DERM therapeutics Flashcards
1
Q
epidermis features/function
A
- outer barrier
- keratin
- melanin
- touch
2
Q
dermis features/function
A
- supports epidermis and protects from injury
- connective tissue
- nerves
- blood vessels
- hair follicles
- immune response
- oil, sweat glands
3
Q
hypodermis features/function
A
- adipose tissue
- larger blood vessels
- regulation of temperature
4
Q
pediatric skin anatomy
A
- more water
- thinner
- enhanced drug absorption
5
Q
elderly skin anatomy
A
- drier
- thinner
- slower healing
- enhanced drug absorption
6
Q
macule
A
- flat, non-palpable
- different color
7
Q
macule example
A
freckles
drug eruption
8
Q
papule
A
solid
elevated
can palpate
no visible fluid
9
Q
papule example
A
wart
insect bite
10
Q
nodule
A
firm papule that extends into the dermis or subcutaneous tissue
11
Q
nodule example
A
severe acne
12
Q
vesicle
A
small, elevated, fluid filled blisters
13
Q
vesicle example
A
contact dermatits
burns
14
Q
bulla
A
a larger vesicle
15
Q
pustule
A
vesicles that contain pus
16
Q
pustule example
A
acne
folliculitis
17
Q
wheals
A
- elevated and transient plaque or papule caused by localized edema
- almost always itches
18
Q
other names for a wheal
A
hive
urticaria
19
Q
wheal example
A
hypersensitivity to drugs, bee sting
20
Q
topical formulations to use on hairy skin
A
solutions lotions gels aerosols foams
21
Q
topical formulations to avoid on hairy skin
A
ointments
patches
22
Q
topical formualtions to us for moist area between skin folds
A
solutions
lotions
creams
powders
23
Q
topical formulations to avoid for moist area between skin folds
A
ointments
24
Q
how many grams to cover the whole body once
A
30g
25
dermatitis is synonymous with what
eczema
26
atopic dermatitis is most common in
young children
27
areas of body most commonly affected by atopic dermatitis in infants
- face/cheeks
- trunk
- neck
- arms/legs
28
areas of body most commonly affected by atopic dermatitis in children/adults
antecubital and popliteal fossa
hands
face
29
atopic triad
IgE mediated diseases
- dermatitis
- allergic rhinitis
- asthma
30
factors with increased prevalence of atopic dermatitis
- air polluted areas
- industrialization
- urban
- dietary changes
- higher socioeconomic status
31
hygiene hypothesis
having less exposure to infectious agents at a younger age can make you more susceptible later in life
32
symptoms of atopic dermatitis
- chronic with flares and remissions
- intense itch
- dry, flaky
- inflamed/red
- weepy
33
atopic dermatitis nonpharm treatment
reduce the following:
- allergens
- stress
- excessive bathing
- detergents
- sun exposure
- itching the rash
34
first line treatments for atopic dermatitis
-skin hydration with thick creams or ointments twice daily
or
-topical corticosteroids
35
what dosage form to avoid in treating atopic dermatitis
lotions
36
topical corticosteroids use duration
- for very high or high potency use 7-14 days then switch to lower potency
- medium or low potency can be used longer safely
37
corticosteroid adverse effects
```
skin atrophy
hypopigmentation
bruising
stretch marks
rash
```
38
corticosteroid affect on HPA axis
suppresses production of cortisol
39
suppression of HPA axis causes what side effects
```
growth retardation
adrenal insufficiency
Cushings
secondary infections
mood changes
```
40
benefit of using bid dosing over QD in high potency steroids
none
| HPA side effect risk is low if used less than 2 weeks
41
dosage form absorption comparison
ointment > cream > lotion
42
atopic dermatits second line treatment
calcineurin inhibtors
| UV light therapy
43
calcineurin inhibitor drugs
tacrolimus
| pimecrolimus
44
calcineurin inhibitors use features
do not cause skin atrophy and can be used on the face
45
calcineurin inhibitors are equivalent in effectiveness to what strength steroids
low-moderate
46
atopic dermatitis third line treatment
oral immunosuppressive drugs
47
things to avoid in atopic dermatitis
- all antihistamines
- systemic antibiotics
- probiotics
- immunotherapy
- food elimination based only on allergy tests
- special laundry products
48
drug induced skin reactions presentation
- hives, vomiting, diarrhea, anaphylaxis
| - occurs minutes to hours after drug exposure
49
DRESS acronym
Drug Reaction with Eosinophilia and Systemic Symptoms
50
DRESS features
- rash, fever, hematologic effects
- occurs 1-4 weeks after starting drug
- can be fatal if not treated
51
common drugs that cause DRESS
allopurinol
sulfa
anticonvulsants
52
stevens-johnson syndrome features
- severe blistering
- fever, HA, respiratory distress
- acute onset
53
drugs that cause stevens-johnson syndrome
```
sulfa drugs
penicillins
anticonvulsants
NSAIDS
allopurinol
```
54
toxic epidermal necrolysis
SJS when over 30% of the body is involved or reaction is even more severe
