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SBL Exam 2 > 3. Dermatologic Pharm > Flashcards

3. Dermatologic Pharm Flashcards

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1
Q

what are adverse effects of spironolactone

A

(contraindicated in preg)

menstrual irregularity, breast tenderness

minor GI symptoms

orthostatic hypotension

hyperK

dizzy, HA, Fatigue

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2
Q

Topical imidazoles block ergosterol synthesis, what are examples of these medications

A

Miconazole: cream/lotion; vaginal cream/suppository for vulvovaginal candidiasis

Clotrimazole: cream/lotion; vaginal cream/tablet for vulvovaginal candidiasis

Efinaconazole: onychomycosis treatment (give for 48 wks)

Ketoconazole: topical treatment for dermatophytosis & candidiasis; shampoo/foam for seborrheic dermatitis

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3
Q

what UV light therapy is used for moderate to severe psoriasis

A

UVB- (290-320 nm) radiation to point of erythema 3x/wk (+/-) topical tar; narrowband (311 nm) cause apoptosis of T cells at sub-erythema doses

PUVA- photochemotherapy - uses UVA - penetrate deep into skin w/o sunburn; ingest plant photosensitizer psorlen 2 hrs before treatment; 3x/wk - must protect from sun and have increased chance of melanoma

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4
Q

what do you need for adequate wound healing

A

oxygenation

nutrition

debridement

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5
Q

what is crisaborole

A

PDE4 inhibitor recently approved as topical therapy for dermatitis

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6
Q

what is the pathogenesis of follicular distention, rupture, inflammation in acne vulgaris

A
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7
Q

what type of skin would you use water based products labeled “noncomedogenic”

A

oily skin

to prevent acne

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8
Q

how does epidermal gorwth factor affect epithelialization

A

IT DOES NOT significantly improve epithelialization

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9
Q

what is the pharmacokinetics, MOA and effects of apremilast

A

take orally

MOA : (-) PDE4 –> increase cAMP in cell

effect = regulate inflam mediators, decrease NO synthase, TNF-alpha and IL23 & increase IL10

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10
Q

What are local anesthetics and what are they useful for

A

pramoxine 1-2.5% - OTC remedies alone w/ hydrocortisone ; use for pruritus on face & thats associated w/ CKD

lidocaine patch - for neuropathic pruritis

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11
Q

what is the ancient remedy for psoriasis?

A

tar

anti-prolif effects, largely displaced by less messy/odorous choices

can be useful adjunct for psoriasis

(topical tar used w/ UVB therapy)

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12
Q

what treatment is considered for melanoma

A
  1. surgical excision - w/ 1-2 cm margins, combined w/ sentinel node biopsy
  2. conventional chemo: Dacarbazine (+/- carmustine & tamoxifen) or (+/- cisplatin & vinblastin)
  3. MAP kinase pathway inhibitor- if BRAF V600D gene mutation present –> vemurafenib
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13
Q

what are the most/least resistant bacteria, viruses, protozoa & yeast?

A
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14
Q

What type of moisturizer do you choose for normal skin?

A

water-based moisturizer w/ light, nongreasy feel

-contain light weight oils, like cetyl alcohol, or silicone-derived ingredients like cyclomethicone

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15
Q

what can cause antibiotic resistance of bioflims

A

limited penetration

antibiotic neutralization

(enzymes, persistent cells non-replicative, biofilm phenotype, slow growth)

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16
Q

When it comes to wound dressing, what is the concensus on choice for :

debridement stage

granulation stage

epilthelialization stage

A

debridement stage- hydrogel

granulation stage- foam & low-adherence dressing

epilthelialization stage- hydrocolloid & low adherence dressing

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17
Q

what can be used to kill ectoparasites

A

malathion - organophosphate cholinesterase inhibitor

permethrin- bind to insect Na channels & block repol

ivermectin- binds to glutamate-gated Cl- –> hyperpolarize N & M. cells

lindane: disrupt GABAergic tranmission (use at last resort!)

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18
Q

what hormonal agents are used for acne treatment?

