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Skin MS: Week 3 > Derm Therapies > Flashcards

Derm Therapies Flashcards

1
Q

Drug delivery is dependent on

A 
skin type 
skin condition 
lipid vs. water-based vehicle
charge 
concentration gradient
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2
Q

The __________ provides a “bricks and mortar” barrier for the skin. It is the rate-limiting step to topical therapy absorption.

A

The stratum corneum provides a “bricks and mortar” barrier for the skin. It is the rate-limiting step to topical therapy absorption.

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3
Q

__________ of the skin increases absorption by making the SC more penetrable

A

hydration

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4
Q 
Actions : Anti-inflammatory
		Immunosuppressive
		Anti-proliferative
		Vasoconstrictive
Uses: Eczema, contact dermatitis, psoriasis, itch, LP
A

Corticosteroids

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5
Q

AE of Corticosteroids

A

SKIN ATROPHY, striae, acne, suppression of the HPA axis.

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6
Q

How is strength of corticosteroids based?

A

standardized laboratory vasoconstriction assay.

Chemical vs. % (higher % does not mean stronger)

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7
Q

Vitamin A analogs which work through nuclear receptors on DNA causing alteration of gene transcription.

A

Retinoids

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8
Q

tretinoin(Retin-A), tazarotene(Tazorac),

adapalene(Differin).

A

Retinoids examples

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9
Q

Actions: Regulate cell growth, inhibit carcinogenesis, alter enzymes involved with cellular differentiation

A

Retinoids

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10
Q

Uses: acne, psoriasis, cosmetic skin improvement.

A

Retinoids

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11
Q

AE of Retinoids

A

dryness, irritation, sun sensitivity

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12
Q

A vitamin D analog that acts through DNA receptors to alter skin differentiation

A

Calcipotriene (i.e. Dovonex)

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13
Q

Uses of calcipotriene

A

Psoriasis, eczema?

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14
Q

AE of Calcipotriene

A

irritation, increased serum calcium.

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15
Q

Examples of Topical Antimicrobials

A 
clindamycin or erythromycin gels
benzoyl peroxide gel or wash
terbinafine, oxiconazole…..creams
metronidazole gel or lotion
bacitracin or mupirocin ointment
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16
Q

Wounds, acne, fungal inf., rosacea

A

Topical antimicrobials

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17
Q

Work through calcineurin to alter T cell activation

A

Topical Calcineurin Inhibitors “nonsteroidal antiinflammatories”

tacrolimus(Protopic) pimicrolimus(Elidel)

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18
Q

AE TCIs

A

limited, local irritation/burning

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19
Q

Controversy of TCIs

A

The FDA added a ‘black-box’ warning to the drug information label on these products.
Based on animal studies with systemic forms of these meds…risk of lymphoma?
The AAD and other patient advocate groups DON’T agree based on current data.

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20
Q

TCI use

A

Eczema (around eyes), dermatitis

second-line, follow dx

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21
Q

3 kinds of UV light and how sunscreen blocks then

A

Traditionally - UVB
Newer ones with avobenzone/helioplex - UVA
Titanium Oxide + Zinc oxide - block

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22
Q

SPF

A

SPF=sun protection factor.
A number based on a standardized application. Indicates relative sun protection from a given product against UVB.

SPF 2 blocks 50% of sun’s UV rays.
SPF 15 blocks 93% of sun’s UV rays.
SPF 30 blocks 97% of sun’s UV rays.

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23
Q

New sunscreen labeling

A

Can’t say “water proof”.
Indicate water resistant 40 mins or 80 mins.
Have to be SPF 15 to claim they decrease the risk of skin cancer or aging effects.
Look for “broad spectrum” to cover all wave lengths

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24
Q

“Immune response modifier”

Increases local immune activity through Toll receptors (i.e. INF, TNF, NK cells, T cells).

A

Imiquimod (Aldara)

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25
Q

Uses for Imiquimod

A

Condyloma, now Actinic keratosis, BCC, common warts, molluscum, in sit Cancer

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26
Q

inhibits thymidylate synthase resulting in reduced DNA synthesis.
Acts selectively in actinic damaged skin cells

A

5-Fluorouracil (topical)

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27
Q

Wound care

A

New research»»keep it covered with a nonstick dressing to allow natural cytokines to facilitate healing.
Monitor for infection.
“Airing out” wounds slows healing and increases likelihood of scarring.

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28
Q

Uses for systemic retinoids

A

Uses: acne, psoriasis, ichthyosis, Darier’s disease, chemoprophylaxis of skin ca…
(repair disordered keratinization).

