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S3 - Pharm Exam 1 > Derm Preparations > Flashcards

Derm Preparations Flashcards

1
Q

What causes diaper rash?

A
  1. Urine + feces in diaper
  2. Superinfx from systemic abx
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2
Q

MCC of diaper rash?

A
  1. Candida albicans species
  2. Bacterial - S. aureus, group A S. pyogenes
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3
Q

How can we prevent diaper rash?

A
  • Keep area clean + dry
  • Powder/cornstarch
  • Freq diaper changes
  • Loose fitting, ventilated diaper
  • Change to cloth if needed
  • Remove diaper + leave off as time permits
  • Wash w/ water + mild cleanser (Cetaphil)
  • Use cool air to dry buttocks
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4
Q

What oints can be used as a protective barrier to prevent/tx diaper rash?

A

A+D oint

Petrolatum (Vaseline) ***not aquaphor

Zinc oxide

Desitin (zinc oxide + emollient)

Some have protectant + drying agent + anti-microbial + vitamins

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5
Q

What can be used for the sx tx for diaper rash?

A

Topical steroids

*do little to treat rash, but beneficial for anti-inflamm effect

**caution: can cause adrenal suppression if too much absorbed (use low potency)

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6
Q

Tx for a diaper rash caused by yeast - “red satellite lesions”?

A
  • Topical antifungal
    • Nystatin - powder/cream/oint
    • Nystatin + Triamcinolone - cream/oint
    • Clotrimazole - cream
    • Clotrimazole + Betamethasone - cream
  • Combo product - zinc oxide, petrolatum + 0.25% miconazole
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7
Q

Tx for a diaper rash caused by bacteria (usually staph/strep) - “yellowish, fluid-filled pustules, honey-colored, crusty”?

A

Mild -> topical tx (bacitracin, mupirocin)

More severe -> systemic PO abx (beta-lactams)

Combo therapy -> topical + PO **most effective

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8
Q

What is “butt paste” and what is it used for?

A

Zinc oxide + Aquaphor/A+D oint/petrolatum + Cholestyramine (binds uric acid, keeps pH at normal levels)

*NOT for prevention, for tx of diaper rash only

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9
Q

What is true about the 3 main diff types of poisons (ivy, sumac, oak)?

A

If you are sensitive to one type -> sensitive to all

Tx for all is similar (self-limiting, resolve on own but take a long time)

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10
Q

Why do most pts w/ poison contact end up spreading the poison all over themselves?

A

Rhus dermatitis - delayed hypersensitivity rxn occurs 12-72 hrs after exposure *most pts don’t know they have it on them

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11
Q

What is urushiol?

A

Chemical secreted by bruised plants (poison ivy, oak + sumac)

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12
Q

How can pts come in contact w/ urushiol?

A

Primary exposure - direct contact to bruised portion of plant that exudes urushiol

Secondary exposure - contact w/ exposed pets, contaminated clothing, smoke from burning plants

**NOT transmitted via fluid vesicles/blisters

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13
Q

What are the sx for poison dermatitis?

A

Severe itching, burning sensation

*condition is self-limiting + resolves in 14-20 d

Secondary infx can occur b/c of scratching

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14
Q

Tx goals for poisons - Ivy, Oak, Sumac?

A

Wash area immediately w/ soap + alcohol

Barrier products to protect/prevent plant oils penetrating skin + causing rash - Bentoquatam

Zanfel (OTC wash, not recommended)

Reduce pain/itch to prevent 2’ infx

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15
Q

Tx of mild/moderate cases of poison ivy, oak + sumac - soaks, baths, mild dressings?

A

Colloidal oatmeal - bath, transient relief

Aluminum acetate - moist/wet dressings, reduce itch, mild astringent

For facial lesions use moist/wet dressings (NOT lotions - difficult + painful to remove once dry)

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16
Q

Tx of mild/moderate cases of poison ivy, oak + sumac - topical preps for lesions?

