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IPT: Derm > Block 2 > Flashcards

Block 2 Flashcards

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1
Q

What is the MOA of anti-allergy medications for the eye?

A

H1 receptor blocker

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2
Q

Anti-Cholinergic MOA + eye?

A

Inhibits glandular secretions

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3
Q

Beta blocker MOA + eye?

Non-selective MOA?

A

Reduces lysozyme lvls and IgA

Non-selective = reduces IOP by decreasing aqueous formation by ciliary body

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4
Q

What Rx causes band keratopathy?

A

Diuretics

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5
Q

What Rx causes vortex keratopathy?

A

Amiodarone + Chloroquine/Hydroxychloroquine

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6
Q

What are the side effects of Amiodarone + eye?

A
  1. Vision loss
  2. Pseudotumor cerebri
  3. Haloes
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7
Q

What is pseudotumor cerebri and what causes it?

A

Increased intracranial pressure leading to optic nerve swelling and eventually vision loss

  • Amiodarone
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8
Q

What are the side effects of Digoxin + eye?

A
  1. Red/Green color defect
  2. Xanthopsia
  3. Flashes of light
  4. Reduces IOP
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9
Q

Digoxin MOA + eye?

A

Inhibits Na-K ATPase pump

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10
Q

What are some side effects of anticoagulants and antiplatelets and eye?

A

Subconjunctival and retinal hemorrhage

Chronic use = yellowing of vision

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11
Q

What are the side effects of Accutane + eye?

A
  1. Blepharoconjunctivitis
  2. Night blindness
  3. Contact lens intolerance
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12
Q

What drugs cause hyperpigmentation and dark deposits in palpebral conjunctiva?

A

Tetracyclines

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13
Q

Tetracyclines can cause what to the eye?

A

Hyperpigmentation and dark deposits in palpebral conjunctiva

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14
Q

What is blepharoconjunctivitis and what causes it?

A

Swelling of lids and conjunctiva

  • Accutane
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15
Q

How would you manage tetracycline + eye issues?

A

d/c Rx

Oral steroids and/or diamox to reduce intracranial pressure

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16
Q

How would you manage amiodarone + eye issues?

A

Frequent eye exams (q6months), decrease dose or d/c Rx

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17
Q

What drugs have irreversible damages to the eye?

A

Chloroquine and Hydroxychloroquine

Maybe…Anti-tuberculosis Rx…?

Phosphodiesterase agents

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18
Q

How would you manage chloroquine/hydroxychloroquine + eye?

A
  1. Baseline testing before starting Rx, then annual exam

2. If toxicity is found, immediately d/c

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19
Q

Chloroquine/Hydroxychloroquine can cause what to the eye?

A
  1. Bulls-eye maculopathy
  2. Vortex keratopathy
  3. Ptosis
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20
Q

What specifically do chloroquine and hydroxychloroquine target in the eye?

A

High affinity to melanin and toxic to retina

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21
Q

What specifically do anti-tuberculosis Rx target in the eye?

A

Chelates copper

Decreased levels impair mitochondrial activity and leads to optic neuropathy

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22
Q

What specifically do anti-hyperglycemics target in the eye?

A

Activate PPAR-gamma which leads to fluid retention in retinal vasculature

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23
Q

Corticosteroids can cause what to the eye?

A

Cataracts (posterior lens opacity)
Increased IOP
+ Glaucoma

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24
Q

What drugs can cause macular edema?

A

Hyperglycemics

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25
Q

What drugs for the eye can cause cataracts and increased IOP?

A

Corticosteroids

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26
Q

Tamsulosin can cause what to the eye?

A

Floppy Iris Syndrome

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27
Q

How would you manage Tamsulosin + eye?

A

D/c Rx prior to cataract surgery otherwise no harm

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28
Q

What drugs can cause Non-Arteritic Anterior Ischemic Optic Neuropathy?

A

Phosphodiesterase agents

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29
Q

Phosphodiesterase agents can cause what to the eye?

A

Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

Changes in color perception

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30
Q

Which glaucoma is considered an emergency if it were to happen?

A

Primary angle closure glaucoma; vision loss can occur within hours

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31
Q

How does primary open angle glaucoma present?

A

Bilateral but asymmetric (one eye is more severely affected vs the other)

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32
Q

What is glaucoma?

A

Progressive structural and/or functional damage to optic nerve fibers

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33
Q

What is a normal IOP?

A

10 to 21

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34
Q

What is the post-cataract surgery Tx plan for cataracts?

A
  1. Abx
  2. Steroids
  3. NSAIDs (best for reducing retinal inflammation)
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35
Q

What is the primary Tx option for cataracts?

