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Pharmacotherapeutics > Dermatitis (Exam 1) > Flashcards

Dermatitis (Exam 1) Flashcards

1
Q

Forms of contact dermatitis

A

irritant
allergic

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2
Q

in contract dermatitis, lesions are found

A

only in the area of exposure

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3
Q

irritant contact dermatitis

A

non-immune modulated irritation of the skin by a substance
can be acute or chronic

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4
Q

acute irritant contact dermatitis

A

irritant exposure to oxidizing agents, strong acids, detergents or solvents
effect in minutes to hours

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5
Q

chronic irritant contact dermatitis

A

continuous skin exposure to liquids
prolonged wearing of slices
hand washing/disinfectant

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6
Q

difference in appearance of acute and chronic irritant contact dermatitis

A

acute - erythema
chronic - cracks/skin fissures

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7
Q

allergic contact dermatitis

A

delayed hypersensitivity reaction
foreign substance comes into contact with the skin
immune modulated

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8
Q

examples of allergic contact dermatitis

A

poison ivy
nickel
fragrance exposure

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9
Q

what is the dominant feature of allergic contact dermatitis

A

pruritis

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10
Q

chronic allergic contact dermatitis symptoms

A

dry, scaly and thicker
lichenification and fissuring

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11
Q

what type of hypersensitivity reaction is contact dermatitis?

what about eczema?

A

type IV

type I (also type IV)

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12
Q

goals of therapy for contact dermatitis

A

restoration of normal epidermal barrier
treatment of inflammation of skin
control of itching

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13
Q

the mainstay of therapy in dermatitis are

A

topical corticosteroids

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14
Q

when prescribing topical corticosteroids, the ____________ potent topical agent that is effective for the patient should be used for the _______________________

A

least

shortest possible time

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15
Q

topical corticosteroids are classified according to

A

potency

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16
Q

which type of corticosteroids are more potent?

why?

A

fluorinated steroids (groups 1-3)

they penetrate the skin better than non fluorinated steroids

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17
Q

why are fluorinated steroids not used mostly first?

A

more local complications
may be associated with systemic absorption and side effects

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18
Q

the choice of steroid based on potency is determined by the ________________ to be treated.

low potency agents treats __________

Higher potency agents treats __________

A

area of skin

thinner stratum corneum (face, scrotum, skin folds)

palms and soles, crusting and thickened conditions

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19
Q

________________ are the most potent and most lubricating and have ____________ properties

A

ointments and gels

occlusive

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20
Q

what type of formulation in most desirable?

A

lotions and creams - less greasy

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21
Q

what formulations are useful for treating the scalp

A

foam sprays and solutions

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22
Q

correct usage of topical corticosteroids

A

use sparingly to affected areas 2-4 times a day
tolerance is common
repository effect (1 or 2 applications/day may be as effective as 3 or more)

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23
Q

what type of topical corticosteroids are preferred in children?

A

low potency

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24
Q

super high potency topical corticosteroids should generally not exceed

A

2 consecutive weeks due to increased risk of immunosuppression

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25
Q

topical corticosteroids should not be _______________ because a __________ effect may occur

A

abruptly discontinued

rebound

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26
Q

topical corticosteroids should not be applied to

A

wet or weeping lesions

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27
Q

adverse effects of topical corticosteroids

A

local tissue atrophy, skin degeneration and striae
thinning of the epidermis
risk of suppression of HPA axis
development of cushingoid features

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28
Q

first line for irritant contact dermatitis

A

mild to moderate potent topical steroid
oral antihistamine as needed

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29
Q

second line for irritant contact dermatitis

A

more potent topical corticosteroid for up to 14 days

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30
Q

first line for allergy contact dermatitis

A

moderate potent topical steroids
oral antihistamine as needed

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31
Q

second line for allergy contact dermatitis

A

systemic corticosteroids, taper to no medication by 2 weeks

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32
Q

atopic dermatitis

A

chronic disorder due to defective skin barrier
similar presentation to allergic contact dermatitis but more widespread

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33
Q

pathogenesis of atopic dermatitis

A

IgE dysregulation
defects in the cutaneous cell mediated immune response
genetic factors

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34
Q

cytokines that cause inflammation in atopic dermatitis

A

IL4 and IL13

35
Q

atopic dermatitis severity scale we need to know is

A

United Kingdom National Institute for Health and Care Excellence

36
Q

mild atopic dermatitis

A

areas of dry skin
infrequent itching
little impact on everyday activities
sleep and psychological well being

37
Q

moderate atopic dermatitis

A

areas of dry skin
frequent itching and redness
moderate impact on everyday activities
frequently disturbed sleep

38
Q

severe atopic dermatitis

A

widespread areas of dry skin (incessant itching, redness, bleeding, oozing, etc)
severe limitation of everyday activities
nighyly loss of sleep

39
Q

goals of therapy for atopic dermatitis

A

restoration of normal epidermal barrier
treatment of inflammation of skin
control of itching
remission

40
Q

first line treatment for mild-moderate atopic dermatitis

A

emollients/moisturizers, education

41
Q

when acute control of pruritis and inflammation is needed in mild-moderate atopic dermatitis

A

low potency topical corticosteroid

42
Q

second line treatment for mild-moderate atopic dermatitis

A

switch to topical calcineurin inhibitors or crisaborole

43
Q

third line treatment for mild-moderate atopic dermatitis

A

medium-high potency topical corticosteroid
low potency topical corticosteroid or topical calcineurin inhibitors on areas of increased risk of atrophy

