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A Wolverton > CME and randoms > Flashcards

CME and randoms Flashcards

1
Q

acyclovir - most common toxicity?

A

GI is most common but renal is the worst

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2
Q

sebaceous nevus - 5 tumours benign 2 malignant?

A

BMi + smoking + alcohol - > in AA trichoBlastoma, tricholeMomma, DESMO tricholemmoma, SCAP, Sebaceous Adenoma, Apocrine Adenoma, poroma > sebaceous carcinoma, BCC

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3
Q

PDT full name for ALA and mALA? what is an active product

A

5-aminolevulinic acid
methylaminovulinate
- >
protoporphyrin IX

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4
Q

light used with ALA? mALA?

A

ALA - blue - 417
mALA - red - 630

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5
Q

what is the light used in in PDT and what does it convert?

A

visible light
O2 into singlet O2 which does tissue damage

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6
Q

c/i for TCS ?

A

allergy to vehicle or active steroid ingredient
epidermal thinning
active infection
ulcera or loss of epidermal barrier (NOT IN BOLOGNA)
pregnancy lactation

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7
Q

Vit D3 analogues maximum doses and names of 3 D3 analogues?

A

calciPOtriol
100 g/ week BID
calcipotriene
calcitriol - non-synthetic
200 g/ BID

tacalcitol
70 g

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8
Q

indications and c/i for anthralin?

A

Pso -
UNSTABLE
PUSTURAR
ERYTHRODERMIC

ie cannot use in acute

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9
Q

maximum area that can be treated by bazarotene?

A

10-20% max

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10
Q

nB UVB - wavelength

A

311

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11
Q

excimer laser wavelength?

A

308

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12
Q

contraindications for phototherapy - name 5?

A

photo aggravated conditions like PCP, SLE
light sensitive genodermatoses
CsA
pregnancy and lactation
OCA
photo aggravated dermatosis
solar urticaria

HIGH PREVIOUS PUVA > 200
genetic conditions w/ increased photosensitivity
CsA
hx of skin cancer
preggo lactation
skin type I
photosensitive dermatoses
vitiligo
ARSENIC
atypical melanocytic nevi
SEIZURE disorder
bad compliance
no contraception for PUVA
LIVER impairment PUVA
CATARACTS PUVA

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13
Q

MTX - c/i - 7?

A

immunodeficiency syndrome
active infection

pregnancy, lactation
obesity, T2DM - relative

severe hepatic disease
alcohol use
unreliable

severe heme abn - severe anemia, leukopenia, thrombocytopenia

bologna also: impaired kidney function
concominant meds that increase MTX levels like Septra
significantly reduced pulmonary function
planning to have children
concomitant radiation
hypersensitivity to MTX
gastritis or peptic ulcer

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14
Q

MTX - risks for hepatic complications?

A

old fat druggie and alcoholic with hepatitis and diabetes

ALCOHOL
obesity
IVDU
hepatitis
personal or family hx of liver dz
T2DM esp insulin
age

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15
Q

cutaneous s/e of methotrexate

A

oral erosions
necrosis /tenderness

alopecia
delayed phototoxicity

urticaria
angioedema
vasculitis

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16
Q

CsA - c/i = 5

A

CHIKS

active malignancy
hypertension - uncontrolled
hypersensitivity
active infection
severe kidney dysfunction

relative:
immunodeficiency disorder
vaccine - live
<18 >65
preggo/lactation
PUVA
drugs interfering with function
significant hepatic dz
scontrolled HTN
unreliable
MTX

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17
Q

drug c/i with TNF? MTX?

A

anakinra; CsA

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18
Q

acitretin - dose for plaque? erythrodermic and pustular?

A

plaque - 0.5 mg/kg/day, erythrodermic 0.25 and pustular 1 mg/kg day -
“mild cheilitis is the goal”

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19
Q

acitretin - c/i?

