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dermatology normal > Derm therapies > Flashcards

Derm therapies Flashcards

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Dermatology Board Prep flashcards
1
Q

What is essential to the efficacy of any topical med?

A

active ingredient (strength), location, vehicle, concentration

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2
Q

What is a vehicle that is lucricating, occlusive and greasy?

A

ointment (vaseline)

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3
Q

When should ointments be used?

A

smooth, non-hairy skin lesions; dry, thick, or hyperkeratotic lesions

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4
Q

What is a less greasy, drying effective agent that can sting, is not occlusive and may cause irritation?

A

creams

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5
Q

When are creams indicated?

A

acute exudative inflammation, intertriginous areas (skin-skin contact)

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6
Q

when should oils be used?

A

on scalp

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7
Q

What is a jelly like vehicle that may contain alcohol, greaseless, least occlusive and dries quickly?

A

gel

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8
Q

When are gels indicated?

A

acne, exudative inflammation (contact dermatitis); scalp/hairy areas w/o matting

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9
Q

What is a more expensive, easily spread and applied substance that is cosmetically elegant?

A

foams

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10
Q

When are foams indicated?

A

hairy areas; inflammation

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11
Q

What conditions are topical corticosteroids effective against?

A

hyperproliferation, inflammation, immunologic involvement

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12
Q

In what lesions do topical corticosteroids provide relief?

A

burning and pruritic lesions

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13
Q

How are corticosteroids organized into classes?

A

based on strength (potency)

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14
Q

T/F steroids w/in any class are equivalent in strength

A

true => strength based on concentration

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15
Q

What is a class I (super high) topical corticosteroid? When is it used?

A

clobetasol propionate => severe dermatoses over nonfacial/nonintertrignous areas

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16
Q

What is a class II (high) topical corticosteroid? When is it used?

A

fluocinonide => mild to moderate nonfacial/nonintertriginous areas

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17
Q

What is a class III-V (medium) topical corticosteroid? When can it be used?

A

triamcinolone=> ointment>cream>lotion => mild to moderate nonfacial/nonintertriginous areas

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18
Q

What is a class VI-VII (low) topical corticosteroid? When can it be used?

A

fluocinolone, desonide, hydrocortisone => large areas and thinner skin=> face, eyelid, genital, intertriginous areas

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19
Q

What are some local side effects occurring greater with potency?

A

skin atrophy, acne, telangiectasias, striae, steroid rosacea, hypopigmentation

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20
Q

What are systemic side effects of topical steroids? (rare due to low absorption)

A

glaucoma (eyelid application), hypothalamic pituitary axis suppression, cushing’s, HTN, hyperglycemia

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21
Q

What is the key to reducing the risk of side effects with steroid use (local/systemic)?

A

least potent used for shortest time while maintaining effectiveness

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22
Q

Duration of Tx is limited by side effects. How long do you Tx with class I steroids?

A

<3 weeks

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23
Q

How long do you Tx with class II-V steroids?

A

<6-8 weeks

24
Q

What is important in the use of low potency steroids even though side effects are rare?

A

1-2 wk intervals to avoid skin atrophy, telangiectasia, steroid acne

25
Q

1 palm is equal to what % of BSA (body surface area)?

A

1%

26
Q

What does a fingertip unit (FTU) treat?

A

500mg treats 2% BSA

27
Q

What is the best way to assure you are giving the right amount of steroid?

A

follow-up

28
Q

When estimating the BSA, what does the rule of 9s mean?

A

each are 9%=> 1 entire arm, HEENT, posterior upper trunk, posterior lower trunk, 1 posterior leg

29
Q

What is important in pediatric dosing of medication steroids?

A

infants have high body surface area to volume ratio => increased systemic absorption risk

30
Q

When and why is benzoyl peroxide used?

A

acne vulgaris => topical Rx with both antibacterial and comedolytic properties (breaks up comedones)

31
Q

When should topical antibiotics be used?

A

to reduce P. acnes and reduce inflammation in inflammatory acne

32
Q

What is significant about Tx with topical antibiotics?

A

cannot use as a monotherapy

33
Q

What is used a Tx for rosacea?

A

metronidazole

34
Q

When are topical retinoids used?

A

acne vulgaris, photodamaged skin, fine wrinkles, hyperpigmentation

35
Q

What are common ADE with topical retinoids?

A

dryness, pruritis, erythema, scaling; photosensitivity

36
Q

How long does it typically take topical agents to take effect?

A

2-3 months

37
Q

What are used in the Tx for moderate to severe inflam acne?

A

oral antibiotics (tetracyclines, doxycyclines, minocyclines)

38
Q

If a patient does not respond in 3 months of oral ABx use, what do you do?

A

increase dose, change Tx, refer to derm

39
Q

What are the side effects of tetracycline use?

A

contraindicated in pregnancy/children >8; GI upset’ photosensitivity

40
Q

Patient counseling is key in oral tetracyclines. What are the most important ADE if tetracycline use?

A

GI upset; photosensitivity

41
Q

ADE in doxycycline use?

A

GI upset; photosensitivity

42
Q

ADE in minocycline use?

A

GI upset; vertigo; hyperpigmentation

43
Q

T/F Tetracyclines interfere with birth control pills

A

FALSE

44
Q

When is oral isotretinoin indicated?

A

severe, nodulocystic acne that fails other therapies over a 5-6 month course

45
Q

What is most important in administering oral isotretinoin?

A

teratogenic=>absolutely contraindicated in pregnancy => 2 forms of contraception must be used

46
Q

What are common side effects of isotretinoin?

A

Xerosis (dry skin); cheilitis (chapped lips); elevated liver enzymes; hypertriglyceridemia

47
Q

What antifungals are used to treat candida and dermatophytes?

A

imidazoles: (AZOLES)

48
Q

What antifungals are better for dermatophytes but not candida?

A

Allylamines, benzymlamines => “-fines”

49
Q

What antifungals are better for candida but not dermatophytes?

A

nystatin

50
Q

What are the advantages to topical antifungals?

A

low cost, efficacy, ease of use, low side effects

51
Q

Antihistamines are the most widely used agents for what?

A

pruritus and chronic urticaria

52
Q

For most pruritic dermatoses that are NOT urticaria, How do the 1st gen H1 antagonists work?

A

sedative effect rather than anti-histaminic properties

53
Q

Topical therapies that inhibit keratinocyte proliferation are indicated in what disease?

A

psoriasis

54
Q

What are considered inhibitors of keratinocyte proliferation?

A

Vit D analogs, coal tar, tazarotene

55
Q

What is a Vit D analog in Tx of psoriasis that has a common side effect of skin irritation?

A

calcipotriene (topical)

56
Q

What vit D analog stimulates keratinocye differentiation and inhibits T cell proliferation?

A

Calcitriol (topical)

57
Q

In psoriasis Tx, what are disadvantages for using tazarotene?

A

skin irritation; teratogenic; photosensitivity

dermatology normal (4 decks)

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