A

Calamine (he says hydrocortisone is better)

Local anesthetics (Caladryl = calamine + pramoxine)

Antihistamines (Diphenhydramine cream - may sensitize skin, generally NOT effective, does not penetrate skin + may irritate further)

Camphor + menthol (“cooling effect”), phenol + EtOH (antibacterial) - promotes drying of vesicles

Aluminum Acetate solns

Steroids

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17
Q

What type of tx should you not use for poisons while vesicles are present and/or weeping?

A

Ointments - can form a barrier + seal moisture in (vesicles need to dry)

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18
Q

Tx of severe cases (widespread or eye involvement) of poison ivy, oak + sumac?

A

Antihistamines PO

Glucocorticosteroids PO

Abx PO *if 2’ infx

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19
Q

Antihistamine for severe cases of poison ivy, oak + sumac?

A

Diphenhydramine - 25-50 mg PO QID PRN

ADRs: sedation, dry mouth

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20
Q

Glucocorticosteroid for severe cases of poison ivy, oak + sumac?

A

Prednisone PO 7-21 d, taper off

Anti-inflamm, may be used in moderate cases too

*problem is that steroids mask infx

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21
Q

Abx for severe cases of poison ivy, oak + sumac?

A

Tx for staph: cephalosporins + penicillins

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22
Q

What is acne stimulated by?

A

Testosterone + dihydrotestosterone (its metabolite)

Multifactorial pathogenesis = bacterial (P. acnes) + irritants

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23
Q

General tx guidelines for acne?

A

Cleanse skin BID w/ mild cleanser (Cetaphil) + pat dry

Use coarse cloth/sponge to exfoliate

Astringent

Medication prn

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24
Q

Pharmacological tx of acne?

A

Topical Benzoyl Peroxide

Topical Salicylic Acid

Topical Retinoids

Misc topicals

Topical abx

PO abx

PO isotretinoin (Accutane)

OCP

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25
Q

MOA of Benzoyl Peroxide 2-5-10% for acne?

A

Causes desquamation - increases turnover of epithelial cells, promotes healing, may be bacteriostatic/bacteriocidal

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26
Q

Precautions/ADRs for Benzoyl Peroxide?

A

Do not use around mouth/eyes/lips

Some pts are hypersensitive

ADRs: drying, peeling, stinging; may bleach clothing/linens

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27
Q

MOA for salicyclic acid?

A

Keratolytics - helps remove upper layer of dead cells

0.5-2% -> acne

10-15% -> wart removal

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28
Q

ADRs for salicylic acid?

A

Drying, peeling

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29
Q

What is the 1st line tx of acne after OTCs?

A

Topical Retinoids - Vit A derivatives

Exs: Tretinoin gel + cream, Tazarotene gel + cream

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30
Q

MOA for topical retinoids?

A

Increases epithelial cell proliferation, reduces comedo formation

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31
Q

Precautions/ADRs for topical retinoids?

A

AVOID sun (SPF 30-45), don’t use around eyes/mouth/lips

ADRs: erythema, dryness, peeling, scaling, itching, crusting, photosensitivity, pigmentation changes (bleaching)

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32
Q

Misc topicals for acne?

A

Adapalene

Azelaic acid

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33
Q

MOA of Adapelene used in tx of acne?

A

Retinoid-like compound, binds to different retinoid type receptors

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34
Q

ADRs of Adapelene?

A

Similar to other retinoids- local skin irritation, not shown to be teratogenic in rodents (no human studies)

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35
Q

MOA of Azelaic Acid used in tx of acne?

A

Not fully determined, but may have antimicrobial activity against P. acnes + blocks conversion of testosterone to dihydrotestosterone

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36
Q

ADRs of Azelic Acid?

A

Erythema, dryness

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37
Q

MOA for topical abx used in tx of acne?