A

severe liver dysfunction
severe kidney dysfunction
pregnancy or lactation
no contraception
hyperlipidemia
excessive alcohol
unreliable
hepatotoxic drugs like methotrexate
pancreatitis
atherosclerosis

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20
Q

PLEVA infection? med (2 each)

A

HIV, Parbo B19
radio contrast dye and TNF alpha

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21
Q

PLEVA PATH

A

interface derm
WEDGE SHAPED
lymphocytes and neutrophis
focal parakeratosis
epidermal necrosis
erythrocyte extravasation frequeint

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22
Q

PLEVA ddx (only more atypical ones)

A

vasculitis
VZV
arthro
EM
lichenoid drug
follidulitis

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23
Q

Pleva/plc - 3 drug classes? TOC for fulminant

A

tetracyclines
azitromycin/erythromycin
MTX = for fulminant
if severe CS, IVIGI, CsA
reports of TNFs, bromelin, PDT

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24
Q

PRP - drug trigger?

A

imatinib

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25
Q

6 biologic agents for psoriasis and dose

A

a. adalimumab: 80, 40 1 week apart, then 40 q2weekly ada40Q2
b. infliximab: 5mg/kg 0, 2, 6, q8 IN0,2 ,6,Q8
c. Etanercept 50mg twice weekly 3 months, then once weekly
d. Secukinumab: 300mg 0, 1, 2, 3, 4, then every 4 weeks l’amour a trois x 5 doses, then Q4 3e5u4inumab
e. Brodalumab 210 q 0, 1, 2 then every 2 weeks
f. Guselkumab: 0, 4, then every 8 100mg
g. Ustekinumab: 0, 4, then every 12 if <100kg 45mg; if >100kg 90mg
h. Ixekizumab: 160mg x1, then 80 mg q2wks x6, then 80mg q4 weeks Humira like HS -> ex

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26
Q

anthralin MOA

A

topical agent that binds DNA, inhibiting synthesis of nucleic protein, and reduces mitotic activity.

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27
Q

Hep B - 3 signs, Hep C - 3 cutaneous findings per CME?

A

hep B : BaG and PANtSS – B -> Gianotti Crosti and PAN, Serum sickness like
but see nipple -> CC NPL: C = Cryo necrolytic acral erythema PCT and LP

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28
Q

3 tx for atrophic vagina

A

estradiol cream or vaginal tablets
moisturizers/lubricants for sexual activity
HC
fractional CO2
increased risk of candidiasis - give flu 200 mg weekly PRN

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29
Q

vvulvodynia management - 4 categories?

A

ALL THE SOFTS - pelvic, botox, acupuncture, sex ed, TCAs, education

patient education, avoidance of irritants
pelvic floor physio
topicals: lidocaine 5% gaba 5% ambaclofen, etc
PO: duoloxetine, gaba (100->1200), pregabalin, TCAs
counselling - CBD, sex therapy
BOTOX, acupunture

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30
Q

AD IL?

A

TSLP, IL 4, Il 13, IL 31, 33

31
Q

Q 4 steroids that you should avoid in budesonide allergy

A

fluocinonide, desonide, amcinonide, triamcinolone acetonide, HC-17-butyrate (group D2 cross reacts)

32
Q

descriptions of hand dermatitis

  1. explosive, fast resolving
  2. reaction to fungal infxn
  3. central palm
  4. hyperkeratotic (peeling skin) with hyperhidrosis-
  5. (acral peeling skin syndrome:
A
  1. explosive, fast resolving- pompholyx
  2. reaction to fungal infxn - vesicles on lateral fingers- id reaction/ autosensitization
  3. central palm- hyperkeratotic hand eczema
  4. hyperkeratotic (peeling skin) with hyperhidrosis- keratolysis exfoliativa
  5. (acral peeling skin syndrome: transglutaminase 5)
33
Q

humectants - 4

A

a. Glycerin
b. Honey
c. Urea
d. Propylene glycol
e. Gelatin
f. HA

HUMECTANS HHUG – Honey HA Urea glycerin prop glycol gelatin

34
Q

what are emollients? humectants? occlusives?

