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SBL Exam 2 > 3. Dermatologic Pharm > Flashcards

3. Dermatologic Pharm Flashcards

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
Q

what is the general application instructions for topical imidazoles?

adverse effects?

A

1-2x/day application to the affected area - usually clear superficial dermatophyte infxn in 2-3 wks

adverse effects = local - stinging, pruritis, erythema, iritation

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26
Q

What is amphotericin B

A

binds to fungal sterols alters membrane permeability

topical Tx of cutaneous candida infxn

well tolerated, possible yellow staining of skin

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27
Q

What oral acne medication is absolutely contraindicated in pregnancy? and why?

A

oral isotretinoin

=teratogeniticty

(also can cause mucocutaneous effects, hypertriglyceridemia, increased suicide ideation, etc)

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28
Q

what eye drops can be used to remove redness

A

all = adrenergic agonist

naphazoline

tetrahydrozoline

phenylephrine

oxymetazoline

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29
Q

What is ciclopirox

A

synthetic topical antimycotic agent, disrupts macromolecular synthesis

active against dermatophytes, candida & malassezia

low incidence of adverse rxns & contact dermatitis

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30
Q

The use of dilute iodine, chlorhexidine or hydrogen peroxide not necessary

what are these examples of?

A

=antiseptic wash sol’n

have minimal action against bacteria

-potentially impede wound healing

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31
Q

what are home skin care recommendations for acne?

A

synthetic detergent cleanser (pH 5.5-7) w/ warm water 2x/day

water based lotions, cosmetics and hair products

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32
Q

what are oral antibiotics used for acne?

A

tetracycline

doxycycline

minocycline

erythromycin

azithromycin

trimethoprim-sulfamethoxazole

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33
Q

what is the MOA for chlorhexidine?

Why is it used often in homes/hospitals

A

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

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34
Q

what is the initial choice for mild to moderate psoriasis

A

emollients

corticosteroids

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35
Q

what are chemical components that can be found in sunscreen

A

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

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36
Q

what is the MOA for retinoids

A
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37
Q

What is Azaleic Acid

A

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
Q

what are examples of moisturizer components that form an oily layer on top of skin and trap water in the skin

A

=emollients

petrolatum, lanolin, mineral oil and dimethicone

39
Q

what are characteristics of ointments:

A

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
Q

what is the pharmacokinetics, MOA and effects of secukinumab

A

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
Q

Discuss the variables that affect cutaneous absorption & the steps of absorption

A

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
Q

What is acyclovir

A

synthetic guanine analog w/ inhibitory activity against HSV-1 & 2

used for recurrent orolabial HSV in immunocompetent adults

=ointment, cream & buccal

43
Q

who is most likely to get salicylate toxicity with prolonged use

A

kids

people w/ reduced kidney or liver fxn

44
Q

differentiate gels and pastes?

A

gels= polyionic colloids expanded w/ water

pastes = mixture of oil, water and powder

45
Q

when do you use dermal antibiotic therapy

A

for wounds that appear clinically infected

*no evidence to support use for prophylaxis or healing non-infected wounds*

46
Q

what is the clinical application and toxicites of apremilast

A

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
Q

what is the function of topical vitamin D analogs (calcipotriene and calcitriol)

A

reduce keratinocytes

used in psoriasis

48
Q

Define SPF

A

ratio of minimal erythema dose w/ sunscreen to the minimal erythema does w/o sunscreen

49
Q

why is soap and water better than alcohol based hand disinfection?

A

alc-based hand disinfection NOT EFFECTIVE against C.difficile

50
Q

Polymixin B

MOA

used for

side effect

A

=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
Q

what type of moisturizer do you use for dry skin

A

heavier, oil based w/ antioxidants, grape seed oil or dimethicone (helps to keep skin hydrated)

very dry skin - petrolatum to prevent water evaporation

52
Q

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

A

=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
Q

what are the phases for wound healing

& compare first intention vs second

A
54
Q

what is the clinical application and toxicities of secukinumab

A

applications - ankylosing spondylitis

plaque psoriasis

prosiatic arthritis

toxicities: increase risk for infxn, exacerbate IBD, hypersensitivity rxn

55
Q

What happens when a pt takes 5-FU for actinic keratosis

A

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
Q

What are nonphamacologic interventions for pruritus?

A

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
Q

what is the fxn and examples of humectants

A

draw water into outer layer of skin

ex: glycerin, lecithin and propylene glycol

58
Q

What treatments are considered from advanced BCC

A

vismodegib or sonidegib

(both hedgehog signaling pathway)

59
Q

What is terbinafine

A

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
Q

what are the clinical applications and toxicities for ustekinumab

A

application: plaque psoriasis

psoriatic arthritis

Crohn dz

toxicity - increase rise for infxn, SCC & hypersensitivity rxns

61
Q

what are characteristics of creams:

A

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
Q

what type of moisturizer do you use for sensitive skin

A

soothing ingredients (chamomile or aloe)

w/o allergens or acids

63
Q

Urea, alpha hydroxy acids (lactic, citric, glycolic) and allantoin are examples of ….

how do they fxn?