A

Surgery

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36
Q

What is the pathophysiology of cataract formation?

A

Swelling of lens + liquefaction of collagen fiber cells, leads to opacification of cells and color of lens change

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37
Q

Where are corticosteroids synthesized?

A

Adrenal cortex

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38
Q

When is the production of cortisol the greatest? Least?

A

Greatest - early morning or during food intake, stress, emotion

Least - during the night

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39
Q

(Glucocorticoids/Mineralocorticoids) have anti-inflammatory potency

A

Glucocorticoids

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40
Q

(Glucocorticoids/Mineralocorticoids) have Sodium-retaining potency

A

Mineralocorticoids

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41
Q

All natural corticosteroids are derived from _______ and have a __-ring structure

A

Cholesterol

4

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42
Q

Where does metabolism of corticosteroids occur?

A

Liver

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43
Q

When should cortisone or prednisone not be prescribe to someone?

A

Severe hepatic failure or with rare condition of cortisone reductase deficiency

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44
Q

Severe hepatic failure is contraindicated for which corticosteroid?

A

Prednisone and cortisone

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45
Q

C11B-OH is found in which corticosteroid?

A

Prednisone and cortisone

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46
Q

Introduction of an additional C1=C2 double bond does what to corticosteroids?

A

Increases glucocorticoid activity only

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47
Q

What does alpha-fluorination at C9 do for corticosteroids?

A

Increases both glucocorticoid and mineralocorticoid activity

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48
Q

What does substitution at C16 do for corticosteroids?

A

Increases glucocorticoid activity only; completely takes away mineralocorticoid activity

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49
Q

What hormone does the hypothalamus release?

A

Corticotropin releasing hormone

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50
Q

What hormone does the pituitary gland release?

A

Adrenocorticotropic hormone

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51
Q

Cortisol is a (glucocorticoid/mineralocorticoid)

A

Glucocorticoid

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52
Q

Aldosterone is a (glucocorticoid/mineralocorticoid)

A

Mineralocorticoid

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53
Q

What are the negative effects of the HPA axis?

A

Adrenocorticotropic hormone on hypothalamus

Cortisol on both anterior and hypothalamus

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54
Q

Prolonged use of glucocorticoids produces _______ wasting

A

muscle

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55
Q

How long do intranasal glucocorticoids takes to become effective?

A

Several days to one week

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56
Q

How long do intranasal glucocorticoids take to reach maximal efficacy?

A

2 - 3 weeks

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57
Q

What are some advantages of using intranasal glucocorticoids vs antihistamines

A

Reduce rhinorrhea and congestion

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58
Q

What kind of infections are common with inhaled corticosteroids for asthma?

A

Candida albicans

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59
Q

What are some side effects of intranasal glucocorticoids?

A

Sore throat
Epistaxis (nose bleed)
Headache

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60
Q

What is the most potent topical glucocorticoid?

A

Betamethasone
Diflorasone
Clobetasol

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61
Q

How often are topical glucocorticoids applied?

A

Twice daily

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62
Q

Which glucocorticoids should you avoid putting on the face?

A

Fluorinated glucocorticoids

Triamcinolone
Betamethasone

Next 2 are not topical:
Fludrocortisone
Dexamethasone

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63
Q

Most drug allergies are Type ___ mediated

A

I

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64
Q

Serum sickness is a type ____ hypersensitivity

A

III

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65
Q

What drugs are associated with serum sickness?

A

Antitoxin and anti-venom serums

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66
Q

Drug rash with eosinophilia and systemic symptoms is composed of a triad of:

A
  • Maculopapular rash (with facial/neck edema)
  • Eosinophilia (>1500 or atypical lymphocytes)
  • Internal/systemic organ involvement
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67
Q

What drugs are associated with Drug rash with eosinophilia and systemic symptoms?

A

Phenytoin
Allopurinol
Lamotrigine
Sulfonamides

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68
Q

Drug rash with eosinophilia and systemic symptoms is a type _____ hypersensitivity

A

IV

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69
Q

What drugs are associated with drug fever?

A

Tetracycline
Sulfonamides
Phenytoin
Carbamazepine

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70
Q

What drugs are associated with vasculitis?

A

Beta lactams
Sulfonamides
Thiazide
Phenytoin

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71
Q

What is the most common medication allergy reported?

A

PCN allergy

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72
Q

Which allergy can cause all type I - IV hypersensitivity?

A

PCN allergy

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73
Q

Who are not candidates for skin testing or drug challenges?

A

Non-IgE mediated rxn

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74
Q

Can you diagnose based on reaction for a skin allergy test?

A

Nope, poor predictor

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75
Q

What are some pros and cons of PCN skin allergy testing (Pre-Pen)?