A

BC - (estrogen/progestin)

Spiranolactone - esp for women w/ menstrual cycle related breakouts on lower face

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19
Q

list the 1st choice of acne treatment from mild to severe

A
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20
Q

what is the treatment for alopecia areata

A

(chronic, relapsing immune mediated disorder–> non-scarring hairloss)

untreated - 50% grow back in < 1 yr but have recurrence

Tx: corticosteroids (intalesional or topical)

topical immunotherapy - diphenylcycloprpenone (DPCP) -cause contact dermatitis–> cause hair growth

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21
Q

what can be reasons for inadequate oxygenation

A

local vasoconstriction due to sympathetic overactivity

blood volume deficit, unrelieved pain, hypothermia

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22
Q

what are systemic therapies for pruritus?

(provide examples and use if needed)

A

antihistamine

antidepressants (mirtazapine - nocturnal pruritus & sertaline- cholestatic pruritis)

mu-opioid receptor antagonists ( naltrexone - cholestatic & CKD related)

k-opioid receptor agonist/mu-opioid receptor antagonist (butorphanol - nocturnl & intractable pruritus)

anticonvulsants (gabapentin & pregabalin - neuropathic pruritis)

substance P antagonist

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23
Q

what is anthralin

A

topical treatment for psoriasis

anti-inflam effects and slows the dz

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24
Q

what is the general principle for wound dressing

A

keep moist

not exposed to air

  • occluded wounds heal 40% faster and have less scarring
  • wounds are exposed to own fluid, mix of metalloproteases & cytokines
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25
what is the general application instructions for topical imidazoles? adverse effects?
1-2x/day application to the affected area - usually clear superficial dermatophyte infxn in 2-3 wks adverse effects = local - stinging, pruritis, erythema, iritation
26
What is amphotericin B
binds to fungal sterols **alters membrane permeability** topical Tx of **_cutaneous candida infxn_** well tolerated, possible yellow staining of skin
27
What oral acne medication is **absolutely contraindicated in pregnancy**? and why?
oral isotretinoin =teratogeniticty (also can cause mucocutaneous effects, hypertriglyceridemia, increased suicide ideation, etc)
28
what eye drops can be used to remove redness
all = adrenergic agonist naphazoline tetrahydrozoline phenylephrine oxymetazoline
29
What is ciclopirox
synthetic topical antimycotic agent, **disrupts macromolecular synthesis** active against _dermatophytes, candida & malassezia_ _low incidence_ of adverse rxns & contact dermatitis
30
The use of dilute iodine, chlorhexidine or hydrogen peroxide not necessary what are these examples of?
=**antiseptic wash sol'n** have minimal action against bacteria -potentially **impede** wound healing
31
what are home skin care recommendations for acne?
synthetic detergent cleanser (pH 5.5-7) w/ warm water 2x/day water based lotions, cosmetics and hair products
32
what are oral antibiotics used for acne?
tetracycline doxycycline minocycline erythromycin azithromycin trimethoprim-sulfamethoxazole
33
what is the MOA for chlorhexidine? Why is it used often in homes/hospitals
target cytoplasmic membrane - affect membrane integrity at [low] and congealing of cytoplasm at [high] **used as antimicrobial agent bc general efficacy on skin (& oral mucosa) & low irritablity**
34
what is the initial choice for mild to moderate psoriasis
emollients corticosteroids
35
what are chemical components that can be found in sunscreen
**PABA** - active in _UVB range_ **Benzophenones :** 250-360 nm (wide range but less effective than PABA) **dibenzylmethanes**: _UVA range_; useful for _drug induced photosensitivity_ & cutaneous lupus
36
what is the MOA for retinoids
37
What is Azaleic Acid
dicarboxylic acid (white powder in wheat, rye and barely - involved in plant defense response) **kills acne bacteria and decreases the production of keratin** Tx for mild-moderate acne and post-inflam hyperpigmentation
38
what are examples of moisturizer components that form an oily layer on top of skin and trap water in the skin
