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Clinical Pharmacology > Derm > Flashcards

Derm Flashcards

1
Q

How does regional variation determine the potency you choose in dermatology?

A

lighter potency in more sensitive areas like skin and groin, and heavier potency in areas like forearm and palm

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2
Q

When someone displays resistance to your first line therapy, what do you do?

A

increase concentration

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3
Q

What is a vehicle?

A

substance that carries a drug to the skin to help treat skin conditions. ointment, cream, lotion, gels, powders, pastes

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4
Q

What helps maximize efficacy?

A

occlusion – plastic wrap, mittens/socks

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5
Q

What are low potency topical corticosteroids?

A

hydrocortisone (hytone, cortizone), hydrocortisone acetate (cortaid), triamcinolone acetonide (aristocort, kenalog)

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6
Q

What are medium potency topical corticosteroids?

A

hydrocortisone valerate (westcort), mometasone furoate (elocon), betamethasone valerate (valisone), triamcinolone acetonide (aristocort, kenalog)

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7
Q

What are high potency topical corticosteroids?

A

fluocinonide (lidex), betamethasone dipropionate (diprosone, maxivate), triamcinolone acetonide (aristocort, kenalog)

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8
Q

What are very high potency topical corticosteroids?

A

betamethasone dipropionate (diprolene) ointment, clobetasol propionate (temovate, olux)

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9
Q

What are low potency topical steroids used for?

A

face and groin, children

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10
Q

What are medium potency topical steroids used for?

A

most adults for majority of areas

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11
Q

What are high potency topical steroids used for?

A

thick plaques not responding to treatment, palms and soles

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12
Q

When are topical steroids recommended?

A

atopic dermatitis, eczema, seborrheic dermatitis, contact dermatitis, psoriasis
“inflammation”

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13
Q

What’s the MOA of corticosteroids?

A

depress formation, release, and activity of chemical mediators of inflammation (induction of ph.A), decreases leukocytes, suppresses cytokines , vasoconstrictive…

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14
Q

Why do topical steroids only work on inflammation?

A

absorption markedly increased in inflamed skin

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15
Q

What are ADRs of topical steroids?

A

tachyphylaxis, rapid tolerance, can do one week on, one week off. skin atrophy, striae, common skin conditions caused by steroidal use

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16
Q

What are ADRs of topical corticosteroids that are systemic?

A

iatrogenic cushing’s syndrome – weight gain, “Buffalo hump” “moon face”, HTN, hypokalemia, hyperglycemia, osteoporosis, ulcers, muscle weakness, cataracts or glaucoma

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17
Q

What is preferred for infants and elderly patients?

A

low potency agents

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18
Q

When should you use topical steroid ointments?

A

for thick, lichenified lesions to enhance penetration

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19
Q

When should you use topical steroid cream?

A

acute and subacute dermatoses; moist skin, intertriginous areas

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20
Q

When should you use topical steroid gels, solutions, or sprays?

A

scalp or non-oil based vehicles needed

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21
Q

How long should very high potency steroid agents be used?

A

no longer than 2-3 weeks

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22
Q

What is acne vulgaris treatment for mild non-inflam disease?

A

topical retinoid or salicyclic acid

without improvement, can add topical antibiotic

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23
Q

What is acne vulgaris treatment for mild inflammatory disease?

A

topical retinoid (adapalene) + BPO in AM or topical abx +BPO
no improvement, add oral abx

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24
Q

What is acne vulgaris for moderate disease?

A

topical retinoid + topical abx in AM + oral abx + BPO

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25
Q

What should you consider for hormone-related acne?

A

combined oral contraceptive and topical retinoid + oral abx + BPO for longer term

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26
Q

What should you do about severe acne vulgaris?

A

refer to derm
Oral abx + topical therapy
oral retinoid if all else fails

27
Q

What is the MOA of salicylic acid?

A

Keralytic —- dissolve cell surface proteins that keep outermost epidermal layer intact, applied to whole treatment area

28
Q

What are ADRs of salicylic acid?

A

skin irritation (limit area), photosensitivity, allergic reaction (note: not good for any aspirin allergies)

29
Q

What is the MOA of topical retinoids?