A
  • Lanolin, glyceryl stearate, and soy sterols are oily substances that make up true emollients. They fill cracks in the skin’s outermost layer, which improves the skin’s appearance by creating a smooth skin surface, increasing light reflection, and enhancing skin flexibility [6].
  • Protein-based emollients are rejuvenators and are mainly used for cosmetic purpose
  • Humectants such as urea, glycerol, and lactic acid are used to increase the skin’s water content by their ability to attract water vapour [6]. Glycerol (glycerine) is the most effective humectant [1,6].
  • Occlusives such as petroleum jelly (paraffin), mineral oil, and dimethicone are hydrophobic moisturisers that prevent evaporation by forming a waterproof barrier on the skin’s surface. For optimal results, it is recommended to apply occlusive agents on slightly dampened skin [1,6].
35
Q

terbinafine MOA dose for nails

A

squalene epoxidase inhibitor - > dermatophyte and non-DM 250 PO 6 weeks/12 weeks nails

36
Q

terbinafine MC s/e and which CYP

A

headache, GI and rash → LFT, taste disturbances, an, category B, CYP 450 inhibitor

37
Q

predictor of liver injury on terbinafine?

A

idiosyncratic

38
Q

best drug for nondermatophytes? MOA

A

itraconazole

lanosterol 14 alpha DEMEthylase

I try but I’m DUM

39
Q

itraconazole - dose, CYP

A

200 mg BID x 1 week on 3 weeks off - 2 pulses

200 mg PO OD x 12 weeks for toes

I try but i’m dum/messy – itraconazole lanosterol 14 alpha DeMethylase 222222

2 x 2 x 2 pulses

2 x 1 x 12 toes

CYP 3A4

40
Q

itraconazole when can’t use ?

A

ventricular dysfunction, including CHF, pregnancy and 2 MONTHS (2222222 for itra )

41
Q

fluc CYP and dosing ?

A

CYP 2C9 fluke 2 see 9 toes

and CYP 3a4

42
Q

terbinafine pulse dosing for onychomycosis

A

2 cycles of 250 mg 4 weeks on 4 weeks off (2 months total like itra, except itoa was 200 BID x 1 week on 3 off)

43
Q

again terbinafine 5 s/e

A

headache, diarrhea/ GI pain, rash, taste disturbances, LFT elevation

VISUAL DISTURBANCES (connect to taste), can also lead to anemia and hearing loss

44
Q

terbinafine - 4 cutaneous s/e

A

morbilliform drug

SLE

SJS/TEN

angioedema

45
Q

itraconazole enzyme and 6 s/e

A

lanosterol 14 alpha Demethylase

headache, GI pain, diarrhea, URTI, hyperglyceredemia, LFTs, peripheral neuropathy, CHF, QT prolongation, pancreatitis, SJS/TEN, sexual - menstrual and erectile dysfunction

iTRY - TRUNK - URTI, CHF, QT, menstrual, erectile, pancreatitis and hyperglyceredemia

46
Q

fluconazole enzyme, dose and 7 s/e

A

150 mg PO OW x 6 months, 12 mo for nails

headache, nausea, vomingit, rash, transaminase elevation, liver injury, QT, torsades

leukopenia, agranulocytosis, TEN, taste changes

47
Q

3- topical treatments - onychomycosis

A

Ciclopirox olamine 8 Cytochrome inhibition

Efinaconazole 10 - lanosterol 14 alpha demethylase (effin conazole 10%)

tavaborole 5 tRNA synthase (tavaborole like crisaborole aminoacyl transfer RNA synthase)

48
Q

what drug poses a very high risk of invasive aspergillosis?

A

ritux

49
Q

what is the highest risk factor for disseminated Mucormycosis?

A

DM

also high iron states - feed on iron

50
Q

chemo induced eyelash hypotrichosis tx?

A

bimatoprost 0.03%

51
Q

5 cutaneous reactions to EGFR inhibitors

A

so EGR acne, nail (CAMERAS), xerosis, pruritis, alopecia, trichomegaly, hirstusm, mucositis, photosensitivity, rad induced dermatitis → so acne, dryness, nail/hair

  • Papulopustular eruption, paronychia, acne, itch, dryness*
  • UptoDate (): papulopustular/acneiform, abnormal scalp/facial/eyelash hair growth, paronychia +/- pyogenic granuloma, telangectasias, xerosis, pruritus, purpuric xerotic dermatitis, alopecia, hand foot skin reaction*
52
Q

what’s specific about acne like lesions of EGFR?

A

tender, pruritic papules

seborrheic distribution

actually improves with TCS! (and oral CS/retinoids, but not topical retinoids, tetracyclines work super well for them)

53
Q

MEK inhibitors - 5 s/e

A

this is eGFR without acne and radiation/photo

PRURITIS,

alopecia, paronychia, trichomegaly, mucositis,

54
Q

imatinib - 5 cutaneous s/e?