A

=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
Q

What is nystatin?

A

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
Q

what are 5 circumstances to wash hands to save lives!?

A

before touching pt

before cleaning/aseptic procedures

after body fluid exposure/risk

after touching pt

after touching pt surrounding

66
Q

where are human scabies mites often found?

A

btn fingers and on wrists

67
Q

What is the peptide antibiotic that inhibits bacterial cell wall synthesis?

used for?

effects?

A

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
Q

what is the purpose of wound debridement?

what are the types of debridement?

A

-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
Q

Salicyclic acid is a COX inhibitor, used for anti-inflam and found in many skin care products..why?

A
  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
Q

what are the exceptions of antibiotic therapy when it comes to prophylaxis or treating non-infected wounds

A

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
Q

what medications can be used for Rosacea

A

brimonidine - alpha2-agonist; topical gel; –> (+) postsyn vascular alpha2 –> vasoconstrict

oxymetazoline- alpha1a & alpha2 agonist; topical cream; vasoconstrict

72
Q

what is the pharmacokinetics, MOA and effects of ustekinumab

A

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
Q

Neomycin:

MOA?

Used for?

Side effects?

A

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
Q

what is becaplermin?

A

platelet derived growth factor –> promote cell proligeration & angiogenesis

ONLY agent approved for treatment of chronic diabetic foot ulcers

black box warning for malignancy

75
Q

what are the treatment options for actinic keratosis

A
  • liquid nitrogen cryotherapy
  • surgical
  • pharm - topical 5-FU, imiquimod, ingenol mebutate, topical diclofenac and retinoids
  • photodynamic (red light) therapy
  • dermabrasion
  • chemical peel
76
Q

what are systemic therapies used for psoriasis

A

methotrexate

apremilast- PDE4 inhibitor; side-effect -short-term diarrhea

retinoids

systemic calcineurin inhibitors

biological agents- ustekinumab (IL12 & IL23 mAB) & secukinumab/izekuzumab (IL17a AB)

77
Q

What is tolnaftate

A

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
Q

what are the treatments for male pattern baldness & their respective mechanisms

A
  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
Q

how does glycemic control affect wound heeling

A

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
Q

what is the difference btn UVB and UVA radiation & what do each cause

A

UVB = 280-320 nm –> erythema/sunburn, skin aging & photocarginogenesis

UVA = 320-400 nm –> skin aging and CA

81
Q

What is used for female pattern hair loss?

A
  • minoxidil (1st line)
  • anti-androgen (2nd line)
    1. spironolactone (androgen partial agonist)
    2. finasteride (block DHT synthesis)
    3. flutamide (androgen antagonist)
82
Q

what is an example of an opaque material that reflects light

A

titanium dioxide

=sunshades!

83
Q

What are the components for Tretinoin and what are the side effect?

A

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
Q

when should you suspect malnutrition

A

*chronic illnesses

*inadequate societal support

*multisystem trauma

*GI/neuro problems

*must address protein-cal malnutrition and vitamin/mineral def

85
Q

how does chlorhexidine act on:

bacterial spores

mycobacteria

nonsporulating bacteria

yeast

viruses

protozoa

A
  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
Q

which topical therapies are used for anogenital pruritus (transient burning/stinging)

A

topical calcineurin inhibitors

tacrolimus 0.03 & 0.1% ointment

pimecrolimus 1 cream

87
Q

what type of moisturizer do you use for mature skin

A

oil-based w/ petrolatum as base to keep hydrated

plus antioxidants/alpha hydroxy acids (for wrinkles)

88
Q

What is the cause of neuropathic localized pruritus w/o primary rash?

A

due to compresson/degeneration of Ns in the skin

en route to the spine or in the spine itself

89
Q

how does the use of topical steroid vary throughout the body based on potency

A

low potency - face, genital and skin folds

high - everywhere else to gain control and titrate down for maintanance

90
Q

which oral acne medication is contraindicated in pregnancy and young children ?

A

tetracycline -(bc it can cause yellowing of teeth)

doxycycline

minocycline

91
Q

What topical antimicrobials are used for acne & what are their side effects?

A

benzoyl peroxide - local skin irritation; may bleach hair/clothes

clindamycin- rare risk of pseudomembrnous colitis

erythromycin

92
Q

what anti-rejection medication can also be used for psoriasis

A

calcineurin inhibitors

(tacrolimus, pimecrolimus)

SBL Exam 2 (8 decks)

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