Chapter 110 Integumentary Agents Flashcards
How should you administer a glucocorticoid topical agent?
Thin layer on the skin, do not use occlusive bandages or tight fitting diapers covering it up.
When would you draw concern for systemic toxicity of a glucocorticoid topically for skin?
Prolonged therapy within a large area where big doses occur and an occlusive dressing
What medication would you use for mild to moderate acne?
Benzyl peroxide as an antibiotic and keratolytic agent
What is a keratolytic agent?
Promotes shedding of the horny later of the skin for things such as warts, corns, acne, dandruff, psoriasis, etc…
The abx agents of choice for acne are? How long does it take to reach max potential?
Doxycycline & Minocycline combined with a topical retinoid (Vitamin A)
6 mos! (SLOW!)
What are the best oral drugs for severe acne? Use? Rare a/e? What lab value should you monitor? Considerations? Drug interactions?
Isotretinoin (i.e., Accutane) used for severe acne
A/e - depression
Monitor - Triglyceride lvls
Considerations - Teratogenic
DI - tetracycline & Vit A
Hormonal agents (oral contraceptive pills - OCPs) should be used when for acne? How long will it take for them to work?
> 15 y/o and may take 6 mo to see improvement
When should you administer spironolactone for acne? What should you consider?
When other regimens do not work, can be teratogenic (need for contraception)
What is the primary cause of immunosuppression and photoaging of the skin?
ultraviolet radiation A (UVA) penetrates deeper than UVB
How deep does UVA go vs UVB?
UVA: deep into the dermis
UVB: ONLY into the epidermis
remember the layers:
epidermis (top)
dermis (middle)
hypodermis (bottom)
What does UVA and UVB cause?
DNA damage: keratsoes, carcinoma, melanoma
What does sunscreens do for the skin?
Impede penetration of radiation to the skin decreasing photoaging, sunburn and rx to non-integumentary medications
How do sunscreens work? What are the two types of sunscreens?
Organic –> chemical screens
Absorb UV radiation and dissipate it as heat
Inorganic –> physical screens
Scatter UV radiation
SPF identifies protection against what radiation spectrum? What spectrum of coverage is the max amount of benefit?
UVB - SPF 30 is not x2 of SPF 15
ANY SPECTRUM ABOVE SPF 30 PROVIDES A SMALL ADDITIONAL BENEFIT
not UVA
What is psoriasis? Symptoms? Tx?
Common chronic inflammatory trigger response to skin antigens
S/sx - Excessive activity from inflammatory cells & maturation of epidermal cells
Tx - suppress inflammatory response (I.e., Methotrexate, GCs, biologic agents, etc…)
What is actinic keratoses (AK)? Can AK lead to cancer?
Rough, scaly red or brown papules caused by chronic sunlight exposure.
Yes - it can lead to cancer as half of all cancers begin from AK.
What does Fluorouracil do for actinic keratoses? Is it concerning?
Initial tx is not desirable as it can cause tissue disintegration, ulcerations, necrosis as part of the course of the desired effects – can last b/w 2-6 weeks, healing takes several mos.
What is the first medication approved as an NSAID for actinic keratoses?
Diclofenac sodium topically
What is atopic dermatitis? What is the first line tx for atopic dermatitis?
Commonly known as eczema, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin
Glucocorticoids
What topical medications must be applied by a provider for removal of venereal warts?
Podophyllin, trichloroacetic acid (TCA), Bichloroacetic acid (BCA)
ANY OTHERS CAN BE APPLIED AT HOME
What active ingredient in any antiperspirant medication can reduce flow of eccrine sweat?
Aluminum
What can deodorants do for skin protection?
Reduce bacterial growth on the skin surface that then further degrade apocrine sweat into malodorous products – do NOT SUPPRESS SWEAT FORMATION
What medication helps with dermatitis and dandruff?
Topical ketoconazole
What medication helps with tx of hair loss?
Topical minoxidiil or finasteride
What medication helps with tx of unwanted facial hair?
Eflornithine
Impetigo is what? Is it contagious? What medications do you use for tx style?
Bacterial infx of the skin caused by staph aureus and is very contagious
Mild to moderates–> topical (2 agents)
Severe –> oral (4 agents)
Mild to moderate Impetigo tx? Which 2 medications?
mupirocin can use intransally with kids 2 yos+
retapamulin DO NOT USE INTRANASALLY d/t local irritation and 9 mos+
What topical infection is amoxicillin/clavulanate is used for?
severe impetigo (1 of the 4 major medications) including dicloxacillin, cephalexin, and clindamycin all orally
aminopenicillin + beta lactamase inhibitor (prior knowledge)
What major a/e can cephalexin cause?
eosinophilia - grow concern for counter infx
Clindamycin should be used as first line or second line? What are major BBW regarding clindamycin for integumentary tx?
Alternative to penicillin due to activity vs. gram positive cocci
BBW - severe CDAD (Clostridium difficile-associated disease) - pts should report diarrhea if noted!