A

Good-

  • Antimicrobial stewardship
  • Less deviation from guidelines
  • Negative predictive power (97-99%)

Bad -

  • Tests only IgE rxn
  • Pre-pen contraindicated (hypersensitivity, etc)
  • Minor determinants is recommended
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76
Q

NSAIDs can cause type _____ hypersensitivity

A

I and IV

I - urticaria, angioedema, anaphylaxis

IV - delayed hypersensitivity

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77
Q

Insulin can cause type ____ hypersensitivity

A

I, III, and IV

I - most common
III - SQ nodule at site
IV - rxn to additives

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78
Q

How long does Drug Rash with Eosinophilia and Systemic Symptoms take to develop?

A

Delay; 3 - 8 weeks

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79
Q

How long does a drug fever take to develop?

A

7 to 10 days

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80
Q

Allergy to penicillin is due to what?

A

R1 side chain

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81
Q

If someone has a true IgE mediated allergy and they conduct a PCN allergy test with a positive result and no alternative, what do you do?

A

PCN desensitization

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82
Q

If someone has a true IgE mediated allergy and they conduct a PCN allergy test with a positive result and an alternative is available, what do you do?

A

Administer alternative

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83
Q

If someone has a true IgE mediated allergy and they conduct a PCN allergy test with a negative result, what do you do?

A

Administer PCN

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84
Q

If someone has a true IgE mediated allergy, should you do a PCN allergy test?

A

Yes

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85
Q

If someone has a urticarial skin reaction to an aminopenicillin, should you do a PCN allergy test?

A

Yes

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86
Q

If someone has a non IgE mediated allergy, should you do a PCN allergy test?

A

No, administer PCN

No testing involved

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87
Q

If someone has a non-immediate reaction, should you do a PCN allergy test?

A

No, do not administer PCN nor test

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88
Q

Pre-pen, what is the major and minor determinant?

A

Major - Benzylpenicilloyl polylysine

Minor - Pen G

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89
Q

When would you desensitize a patient with an alternative Rx besides PCN?

A

True IgE mediated allergy
Positive PCN test
No alternative available

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90
Q

When would you administer an alternative Rx besides PCN?

A

True IgE mediated allergy
Positive PCN test
Alternative available

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91
Q

When would you not administer Rx test nor drug for PCN allergy?

A

Non-immediate rxn

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92
Q

When would you administer Rx without a skin test?

A

No suggestion of IgE mediated allergy

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93
Q

What types of Rx would interfere with skin allergy testing?

A

Antihistamines

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94
Q

Which enzyme via NSAIDs potentially causes hypersensitivity?

A

Inhibition of COX-1

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95
Q

Dermatologic effects via sulfonamides are higher in what population group?

A

HIV/AIDS

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96
Q

Sulfonamides present _____ hypersensitivity

A

delayed

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97
Q

What is anaphylactic shock?

A

Vasodilation and reduction in effective plasma volume

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98
Q

Is anaphylactoid reaction immune mediated?

A

Nope

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99
Q

How does anaphylaxis present?

A

Slow heart rate
Wheezing
NVD
Swelling

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100
Q

How would you treat anaphylaxis?

A

IM or SC epinephrine

0.01mg/kg up to 0.5mg

Repeat every 5 to 20 mim

Should be given within 20 min

Also give fluids to restore intravascular volume

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101
Q

How does urticaria present?

A

Edema in superficial dermas

Red raised rash w/ wheal and flare lesions

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102
Q

How would you treat urticaria?

A

2nd gen antihistamine for 2 weeks. May increase dose if symptoms exist by 4x it

If symptoms still exist, add leukotriene antagonist and/or change antihistamine

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103
Q

What is the last line treatment for urticaria after youve tried everything?

A 
Cyclosporine
1st gen antihistamine
MMF
Azathioprine
Omalizumab
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104
Q

How does angioedema present?

A

Non-pitting edema

Affects deep layers of epidermis, and hypodermis

Hereditary or drug induced

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105
Q

What drugs can cause angioedema?

A

ACEi, ARBs, NSAIDs during 1st month of initiation

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106
Q

What causes drugs to inflict angioedema?

A

Elevated levels of bradykinin

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107
Q

How would you treat angioedema?

A

Depends if it’s mast cell mediated or bradykinin mediated

Mast cell - high dose antihistamine, corticosteroid, epi

Bradykinin - frozen plasma, C1 inhibitor (ecallantide)

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108
Q

Abrasions vs incisions, which is more likely to get infected and why?

A

Abrasions; rubbed off

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109
Q

What is the general wound healing process?

