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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
Uses for Imiquimod
Condyloma, now Actinic keratosis, BCC, common warts, molluscum, in sit Cancer
26
inhibits thymidylate synthase resulting in reduced DNA synthesis. Acts selectively in actinic damaged skin cells
5-Fluorouracil (topical)
27
Wound care
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.
28
Uses for systemic retinoids
Uses: acne, psoriasis, ichthyosis, Darier’s disease, chemoprophylaxis of skin ca… (repair disordered keratinization).
29
Ex of systemic retinoids
isotretinoin (Accutane, Sotret, Amnesteem, Claravis) | acitretin (Soriatane)
30
AE of systemic retinoids
``` Dryness Hyperlipidemia Teratogenicity Hepatitis Hair loss Arthralgias Pseudotumor cerebri Headaches DISH Depression? ```
31
Monitoring labs for Systemic retinoids
Lipids, LFT, HCG
32
Inhibits myeloperoxidase in PMNs. Affect on CD11a/CD18. * Neutrophils
Dapsone (systemic) | - a sulfone
33
Uses of dapsone
dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet’s syndrome, spider bite….(neutrophilic skin dz)
34
AE Dapsone
Hemolysis (esp. G6PD deficiency), | Methemaglobinemia, Motor neuropathy
35
Labs for Dapsone
G6PD, CBC
36
Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division. Immunosuppressive
Methotrexate (systemic)
37
Uses of methotrexate
psoriasis, CTCL, lupus, others
38
AE of methotrexate
hepatotoxicity, myelosuppression, pneumonitis
39
Labs for methotrexate
CBC, LFT, Liver biopsy
40
Biological therapy uses
psoriasis, psoriatic arthritis, (RA).
41
Biogenetically engineered proteins which disrupt/inhibit focused portions of the immune system involved in psoriasis
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
AE of bio therapy
``` Injection site irritation. Risk of Infection? Exacerbate CHF? Reactivate TB? Risk for cancer? Others? ```
43
Uses for oral antimicrobials
Antibiotics: acne, folliculitis, cellulitis, rosacea, wound infection…… Anti-virals: HSV infection, cold sores, zoster…… Anti-fungals: ‘ring worm’, ‘athletes foot’, infected nails…..
44
Forms pyrimidine dimers in DNA and reduces langerhans cell and leukocytes
UV light therapy
45
Types of UV light therapy
UVB (290-320 nm) Narrow band UVB (311 nm) PUVA (psoralen +UVA) 320-400nm
46
Actions of UV light therapy
Anti-inflammatory | Immunosuppressive
47
Uses UV light therapy
Psoriasis, pruritis, eczema, CTCL
48
AE of UV Light therapy
burns, carcinogenic, photoaging
49
Minoxidil
Rogaine
50
vasodilatation and direct stimulation of hair shaft growth
Minoxidil
51
Uses of minoxidil
Alopecia
52
Blocks 5-alpha reductase enzyme in follicles to inhibit the conversion of testosterone to dihydrotestosterone.
Finasteride (i.e. Propecia)
53
Uses of finasteride
androgenetic alopecia
54
Freezes tissue (-196 C)
Liquid nitrogen
55
Uses of Liquid N
warts, AK, skin cancer, others
56
Moisturizers (kinds)
Occlusives-trap moisture in. Humectants-bind water. Emollients-give skin a smooth feel.
57
Suggestions for moisturizers
Suggest: fragrance-free, dye-free (Cetaphil, Vanicream, Eucerin…)
58
Suggestions for soap
Minimizing their use. Try non-soap cleansers like Cetaphil, Purpose, Basis.
59
Exfoliate. Thicken epidermis. Stimulate collagen growth. Increase skin profusion.
Alpha hydroxy acids
60
Overall goal of AHA
fewer wrinkles, more pliable skin, with better hydration
61
Uses for corticosteroids
eczema, contact dermatitis, psoriasis, itch, lichen planus...
62
Uses for retinoids
acne, psoriasis, cosmetic skin improvement
63
Uses for calcipotriene
psoriasis, eczema
64
Uses for topical antimicrobials
wounds, acne, fungal infections, rosacea
65
TCIs uses
Eczema, second line
66
Immune response modifier
Imiquimod - Aldara cream | Increases local immune activity through Toll Receptors
67
Imiquimod uses
condyloma, actinic keratosis, BCC, common warts, molluscum, in sit Cancer...
68
Repair ordered keratinization
Retinoids (vitamin A analogs that bind to nuclear retinoid receptors to alter cell differnetiation)
69
Uses for systemic retinoids
Acne, psoriasis, ichthyosis, darier's disease, chemoprophylaxis of skin cancer
70
Dapsone is a _____
Sulfone
71
Dapsone uses
dermatitis herpetiformis, linear IgA disease, bullous lupus, Sweet's syndrome, spider bite
72
Dapsone acts on
polymorphonuclear luekocytes
73
Immunosuppressive | Dihydrofolate reductase inhibitor that disrupts DNA synthesis to block cell division
Methotrexate
74
Methotrexate uses
psoriasis, CTCL, lupus, others.

Skin MS: Week 3 (14 decks)

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