=**emollients** petrolatum, lanolin, mineral oil and dimethicone
39
what are characteristics of ointments:
mix of **20% h2o in 80% oil** **greasy and occlusive** - **stay on surface of skin** (not well abs) _Use for **dry skin -to trap moisture**_ -for **more complete Abs** **- less likely to cause allergic rxn** (compared to creams)
40
what is the pharmacokinetics, MOA and effects of secukinumab
subQ MOA: human monoclonal Ab - **target proinflam cytokine IL17a** effect: **blunt IL17a -\> decrease ability to induce production of proinflam signal molecules** (cytokines IL6, GC-CSF, IL1beta, TGF beta & alpha, chemokines IL8, GRO-alpha and NCP1 and prostoglandins)
41
Discuss the variables that affect cutaneous absorption & the steps of absorption
variables that affect abs: **regional:** ex. axilla more permable than forearm **concentration gradient**: increased concentration --\> drug mass/unit time **dosing schedule:** local half-life of skin reservoir affect dosing **occlusion/vehicle:** can maximize penetration
42
What is acyclovir
synthetic _guanine analog_ w/ inhibitory activity against **HSV-1 & 2** used for recurrent **orolabial HSV** in immuno**_competent_** adults =ointment, cream & buccal
43
who is most likely to get salicylate toxicity with prolonged use
kids people w/ reduced kidney or liver fxn
44
differentiate gels and pastes?
gels= polyionic colloids expanded w/ water pastes = mixture of oil, water and powder
45
when do you use dermal antibiotic therapy
for wounds that appear clinically infected \*_no evidence to support use for prophylaxis or healing non-infected wounds\*_
46
what is the clinical application and toxicites of apremilast
applications - **_moderate to severe plaque psoriasis,_** **_active psoriatic arthritis_** _(55% pt have \>= 75% reduction in psoariasis area and severity index (PASI)_ Toxicities: severe diarrhea, nausea, vomit, HA (most common CNS complaint)
47
what is the function of topical vitamin D analogs (calcipotriene and calcitriol)
reduce keratinocytes used in psoriasis
48
Define SPF
ratio of minimal erythema dose w/ sunscreen to the minimal erythema does w/o sunscreen
49
why is soap and water better than alcohol based hand disinfection?
alc-based hand disinfection NOT EFFECTIVE against **C.difficile**
50
Polymixin B MOA used for side effect
=peptide antibiotic, bind phophor-lipids to alter permeability & damage bacterial cytoplasmic membrane (against gram (-): Paeruginosa, E.coli, Enterobacter & Klebsiella) side effect: rarely cause allergic rxn
51
what type of moisturizer do you use for dry skin
heavier, oil based w/ antioxidants, grape seed oil or dimethicone (helps to keep skin hydrated) very dry skin - petrolatum to prevent water evaporation
52
Pt presents with chronic pain/pruritus and you tell them to eat chili peppers, jk take this medication that derived from chili peppers... why does this work
=**capsaisin -** activate transient release potential vanilloid-1, **TRPV-1**, on ion channel in cutaneous N fibers --\> stimulate neurons to release and eventually deplete certain neuropeptides (including substance P) **induce lasting desensitization** (cold is sensed & menthol cool by activating TRPM8)
53
what are the phases for wound healing & compare first intention vs second
54
what is the clinical application and toxicities of secukinumab
applications **- ankylosing spondylitis** **plaque psoriasis** **prosiatic arthritis** toxicities: **increase risk for infxn,** exacerbate IBD, hypersensitivity rxn
55
What happens when a pt takes 5-FU for actinic keratosis
decreased DNA synthesis bc inhibit thymidylate synthetase cause inflam and destruction of the lesion 4-6 wk progress from erythema through blistering, necrosis w/ erosin and then re-epithelialization
56
What are nonphamacologic interventions for pruritus?
**_skin moisturization_**- gentle cleanser & apply emollient daily **_cool environment-_** light wt clothing, air conditioned environment, cooling lotion, lukewarm shower/bath **_avoidance of skin irritants_** **_stres reduction-_** meditation, acupunture and yoga **_physical interventions-_** occlusive dressing to stop itch-scratch cycle
57
what is the fxn and examples of **humectants**
draw water into outer layer of skin ex: glycerin, lecithin and propylene glycol
58
What treatments are considered from advanced BCC
