available in liquid, gel and patches
53
2nd line therapy for warts
Cryosurgery, electrotherapy, CO2 laser surgery
54
Most common causes of bacterial skin infections
Staph aureus and group A strep
55
Impetigo
Superficial skin infections | Due primarily to staph aureus
56
Ecthyma
Chronic form of impetigo G- organisms such as pseudonomas More common in children Spread between people in schools and daycare center and due to crowded living spaces
57
Cellulitis
Infection involving skin and subcutaneous layers, can spread systemically
58
Common precipitants to cellulitis
Break in skin, stasis dermatitis, stasis ulcers, edema of lower extremities, venous insufficiency, obesity, iV site of drug user
59
Cellulitis usually due to
Staph aureus or Group A strep
60
Primary cause of infection due to animal bites
Pasteurella multocida
61
Erysipelas
Superficial form of cellulitis in children | Due to group A strep
62
Folliculitis
Superficial infection of hair follicle | Primarily due to staph aureus
63
Predisposing factors to folliculitis
Shaving, waxing, plucking, humidity, tight clothing, DM, sunscreen or make up, poor hygiene
64
Necrotizing fasciitis
Serious infection of subcutaneous tissues that can be life threatening Polymicrobial: group A strep, staph aureus, anaerobic bacteria
65
Broad spectrum penicillins for bacterial skin infections
Choose agent that is penicillinase resistant | Amoxicillin-clavulanate
66
1st generation cephalosporin for bacterial skin infections
Cephalexin oral or cefazolin IV | Active against GAS and Staph aureus mostly
67
2nd generation cephalosporin for bacterial skin infections
Cefaclor, cefuroxime, cefprozil | Additional coverage against H. Influenzae, E Coli, Klebsiella, Proteus
68
3rd generation cephalosporin for bacterial skin infection
Cefpodoxime, ceftriaxone, ceftazidine Reserved for more serious infection Less effective against staph aureus
69
Clindamycin for bacterial skin infection
Alternative for patients allergic to penicillin or cephalosporin Can be active against community acquired MRSA
70
Fluoroquinolones for bacterial skin infection
Levofloxacin, moxifloxacin, ciprofloxacin Useful for patients with penicillin allergy or infection with G- bacteria Levo and Cipro active against pseudomonas
71
Vancomycin for bacterial skin infection
Active against MRSA
72
Mupirocin ointment
Active against staph aureus and some strep Metabolized by skin Adjunct therapy to antibiotics
73
First line therapy for impetigo
``` Topical mupirocin for 7-10 days for minor Oral antibiotic (penicillin or 1st gen cephalosporin) for 7-10 days ```
74
First line therapy for ecthyma
Dicloxacillin or cephalexin for 2-3 weeks
75
First line therapy for cellulitis
Mild-moderate without systemic symptoms or purulence: penicillin, augmentin, dicloxacillin Purulent infection: bactrim, minocycline, clindamycin, linezolid
76
First line therapy for pustular infections
If deep infection, dicloxacillin, cephalexin, clindamycin
77
first line therapy for necrotizing fasciitis
Combo antibiotics | Surgery
78
Drugs known to exacerbate psoriasis
Systemic steroids, lithium carbonate, antimalarials, beta blockers, interferon, alcohol
79
Psoriasis
Autoimmune-mediated process driven by abnormally activated helper T cells
80
Characteristics of psoriasis
Well-demarcated, erythematous papules/plaques surrounded by silvery or whitish scales Symmetric lesions usually found on face, extensor joints, anogenital area, palms and soles, trunk, scalp, ears, nails
81
3 treatment modalities for psoriasis
topical agents, phototherapy, systemic agents
82
Emolients for psoriasis
Useful as adjunct therapy | Hydrate the stratum corneum, decrease water evaporation and soften scales or plaques
83
Examples of emolients for psoriasis
Eucerin, lubriderm, moisturel, cetaphil
84
Topical corticosteroids for psoriasis
Decrease redness, itching and scaling, promote vasoconstriction Most effective tx is medium to high dose agent for limited time followed by less potent for maintenance
85
Coal tars for psoriasis
Decrease DNA synthesis and has anti inflammatory and anti pruritic properties Used as adjunct to steroids Unpleasant odor, staining, photosensitivity
86
Anthralin for psoriasis
Topical coal tar derivative Time consuming and slow onset of action Decreases DNA synthesis and epidermal proliferation
87
Vitamin D analogs for psoriasis
Calcipotriene + Calcipotriol For mild to moderate Decreases proliferation and anti inflammatory Topical format Similar efficacy as high potency corticosteroids
88
Topical retinoid
``` Vitamin D derivative Tazarotene for mild to moderate Normalizes epidermal differentiation, decreased hypoproliferation, diminishes inflammation Promotes longer remission ```
89
Systemic retinoids
Acitretin | Long term therapy for psoriasis
90
Methotrexate
Treatment of generalized psoriasis | Inhibits folic acid reductase which inhibits cellular replication
91
Cyclosporine for psoriasis
Decreases cell mediated immune reactions and humoral immunity; decreased production of IL2 Promotes rapid remission of severe psoriasis Used short term for severe exacerbations
92
Phosphodiesterase 4 inhibitors for psoriasis
Apremilast, etanercept, infliximab
93
First line therapy for psoriasis
Moisturizers and topical steroids | 2 weeks of high potency topical steroid 2x a day and cover with occlusive dressing
94
Second line therapy for psoriasis
Taper high potency topical steroid to 1-2x a week and add vitamin D analog 2x a day
95
Comedolytics for acne
Retinoic acid Adapalene gel Tazarotene gel
96
Comedolytic bactericidals for acne
Benzoyl Peroxide + Azelaic acid Specific to p.acnes Decreases inflammation
97
Topical antibiotics for acne
Inhibit growth of p. acnes + decreases number of comedones | Clindamycin 2% or erythromycin 2-3%
98
Oral antibiotics for acne
When improvement does not occur with topical Indicated for inflammatory acne Tetracycline or erythromycin
99
Tetracycline for acne
Improvement can take 3-4 weeks | Can stain teeth and decrease effectiveness of OC
100
Isotretinoin
Reserved for severe nodulocystic acne when other treatment fails Decreases sebum production, follicular obstruction and number of skin bacteria Requires 2 forms of birth control due to teratogenicity
101
Hormonal therapy for acne
Oral contraceptive containing ethinyl estradiol, levonorgestrel, norgestimate
102
First line tx for acne
Topical antibiotics or comedolytics
103
Second line tx for acne
oral antibiotics + topical medications | Oral contraceptives
104
Third line tx for acne
Isotretinoin
105
Rosacea
Acneiform disorder that begins in midlife; symmetric rash on central part of face
106
First line tx or rosacea
Topical metronidazole
107
Second line tx for rosacea
If no improvement after 6 weeks Oral tetracycline DOC doxycycline, erythromycin, bactrim and isotretinoin can be tried

Pharmacology (56 decks)

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