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Pharm (Cholley) > Derm > Flashcards

Derm Flashcards

1
Q

The efficacy of a topical applied drug depends on…

A

its potency & on its ability to penetrate skin

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2
Q

What are factors that affect penetration?

A
  • Concentration of med
  • Thickness & integrity of stratum corneum
  • Frequency of application
  • Occlusiveness of the vehicle
  • Compliance
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3
Q

Topical formulations are meant to…

A

enhance the beneficial effects of the med

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4
Q

What can cause local toxicity?

A

The vehicle or its active ingredients

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5
Q

Topical meds can induce…

A

systemic toxicity

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6
Q

Penetration w/ regards to regional differences

A 
1 = most penetration 
10 = less penetration
  1. MM
  2. Scrotum
  3. Eyelids
  4. Face
  5. Chest/back
  6. Upper arms & legs
  7. Lower arms & legs
  8. Dorsa of hands/feet
  9. Palmar & plantar skin
  10. Nails
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7
Q

Is the epidermis thicker in acral skin or eyelid skin?

A

Acral

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8
Q

What all determines the response to topical drugs?

A
  • Regional variation in drug penetration
  • Concentration
  • Dosing schedule
  • Vehicles
  • Occlusion
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9
Q

What are the goals of derm therapy?

A
  • Counteract disease
  • Reduce inflammation
  • Relieve sx
  • Promote epithelial healing
  • Restore integrity of cutaneous barrier
  • Prevent complications
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10
Q

Topical therapy considerations

A
  • Vehicle selection
  • Class selection
  • Appropriate quantity for BSA involved
  • Enhance absorption
  • Tachyphylaxis: diminishing response to doses of a drug, rendering it less effective
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11
Q

1 palm area = ….

A

1% BSA

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12
Q

2 FTUs = …..

A

1 g of topical steroid

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13
Q

How can you enhance absorption w/ topical therapy?

A
  • Cover area to increase effectiveness & absorbency into skin
  • Apply topical to skin & cover w/ plastic wrap, cellphane, waterpoof dressing, cotton socks, or nylon.
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14
Q

How can topical therapies be delivered?

A
  • Powders
  • Liquids: foams, solutions, lotions, gels
  • Combo of liquid & oil: creams, ointments
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15
Q

What is an example of a nonocclusive dressing? What are they used for?

A
  • MC = gauze
  • Allow air to reach wound
  • Allow the lesion to dry
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16
Q

What are wet-to-dry dressings? What are they used for?

A
  • Nonocclusive dressing wetted w/ saline

- Cleanse & debride lesions

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17
Q

What are occlusive dressings? What are they used for?

A
  • MC = transparent films or transparent semi-permeable dressings
  • Increase absorption & effectiveness of topical
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18
Q

What are characteristics of topical corticosteroids?

A
  • Antimitotic effects on epidermis
  • Minimally absorbed
  • Occlusion enhances penetration (10x increase in absorption)
  • Penetration increases in inflamed skin
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19
Q

When are super high potency (Class I) corticosteroids used?

A

For severe dermatoses over nonfacial areas:

- Scalp, palms, soles, thick plaques over extensor surfaces

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20
Q

When are medium-high potency (class II-V) steroids used?

A

Mild-mod nonfacial areas

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21
Q

When are low potency steroids (Class VI, VII) used?

A

Large areas & thinner skin:

- Face, eyelid, genital, intertriginous areas

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22
Q

How long are corticosteroids used for depending on potency?

A

High: < 3 wks
Med-high: < 6-8 wks
Low: side effects rare, 1-2 wk intervals

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23
Q

What is an example of a class I (high potency) topical corticosteroid?

A

Clobetasol propionate .05% cream or ointment

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24
Q

What are 2 examples of class II (med-high potency) topical corticosteroids?

A
  • Betamethasone .05% cream

- Fluocinonide .05% cream

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25
Q

What are 3 examples of class III (med-high potency) topical corticosteroids?