44
Q

maintenance therapy for mild to moderate atopic dermatitis

A

topical calineurin inhibitors (2 consecutive days/week) or crisaborole

include intermittent topical corticosteroids prn

45
Q

adjunctive therapy for mild to moderate atopic dermatitis

A

avoidance of trigger factors
antihistamine as needed

46
Q

newer options that can be used as maintenance for mild to moderate atopic dermatitis

A

topical roflumilast
tapinarof
ruxolitinib

47
Q

examples of emollients/moisturizers

A

eucerin
lubriderm
lac-hydrin
vaseline

48
Q

the thicker the preparation,

A

the more effective the product

49
Q

Eucrisa (crisaborole)

A

topical phosphodiesterase 4 inhibitor
mild-moderate atopic dermatitis
can be used in infants 3 months and older

50
Q

examples of topical immunosuppressants

A

Protopic (tacrolimus)
Elidel (pimecrolimus)

51
Q

topical immunosuppressants

A

inhibit calcineurin which normally initiates T cell activation
acute or maintenance
ages 2 and up

52
Q

adverse effects of topical immunosuppressants

A

stinging, itching, burning (common)
flu like symptoms
muscle pain
swollen glands
skin infections

53
Q

Drama (Tapinarof)

A

topical immunosuppressant
modulation of T helper cytokines
alternative to topical steroids/ineffective treatments
adults

54
Q

Zoryve (roflumilast)

A

inhibits PDE4
topical immunosuppressant
alternative to topical steroids/ineffective treatments
ages 6 and up

55
Q

Opzelura (Ruxollitinib)

A

topical immunosuppressant
JAK inhibitor
inhibits cytokines IL4 and 13
ages 12 and up

56
Q

when using Opzelura (Ruxollitinib), when signs and symptoms resolve

A

discontinue use

57
Q

Opzelura is approved for

A

short term treatment only

58
Q

First line treatment for moderate/severe atopic dermatitis

A

Dupixent (dupilumab)
inhibits IL4 and 13
ages 6 months and up

59
Q

alternate treatments to the first line treatment for moderate/severe atopic dermatitis in adults

A

tralokinumab (Adbry)
Lebrikizumab (Ebglyss)

60
Q

second line treatment for moderate/severe atopic dermatitis

A

oral JAK (janus kinase) inhibitors:
Rinvoq(upadacitinib)
Cibinqo (abrocitinib)

phototherapy

61
Q

can topical corticosteroids or other topical agents still be used in a person who has moderate/severe atopic dermatitis on maintenance treatment?

A

yes!

only as needed

62
Q

biologic agents adverse effects

A

conjunctivitis and keratitis
eosinophilia
antibody development
viral infection
injection site reactions

63
Q

biologics inhibit the

A

binding of one or more cytokines, by either binding the cytokine or receptor causing changes that trigger inflammation

64
Q

biologics are ____________ while JAK inhibitors are ______________

A

genetically engineered proteins from living organisms

synthetic

65
Q

JAK inhibitors block

A

enzymes which decrease inflammation from INSIDE the cells

66
Q

are biologics or JAK inhibitors preferred when treating atopic dermatitis?

why?

A

while JAK inhibitors provide more rapid improvement,
BIOLOGICS are preferred

there is potential risk for serious adverse events when using JAK inhibitors

67
Q

when to use JAK inhibitors

A

control of seasonal flares
eczema that does not respond to biologics

68
Q

JAK inhibitors are considered _____________ due to their serious adverse effects

A

last line agents

69
Q

phototherapy

A

use of UV light to slow the rapid growth of new skin cells in atopic dermatitis

70
Q

JAK inhibitors warnings/precautions

A

cerebrovascular accidents
MI
hypotension
arrhythmias
hematologic toxicities
severe hepatic reactions
reactivation of HBV
active TB

71
Q

non targeted oral immunosuppressive agents for moderate/severe atopic dermatitis

A

cyclosporine (Neoral, Sandimmune)
methotrexate

72
Q

cyclosporine (Neoral, Sandimmune)

A

blocks calcineurin activation inhibiting T cell activation and non targeted cytokine production

73
Q

Methotrexate

A

inhibits folic acid reductase resulting in the inhibition of cellular DNA replication
leads to suppression of inflammation

74
Q

methotrexate is often combined with

A

folic acid

75
Q

methotrexate is contraindicated in

A

pregnancy (X)

76
Q

treatments for scalp seborrhea

A

topical corticosteroids in conjunction with a shampoo: either selenium sulfide (Selsun) or ketoconazole (Nizoral)
salicylic acid
coal tar products

77
Q

treatments for diaper rash

A

occlusive agents (zinc oxide, petrolatum)
low potency topical corticosteroid

78
Q

if secondary Candida infection is present in diaper dermatitis, the treatment should include

A

anti fungal agents (nystatin, clotrimazole, miconazole, ketoconazole)

79
Q

super high potency topical corticosteroids (group 1)

A

betamethasone dipropionate augmented
clobetasol propionate
fluocinonide
halobetasol propionate

80
Q

high potency topical corticosteroids (group 2)

A

halcinonide

81
Q

medium potency topical corticosteroids (group 4)

A

mometasone furoate

82
Q

lower mid potency topical corticosteroids (group 5)

A

hydrocortisone butyrate
hydrocortisone probutate
hydrocortisone valerate

83
Q

low potency topical corticosteroids (group 6)

A

alcometasone dipropionate
desonide

84
Q

least potent topical corticosteroids (group 7)

A

hydrocortisone (base less than 2%)

Pharmacotherapeutics (8 decks)

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