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29
Q

Ex of systemic retinoids

A

isotretinoin (Accutane, Sotret, Amnesteem, Claravis)

acitretin (Soriatane)

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30
Q

AE of systemic retinoids

A 
Dryness
    Hyperlipidemia
    Teratogenicity
    Hepatitis
    Hair loss
Arthralgias
Pseudotumor cerebri
Headaches
DISH
Depression?
31
Q

Monitoring labs for Systemic retinoids

A

Lipids, LFT, HCG

32
Q

Inhibits myeloperoxidase in PMNs.
Affect on CD11a/CD18.
* Neutrophils

A

Dapsone (systemic)

- a sulfone

33
Q

Uses of dapsone

A

dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet’s syndrome, spider bite….(neutrophilic skin dz)

34
Q

AE Dapsone

A

Hemolysis (esp. G6PD deficiency),

Methemaglobinemia, Motor neuropathy

35
Q

Labs for Dapsone

A

G6PD, CBC

36
Q

Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division. Immunosuppressive

A

Methotrexate (systemic)

37
Q

Uses of methotrexate

A

psoriasis, CTCL, lupus, others

38
Q

AE of methotrexate

A

hepatotoxicity, myelosuppression, pneumonitis

39
Q

Labs for methotrexate

A

CBC, LFT, Liver biopsy

40
Q

Biological therapy uses

A

psoriasis, psoriatic arthritis, (RA).

41
Q

Biogenetically engineered proteins which disrupt/inhibit focused portions of the immune system involved in psoriasis

A

Biological therapy, ie.
Amevive-inhibits T memory cells.
Enbrel-binds to TNF making it inactive.
Raptiva-removed from the market
Remicade-binds TNF, inhibits some cytokines.
Humira-binds TNF.
Stelara-binds to p40 subunit of IL-12 and IL-23

42
Q

AE of bio therapy

A 
Injection site irritation.
		    Risk of Infection?
		    Exacerbate CHF?
		    Reactivate TB?
		    Risk for cancer?
		    Others?
43
Q

Uses for oral antimicrobials

A

Antibiotics: acne, folliculitis, cellulitis, rosacea, wound infection……
Anti-virals: HSV infection, cold sores, zoster……
Anti-fungals: ‘ring worm’, ‘athletes foot’, infected nails…..

44
Q

Forms pyrimidine dimers in DNA and reduces langerhans cell and leukocytes

A

UV light therapy

45
Q

Types of UV light therapy

A

UVB (290-320 nm)
Narrow band UVB (311 nm)
PUVA (psoralen +UVA) 320-400nm

46
Q

Actions of UV light therapy

A

Anti-inflammatory

Immunosuppressive

47
Q

Uses UV light therapy

A

Psoriasis, pruritis, eczema, CTCL

48
Q

AE of UV Light therapy

A

burns, carcinogenic, photoaging

49
Q

Minoxidil

A

Rogaine

50
Q

vasodilatation and direct stimulation of hair shaft growth

A

Minoxidil

51
Q

Uses of minoxidil

A

Alopecia

52
Q

Blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testosterone to dihydrotestosterone.

A

Finasteride (i.e. Propecia)

53
Q

Uses of finasteride

A

androgenetic alopecia

54
Q

Freezes tissue (-196 C)

A

Liquid nitrogen

55
Q

Uses of Liquid N

A

warts, AK, skin cancer, others

56
Q

Moisturizers (kinds)

A

Occlusives-trap moisture in.
Humectants-bind water.
Emollients-give skin a smooth feel.

57
Q

Suggestions for moisturizers

A

Suggest: fragrance-free, dye-free (Cetaphil, Vanicream, Eucerin…)

58
Q

Suggestions for soap

A

Minimizing their use. Try non-soap cleansers like Cetaphil, Purpose, Basis.

59
Q

Exfoliate.
Thicken epidermis.
Stimulate collagen growth.
Increase skin profusion.

A

Alpha hydroxy acids

60
Q

Overall goal of AHA

A

fewer wrinkles, more pliable skin, with better hydration

61
Q

Uses for corticosteroids

A

eczema, contact dermatitis, psoriasis, itch, lichen planus…

62
Q

Uses for retinoids

A

acne, psoriasis, cosmetic skin improvement

63
Q

Uses for calcipotriene

A

psoriasis, eczema

64
Q

Uses for topical antimicrobials

A

wounds, acne, fungal infections, rosacea

65
Q

TCIs uses

A

Eczema, second line

66
Q

Immune response modifier

A

Imiquimod - Aldara cream

Increases local immune activity through Toll Receptors

67
Q

Imiquimod uses

A

condyloma, actinic keratosis, BCC, common warts, molluscum, in sit Cancer…

68
Q

Repair ordered keratinization

A

Retinoids (vitamin A analogs that bind to nuclear retinoid receptors to alter cell differnetiation)

69
Q

Uses for systemic retinoids

A

Acne, psoriasis, ichthyosis, darier’s disease, chemoprophylaxis of skin cancer

70
Q

Dapsone is a _____

A

Sulfone

71
Q

Dapsone uses

A

dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet’s syndrome, spider bite

72
Q

Dapsone acts on

A

polymorphonuclear luekocytes

73
Q

Immunosuppressive

Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division

A

Methotrexate

74
Q

Methotrexate uses

A

psoriasis, CTCL, lupus, others.

Skin MS: Week 3 (14 decks)

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