Derm/HEENT Flashcards
Topical retinoids
adapalene, tazarotene, tretinoin
avoid in pregnancy, women should use contraception; photosensitivity
first line therapy for acne
Topical antimicrobials
clindamycin, erythromycin
best efficacy for acne when combined with retinoids or benzoyl peroxide
benzoyl peroxide
photosensitivity, skin and fabric bleaching
ofen used in combo with oral or topical antimicrobials for acne
azelaic acid cream
skin irritation, hypopigmentation possible
adding to topical antimicrobials is more effective than alone
experts believe it has limited efficacy
dapsone topical gel
newer drug for acne; still being studied for long-term and combination efficacy
possible decrease in Hgb; photosensitivity
oral antibiotics for acne
minocycline, doxy, tretra, and erythromycin are all efficacious
minocycline is most efficacious then doxy and tetra
oral isotretinoin
for severe, treatment resistant acne highly teratogenic (iPledge); suicidal ideations; sunburn risk monthy monitoring: CBC, glucose, lipids, creatine phosphokinase, liver fxn, mood changes
azelastine
intranasal antihistamine
some somnolence and drowsiness
less effective than intranasal corticosteroids
first line therapy for pts with mild disease (possibly more effective than oral antihistamines)
leukotriene receptor antagonists
montelukast, zafirlukast, zileuton
rare neuropsychiatric disorders
less effective than intranasal corticosteroids, as effective as oral antihistamines (may be used in combo)
zileuton- drug interactions and liver monitoring
zafirluast- administer 1 hour before or 2 hours after meals
permethrin 5%
first line for scabies may worsen asthma; photosensitivity cover ALL areas of the body below head, leave on 8-14 hours age 2 and older once weekly for up to 3 weeks
ivermectin
oral, not FDA approved but used for scabies if not eradicated by permethrin; same for head lice
warnings: symptomatic postural hypotension; association with increased 6-month mortality in long-term care residents
peripheral edema, tachycardia, GI effects, transaminase elevations
single dose repeated after 14 days
topical lindane
second-line for scabies for permethrin non-responders
BBW: neurologic toxicity (seizures and death) w/prolonged or repeated exposure
May cause pruritis for several weeks
one total body application (leave on 8-12 hours) - do not retreat!
permethrin 1%
first line for pediculosis
may repeat in 7-10 days if nits present
malathion 0.5%
for pediculosis when permethrin resistance suspected
flammable; CI in children < 24 months; no safety data for children < 6 years
apply to hair and remove after 8-12 hours (may repeat in one week)
spinosad
limited data suggest it is superior to permethrin but not yet in guidelines
Not for infants < 6 months d/t benzyl alcohol (gasping syndrome)
ADE: alopecia
may repeat in 7 days if nits present
Bactrim for head lice
can add to permethrin for higher success rate than either agent alone. Add to permethrin if nits and lice are found 2 weeks after first course.
CI: < 2 months old; pregnant/nursing
BID for 10 days
AREDS formula
vitamin C, E, (A or beta-carotene) and zinc
effective preventing pts with intermediate macular degeneration from progressing to advanced dx or visual acuity loss
no benefit in pts with age-related macular degeneration
do not use the beta-carotene formulation in smokers or lung cancer pts
bevacizumab
intravitreal therapy for neovascular (wet) macular degeneration
not FDA labeled for AMD; however it is more widely used and covered by insurance d/t cost advantage over ranibizumab
ranibizumab
intravitreal therapy for neovascular (wet) macular degeneration
most extensively studied but also very expensive
prostaglandin analogs
for open-angle glaucoma
bimatoprost, latanoprost, tafluprost, travoprost
CI: macular edema, hx of herpetic keratitis
greatest IOP reduction of the available pharm agents
B-antagonists (topical)
betaxolol, timolol, levobunolol, metipranolol, carteolol
adding to prostaglandin analog for OAG decreases variations in IOP
do not use as monotherapy in angle-closure glaucoma
a-antagonists
apraclonidine, brimonidine (preferred)
third-line for glaucoma
caution: CV dx, cerebrovascular dx, depression, orthostatic hypotension, Raynaud
carbonic anydrase inhibitors
topical: brinzolamide, dorzolamide
oral: acetazolamide, methazolamide
third-line agent for glaucoma
topical used before oral formulations
CI to systemic: aplastic anemia, nephrolithiasis, sulfonamide allergy, thrombocytopenia
topical corticosteroids for psoriasis
TOC for mild-mod dx
as effective as vitamin d analog but fewer ADRs
calcipotriene
topical vitamin d analog for psoriasis
use in combo with topical corticosteroid (betamethasone best) for added efficacy
NOT contraindicated in UVB phototherapy
ADE: photosensitivy, UV-induced skin tumors, hypercalcemia
tazarotene
topical retinoid for psoriasis
preg category X, photosensitivity
use w/topical corticosteroids
alefacept
t-cell inhibitor shows improvement in chronic plaque psoriasis
ADE: flulike, elevated hepatic transaminases
once weekly intramuscular inj for 12 weeks then 12 week tx free
TNF inhibitors
adalimumab, etanercept, infliximab for psoriasis linked with new or worsenign HF infliximab has greatest decrease in sxs in shortest time (10 vs 12 weeks) have been combine with methotrexate subq dosing
methotrexate
may be less effective than cyclosporine
reserved for pts w/moderate to severe or refractory psoriasis
probably not as effacacious as t-cell inhibitors or TNF inhibitors
cyclosporine
do not use with UV phototherapy
reserved for pts w/moderate to severe or refractory psoriasis
probably not as effacacious as t-cell inhibitors or TNF inhibitors
acitretin
preg cat X; less effective than other therapies for psoriasis
reserved for pts w/moderate to severe or refractory psoriasis
probably not as effacacious as t-cell inhibitors or TNF inhibitors
