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Pharmacology- Exam #4 > Derm > Flashcards

Derm Flashcards

1
Q

Palm area rule

A

2 palm areas x2/day needs 30g for 1 month

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2
Q

Fingertip Units (FTU’s)

A

2 FTU=1 g of Topical Steroid

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3
Q

How can we enhance absorption/efficacy with topical agents?

A

Occlusion-Apply plastic wrap

10x increase with topical steroid agents

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4
Q

What is the role of dressings?

A
  1. Protect open lesions
  2. Facilitate healing
  3. Increase drug absorption
  4. Protect patient’s clothing
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5
Q

What is the MC Nonocclusive dressing?

A

Gauze dressings

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6
Q

Purpose of Nonocclusive dressing?

A
  1. Maximally allow air to reach wound

2. Allow lesion to dry

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7
Q

Purpose of wet-to-dry dressings

A

Cleanse and Debride thickened/crusted lesions

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8
Q

How do you apply wet-to-dry dressings?

A 
Applied Wet (saline solution) 
Removed after solution has evaporated
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9
Q

What conditions increase penetration in topical steroids?

A
  1. Inflamed skin-Atopic dermatitis

2. Exfoliative disease

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10
Q

Class I Potency and areas of application

A 
Super High Potency steroid 
Severe dermatoses over nonfacial and nonintertriginous:
1. Scalp
2. Palms 
3. Soles
4. Thick plaques on extensor surfaces
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11
Q

Class I length of treatment

A

<3 weeks

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12
Q

Class II-V Potency and areas of application

A

Medium-to-High Potency Steroid

Mild-to-Moderate nonfacial and nonintertriginous

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13
Q

Class II-V length of treatment

A

<6-8 weeks

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14
Q

Class VI-VII Potency and areas of application

A 
Low Potency Steroid 
Large Areas and thinner skin:
1. Face
2. Eyelid
3. Genital
4. Intertriginous areas
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15
Q

Class VI-VII length of treatment

A

1-2 weeks

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16
Q

Low potency steroids SE’s?

A
  1. Skin atrophy
  2. Telangiectasia
  3. Steroid induced acne
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17
Q

Systemic SE’s of Topical Glucocorticoids

A
  1. HPA Axis suppression
  2. Cushings
  3. Growth retardation
  4. Edema
  5. Sodium retention
  6. Pseudotumor cerebri
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18
Q

Ocular SE’s Topical Glucocorticoids

A
  1. Cataracts
  2. Glaucoma
  3. Retarded healing of corneal abrasion
  4. Extension of herpetic infection
  5. Increased susceptibility to bacterial and fungal infections
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19
Q

Cutaneous SE’s of Topical Glucocorticoids

A
  1. Skin atrophy
  2. Striae
  3. Telengiectasis, purpura, echymosis
  4. Retardation of wound healing
  5. Contact allergic dermatitis: Vehicle induced=common
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20
Q

What organisms does Bacitracin cover?

A

Gram +

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21
Q

Bacitracin Vehicle

A

Compound ointment base:
Alone OR
Combo with Neomycin/polymyxin B OR
Both

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22
Q

Most frequent SE of Bacitracin ?

A

Allergic contact dermatitis

Most likely from Neomycin

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23
Q

What organism does Mupirocin (Bactroban) cover?

A
  1. Gram +

2. MRSA

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24
Q

What is the preferred vehicle of Mupirocin? What is covered by insurance?

A

Ointment=preferred

Cream=covered by insurance

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25
Q

Mupirocin ADE’s

A
  1. Stinging/Burning
  2. Pruritis
  3. HA
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26
Q

List the Triple ABx Ointment

A
  1. Polymyxin B
  2. Neomycin
  3. Bacitracin
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27
Q

What organisms does Polymyxin B cover?

A 
Gram -
1. P. aeruginosa
2. Enterobacter
3. E.coli 
ALL gram + are resistant
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28
Q

What organism does Neomycin cover?

A
  1. Gram - (E.coli)

2. Gram + (S. aureus)

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29
Q

Neomycin SE

A

Sensitization (contact dermatoses)

= 30%

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30
Q

What is the main benefit of Gentamcin?