A

Antimicrobial activity against causative organisms

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38
Q

Exs of topical abx used in tx of acne?

A

erythromycin

erythromycin + benzoyl peroxide

sodium sulfacetamide

clindamycin

combo w/ benzoyl peroxide

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39
Q

ADRs for topical abx used in tx of acne?

A

Burning, stinging, drying, peeling, erythema

Dosed 2-6xd; resistance rare due to minimal systemic absorption

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40
Q

MOA for oral abx used in tx of acne?

A

Antimicrobial activity against causative organisms

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41
Q

Exs of oral abx used for tx of acne?

A

Tetracyclines (doxycycline, minocycline)

Macrolides (erythromycin)

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42
Q

Precaution/ADRs for oral abx used in acne tx?

A

May increase risk of resistance due to chronic usage

ADRs: N/V/D, vertigo (w/ minocycline), OCP failure

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43
Q

What oral retinoid is used only for severe acne tx?

A

Isotretinoin (Accutane)

0.5-1 mg/kg/day divided BID x 15-20 wks (may repeat x 1 after 2 months off)

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44
Q

MOA of isotretinoin for acne tx?

A

Reduce sebaceous gland size, regulates cell proliferation + differentiation

Best tx for severe acne

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45
Q

ADRs for isotretinoin used for acne tx?

A

Dryness, itching of skin + mucous membrane

HA, depression, increase suicide risk

Hyperlipidemia, increase LFTs

Alopecia

Myalgia

Hematologic ADRs

Ocular ADRs, photosensitivity

***must sign informed pt consent + cannot be pregnant or get pregnant (cat X)

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46
Q

Which tx of acne can only be used in females?

A

OCP (for >18 yo)

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47
Q

MOA of OCPs that helps tx acne?

A

Increased estrogen helps counterbalance the high testosterone levels which cause acne

Estrogen alone or Estrogen/Progesterone combo (want high estrogenic activity + low androgenic activity - tricycline brands are good)

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48
Q

ADRs for OCPs used in acne tx?

A

PMS-like sx, bloating, weight gain

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49
Q

What drugs cause acne?

A

Hormones (gonadotropins, anabolic steroids, corticosteroids)

Anti-epileptic drugs

TB drugs (INH, Rifampin)

Misc (Lithium, Cyclopsorine, Iodine)

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50
Q

Tx of psoriasis can be defined as?

A

Acute or chronic

NO CURE

Tx aimed to reduce severity + be palliative

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51
Q

What factors influence tx selection?

A

Age of pt

Type of psoriasis

Site/extent of involvement

Previous tx

Coexisting disease

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52
Q

Tx of acute psoriasis?

A

Non-medicated topicals to soothe irritation to severely erythematous lesions: Aquaphor, cold cream, Lac-hydrin, Eucerin

May also use topical steroids

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53
Q

Tx of chronic psoriasis?

A

Topical corticosteroids: anti-inflamm, anti-pruritic, vasoconstrictor, immunosuppressive

Coal Tar

Psoralens

Retinoids

Monoclonal ABs

Phosphodiesterase 4 (PDE4) Inhibitors

Misc. agents: antimetabolites, immunosuppressants, topical immune modulators

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54
Q

How should topical steroids be used in tx of chronic psoriasis?

A

Start w/ super high potency (class 1-2) BID x 2-3 wks -> pulse tx (2 days on, 5 days off) OR change to lower potency

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55
Q

Which topical steroids can be used on face, perineum or mucous membranes in tx of chronic psoriasis?

A

Non-fluorinated steroids

*Halogenated or fluroinated steroids CANNOT, but increase absorption

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56
Q

ADRs of topical corticosteroids used in tx of chronic psoriasis?

A

Thinning + tearing

Bruising of skin

Acne

Hypopigmentation - blanching due to vasoconstriction

Infx (immune sx suppressed)

Contact dermatitis

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57
Q

Precautions for tx w/ topical corticosteroids?