A

cKIT so pigmentary cue

hair depigmentation

skin hypopigmentation

photosensitivity

general: alopecia, morbilliform, pruritis, mucositis

periorbital edema → treats eosinophil d/o helps to remember

55
Q

BRAF - 6 cutaneous s/e?

A

KA and SCC → know that keratinizing so also

acral erythema and acral keratoses

other tumours - eruptive nevi and 1 MM elsewhere

also morbilliform, alopecia, pruritis - no mucositis

56
Q

Q. 2 diagnostic tests to confirm the drug causing DRESS.

A

(2019)

  • Patch test*
  • Leukocyte transformation test*
57
Q

3 most common classes of drugs that cause FDE

A

SNoT

  • a. Sulfonamides*
  • b. NSAIDs*
  • c. Tetracyclines*
58
Q

3 histologic findings of toxic erythema of chemotherapy

A

Eccrine squamous syringometaplasia, vacuolar degeneration of basal layer, keratinocyte necrosis, mild spongiosis

59
Q

1 drug that causes hand - foot syndrome aka calluses?

A

dabrafenib, vemurafenib, etc

60
Q

HLA for abacavir?

A

HLA B 5701

61
Q

3 presentations of halogenodermas

A

aceniform eruption/pustules > granulomatous/vegetative plaques/ulcers

62
Q

2 MC drug eruptions

A
  • exanthematous drug eruption
  • urticaria
63
Q

What are 3 classic clinical findings in Dapsone hypersensitivity syndrome

A
  • morbilliform rash, fever, pharyngitis, hepatitis, eosinophilia
64
Q

2 histopath features of atrophie blanche

A

a. HUALINE thrombi in vessels
b. fibrin in vessel walls
c. no vasculitis
d. ulceration

65
Q

5 risk factors for warfarin induced necrosis

A

a. Lack of bridging heparin
b. Women
c. 6th/7th decade
d. partial deficiency of protein C
e. high loading doses
f. Obesity
g. CME:
i. Protein C, S, FVL, AT3 def
ii. HIT
iii. malignancy

66
Q

3 features of cholesterol emboli - clinical? labs? reason (3)

A

i. livedo reticularis
ii. peripheral gangrene
iii. cyanosis
iv. nodules

v. purpura

vi. ulceration

vii. Labs:
1. Eosinophilia, decreased complement, leukocytosis, eosinophilouria, elevated ESR, Cr, BUN
ix. Settings:

1. Prolonged anticoagulation

2. Arterial/coronoary cath

3. Acute thrombolytic therapy

67
Q

6 systemic diseases associated with urticarial vasculitis

A

SLE, RA, Sjogren syndrome,

HepB, HepC, cryoglobulinemia - C3/C4 deficiency yo!

plasma cell dyscrasia, lymphoma, Castlemans

68
Q

Pregnant patient, best treatment for the following

a. PV who needs steroid sparing agent
b. Psoriasis who failed topicals
c. Scabies
d. Acute cutaneous lupus not responding to topicals

A

Pregnant patient, best treatment for the following 2016

a. PV who needs steroid sparing agent
i. IVIg
b. Psoriasis who failed topicals
i. TNF, phototherapy, secukinumab (B)
c. Scabies
i. Permethrin 5% x 2 hours
d. Acute cutaneous lupus not responding to topicals
i. Plaquenil ©

69
Q

what is the active metabolite of hydroxyzine?

A

cetirizine

70
Q

SDRIFE criteria

A
  1. drug exposure
  2. erythema of gluteal/perianal area
  3. at least one other intertriginous area
  4. SYMMETRIC
    1. NO SYSTEMIC SIGNS
71
Q

5 MC drugs to induce alopecia

A

R I BAL

retinoids interferons betas antiCOAGULANTS Lithim

72
Q

2 common morphologies of HITS?

A

retiform branching purpura or non-inflammatory necrosis

at heparin sites or distal sites

days 5-10

73
Q

organ systems involve

A

GI

CNS including seizures and motor neuropathies

CV/pulmoanry - tachy, resp distress, etc

A Wolverton (13 decks)

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