55
pseudoallergic reaction characterized by
direct mast cell activation
56
example of pseudoallergic reaction
vancomycin causing red man syndrome
57
fixed drug eruption features
- pruritic, red raised lesions
- occur in same area when drug is given
- appears quickly
58
drugs that cause fixed drug eruptions
tetracycline
sulfonamides
codeine
59
which medication can cause purple toe syndrome
warfarin
60
which medication causes blue skin
amiodarone
| colloidal silver
61
which drug can cause hypertrichosis
minoxidil
| cyclosporine
62
which medication can cause permanent tooth discoloration
tetracyclines
63
comedone
obstructed sebaceous follicle
64
pathophysiology of acne
- obstructed follicle
- increased sebum production
- colonizaiton by propionibacterium acnes
- hyperproliferation of ductal epidermis
- inflammation at acne sites
65
blackhead
open comedone
| non-inflammatory
66
white head
close comedone
| non-inflammatory
67
mild acne definition
<20 comedones
<15 inflammatory lesions
<30 total lesions
68
moderate acne definition
20-100 comedones
15-20 inflammatory lesions
30-125 lesions total
69
severe acne definition
>5 cysts
>100 comedones
>50 inflammatory lesions
>125 total lesions
70
exacerbating factors of acne
- heat and humidity
- pimple popping
- excessive scrubbing or washing
- sunlight exposure
- stress
- dietary changes
71
medications that can worsen acne
```
phenytoin
isoniazid
rifampin
phenobarbital
lithium
steroids
B vitamins
```
72
first line treatment for mild acne
```
benzoyl peroxide
or
topical retinoid
or
topical combo with antibiotic
```
73
first line treatment for moderate acne
combo therapy
| using any combination of BP, retinoid, topical antibiotic and oral antibiotic
74
first line treatment for severe acne
oral antibiotic + any two of BP, retinoid, topicl antibiotic
OR
oral isotretinoin
75
gels tend to be
drying
76
creams and lotions tend to be
moisturizing
77
solutions tend to do what to the skin
drying
78
preferred dosage form for patients with oily skin
gels
79
benzoyl peroxide used for
first line option for acne
80
benzoyl peroxide directions
wash face and apply bid
| when using with retinoids separate timing
81
benzoyl peroxide adverse effects
irritation
| can bleach or discolor fabric
82
salicylic acid use
- for keratolytic and comedolytic acne
| - useful if retinoids cannot be tolerate
83
salicylic acid adverse effects
- erythema
- peeling
- scaling
84
retinoids use
- first line option for acne
| - for comedolytic, karatolytic and anti-inflammatory
85
retinoids directions
wash face and apply in evening
86
retinoid adverse effects
photosensitivity
| dryness/flaking
87
specific retinoid to not use with benzoyl peroxide
tretinoin, breaks down when used at the same time
88
topical antimicrobials place in acne treatment
first line option when used in conjunction with BP or a retinoids
89
clindamycin foam (Evoclin) unique use instructions
dispense foam onto cool surface, not had and apply small amounts with fingertips
90
dapasone co-administration with BP causes
orange-brown skin discoloration
91
best topical antibiotics
clindamycin
erythromycin
dapsone
92
oral antibiotics use in acne
- mod-severe for a limited course
| - don't use at the same time as topicals
93
oral antibiotic options for acne
minocyclin > doxycycline > tetracycline
| Macrolides
94
side effects of tetracyclines
phototoxicity
| tooth discoloration
95
oral isotretinoin use in acne
severe cases
| potential for long term improvement
96
oral isotretinoin MoA
decreases sebum production and shrinks sebaceous glands
97
oral isotretinoin directions for use
qd or bid with meals
98
oral isotretinoin max duration of use
20 weeks
99
oral isotretinoin adverse effects
hepatotoxicity
hypertriglyceridemia
highly teratogenic
100
secondary options for acne
```
oral contraceptives (estrogen dominant ones)
spironolactone
```
101
how long to typically see improvement in acne
8 weeks
102
psoriasis cause
pathogenic T-cell production
103
factors that improve psoriasis
warmth
| sunlight
104
factors that worsen psoriasis
```
cold
stress
alcohol
smoking
obesity
```
105
medications that trigger psoriasis flares
```
NSAIDs
ACEI
antimalarials
beta blockers
lithium
salicylates
steroid withdrawal
```
106
non pharm treatment for psoriasis
UV A or B
smoking cessation
balneotherapy?
107
emollients in psoriasis
avoids dryness
| apply multiple times per day
108
keratolytics in psoriasis
removes scales and decreases hyperkeratosis
| can increase penetration of other agents
109
corticosteroids in psoriasis
apply 1-4 times per day and taper
110
vitamin D analogs in psoriasis
inhibit keratinocyte proliferation
| apply BID
111
retinoids in psoriasis
use with steroids
| apply in evening
112
second line agents for psoriasis
topical calcineurin inhibitors
| methotrexate