A

Do not use super potent on children or elderly due to increased systemic absorption (children -> skin not keratinized, elderly -> thin skin)

Avoid use of super potent in flexural areas (groin, axilla, popliteal + antecubital fossa) -> areas tend to be warm/moist -> added absorption

Super potent may also inhibit HPA axis

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58
Q

What is Coal Tar used for?

A

Tx of chronic psoriasis - oint/lotion/soap/shampoo

Use alone or w/ low potency steroids

Applied HS + washed off in AM

May be used w/ UVB light therapy

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59
Q

Problem w/ coal tar in tx of chronic psoriasis?

A

Non-compliance

Cosmetically non-appealing (staining of clothes, bedding, hair)

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60
Q

ADRs of tx w/ coal tar?

A

Folliculitis

Photosensitivity

Irritation

Scaling

Itching

Inflamm

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61
Q

What is Psoralens?

A

Tx of chronic psoriasis

Methoxsalen - PO, lotion

Follow w/ UVA light tx 2 hrs post

Combo referred to as PUVA

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62
Q

ADRs of tx w/ Psoralens?

A

Pruritis, dry skin, loss of pigmentation

Nausea

Blistering

Painful erythema

Drug-food interx: avoid furocoumarin-containing foods (figs, celery, carrots)

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63
Q

What retinoids are used in tx of chronic psoriasis?

A

Etretinate (PO) - when used in combo w/ PUVA -> “RE-PUVA”

Acitretin (PO)

Tazarotene (topical)

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64
Q

MOA of Etretinate (retinoid) in tx of chronic psoriasis?

A

Normalizes expression of keratin

Suppresses chemotaxis

Decreases stratum corneum cohesiveness

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65
Q

ADRs of Etretinate/Acitretin (retinoids) - tx of chronic psoriasis?

A

LFT abnormalities

Alopecia

Exfoliation

Hyperlipidemia

Myalgia

Arthralgia

66
Q

What should be used if tx w/ retinoids for chronic psoriasis?

A

Birth control - 1 month pre + during therapy (must use for 3 yrs post; all Cat X)

67
Q

What is the half-life of retinoids?

A

Etretinate = 100 days (can be found in plasma 2-3 yrs after d/c)

Acitretin = 49 hrs

68
Q

What monoclonal ABs can be used for tx of chronic psoriasis?

A

Secukinumab - SQ

Izekizumab - SQ

Brodalumab

Guselkumab

69
Q

MOA of Sueckinumab for tx of chronic psoriasis?

A

Human IL-17A antagonist: inhibits release of proinflamm cytokines + chemokines

70
Q

Precautions/ADRs for Secukinumab in tx of chronic psoriasis?

A

Serious infx, check for TB, Crohn’s exacerbations, anaphylaxis

Nasopharyngitis, diarrhea + URTIs

71
Q

MOA for Ixekizumab in tx of chronic psoriasis?

A

Human IL-17A antagonist - tinea infx

72
Q

MOA for Brodalumab in tx of chronic psoriasis?

A

Human IL-17RA antagonist - Chron’s dis, TB

73
Q

MOA for Guselkumab in tx of chronic psoriasis?

A

IL-23 blocker - plaque psoriasis who are candidates for systemic therapy or phototherapy

74
Q

Which phosphodiesterase 4 (PDE4) inhibitor can be used for tx of chronic psoriasis?

A

Apremilast - PO

75
Q

MOA of Apremilast - tx of chronic psoriasis?

A

Increase cAMP levels (phosphodiesterase 4 inhibitor); exact mech unknown

76
Q

Indications for tx of chronic psoriasis w/ Apremilast?

A

Adult pts w/ active psoriatic arthritis

Pts w/ mod-severe plaque psoriases who are candidates for phototherapy or systemic therapy

77
Q

Precautions/ADRs for Apremilast - tx of chronic psoriasis?