**vismodegib** or **sonidegib** (both hedgehog signaling pathway)
59
What is terbinafine
allylamine, selectively **inhibits squalene epoxidase** (key enxyme for synthesis of ergosterol) HIGHLY active against _dermatophytes_, less so for yeasts cream can cause _local irritation,_ avoid contact w/ mucous membranes
60
what are the clinical applications and toxicities for ustekinumab
application: **plaque psoriasis** **psoriatic arthritis** **Crohn dz** toxicity - _increase rise for infxn,_ SCC & hypersensitivity rxns
61
what are characteristics of creams:
mixture - **half h2o/half oil** w/ **emulsifier,** h2o evaporate **spread easily** (good for large SA!), **well absorbed,** **wash off w/ h2o** use of **_oozing/wet skin_** _BUT-_ too think to pump
62
what type of moisturizer do you use for sensitive skin
soothing ingredients (chamomile or aloe) w/o allergens or acids
63
Urea, alpha hydroxy acids (lactic, citric, glycolic) and allantoin are examples of .... how do they fxn?
=**horny substance (keratin) softners** loosening the bonds btn the top layer of cells helps dead skin fall off, helps the skin retain water and gives it a smoother, softer feeling
64
What is nystatin?
binds fungal sterols, **alters membrane permeablity** topical Tx of _cutaneous & mucosal_ **_candida infxns (only)_** (_hold in mouth before swallowing)_, narrow spectrum & negligible abs from GI tract non-irritating topically, mild nausea/diarrhea if swallowed
65
what are 5 circumstances to wash hands to save lives!?
before touching pt before cleaning/aseptic procedures after body fluid exposure/risk after touching pt after touching pt surrounding
66
where are human scabies mites often found?
btn fingers and on wrists
67
What is the peptide antibiotic that inhibits bacterial cell wall synthesis? used for? effects?
**bacitracin** (target gram (+), most anaerobic cocci, neisseriae, tetanus bacilli, diphtheria bacilli) side effect: allergic contact dermatits & rarely allergic contact urticaria (poorly abs thru skin- systemic effects rare)
68
what is the purpose of wound debridement? what are the types of debridement?
-remove dead tissue and debris - promote wound healing by limiting protease production & conserving the resources for healing 1. **low pressure irrigation w/ normal saline:** _ROUTINE!_ -flush out bacteria and remove loose material 2. **surgical:** appropriate for _removing large areas of necrotic/infected tissue_ 3. **enzymatic:** collagenase may promote endothelial and keratinocyte migration for angiogenesis & epithelialization (mixed results) 4. **biologic:** _maggot therapy has neg perception_ - results in liquefaction of necrotic tissue while leaving healthy intact - _BUT pressure ulcer healing time is not consistent_
69
Salicyclic acid is a COX inhibitor, used for anti-inflam and found in many skin care products..why?
1. _epidermal cells to shed more readily_ (keratolytic) --\> dissolve the intercellular cement; applied in more concentrated sol'ns to calluse for hour and wash away 2. _antibacterial properties_ 3. _open clogged pores_ \*treated areas will be photosensitive: protect from sun\*
70
what are the exceptions of antibiotic therapy when it comes to prophylaxis or treating non-infected wounds
**cadexomer iodine-** reduce bacterial load while providing moist wound environment **silver-** toxic to bacteria & widely used by clinicals to decrease bacterial surface contamination; but rate of healing NOT improved
71
what medications can be used for Rosacea
**brimonidine - alpha2**-agonist; topical **gel**; --\> (+) postsyn vascular alpha2 --\> vasoconstrict **oxymetazoline**- **alpha1a & alpha2** agonist; topical **cream**; vasoconstrict
72
what is the pharmacokinetics, MOA and effects of ustekinumab
subQ at 8-12 wk intervals MOA: human monoclonal Ab - **target proinflam cytokines IL12 & IL23** effect= **blunts IL12/IL23 --\>** decrease NK cell activation, CD4 Tcell differentiation and activtion and MCP-1, TNF-alpha, CXCL-10 and IL-8 expressoin
73
Neomycin: MOA? Used for? Side effects?
aminoglycoside antibiotic that binds 30S to inhibit protein synthesis (against gram (-)) side effect = allergic contact dermatitis, cross-sensitization to other aminoglycosides (poorly abs so systemic detection rare)
74
what is becaplermin?