A

Coagulation/hemostasis
Inflammation
Proliferation/repair
Maturation/remodeling

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110
Q

What happens in the coagulation/hemostasis wound healing process?

A
  1. Vascular response to injury which releases epi
  2. Vasoconstriction and platelet aggregation
  3. Platelet plug forms and releases growth factor to begin healing
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111
Q

What happens in the inflammatory wound healing process?

A
  1. Leukocytes and macrophages go to wound
  2. Remove bacteria and releases proteases and cytokines
  3. Degrade damaged portions of matric and release more growth factor
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112
Q

What happens in the proliferation/repair wound healing process?

A
  1. Dermal regeneration via angiogenesis, epithelialization, fibroblast formation, wound contraction
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113
Q

What happens in the maturation/remodeling wound healing process?

A
  1. Collagen reorganizes and remodels

2. Strengthens wound tissue within 3 months

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114
Q

How long is the inflammatory phase of wound healing?

A

4 to 6 days

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115
Q

How long is the proliferation/repair phase of wound healing?

A

4 to 60 days

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116
Q

How long is the maturation/remodeling phase of wound healing?

A

60 days to 2 years

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117
Q

What are the goals of wound care?

A
  1. Facilitate hemostasis
  2. Decrease tissue loss
  3. Promote wound healing
  4. Minimize scar formation
  5. Minimize complications
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118
Q

What medications slow down wound healing?

A

Systemic glucocorticoids, NSAIDs, and chemo

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119
Q

How does necrotic tissue impede wound healing?

A

Delays development of granulation tissue and re-epithelialization

Increases bacterial growth`

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120
Q

Why is it important for a moisture balance for wound healing?

A

Moist wounds heal 2-3x faster

Facilitates autolytic debridement

Promotes cell growth

Too much moisture can lead to surrounding tissue damage though :/

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121
Q

When is an absorbent dressing used?

A

Soak up drainage

May cause damage to surrounding skin upon removal

122
Q

When is a foam dressing used?

A

Soak up drainage on partial or full thickness wounds

Packs in deep cavity wounds to prevent premature closure

123
Q

When is hydrogel used?

A

Minimal or no drainage, painful and dry wounds, burns

124
Q

When is a hydrocolloid used?

A

Light draining wounds, DO NOT use in dry wounds or in wounds with bone or muscle

125
Q

When is an alginate used?

A

High drainage, but requires a secondary dressing

126
Q

When is a film dressing used?

A

Dry superficial wounds

127
Q

When are compression dressings used?

A

Apply compression to treat venous ulcerations

128
Q

When is a protease modulating dressing used?

A

Associated with angiogenesis and cleanses wound

Degrades collagen which assist in tissue remodeling

129
Q

When is a negative pressure wound therapy used?

A

Enhance blood flow, reduce edema, limit bacterial proliferation, acceleration granulation

130
Q

What are the cutaneous red flag signs from drug reactions?

A

BUMP CF

Blisters
Ulcers
Mucosal involvement
Palpable purpura

Confluent erythema
Facial edema

131
Q

What are the systemic red flag signs from drug reactions?

A

SLASH F

SOB, wheezing
Lymphadenopathy
Arthralgias
Skin tenderness
Hypotension

Fever

132
Q

What are the red flag laboratory findings from drug reactions?

A

LFT>3x ULN
Eosinophilia
Neutropenia

133
Q

What Rx causes skin pigmentation?

A

Amiodarone

134
Q

Which cutaneous drug reaction does amiodarone cause?

A

Skin pigmentation (blue-grey color)

135
Q

What is the physiology behind skin pigmentation?

A

Either increased melanin activity or increased deposition of Rx

136
Q

Which hair cycle phase is affected by drug induced hair disorders like hair loss?

A

Telagen, Anagen

137
Q

What Rx causes onycholysis?

A

Tetracyclines, NSAIDs

138
Q

What is the physiology behind warfarin-induced skin necrosis?

A

Reduction in protein C

139
Q

How do you treat warfarin-induced skin necrosis?

A

Vit. K, heparin, surgical debridement, wound care

140
Q

How do you treat red man syndrome?

A

Antihistamines, baths, antipyretics, short course of corticosteroids, plasmapheresis, IVIG, immunomodulatory RX

141
Q

How do you treat maculopapular eruptions?

A

Antihistamines, baths, short course of topical glucocorticoids

142
Q

How do you treat pustular eruptions?

A

Moisturizers, topical corticosteroids, antihistamines, analgesics

143
Q

Where do fixed drug eruptions occur?

A

Lips, hands, legs, genitalia, oral mucosa

144
Q

What are the signs/symptoms of vasculitis?