A

Worsening of depression, suicidal thoughts or other mood changes, severe weight decrease, do not use w/ strong CYP450 inducers

Diarrhea, nausea, URTIs + HA

78
Q

What is methotrexate (PO) used for?

A

Antimetabolite: chemo drug, misc. agent used for tx of chronic psoriasis

79
Q

What is cyclosporine A used for?

A

Immunosuppressant for tx of chronic psoriasis

80
Q

What are Tacrolimus + Pimecrolimus (topicals) used for?

A

Topical immune modulators - tx of chronic psoriasis

81
Q

What is Calciprotriene (topical) used for?

A

Misc. agent in tx of chronic psoriasis

Effects = class 2-3 steroids

Combo w/ betamethasone

82
Q

SEs of Calciprotriene?

A

Vit D analong, therefore no steroid SE

SEs: local irritation + skin rxns

*DO NOT use on face, eyelids, perineum or skin folds

83
Q

What is Anthralin (topical) used for?

A

Misc. agent used for short-term tx of chronic psoriasis

Apply for 1 hr or <, then wash off

84
Q

SEs of Anthralin - tx of chronic psoriasis?

A

Staining (permanent brown color), irritation of un-involved skin

85
Q

What are keratolytics used for?

A

Misc. agent for tx of chronic psoriasis

Soften keratin layer of skin -> enhance absorption of other agents

Phenol, Salicylic acid used + mixed w/ aquaphor, cold cream, emollients, coal tar

86
Q

What is phototherapy/photochemotherapy used for?

A

Misc. agents - tx of chronic psoriasis

Phototherapy -> sunlight, UVB light therapy

Photochemotherapy -> PUVA = psoralens + UVA ligh

87
Q

What are the non-FDA approved agents for tx of chronic psoriasis?

A

IV Immune Modulators - Etanercept (usually used for RA + JRA)

Immunosuppressants - Siroliums (PO, usually for organ transplant)

88
Q

What topical creams/lotions/oints/gels can be used for tx of rosacea?

A

Abx

Azelaic acid

Sulfur lotions

Ivermectin 1% cream (QD to inflamm lesions)

Benzoyl peroxide (limited data on effectiveness)

89
Q

What topical abx can be used for tx of rosacea?

A

Metronidazole = TOC for rosacea, also an antiprotozoal agent

Sulfur products

Clindamycin + Erythromycin (not as effective as other topical abx or azelaic acid)

90
Q

MOA for Azelaic Acid - tx of Rosacea?

A

Antibacterial, comedolytic, anti-inflamm

*one small study: as effective as Metrogel

Products: Finacea Gel 15% (for rosacea) + Azelex/Finevin Cream 20% (for acne)

91
Q

ADRs for Azelaic Acid - tx of rosacea?

A

Local skin irritation

92
Q

What oral abx can be used for tx of rosacea?

A

Tetracyclines (m/c used)

Erythromycin

Clarithromycin (Biaxin)

Sulfamethoxazole/Trimethoprim

Metronidazole

93
Q

Other misc. tx for rosacea?

A

Glycolic acid - peels (q2-4 wks), washes/creams

Topical tretinoin (Retin-A)

Isotretinoin (Accutane) - severe cases, off label use

94
Q

Tx for rosacea eye problems?

A

Doxycycline (PO)

Minocycline (PO)

Tetracycline (PO)

95
Q

Tx for redness/flushing of rosacea?

A

Anti-inflamm meds - steroid creams

Oxymetazoline - alpha1A adrenoceptor agonist (vasoconstrictor)

Electrosurgery

Intense light therapy

Vascular lasers

96
Q

Tx for rhinophyma - rosacea?

A

Dermabrasion

Electrosurgery

Laser surgery

97
Q

Overall goal of tx of rosacea?