A

More active against Pseudomonas than Neomycin

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31
Q

Mild inflammatory acne treatment

A

Topical Retinoid OR
Topical Benzoyl Peroxide AND/OR
Topical Abx

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32
Q

Moderate acne treatment

A

Retinoid + Benzoyl Peroxide

+/- Topical Abx

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33
Q

What should you consider for moderate acne treatment in females?

A

Oral Abx
Derm referral
Hormal therapy

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34
Q

Severe acne treatment t

A

Retinoid + Benzoyl Peroxide+ Oral Abx

+/- Topical Abx

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35
Q

What should you consider for severe acne treatment in females?

A

Oral Isotretinoin
Derma Referral
Normal therapy

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36
Q

Comedone treatment

A

Topical Tretinoin (Retin A)

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37
Q

Cystic Acne treatment

A

Intralesional Triamcinolone

38
Q

List Topical Abx for use in mild-to-moderate cases of inflammatory acne

A
  1. Clindamycin (water-based gel)

2. Erythromycin (water-based gel)

39
Q

What can you combine both. Topical Clindaymycin and Erythromycin with?

A

Benzoyl Peroxide

40
Q

Who is Retinoic Acid beneficial in?

A
  1. Tx of Acne Vulgaris
  2. Photodamaged skin
  3. Thickened skin (psoriasis)
  4. Atrophic areas
41
Q

What is the best Retinoic Acids (acid form of Vitamin A)

A

Tretinoin (Retin A)

42
Q

Retinoic Acid application

A

Every night at bedtime to dry skin only x4-6 weeks

43
Q

What should you educate your patients about with the use of Retinoic acid?

A
  1. Avoid contact with: corner of nose, eyes, mouth, mucous membranes
  2. Can look worse initially
  3. Avoid sun exposure and wear SPF
44
Q

Who is Retinoic acid NOT recommended in?

A

Pregnant patients

45
Q

Benzoyl Peroxide PK/Mechanism

A
  1. Converted to Benzoic acid within epidermis and dermis

2. Bacteriostatic against P.acnes

46
Q

What is the OVERALL recommendation in Acne?

A

COMBO THERAPY

  1. Topical Retinoid +Abx (when inflammatory lesions are present)
  2. Benzoyl Peroxide +/- ABx
47
Q

When should you discontinue Abx therapy in acne?

A

Inflammatory lesions resolve

48
Q

Tetracycline ADE’s

A
  1. Slate gray hyperpigmentation
  2. Drug-Induced lupus
  3. Tetragenic
  4. Dizzines (Minocycline)
49
Q

Erythromycin ADE

A

Pro-kinetic= Increases GI motility=GI upset

50
Q

Management of Isotretinoin (Accutane) to prevent Teratogenic

A
  1. 2 effective forms of contraception: 1 month before, throughout, and 1 menstrual cycle after Tx ends
  2. Serum pregnancy test 2 weeks PRIOR to initiating tx
51
Q

What labs must you obtain monthly with the use of Isotretinoin (Accutane)

A
  1. Serum Pregnancy test

2. Fasting lipids

52
Q

List the Topical abx used in treatment of Rosacea

A
  1. Clindamycin 1% cream/lotion/gel
    2 Erythromycin 2% solution
  2. Metronidazole (Metrogel, Metro cream, Metrolotion)
  3. Sodium Sulfacetamide 4%
53
Q

Who is Metronidazole NOT recommended in?

A

Pregnancy
Nursing
Kids

54
Q

List the ORAL abx used in treatment of Rosacea

A

Tetracyclines:

  1. Doxycycline
  2. Minocycline
55
Q

Stage III rosacea with rhinopehyma and rosacea flumicans treatment

A

Isotretinoin (accurate)

56
Q

What type of rosacea is Isotretinoin (accurate) NOT recommended in?

A

Ophthalmic rosacea

57
Q

List Topical Imidazoles

A
  1. Ketoconazole
  2. Miconazole
  3. Fluconazole
58
Q

Indications for Topical Imidazoles treatment

A

Dermatophyte and Candida infections of:

  1. Stratum Corneum
  2. Mucosa
  3. Cornea
59
Q

What is Topical Imidazoles treatment NOT indicated in?