A

Keratolytic: allowing treatment in, opens up comedones, aids in extraction

30
Q

How are topical retinoids used?

A

entire affected area, do not use with alcohol or astringents

31
Q

What are ADRs of topical retinoids?

A

skin irritation, photosensitivity (wear sunscreen), teratogenicity

32
Q

What is the MOA of BPO?

A

lipophilic oxidizing agent – oxidizes bacterial proteins, active against p. acnes

33
Q

When should you use BPO?

A

adjunct to topical and oral abx, more effective than either alone!
also acne rosacea

34
Q

What are ADRs for BPO?

A

skin irritation, allergic contact dermatitis, inactivation of topical retinoids (apply at different times), bleaching agent

35
Q

What is the MOA of azelaic acid (azelex)?

A

inhibits effect of conversion of testosterone to dihydrotesterone

36
Q

When do you use azelaic acid (azelex)?

A

alternative to topical abx or BPO, less irritating but less effective

37
Q

What are ADRs of azelaic acid?

A

skin irritation, hypopigmentation, vitiligo depigmentation, hypertrichosis

38
Q

What are indications for topical antibacterials?

A

prevention in a clean wound, early treatment, reduce staph colonization, acne, combo with corticosteroids

39
Q

What is bacitracin?

A

gram+, most anaerobes, Neisseriae, tetanus, diptheria, can be Neosporin or PolymyxinB

40
Q

What is polymyxin B sulfate?

A

gram- (pseudomonas, e.coli, enterobacter, klebsiella), resistant to proteus and serratia and g+, avoid with sulfa allergy

41
Q

What is neomycin?

A

gram-, generally avoid up to 25% have allergic reaction (redness in wound), found with polymyxin in Neosporin

42
Q

What is mupirocin?

A

most g+ including MRSA, treats impetigo, intranasal, can be irritating

43
Q

What is clindamycin?

A

fights p.acnes, mild to moderate cases, foam can be drying, lotion/gel is better tolerated
systemic reactions are rare

44
Q

What is erythromycin?

A

mild to moderate cases of acne, unknown MOA, but can see resistance so stop and treat with oral abx
water based gel is less irritating

45
Q

What is metronidazole?

A

anti-inflamm action common for rosacea, but maybe carcinogen. ADR=dryness, burning, cream is better

46
Q

What do you use topical antifungals for?

A

treat superficial fungal infections, mostly candida

47
Q

What are miconazole and clotrimazole?

A

miconazole (monistat) - cream, lotion, or suppositories
clotrimazole (lotrimin) - cream, lotion, vaginal cream/tablets stronger than niastatin

48
Q

What is ketoconazole (nizoral)?

A

cream for dermatophytosis and candidiasis , shampoo for seborrheic dermatitis

49
Q

What is clotrimazole-betamethasone dipropionate cream?

A

antifungal + corticosteroid = rapid symptomatic relief, very strong, “fungus on steroids”

50
Q

What is nystatin?

A

prescription, narrow spectrum, swallowing treatment, may cause GI issues

51
Q

What is imiquimod (aldara)?

A

genital and perianal warts, BCC on trunk/neck/extremities max 16 week use

52
Q

What is permethrin?

A

Nix = lice, apply for 10 minutes and rinse or Elimite = scabies (leave on for 8-14 hours)

53
Q

What is ivermectin?

A

sklice – 6 months and older, apply for 10 minutes then rinse

54
Q

where is tinea corporis?

A

body

55
Q

Where is tinea capitis?

A

head

56
Q

Where is tinea cruris?

A

groin

57
Q

Where is tinea pedis?

A

feet

58
Q

Where is tinea unguium?

A

nail

59
Q

What do you treat dermatophytes with?

A

-azoles, except nails – need stronger

60
Q

What is the yeast that causes pityriasis/tinea versicolor?

A

malassezia furfur

61
Q

What is the treatment for tinea versicolor?

A

selenium sulfide (selsun blue)

62
Q

What is pruritus ani?

A

perianal itching and discomfort, from cycle of scratching, treat with high potency topical corticosteroids

63
Q

What are treatments for breastfeeding?

A

lanolin (oil that is emollient action to condition skin), nipple fissure –> mupirocin, betamethasone, clotrimazole

Clinical Pharmacology (14 decks)

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