A

Minimize flare ups:

Avoid rubbing, scrubbing, massaging face

Use mild cleansers/moisturizers/sun screen

Avoid triggers (hot drinks, spicy foods, EtOH)

SPF 15+, protective clothing

Protect skin from extreme heat/cold

Avoid cosmetics/soaps/moisturizers w/ EtOH + fragrances

98
Q

What is eczema and when does it usually appear?

A

Dry, red, extremely itchy patches on skin (on any part of body)

During infancy

99
Q

How can eczema be prevented?

A

Moisturize

Avoid rapid temp changes

Reduce stress

Avoid scratchy materials

Avoid harsh soaps, detergents

Avoid triggers - allergens

Be aware for foods that cause outbreak

100
Q

Tx of eczema?

A

Prevent scratching

Creams/lotions to moisturize

Cold compress (relieves itch)

Topical corticosteroids (anti-inflamm)

Topical + PO abx (only if infx)

PO antihistamines (reduce itch)

Coal tar

Phototherapy

Cyclosporine A (PO)

Topical Immune Modulators

101
Q

Indication for cyclosporine A?

A

Resistant eczema

*it is an immune modulator (immunosuppressant)

102
Q

Which topical immune modulators can be used for tx of eczema?

A

Tacrolimus

Pimecrolimus

103
Q

Prevention/tx of eczema in kids?

A

Moisturize

Avoid temp changes

Keep bedroom + play area dust free

Mild soaps

Breathable clothing

Topical hydrocortisone (low pot)

Topical immune modulators

PO steroids

PO antihistamines

PO or topical abx

104
Q

What is actinic keratoses?

A

Cutaneous dysplasia of epidermis (early beginning of skin CA)

*MCC = long sun exposure

*Increased risk in fair skin individuals, avg 40-50 yo, teens-20s in Cali/FL

105
Q

What is m/c tx of AK?

A

Cryosurgery

106
Q

What other tx is there for AKs?

A

Surgical excision + biopsy (suspect SCC)

Retinoids - topical + PO

Topical chemotherapy (5-Fluoruracil: 1, 2, 5%)- cat X

Chemical peels

Dermabrasion

Laser skin resurfacing

Electrosurgical skin resurfacing

107
Q

What is Ingenol Mebutate gel used for?

A

Tx of AK; induces cell death, MOA unknown

108
Q

Admin of Ingenol Mebutate - tx of AK?

A

Topical use only!

AK on face/scalp: 0.015% gel to area QD x 3 d

AK on trunk/extremities: 0.05% gel to area QD x 2 d

109
Q

ADR of Ingenol Mebutate?

A

Local skin rxns: severe rxns, application site pain, application site pruritus, application site irritation, application site infx, periorbital edema, nasopharyngitis + HA

110
Q

What is Aminolevulinic acid hydrochloride 10% gel indicated for?

A

Tx of AKs: mild->moderate on face + scalp

Combo w/ photodynamic therapy using BF-RhodoLED lamp (protective eyewear)

111
Q

MOA of aminolevulinic acid hydrochloride 10% gel?

A

Porphyrin precursor- metabolized to protoporphyrin IX

Activated by BF-RhodoLED -> excited state of porphyrin molecules

ROS formed -> damage to cellular components -> destroys cells

112
Q

ADRs of aminolevulinic acid?

A

Erythema, pain/burning, irritation, edema, pruritus, exfoliation, scab, induration + vesicles

113
Q

What is a potentially lethal skin CA?

A

Melanoma - skin CA in melanocytes

114
Q

Tx of melanoma?

A

Localized -> surgical excision

Higher stages -> interferon injection, interleukin injection, combo chemotherapy

115
Q

What are ectoparasites?

A

Parasite that lives outside the body - lice (head/body/pubic) + mites (scabies)

116
Q

TOC for lice?

A

Permethrin

Eradicate the causative organism + provide sx relief

117
Q

Tx of lice?