A

SOB/cough
Numbness in hands/feet
Red spots, lumps, sores

145
Q

Vasculitis is a type ____ hypersensitivity

A

III

146
Q

How do you treat serum sickness?

A

IV corticosteroids x 3 days then oral corticosteroids

If no response; then plasmapheresis or IVIG

147
Q

How does serum sickness present?

A

Triad of fever, rash, and joint pain

148
Q

What is the physiology behind Steven Johnsons Syndrome or Toxic epidermal necrolysis?

A

Drug metabolisms trigger T cell cytotoxic rxn to drug stimulus

Genetic predisposition

149
Q

How do you treat SJS or TEN?

A

No specific treatment

Supportive care, cyclosporine, plasmapheresis, IVIG

150
Q

What is the universal sign of anaphylaxis?

A

Scratching

Itching of throat, mouth, lips

151
Q

Allopurinol can cause what cutaneous drug reaction?

A

Maculopapular eruptions

Can cause DRESS, SJS, TEN

Pts with HLA B*5801 are highly susceptible

152
Q

Which HIV Rx can cause maculopapular eruptions?

A

Nevirapine

153
Q

Nevirapine can cause what cutaneous drug reaction?

A

Maculopapular eruptions

Can cause SJS or TEN

To minimize effect, slowly titrate dose

154
Q

Which Rx reactions correlates with HLA B*5701?

A

Abacavir

155
Q

Which Rx reactions correlates with HLA B*5801?

A

Allopurinol

156
Q

What kind of contrast causes cutaneous drug reactions?

A

High osmolality

157
Q

How do you treat high osmolality contrast reactions?

A

Pre treat with prednisone and diphenhydramine

158
Q

Which anticonvulsants are of concern for cutaneous drug reactions?

A

Phenobarbital
Phenytoin
Carbamazepine
Lamotrigine

Pseudolymphoma syndrome and gingival hyperplasia risk with aromatic anticonvulsants

159
Q

Which specific anticonvulsant is the biggest concern?

A

Lamotrigine

Unclear if rxn is diminished with slow titration in dose

Valproate + lamotrigine increases risk

160
Q

(T/F) Fixed drug eruptions ALWAYS are drug-induced

A

True

161
Q

What is composed of the atopic triad?

A

Allergic rhinitis
Asthma
Atopic dermatitis

162
Q

What are some climate factors for dermatitis?

A

Dry, humid

163
Q

What are some infection factors for dermatitis?

A

Steroid, ABx can disturb the skin

164
Q

What are some genetic factors for dermatitis?

A

Interleukins mutation

165
Q

What are some environmental factors for dermatitis?

A

Anything that increases allergen response like dust

166
Q

What are some food item factors for dermatitis?

A

Anything that increases allergen response

167
Q

How is dermatitis presented in infants/children?

A

Facial, neck, arms, dorsum of hands/feet

168
Q

How is dermatitis presented in adolescents?

A

Face, neck palms, soles

169
Q

How is dermatitis presented in adults?

A

Flexural creases and dorsum of hands/feet

170
Q

What features are found in moderate to severe dermatitis?

A

Involved in >10% BSA

Involved in highly visible areas

Reduced QoL (interferes sleep or daily activities)

171
Q

What are some major non-pharmacological therapies for dermatitis?

A

Skin care
Avoid triggers
Antiseptic measures
Extra stuff

172
Q

What non-pharmacological therapies are involved in skin care + dermatitis?

A

Warm bath QD w/o soap
Apply moisturizer after bath
“Soak and seal” w/ Cetaphil

173
Q

What non-pharmacological therapies are involved in antiseptic measures + dermatitis?

A

Dilute bleach bath or ABx if needed

174
Q

Which severity of dermatitis should you apply topical corticosteroids?

A

Any severity needs topical corticosteroids, non-lesional to mild requires low to medium potency. Moderate to severe requires medium to high potency

175
Q

Which severity of dermatitis should you avoid trigger?

A

Non-lesional to mild

176
Q

Which severity of dermatitis should you use antiseptic measures?

A

Mild

177
Q

Which severity of dermatitis should you refer to atopic dermatitis specialist?

A

Severe

178
Q

Which severity of dermatitis should you apply topical anti-inflammatory medication?

A

Moderate

179
Q

Which severity of dermatitis should you use phototherapy?

A

Severe

180
Q

Which severity of dermatitis should you apply topical anti-inflammatory medication?

A

Moderate

181
Q

Which severity of dermatitis should you use phototherapy?

A

Severe

182
Q

What is the least potent corticosteroids?