**platelet derived growth factor --\> promote cell proligeration & angiogenesis** **_ONLY_ agent approved for treatment of chronic diabetic foot ulcers** _black box warning for malignancy_
75
what are the treatment options for actinic keratosis
* liquid nitrogen cryotherapy * surgical * pharm - _topical 5-FU, imiquimod, ingenol mebutate, topical diclofenac and retinoids_ * photodynamic (red light) therapy * dermabrasion * chemical peel
76
what are systemic therapies used for psoriasis
methotrexate **_apremilast_**- PDE4 inhibitor; side-effect -short-term diarrhea retinoids systemic calcineurin inhibitors biological agents- **ustekinumab** (IL12 & IL23 mAB) **& secukinumab/izekuzumab** (IL17a AB)
77
What is tolnaftate
synthetic antifungal compounds - **distort hyphae/stunt mycelial growth** effectively topically against _various dermatophytes & malessezia infxn_ (not candida) rarely cause irritation of allergic contact dermatitis
78
what are the treatments for male pattern baldness & their respective mechanisms
1. **minoxidil**- vasodilate b/c K-channels open; increase growth phase (anagen), shorten rest phase (telogen) and enlarge miniaturized follicles 2. **finasteride**; oral --\> (-) DHT production (cause sexual dysfxn 3. **surgery**​- trasplant hair follicle units
79
how does glycemic control affect wound heeling
primary closure of surgical wounds in high-risk pts, poor glycemic control ==\> worse outcome -even single elevated glucose postop is adversly associated w/ morbidity and mortality
80
what is the difference btn UVB and UVA radiation & what do each cause
UVB = 280-320 nm --\> **erythema/sunburn, skin aging & photocarginogenesis** UVA = 320-400 nm --\> **skin aging and CA**
81
What is used for female pattern hair loss?
* **minoxidil** (1st line) * **anti-androgen** (2nd line) 1. _spironolactone_ (androgen partial agonist) 2. _finasteride_ (block DHT synthesis) 3. _flutamide_ (androgen antagonist)
82
what is an example of an opaque material that reflects light
titanium dioxide =sunshades!
83
What are the components for Tretinoin and what are the side effect?
creams, polyolprepolymer-2 cream, gels, microsphere gels, polyolprepolymer-2 gel & micronized gell _side effect = local skin irritation, dryness and flaking; sun sensitivity_ _\*contain fish protien - ask about fish allergy!_ (used in acne treatments)
84
when should you suspect malnutrition
\*chronic illnesses \*inadequate societal support \*multisystem trauma \*GI/neuro problems \*must address protein-cal malnutrition and vitamin/mineral def
85
how does chlorhexidine act on: bacterial spores mycobacteria nonsporulating bacteria yeast viruses protozoa
1. **bacterial spores-** not sporicidal but (-) spore formation/outgrowth 2. **mycobacteria-** mycobacteriostatic 3. **nonsporulating bacteria-** _membrane active_; cause protoplast & sheroplast lysis; [high] cause protein and nucleic acid precipitation 4. **yeast-** _membrane active;_ protoplast lysis and intracel leakage, [high] cause intracel coagulation 5. **viruses-** low activity; lipid enveloped viruses more sensitive that nonenveloped 6. **protozoa-** against trophozoites
86
which topical therapies are used for anogenital pruritus (transient burning/stinging)
**topical calcineurin inhibitors** tacrolimus 0.03 & 0.1% ointment pimecrolimus 1 cream
87
what type of moisturizer do you use for mature skin
oil-based w/ petrolatum as base to keep hydrated plus antioxidants/alpha hydroxy acids (for wrinkles)
88
What is the cause of neuropathic localized pruritus w/o primary rash?
due to compresson/degeneration of Ns in the skin en route to the spine or in the spine itself
89
how does the use of topical steroid vary throughout the body based on potency
low potency - face, genital and skin folds high - everywhere else to gain control and titrate down for maintanance
90
which oral acne medication is contraindicated in pregnancy and young children ?
tetracycline -(bc it can cause yellowing of teeth) doxycycline minocycline
91
What topical antimicrobials are used for acne & what are their side effects?
**benzoyl peroxide -** local skin irritation; may bleach hair/clothes **clindamycin-** rare risk of pseudomembrnous colitis **erythromycin**
92
what anti-rejection medication can also be used for psoriasis
calcineurin inhibitors | (tacrolimus, pimecrolimus)

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