A

Permethrin 1%

Malathion 0.5%

Lindane + Ivermectin lotion

Ocular lubricant (Lacri-lube) - infx of eyelids

Calamine/menthol lotion - pruritus

118
Q

Tx of scabies?

A

Permethrin 5%

Crotamiton 10%

Ivermectin PO

Lindane

Topical steroids + PO antihistamines - pruritus

119
Q

MOA of permethrin?

A

Pediculicide, scabicide

Derived from flowers of Chrysanthermum cinerariifolium

Also used as pesticide

120
Q

Precaution/ADR for Permethrin?

A

Precaution - pts w/ ragweed or Chrysanthemum allergy

ADRs - local itching, burning, stinging, tingling

121
Q

Directions for Permethrin use for lice?

A

Wash hair w/ shampoo, towel dry -> saturate scalp/hair w/ lotion + leave on x 10 mins -> rinse -> remove remaining nits (may repeat in 9 days x 2 more times, total = 3 doses)

Cure rate 90-97%

122
Q

Directions for Permethrin use for scabies?

A

Wash + scrub body -> Apply cream from head to toe -> leave on x 8-14 hrs -> wash w/ water

Cure rate 90%

123
Q

What is a 2nd line agent for tx of lice?

124
Q

MOA of Malathion - tx of lice?

A

Organophosphate cholinesterase inhibitor

Must be activated in body by conversion to oxygen analogs (occurs rapidly in insects/vertebrates) -> rapidly metabolized to inactive products in birds/mammals (but NOT insects)

125
Q

Directions for use of malathion to tx lice?

A

Apply to dry hair + leave on x 8-12 hrs -> shampoo hair -> repeat in 7-9 days if necessary

126
Q

What is 2nd or 3rd line tx for lice/scabies?

127
Q

Precaution for use of Lindane in tx of lice/scabies?

A

CNS + hematological toxicity; do NOT use in premature infants or in pts w/ known seizure d/o

128
Q

MOA of Lindane?

A

Pediculicide, scabicide

*can be absorbed + concentrate in fatty tissues, especially the brain

129
Q

Directions for use of Lindane for tx of lice?

A

Apply to clean, dry hair -> massage into hair x 4 mins -> rinse hair then remove nits w/ comb

Use 30-60 mL

130
Q

Directions for use of Lindane for tx of scabies?

A

Apply thin layer on body, bathe + remove after 8-12 hrs

131
Q

What is another 2nd or 3rd line agent for tx of scabies?

A

Crotamiton - MOA unknown, maybe also antipruritic

132
Q

Directions for use of Crotamiton for tx of scabies?

A

Apply to body in 2 applications (24 hrs apart) -> take cleansing bath 48 hrs after last app

133
Q

What would be used for a severe case of scabies/lice if tx w/ Permethrin/Malathion/Lindane failed?

A

Ivermectin - 2nd or 3rd line agent

200 mcg/kg x 1 dose (PO, Sklice - lotion)

134
Q

MOA for Ivermectin?

A

Antihelminthic agent: binds selectively* w/ high affinity to glutamate-gated Cl- channels (which occur in invertebrate nerve + muscle cells) -> increase in permeability of cell membrane to Cl- w/ hyperpolarization of nerve/muscle cell -> paralysis + death of parasite

*some mammals do not have glutamate-gated Cl- channels (does not readily cross the human BBB)

135
Q

Precautions/ADR for Ivermectin?

A

PO -> Mazzoti rxn in pts w/ onchocerciasis (allergic/inflamm response due to death of microfilariae)

Lotion -> conjunctivitis, ocular hyperemia, eye irritation, dandruff, dry skin + skin burning sensation

136
Q

Admin of Ivermectin?

A

For topical use only!

Apply SKLICE lotion to dry hair in an amount sufficient to thoroughly coat hair + scalp -> rinse off w/ water after 10 mins

For single use, discard any unused

137
Q

Uses for topical antibacterial preparations?

