Clinical: Therapeutics Flashcards
2 most common “vehicles” used for topical skin therapy.
Ointments
Creams
Advantage of ointments over creams
Moisturizing
Less likely to cause allergic reaction
Advantage of creams over ointments
Better for cosmetic use, better patient compliance
Which 2 conditions are best treated with ointments?
Atopic Dermatitis
Psoriasis
Which conditions are best treated with creams?
Common skin conditions like acne, tinea, seborrheic dermatitis of the face
Best time to use lotions for treatment.
When a large area needs treated
Best time to use solutions for treatment.
For scalp conditions
Best time to use gels for treatment.
For hairy areas
Best time to use powders for treatment.
Mainly fungal infections: they absorb moisture which is mainly prophylactic against fungal infection
Best time to use pastes for treatment.
Diaper dermatitis
Best time to use foams for treatment.
Scalp condition
3 effects topical corticosteroids have on the skin
- Anti-inflammatory
- Immunosuppressive
- Anti-proliferative
4 conditions highly responsive to topical corticosteroids.
- Psoriasis
- Atopic Dermatitis
- Seborrheic Dermatitis
- Intertrigo
Which steroid class is best used for sensitive areas like the face, groin, and axilla?
Class 4-7
class 1 is most potent, class 7 is least potent
major side effects of topical corticosteroid use
- Skin atrophy and Striae (both occur because steroids have anti-proliferative effects)
- Telangeictasia/Purpura
- Hypopigmentation
- Periorbital Dermatitis
- Infections
Main reason to use Topical Immunomodulator Drugs.
Used in patients that develop a topical steroid dependency.
Name the two topical immunomodulator drugs and the MOA.
Pimecrolimus and Tacrolimus
MOA: Inhibition of calcineurin
-protein phosphatase enzyme that activates T cell receptor production and cytokine production
-overall effect is reduced immune response
3 topical antibiotics used for Gram (+) superficial skin infections.
Mupirocin
Retapamulin
Bacitracin
2 topical antibiotics used for Gram (-) superficial skin infections.
Neomycin/Gentamycin
Silvadene
Topical antifungal used for dermatophyte infections.
Allylamines/Benzylamines
Topical antifungal used for superficial yeast infections.
Imidazoles
Topical antifungal used for onychomycosis.
Cyclopirox
-good penetration of the stratum corneum
Which antifungals should you not use for dermatophytes or malassezia?
Polyenes
Main use for retinoids
Acne
(bexarotene used for cutaneous T cell lymphoma)
(alitretinoin used for Kaposi Sarcoma)
2 indications for 5-Fluorouracil
Actinic Keratoses
Squamous Cell Carcinoma
Indication for Podophyllin
Genital Warts
What is the minimal erythema dose (MED)?
Minimal dose of UVB radiation required to turn the skin red. Sunscreens use an MED of 10 minutes when advertising SPF values.
What is the SPF of sunscreen?
MED of skin with sunscreen/MED of skin without it
MED with sunscreen is 300minutes/MED without is 10minutes. So ratio is 300/10 and the SPF is 30
Main two components of inorganic sunscreens.
Zinc Oxide
Titanium Dioxide
(has broad spectrum coverage)
Most common UVB blocker in organic sunscreens.
Octinoxate
Most common UVA blocker in organic sunscreens.
Oxybenzone
Why don’t most systemic corticosteroids work in liver disease?
They need to be converted to an active form by 3beta-OH steroid dehydrogenase (liver enzyme)
Main immune suppressing effect of corticosteroids.
Inhibits production of IL-2 receptors on T cells preventing T cell proliferation.
Most important side effect of corticosteroid use.
Osteoporosis
-prevents Vitamin D3 induction of osteoblast activity
3 derm indications of methotrexate.
- Psoriasis
- Chronic T cell leukemia
- Atopic Dermatitis
Side effects of methotrexate
Nausea
Cytopenias
Hepatotoxicity
MOA of hydroxychloroquine (Plaquenil)
Anti-malarial
-mainly inhibits antigen presentation to B cells and T cells
(used for cutaneous lupus, dermatomyositis, sarcoid, porphyria, cutanea tarda
Major risk factor in using antimalarial meds.
Retinal Toxicity
MOA and indications of Dapsone
MOA: inhibits neutrophil chemotaxis mainly by inhibiting binding of IgA to neutrophils
Indications: Linear IgA disease, IgA pemphigus
MOA and indication for Azathioprine
MOA: purine analog, inhibits purine synthesis in T cells and B cells
Indication: Immunobullous Diseases
MOA of Mycophenolate Mofetil
Inhibits inosine monophosphate dehydrogenase preventing purine synthesis selectively in B and T cells
MOA of cyclophosphamide
DNA alkylating agent preventing DNA synthesis mainly in B cells
(mainly used for immunobullous disease)