A

Hydrocortisone

183
Q

Which severity of dermatitis should you apply for moderate to severe dermatitis? List the calcineurin inhibitor

A

Tacrolimus

184
Q

Ointments are generally better for absorption compared to creams (T/F)

A

True

185
Q

Which Rx is first line for dermatitis of the face?

A

Calcineurin inhibitors

186
Q

Which severity of dermatitis should you apply for mild to moderate dermatitis? List the calcineurin inhibitor

A

Pimecrolimus

187
Q

What are the AE of calcineurin inhibitors for dermatitis?

A
  • Local burning sensation
  • Increase risk of viral infections
  • Malignancy has been reported
188
Q

What are some counseling points for calcineurin inhibitors for dermatitis?

A

Use sunscreen

189
Q

What are some characteristics of calcineurin inhibitors for dermatitis?

A
  • Indicated for <2yrs
  • Reduces pruritus within days
  • first line for facial disease
190
Q

What are the directions of use for crisaborole (Eucrisa)?

A

Apply to affected area BID

191
Q

What is the MOA of crisaborole (Eucrisa)?

A

Inhibits PDE-4, which increases cAMP, decrease cytokine production

192
Q

Who is approved to use crisaborole (Eucrisa)?

A

Kids aged 2 and above

193
Q

Crisaborole (Eucrisa) AE?

A

Local burning sensation

194
Q

Crisaborole (Eucrisa) AE?

A

Local burning sensation

195
Q

Dupilumab MOA?

A

AB against IL-4 receptor subunit alpha

196
Q

Dupilumab place in therapy?

A

Moderate to severe atopic dermatitis for pt >12yrs old.

Can be used w/ or w/o topical steroids

197
Q

Cyclosporine MOA?

A

Inhibits T cell activity and IL-2 production

198
Q

Cyclosporine place in therapy?

A

Rapid improvement

Short to intermediate term use due to AE

199
Q

Azathioprine MOA?

A

Purine synthesis inhibitor; decreased leukocyte proliferation

200
Q

Azathioprine place in therapy?

A

Modest benefits in trials

Take 2-3 months to see effects

201
Q

Methotrexate MOA?

A

Decreases allergen specific T-cell activity

202
Q

Methotrexate place in therapy?

A

For refractory cases

203
Q

MMF MOA?

A

Inhibits de novo pathway of purine synthesis; suppresses lymphocyte function

204
Q

MMF place in therapy?

A

For recalcitrant cases; takes 2-3 months to see effect

205
Q

Systemic corticosteroid MOA?

A

Inhibits inflammation and immune response

206
Q

Systemic corticosteroids place in therapy?

A

continuous/chronic use is not recommended

Steroid bursts can be used for flares

207
Q

What are the major etiologic factors of acne?

A
  1. Increase in keratinization
  2. Increase sebum
  3. P. acnes colonization
  4. Inflammation
208
Q

Open comedone are known as (black/white) heads

A

blackheads

209
Q

Closed comedones are known as (black/white) heads

A

whiteheads

210
Q

(open/closed) comedones are known as blackheads

A

Open

211
Q

(open/closed) comedones are known as whiteheads

A

Closed

212
Q

Open vs closed comedones

Which is smaller?

A

Open

213
Q

Open vs closed comedones

Which is larger?

A

Closed

214
Q

Open vs closed comedones

Which one will likely rupture?

A

Open

215
Q

Open vs closed comedones

Which one is the first sign of acne?

A

Open

216
Q

A pustule acne is a superficial aggregation of what?

A

Neutrophils

217
Q

Benzoyl peroxide MOA?

A

Releases free-radical oxygen which oxidizes bacterial proteins which decreases anaerobic bacteria and irritating-type free FA

218
Q

Salicylic acid MOA?

A

Produces desquamation of hyperkeratotic epithelium

219
Q

What are the types of light used for acne?

A

Blue - acne

Red - inflammation

220
Q

What are the 4 groups of targets for acne?

A
  1. Against P. acnes proliferation
  2. Inflammatory
  3. Sebum
  4. Keratinization of follicles
221
Q

Which Rx go against P. acnes proliferation?

A

Benzoyl peroxide
ABx
Isotretinoin

222
Q

Which Rx go against keratinization of follicles (for acne)?

A

Benzoyl peroxide
Isotretinoin
Salicylic acid
Topical retinoids

223
Q

Which Rx go against the inflammatory response for acne?

A

Intralesional or oral corticosteroids

Topical or oral ABx

224
Q

Which Rx go against sebum production of acne?

A 
Topical or oral ABx
Isotretinoin
Corticosteroids
Estrogen
Antiandrogens
225
Q

Which acne product is a vitamin A derivative

A

Retinoids

226
Q

What are some key patient counseling points when using topical retinoids?