A

Preventing infx in clean wounds

Early tx of infx’d dermatoses + wounds

Reducing colonization of staph in nares

138
Q

Efficacy of topical antibacterial preps?

A

Varies amongst agent

139
Q

Spectrum for topical antibacterial preps?

A

Varies amongst agents: combo products w/ broader spectrum to cover for mixed infx or infx due to undetermined pathogen

140
Q

What does bacitracin cover?

A

Mostly gram +

Alone or combo w/ neomycin + polymyxin

141
Q

What does gramicidin cover?

A

Mostly gram +

Combo w/ neomycin, polymyxin, bacitracin + nystatin

142
Q

What does mupirocin (Bactroban) cover?

A

MRSA

Preferred agent for impetigo + to eliminate nasal carriage of S. aureus

143
Q

What does polymyxin B cover?

A

Mostly gram -

Available as combo

144
Q

What does neomycin/gentamcin cover?

A

Topical aminoglycosides w/ gram - coverage, incl. pseudomonoas

Combo or alone

145
Q

What does ozenoxacin cover?

A

Quinolone antimicrobial -> impetigo due to Staph aureus or Step pyogenes

146
Q

What is Doxepin hydrochloride used for?

A

Topical antipruritic - atopic dermatitis or lichen simplex chronicus

147
Q

MOA of Doxepin hydrochloride?

A

Blocks H1 + H2 receptors

148
Q

ADRs of Doxepin hydrochloride?

A

Local burning/stinging, sedation, anticholinergic SEs

149
Q

What is Pramoxine used for?

A

Topical anesthetic: temporary relief from pruritus a/w mild eczematous dermatoses + hemorrhoids (external use only)

150
Q

ADRs for Pramoxine?

A

Local burning + stinging

151
Q

What is Dupilumab used for?

A

IL-4R alpha-antagonist for tx of adult pts w/ mod->severe atopic dermatitis

Can be used w/ topical steroids (SQ injection)

152
Q

MOA of Dupilumab?

A

Monoclonal IgG4 AB that inhibits IL-4 + IL-13 signaling

153
Q

Cautions/ADRs for Dupilumab?

A

Cautions - hypersensitivity, conjunctivitis, comorbid asthma

ADRs - injection site rxns, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infx, and dry eye

154
Q

What is Crisaborole used for?

A

Phosphodiesterase 4 inhibitor - topical tx of mild-> mod atopic dermatitis in pts 2yo+

Ointment 2%

*MOA not well defined

155
Q

ADRs for Crisaborole?

A

Hypersensitivity

Application site pain

156
Q

What is Polidocanol Injectable Foam used for?

A

Varicose veins

IV use under US guidance only

157
Q

CI/ADRs for Polidocanol Injectable foam?

A

CI - Acute thromboembolic dis

ADRs - be prepared to tx anaphylaxism, tissue ischemia+necrosis (do not inject intra-arterially, venous thrombosis), pain/discomfort in extremity, infusion site thrombosis, injection site hematoma/pain, thrombophlebitis superficial + extravasation

158
Q

What is Deoxycholic acid (SQ) used for?

A

Improvement in appearance of mod->severe convexity or fullness a/w submental fat in adults

159
Q

MOA for Deoxycholic acid?

A

Cytolytic drug - physically destroys the cell membrane -> lysis

160
Q

Precautions/ADRs for Deoxycholic acid?

A

Marginal mandibular nerve (MMN) injury, Dysphagia, Submental hematoma/bruising

Injct site edema/swelling, hematoma, pain, numbness, erythema + induration

161
Q

What drugs are a/w photosensitivity?

A

Benzocaine

Coal Tar

Hexachlorophene

Isotretinoin

Methoxsalen

Tacrolimus

Tazarotene

Retinoin

Sunscreen agents: PABA, cinnamates, benzyphenones

S3 - Pharm Exam 1 (1 decks)

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