A
  • Betamethasone diproprionate .05% cream or lotion
  • Betamethasone valerate .1% ointment
  • Triamcinolone acetonide .1% ointment
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26
Q

What are 2 examples of class IV (med-high potency) topical corticosteroids?

A
  • Fluocinolone acetonide .025% ointment

- Tramcinolone acetonide .1% cream or ointment

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27
Q

What is an example of a class V (med-high potency) topical corticosteroid?

A

Flucinolone acetonide .025% cream

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28
Q

What is an example of a class VI (low potency) topical corticosteroid?

A

Triamcinolone acetonide .1% cream

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29
Q

What is an example of a class VII (low potency) topical steroid?

A

Hydrocortisone 1%

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30
Q

What are systemic effects of topical steroids?

A
  • suppresion of hypothalamic-pituitary-adrenal axis
  • Cushings syndrome
  • pseudotumor cerebri
  • growth retardation
  • Na retention & edema
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31
Q

What are ocular effects of topical steroids?

A
  • cataracts
  • glaucoma
  • retarded healing of corneal abrasion
  • extension of herpetic infection
  • increased susceptibility to bacterial & fungal infection
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32
Q

What are cutaneous effects of topical steroids?

A
  • atrophy
  • striae
  • telangiectasias, purpura, ecchymosis
  • hypopigmentation
  • retardation of wound healing
  • contact allergic derm
  • “habituation”
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33
Q

What are 4 categories of antibacterial agents?

A
  • Bacitracin
  • Mupirocin
  • Polymyxin B, neomycin, gentamicin
  • Topical/oral abx in acne
34
Q

What are characteristics of bacitracin?

A
  • Active against gram + (s. aureus, strep)
  • Used alone or in combo w/ neomycin, polymyxin B, or both
  • Poorly absorbed
  • Contact derm is common
35
Q

What is mupirocin active against? What are ADEs? What forms is it available in?

A
  • Gram+
  • Stinging, burning, pruritis, HA
  • Cream or ointment
36
Q

What is polymyxin B active against?

A

Gram - (pseudomonas, enterobacter, e.coli)

*All gram+ are resistant

37
Q

What is neomycin active against? What is an ADE?

A
  • Aerobic gram+ & gram- bacilli (s. aureus, e.coli)

- sensitization

38
Q

What is important to know about gentamicin?

A

Has greater activity against pseudomonas than neomycin

39
Q

How do you classify acne severity?

A
  • Mild: < 20 comedones
  • Mod: 20-100 comedones
  • Severe: > 100 comedones
40
Q

What are 4 factors involved in acne vulgaris?

A
  1. Increase in sebum via androgens
  2. Keratin & sebum plug hair follicle –> hyperkeratosis w/ comedone formation
  3. P. acnes proliferates in follicle
  4. Inflammatory response
41
Q

What are 2 actions of retinoids?

A
  • Normalize desquamation

- Reduce inflammation

42
Q

What are 2 actions of abx?

A
  • Reduce microorganisms

- Reduce inflammation

43
Q

What are 4 actions of oral isotretinoin?

A
  • reduce sebum
  • normalize desquamation
  • inhibit p. acnes growth
  • reduce inflammation
44
Q

What is the action of hormones?

A

Reduce sebum

45
Q

What is the action of benzoyl peroxide?

A

Reduce microorganisms

46
Q

How do you tx mild acne?

A

Topical retinoid OR topical benzoyl peroxide

47
Q

How do you tx moderate acne?

A

Topical retinoid & benzoyl peroxide +/- topical abx

48
Q

How do you tx severe acne?

A

Topical retinoid & benzoyl peroxide +/- topical abx & oral abx

49
Q

How do you tx comedones?

A

topical tretinoin

50
Q

How do you tx cystic acne?

A

intralesional triamcinolone

51
Q

What is the preferred oral antibiotic for acne?

A

Tetracyclines

- Doxy = best

52
Q

Why should topical & oral abx not be used as monotherapy for acne?