A
  • avoid in pregnant/breastfeeding individuals
  • may sunburn easily
  • NO occlusive dressings
  • wash area and dry, wait 20-30 min then apply Rx
227
Q

Which dosage form of acne treatment causes mood disorders?

A

Oral retinoids

228
Q

Which dosage form of acne treatment causes initial flare-ups?

A

Topical retinoids

229
Q

What are some general side effects of oral retinoids?

A

Anticholinergic effects
TG lvls increase
Mood disorders

230
Q

Who is required to sign up for the iPledge program for oral retinoids?

A

Men and women

231
Q

What are some counseling points to give to patients on oral retinoids?

A

For females, two forms of birth control required (1 month prior and 4 months after

Monthly pregnancy test

Moisturizer

232
Q

Which dosage form for acne causes psuedomembraneous colitis?

A

Topical antibacterials

233
Q

Topical antibiotics for acne can cause what?

A

Diarrhea or pseudomembranous colitis

234
Q

Tetracycline AE?

A

Tooth discoloration

235
Q

Doxycycline AE?

A

Photosensitivity?

236
Q

Minocycline AE?

A

Drug induced lupus

237
Q

What are some counseling points for tetracycline?

A

Women of child-bearing age must use contraception

Increase % of vuvlovaginal infections

238
Q

Is having an oral and topical ABx allowed?

A

Nope

239
Q

Which topical treatment for acne is useful for women who are wanting to be pregnant/or are pregnant?

A

Azelaic acid

240
Q

Using BSA, how would you classify the severity level of psoriasis?

A 
<3% = mild
3-10% = moderate
>10% = severe
241
Q

Using PSI, how would you classify the severity level of psoriasis?

A 
<10 = mild
≥10 = moderate or severe
242
Q

How is PSI for psoriasis calculated?

A

BSA + lesion severity

Score = 0 to 72

243
Q

For effective response of psoriasis treatment, how is that assessed?

A

Reduction of PASI by ≥75%

Reduction of PASI by 50-75% = now impact of QoL

244
Q

How is the maintenance phase of psoriasis evaluated?

A

Reassessed every 8 weeks

245
Q

What is the initial topical therapy for psoriasis?

A

Mid to high potency topical agents

246
Q

Which potency level of topical agents should be limited to 2 to 4 weeks?

A

High potency (<50g/week)

247
Q

Tazarotene MOA

A

Binds to RAR-B and RAR-y and inhibits psoriasis-associated differentiation

248
Q

When is Tazarotene used?

A

Mild to moderate psoriasis w/ topical steroids

249
Q

Tazarotene is pregnancy category __

A

X

250
Q

Which Rx for psoriasis is applied for about 30 min then wiped off?

A

Anthralin

251
Q

Which Rx for psoriasis were on the lower end of efficacy?

A

Anthralin, Acitretin (compared to methotrexate/cyclosporine), and coal tar

252
Q

Why is adherence for coal tar use on psoriasis low?

A

Stains clothes and the odar of tar

253
Q

If a systemic agent w/ or w/o phototherapy or topical agent is ineffective in treating moderate-severe psoriasis, what can you do?

What happens if that answer doesnt work?

A

Give a more potent systemic agent or give 2+ systemic agents in rotation

If no success, give a biologic response modifier

254
Q

Regardless of how you treat moderate-severe psoriasis, what could you always do regardless of efficacy?

A

Moisturize

255
Q

Methotrexate is pregnancy category ___

A

X

256
Q

What is the dose of methotrexate for psoriasis?

A

7.5 to 25mg once weekly

257
Q

What is the place in therapy for methotrexate on psoriasis?

A

For moderate-severe psoriasis

Safer than cyclosporine

258
Q

What should you monitor if taking methotrexate?

A

CBC + LFT

259
Q

Cyclosporine is pregnancy category ___

A

C

260
Q

What should you monitor if taking cyclosporine?

A

SCr, BUN, BP, Lipid profile

261
Q

Which Rx for psoriasis can take up to 3 years for the med to be eliminated from the body?

A

Acitretin

262
Q

Acitretin is pregnancy category ___

A

X

263
Q

Acitretin is contraindicated in who?

A

Women who fail to use contraception for 3 years after d/c

264
Q

What should you monitor if taking Acitretin?

A

Blood, glucose, lipid panel, LFTs

265
Q

Which Rx for psoriasis can cause brittle nails, hair loss, or sticky skin?

A

Acitretin

266
Q

What are the major components that cause psoriasis?

A

DC + T cells

TNF-alpha
IFN-gamma
IL-12,17,23

267
Q

If a topical agent is ineffective for mild-moderate psoriasis, what can you do?

What if the answer doesnt work?

