Clinical: Therapeutics

Question 1

2 most common “vehicles” used for topical skin therapy.

Answer 1

Ointments

Creams

Question 2

Advantage of ointments over creams

Answer 2

Moisturizing

Less likely to cause allergic reaction

Question 3

Advantage of creams over ointments

Answer 3

Better for cosmetic use, better patient compliance

Question 4

Which 2 conditions are best treated with ointments?

Answer 4

Atopic Dermatitis

Psoriasis

Question 5

Which conditions are best treated with creams?

Answer 5

Common skin conditions like acne, tinea, seborrheic dermatitis of the face

Question 6

Best time to use lotions for treatment.

Answer 6

When a large area needs treated

Question 7

Best time to use solutions for treatment.

Answer 7

For scalp conditions

Question 8

Best time to use gels for treatment.

Answer 8

For hairy areas

Question 9

Best time to use powders for treatment.

Answer 9

Mainly fungal infections: they absorb moisture which is mainly prophylactic against fungal infection

Question 10

Best time to use pastes for treatment.

Answer 10

Diaper dermatitis

Question 11

Best time to use foams for treatment.

Answer 11

Scalp condition

Question 12

3 effects topical corticosteroids have on the skin

Answer 12

1. Anti-inflammatory
2. Immunosuppressive
3. Anti-proliferative

Question 13

4 conditions highly responsive to topical corticosteroids.

Answer 13

1. Psoriasis
2. Atopic Dermatitis
3. Seborrheic Dermatitis
4. Intertrigo

Question 14

Which steroid class is best used for sensitive areas like the face, groin, and axilla?

Answer 14

Class 4-7

class 1 is most potent, class 7 is least potent

Question 15

major side effects of topical corticosteroid use

Answer 15

1. Skin atrophy and Striae (both occur because steroids have anti-proliferative effects)
2. Telangeictasia/Purpura
3. Hypopigmentation
4. Periorbital Dermatitis
5. Infections

Question 16

Main reason to use Topical Immunomodulator Drugs.

Answer 16

Used in patients that develop a topical steroid dependency.

Question 17

Name the two topical immunomodulator drugs and the MOA.

Answer 17

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

Question 18

3 topical antibiotics used for Gram (+) superficial skin infections.

Answer 18

Mupirocin
Retapamulin
Bacitracin

Question 19

2 topical antibiotics used for Gram (-) superficial skin infections.

Answer 19

Neomycin/Gentamycin

Silvadene

Question 20

Topical antifungal used for dermatophyte infections.

Answer 20

Allylamines/Benzylamines

Question 21

Topical antifungal used for superficial yeast infections.

Answer 21

Imidazoles

Question 22

Topical antifungal used for onychomycosis.

Answer 22

Cyclopirox

-good penetration of the stratum corneum

Question 23

Which antifungals should you not use for dermatophytes or malassezia?

Answer 23

Polyenes

Question 24

Main use for retinoids

Answer 24

Acne
(bexarotene used for cutaneous T cell lymphoma)
(alitretinoin used for Kaposi Sarcoma)

Question 25

2 indications for 5-Fluorouracil

Answer 25

Actinic Keratoses

Squamous Cell Carcinoma

Question 26

Indication for Podophyllin

Answer 26

Genital Warts

Question 27

What is the minimal erythema dose (MED)?

Answer 27

Minimal dose of UVB radiation required to turn the skin red. Sunscreens use an MED of 10 minutes when advertising SPF values.

Question 28

What is the SPF of sunscreen?

Answer 28

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

Question 29

Main two components of inorganic sunscreens.

Answer 29

Zinc Oxide
Titanium Dioxide
(has broad spectrum coverage)

Question 30

Most common UVB blocker in organic sunscreens.

Answer 30

Octinoxate

Question 31

Most common UVA blocker in organic sunscreens.

Answer 31

Oxybenzone

Question 32

Why don’t most systemic corticosteroids work in liver disease?

Answer 32

They need to be converted to an active form by 3beta-OH steroid dehydrogenase (liver enzyme)

Question 33

Main immune suppressing effect of corticosteroids.

Answer 33

Inhibits production of IL-2 receptors on T cells preventing T cell proliferation.

Question 34

Most important side effect of corticosteroid use.

Answer 34

Osteoporosis

-prevents Vitamin D3 induction of osteoblast activity

Question 35

3 derm indications of methotrexate.

Answer 35

1. Psoriasis
2. Chronic T cell leukemia
3. Atopic Dermatitis

Question 36

Side effects of methotrexate

Answer 36

Nausea
Cytopenias
Hepatotoxicity

Question 37

MOA of hydroxychloroquine (Plaquenil)

Answer 37

Anti-malarial
-mainly inhibits antigen presentation to B cells and T cells
(used for cutaneous lupus, dermatomyositis, sarcoid, porphyria, cutanea tarda

Question 38

Major risk factor in using antimalarial meds.

Answer 38

Retinal Toxicity

Question 39

MOA and indications of Dapsone

Answer 39

MOA: inhibits neutrophil chemotaxis mainly by inhibiting binding of IgA to neutrophils
Indications: Linear IgA disease, IgA pemphigus

Question 40

MOA and indication for Azathioprine

Answer 40

MOA: purine analog, inhibits purine synthesis in T cells and B cells
Indication: Immunobullous Diseases

Question 41

MOA of Mycophenolate Mofetil

Answer 41

Inhibits inosine monophosphate dehydrogenase preventing purine synthesis selectively in B and T cells

Question 42

MOA of cyclophosphamide

Answer 42

DNA alkylating agent preventing DNA synthesis mainly in B cells
(mainly used for immunobullous disease)