Derm 3 Flashcards
Topical antifungal treatments require __ to ___ weeks of therapy
4 - 6
What are the 4 topical antifungals?
- Clotrimazole
- Miconazole
- Ketoconazole
- Nystatin
What are the 3 Fungicides?
- Tolnaftate
- Naftifine
- Terbinafine
What antifungal has a greater response but is expensive? $$$
Fungicides
- Tolnaftate
- Naftifine
- Terbinafine
What are the 2 oral dissolving Oral Antifungals?
- Clotrimazole
- Miconazole
What is the oral suspension Oral Antifungal?
Nystatin
What are the 2 IV Antifungals?
- Amphotericin B
- Fluconazole
Azoles that are available for systemic use can be classified into what 2 groups?
-
Triazoles
- fluconazole
- itraconazole
-
Imidazoles
- clotrimazole
- ketokonazole
- miconazole
What is the MOA of Azoles?
(Triazoles: fluconazole, itraconazole)
(Imidazoles: clotrimazole, ketoconazole, miconazole)
Interfere w/ fungal cytochrome P450 activity, decreasing ergosterol synthesis & inhibiting cell membrane formation
MOA of what antifungal agent?
- Binds to sterols in fungal cell membrane, changing the cell wall permeability allowing for leakage of cellular contents
Nystatin
Which antifungal?
- For stratum corneum, mucosa, cornea by dermatophytes & Candida sp. infections
- Not for subcutaneous, nail or hair infections
- Paronychial and intertriginous candidiasis applied three or four times daily
- Also treats seborrheic dermatitis (ketoconazole)
- Once- or twice-daily application
- clearing of dermatophyte infections in 2-3 weeks
Topical Imidazoles
- Clotrimazole
- Ketoconazole
- Miconazole
Which antifungal?
- Topical ____ - cutaneous and mucosal candida
- Not effective against dermatophytes
- Oral candidiasis (thrush) - 5 mL (infants, 2 mL) oral suspension in the mouth (Swish and Swallow) four times daily for 7-10 days
- Oral troches four times daily for 7-10 days
- Vulvo-vaginal candidiasis - 1 vaginal tablet BID x 14 days, then Q HS for an additional 14-21 days
Nystatin
Atopic Dermatitis / Pruritis is also called what?
Eczema
What drugs?
- Inhibit T-lymphocyte activation and prevent degranulation of mast cells by antigen IgE complexes
Immunomodulators
-
Calcineurin inhibitors
- Tacrolimus
- Pimecrolimus
What is used to tx:
- Atopic dermatitis
- Off label for other autoimmune dermatologic disorders such as: Vitiligo & alopecia areata
*Neither medication should be used w/ ____.
Immunomodulators
-
Calcineurin inhibitors
- Tacrolimus
- Pimecrolimus
*Occlusive dressings
Which medication?
**Box Warning**
- Rare cases of malignancy (e.g., skin and lymphoma)
- Continuous long-term use in any age group should be avoided
- Application limited to areas of involvement with atopic dermatitis
- NOT indicated for use in children less than 2 years of age
Immunomodulators
-
Calcineurin Inhibitors
- Tacrolimus
- Pimecrolimus
General Tx of ____.
- If underlying cause known, treat that first
- Cool skin - light clothes on the body and bedding
- Air conditioning, humidifier
- Avoid topical products with fragrances, alcohol, wool, alkaline soap, and potential allergens
- Tepid shower before bed or cool compresses - Limit bathing to once per day with a non-soap, low pH cleanser (Cera-Ve, Cetaphil, Aveeno, Dove)
- NO orange or green soaps and NO Ivory
Pruritis
General tx of Pruritis
- Within __ mins after bathing, apply ___ liberally and __ other times in the day
- Emollients can be _____ and compounded w/ 1% menthol, 10% urea to increase their effectiveness
- Topical steroids with inflammatory conditions
- Topical _____ 4x/day -causes burning sensation that decreases compliance
- Topical _____ 3-4x/day - can cause anticholinergic effects
- 3 / emollient cream ointment (Cetaphil) / 2
- Refrigerated
- Capsaicin
- Doxepin
Which antipruritic agent?
- Potent H1- and H2-receptor antagonist properties
- May result in significant drowsiness in patients
- Topical use is contraindicated in urinary retention or narrow angle glaucoma
Topical doxepin 5% cream (Zonalon)
What drugs are these?
- Permethrin
- Lindane (Hexachlorocyclohexane)
- Crotamiton
- Sulfur
- Spinosad
- Malathion
- Ivermectin
Ectoparasiticides
Most common ADEs of what therapy?
- conjunctivitis
- ocular hyperemia
- eye irritation
- dandruff
- dry skin
- skin burning sensation
Sklice (ivermectin 0.5% lotion)
(tx for head lice)
What are the 5 prescription lice products?
- Benzyl alcohol
- Malathion
- Spinosad
- Ivermectin (Skilice)
- Lindane
(MILBS)
Which prescription lice product?
- Age: 6 months+
- Dosage: 4-48 oz
- Time of app: 10 mins, repeat in 7 days
- Benzyl alcohol
Which prescription lice product?
Age: safety not shown <6 yrs
Dosage: 2 oz bottle: apply enough to wet hair & scalp
Time of app: 8-12 hrs, repeat in 7-9 days if lice persist
Malathion
Which prescription lice product?
Age: 4 yrs+
Dosage: up to 120 mL (1 bottle)
Time of app: 10 mins, repeat in 7 days if lice persist
Spinosad
Which prescription lice product?
Age: 6 months+
Dosage: Up to 120 mL (4 oz tube)
Time of app: 10 mins, tube for single use, consult HCP prior to re-treatment
Ivermectin (Sklice Lotion)
Which prescription lice product?
Age: use w/ caution in those <110 lbs
Dosage: 1-2 oz
Time of app: 4 mins, DO NOT re-treat
Lindane
Which Ectoparasiticide?
- Is toxic to Pediculus humanus, Pthirus pubis, and Sarcoptes scabiei
•Residual drug persists up to 10 days following application
- 1% cream rinse pediculosis
- 5% cream for scabies
•Single application applied to the body from the neck down, left on for 8-12 hours, and then washed off
Permethrin
Which Ectoparasiticide?
- is available as a shampoo or lotion
- 10% of a dose is absorbed
- Concentrated in fatty tissues, including the brain
- Potentially neurotoxic and can lead to seizures
- For pediculosis capitis or pubis
Lindane
Tx of which Ectoparasiticide?
What is this treating?
•30 mL of shampoo applied to dry hair on the scalp or genital area for 4 minutes and then rinsed off
Lindane: to tx Pediculosis capitis or Pediculosis pubis
Tx of which Ectoparasiticide?
What is this treating?
•Single application applied to the entire body from the neck down, left on for 8-12 hours, and then washed off
Lindane: tx of scabies
Which ectoparasiticide?
- available as a cream or lotion
- Scabicide with some antipruritic properties
- Two applications applied from the chin down at 24-hour intervals, with a cleansing bath 48 hrs. after the last application
Crotamiton
Which Ectoparasiticide?
•remains a possible alternative drug for use in infants and pregnant women.
- 5% precipitated ____ in petrolatum (compounded)
- Two applications applied from the chin down at 24-hour intervals, with a cleansing bath 48 hrs. after the last application
Sulfur