A
  1. Nail infections
  2. Hair infections
  3. SubQ infections
60
Q

Seborrheic dermatitis treatment

A

Ketoconazole

61
Q

What is Nystatin NOT effective against?

A

Dermatophytes

62
Q

Atopic Dermatitis Treatment

A

Immunomodulators:

  1. Tacrolimus
  2. Pimecrolimus
63
Q

Tacrolimus, Pimecrolimus MOA

A
  1. Calcineruin inhibitors

2. Inhibit T-lymphocyte activation: Prevents degranulation of mast cells by antigen-IgE complexes

64
Q

Tacrolimus, Pimecrolimus Black Box warning

A
  1. Malignancy
  2. Avoid continuous use
  3. Limit application to areas of involvement
  4. Not indicated in kids under 2
65
Q

What low pH cleanser would you recommend for general pruritus?

66
Q

Topical Doxepin: What is it? Used for? CI in?

A

Potent H1/H2 receptor antagonist
Tx Pruritis
CI: Urinary retention, narrow angle glaucoma

67
Q

List the Ectoparasiticides in the treatment of head lice/scabies

A
  1. Permethrin
  2. Lindane
  3. Crotamition
  4. Sulfar
68
Q

Lindane ADE

A

Concentrated in fatty tissues, including brain: Neurotoxic-Seizures

69
Q

List agents that reduce hyper pigmentation. MOA?

A

Hydroquinone + Mequinol

Interferes with biosynthesis of melanin

70
Q

Vitiligo treatment

A

Psoralens:

  1. Trioxsalen
  2. Methoxypsoralen
71
Q

Psoralens MOA

A

Repigmentation of depigmented macule in Vitiligo

72
Q

Risks of psoralen photochemotherapy

A
  1. Cataracts

2. Skin CA

73
Q

Define Sunscreen

A

Chemical compounds that absorb UV light

74
Q

Define Sunblock

A

Contain opaque materials that reflect light

Doesn’t need a chemical reaction to work= can go out immediately

75
Q

Sunscreen instructions

A

Apply 20 minutes before going out

Replace every 2 hours

76
Q

What do we use Salicylic Acid to treat?

A

Keratolytic agent to tx:

  1. Acne
  2. Psoriasis
  3. Warts
77
Q

Who do you want to caution Salicylic Acid use in?

A
  1. Diabetics

2. PAD

78
Q

Effects of Urea?

A

Softening and moisturizing effect on stratum corneal

79
Q

Humectant (urea agent) effects

A

Increases water content of stratum corneum

80
Q

What do we use Podophyllum Resin and Podophyllotoxin to treat?

A

Condyloma acuminatum

81
Q

Actinic Keratoses treatment

A

Fluorouracil

82
Q

What do we use Imiquimod to treat?

A
  1. Warts (FDA approved)
  2. Actinic Keratosis
  3. Basal cell carcinoma
  4. Squamous cell carcinoma
  5. Lentigo maligna melanoma
83
Q

What is a disadvantage of Minodixil (Rogaine)?

A

Effects are not Permanent: Stop tx, hair loss in 4-6 months

84
Q

What do we use Finasteride (trcichogenic agent) to treat? How long?

A

Promotes hair growth: Prevent further hair loss in men with Androgenic alopecia
Tx for 3-6 months

85
Q

Finasteride (trcichogenic agent) ADE’s

A
  1. Decreased libido
  2. Ejaculation disorder
  3. Erectile dysfunction
86
Q

What is initial treatment for Psoriasis?

A

High potency topical steroid + Phototherapy

87
Q

What is Acitretin (soriatane) a metabolite of? Treatment for?

A

Retinoid Metabolite

Treatment of Psoriasis

88
Q

What is the treatment regimen/management/limitatinos of Acitretin (soriatane)?

A
  1. Must not be used in pregnancy/looking to become pregnant years after tx
  2. NO alcohol during tx and 2 years after tx
  3. CANT donate blood during tx AND for 3 years after tx
89
Q

Methotrexate PK

A

Folate antagonist

90
Q

Who is Methotrexate NOT indicated in?

A

Pregnancy and breastfeeding=Category X

91
Q

What is a rare ADE with the use of biologic agents in the treatment of Psoriasis?

Pharmacology- Exam #4 (6 decks)

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