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Derm therapies 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
1 palm is equal to what % of BSA (body surface area)?
1%
26
What does a fingertip unit (FTU) treat?
500mg treats 2% BSA
27
What is the best way to assure you are giving the right amount of steroid?
follow-up
28
When estimating the BSA, what does the rule of 9s mean?
each are 9%=> 1 entire arm, HEENT, posterior upper trunk, posterior lower trunk, 1 posterior leg
29
What is important in pediatric dosing of medication steroids?
infants have high body surface area to volume ratio => increased systemic absorption risk
30
When and why is benzoyl peroxide used?
acne vulgaris => topical Rx with both antibacterial and comedolytic properties (breaks up comedones)
31
When should topical antibiotics be used?
to reduce P. acnes and reduce inflammation in inflammatory acne
32
What is significant about Tx with topical antibiotics?
cannot use as a monotherapy
33
What is used a Tx for rosacea?
metronidazole
34
When are topical retinoids used?
acne vulgaris, photodamaged skin, fine wrinkles, hyperpigmentation
35
What are common ADE with topical retinoids?
dryness, pruritis, erythema, scaling; photosensitivity
36
How long does it typically take topical agents to take effect?
2-3 months
37
What are used in the Tx for moderate to severe inflam acne?
oral antibiotics (tetracyclines, doxycyclines, minocyclines)
38
If a patient does not respond in 3 months of oral ABx use, what do you do?
increase dose, change Tx, refer to derm
39
What are the side effects of tetracycline use?
contraindicated in pregnancy/children >8; GI upset' photosensitivity
40
Patient counseling is key in oral tetracyclines. What are the most important ADE if tetracycline use?
GI upset; photosensitivity
41
ADE in doxycycline use?
GI upset; photosensitivity
42
ADE in minocycline use?
GI upset; vertigo; hyperpigmentation
43
T/F Tetracyclines interfere with birth control pills
FALSE
44
When is oral isotretinoin indicated?
severe, nodulocystic acne that fails other therapies over a 5-6 month course
45
What is most important in administering oral isotretinoin?
teratogenic=>absolutely contraindicated in pregnancy => 2 forms of contraception must be used
46
What are common side effects of isotretinoin?
Xerosis (dry skin); cheilitis (chapped lips); elevated liver enzymes; hypertriglyceridemia
47
What antifungals are used to treat candida and dermatophytes?
imidazoles: (AZOLES)
48
What antifungals are better for dermatophytes but not candida?
Allylamines, benzymlamines => "-fines"
49
What antifungals are better for candida but not dermatophytes?
nystatin
50
What are the advantages to topical antifungals?
low cost, efficacy, ease of use, low side effects
51
Antihistamines are the most widely used agents for what?
pruritus and chronic urticaria
52
For most pruritic dermatoses that are NOT urticaria, How do the 1st gen H1 antagonists work?
sedative effect rather than anti-histaminic properties
53
Topical therapies that inhibit keratinocyte proliferation are indicated in what disease?
psoriasis
54
What are considered inhibitors of keratinocyte proliferation?
Vit D analogs, coal tar, tazarotene
55
What is a Vit D analog in Tx of psoriasis that has a common side effect of skin irritation?
calcipotriene (topical)
56
What vit D analog stimulates keratinocye differentiation and inhibits T cell proliferation?
Calcitriol (topical)
57
In psoriasis Tx, what are disadvantages for using tazarotene?
skin irritation; teratogenic; photosensitivity

Dermatology normal (4 decks)

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