A

Risk of resistance

53
Q

What 2 topical abx are used for rosacea?

A
  • Metronidazole

- Sulfacetamide

54
Q

What 2 topical abx are used for acne?

A
  • Clindamycin
  • Erythromycin
  • Both combined w/ benzoyl peroxide
55
Q

What are the ADEs of metronidazole gel form?

A

Dryness, burning, stinging

56
Q

Can you use topical metronidazole in pregnancy or breastfeeding?

A

Not recommended

57
Q

Sodium sulfacetamide MOA

A

Inhibits p-aminobenzoic acid

58
Q

Sodium sulfacetamide contraindication

A

Sulfonamide sensitivity

59
Q

What are other tx options for rosacea?

A
  • Sunscreen daily
  • Clindamycin & erythromycin
  • Imidazoles, ketoconazole
  • Azelaic acid
  • Tetracyclines
60
Q

What can you use to tx stage III rosacea w/ rhinophyma & fulminans?

A

Isotretinoin

61
Q

What local reactions of erythromycin solution?

A

Burning, drying, irritation

62
Q

What are characteristics of retinoic acid (vit A)?

A
  • Tx for acne vulgaris
  • increases cell turnover
  • expulsion of open comedones
  • transformation of closed comedones to open
  • can induce erythema & peeling
63
Q

What are ADEs of tetracycline?

A
  • slate gray hyperpigmentation
  • drug-induced lupus
  • minocycline –> dizziness
64
Q

What are ADEs of erythromycin & clindamycin?

A 
Erythro = GI upset
Clinda = C. difficile
65
Q

What are the guidelines for isotretinoin?

A
  • Women MUST use 2 forms of contraception (1 month before, through tx, & for 1 cycle following tx)
  • Pregnancy test MUST be obtained within 2 wks prior to tx
66
Q

What are the side effects of isotretinoin (oral retinoid)?

A
  • Dry MMs, xerosis, cheilitis
  • joint pain
  • thinning hair
  • HA
  • nausea
  • mood swings, suicidal ideations, sleep disturbance
67
Q

What is the required duration of tx for topical antifungals?

A

4-6wks

68
Q

What are 2 actions of imidazoles?

A
  • inhibit enzyme –> mem leaking

- alter cell mem –> fungal cell death

69
Q

Do not use topical imidazoles for…

A

subcutaneous, nail or hair infections

70
Q

What is the box warning for immunomodulators?

A
  • malignancy
  • avoid long-term use
  • apply to limited areas
  • don’t use in < 2 yo
71
Q

How do you tx pruritis?

A
  • tx underlying cause
  • cool skin, light clothes
  • AC, humidifier
  • Avoid allergens
  • Tepid shower before bed or cool compresses
  • Apply cream/ointment within 3 mins after bathing
72
Q

What is a side effect of antipruritic agents? What is a contraindication?

A
  • Drowsiness

- Contraindicated in urinary retention or glaucoma

73
Q

What is the MC med used for scabies?

A

Permethrin

74
Q

What is an alternative drug used for scabies in pregnancy or infants?

A

Sulfur

75
Q

What 3 agents affect pigmentation?

A

Hydroquinone
Mequinol
MBEH

76
Q

What is the action of trioxsalen & methoxypsoralen?

A

Repigmentation of depigmented macules of vitiligo

77
Q

Sunscreen vs sunblock

A
  • Suncreen: chemical compounds that absorb UV

- Sunblock: opaque materials that reflect light

78
Q

What drug is used for actinic keratoses?

A

Fluorouracil

79
Q

How do you tx psoriasis?

A
  • Initial = high potency topical steroid

- phototherapy

80
Q

Acitretin (retinoid metabolite) guidelines for the tx of psoriasis?

A
  • DON’T use in pregnancy (must wait to get pregnant 3 yrs after tx)
  • Avoid Etoh (during tx & for 2 months after)
  • MUST NOT donate blood during tx or for 3 yrs after

Pharm (Cholley) (9 decks)

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