A

Add phototherapy

Add a systemic agent if phototherapy doesnt work

268
Q

What are some AE of topical corticosteroids?

A

Systemic (medium-superpotent) can cause HPA axis suppression, cataracts, glaucoma

269
Q

Intermittent allergic rhinitis is defined as…

A

<4 days/week

OR

<4 weeks

270
Q

Persistent allergic rhinitis is defined as…

A

> 4 days/week

AND!!!

> 4 weeks

271
Q

Mild allergic rhinitis is defined as…

A

Normal sleep, no impairment of activities, work, school, no troublesome symptoms

272
Q

Moderate-severe allergic rhinitis is defined as…

A

One of more of the following

Abnormal sleep, impairment of activities, work, school, troublesome symptoms

273
Q

What is the main cause of allergies during the springtime?

A

Tree pollen

274
Q

What is the main cause of allergies during the summer?

A

Summer grass

275
Q

What is the main cause of allergies during the fall?

A

Ragweed

276
Q

Calcipotriol (Calcipotriene) MOA?

A

Synthetic Vit. D3 analog

Binds to Vit. D receptors by inhibiting keratinocyte proliferation

277
Q

When is Calcipotriol (Calcipotriene) used?

A

Combined w/ betamethasone for mild to severe disease

Used at night only because it will become deactivated

278
Q 
Sneezing
Itching
Rhinorrhea
Congestion
Ocular

Oral antihistamine targets include…

A

All but congestion

279
Q 
Sneezing
Itching
Rhinorrhea
Congestion
Ocular

Intranasal antihistamine targets include….

A

Only itching and rhinorrhea

280
Q 
Sneezing
Itching
Rhinorrhea
Congestion
Ocular

Oral decongestant targets include…

A

Only congestion

281
Q 
Sneezing
Itching
Rhinorrhea
Congestion
Ocular

Intranasal steroid targets include…

A

All but ocular

282
Q

Cromolyn targets include…

A

Sneezing, itching, rhinorrhea

283
Q

Of the topical treatments for psoriasis, what is the most efficacious to least efficacious?

A

Corticosteroids
Tazarotene (Tazorac®)
Anthralin

284
Q

Intranasal ipratropium targets include…

A

Rhinorrhea only

285
Q

Which 2nd Gen antihistamine can cause drowsiness?

A

Cetirizine and levocetirizine

286
Q

What are the short-acting intranasal decongestant?

A

Naphazoline – Privine®

Phenylephrine

287
Q

What are the long-acting intranasal decongestant?

A

Oxymetazoline–Afrin®

288
Q

What are the oral decongestants?

A

Pseudoephedrine
(PSE) -Sudafed®

Phenylephrine (PE) -
Sudafed PE®

289
Q

Decongestant MOA?

A

Acts on alpha-1 adrenergic receptors (vasoconstriction)

290
Q

Which is more efficacious, PSE or PE?

A

PSE aka Pseudoephedrine

(PSE) -Sudafed®

291
Q

Oral decongestants are metabolized by what enzyme?

A

monoamine oxidase

292
Q

Rebound congestion is found in what drug class?

A

Only intranasal + ocular decongestants, not oral

293
Q

What is an ocular decongestant and what are they used for?

AE?

A

Naphazoline (Naphcon, Clear Eyes, AK-Con)

Allergic conjunctivitis

Increases IOP

294
Q 
What is the most effective medication
class for allergic rhinitis?
a) Oral antihistamines
b) Oral decongestants
c) Intranasal antihistamines
d) Intranasal steroids
A

d) Intranasal steroids

295
Q

What is the last line therapy for allergic rhinitis? What does it treat?

A

Leukotriene receptor antagonist (Monetelukast)

Treats only nasal symptoms

296
Q

TNF-alpha inhibitors should not be given to who?

A

Patients with MS or serious infections

297
Q

Which monoclonal AB has a off-label use for allergic rhinitis?

A

Omalizumab

298
Q

What should be avoided in pregnant women suffering from allergic rhinitis?

A

Oral steroids

Immunotherapy should not be initiated during pregnancy, but can be continued.

299
Q

What is the first line Tx for psoriasis + pediatrics (mild-moderate)?

A

Calcipotriol +/-
mild-moderate topical steroid
• May add tacrolimus

300
Q

What is the first line Tx for psoriasis + pediatrics (moderate-severe)?

A

First-line: Methotrexate
• Second-line: Cyclosporine
• Third-line: Etanercept (age≥4)
and ustekinumab (age≥12)

301
Q

What are the systemic Rx for psoriasis?

A

Methotrexate
Cyclosporine
Acitretin

IPT: Derm (2 decks)

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