Dermatologic Flashcards
Routs of administration for skin
- topical
- systemic
- intralesion injection
- ultraviolet radiation
Topical drug deliverry forms for derm
- solution/dissolved in solvent
- lotion/powder in water or oil
- cream/wanter in oil
- ointment/oil in water
what can increase the skin penetration of an agent
- decreased molecular size
- increased lipid content
- increased concentration
- decreased skin integrity
- decreased skin thickness, ie face vs heels
- greater surface area to mass - greater dose
Lists of the dermatologic agents
- anti/bacterial/fungal/virals/inflammatories
- retinoids
- psoralens
- sunscreens
- keratolytic agents salicylic acid
- analgesics
- hormone replacement
- nicotine
- alopecia drugs
- cytotoxic agents
why use topical antimicrobials
prophylaxis of superficial infections due to wounds and injuries
What are the topical antimirobials
- Anti microbrial: Neomycin/Neosporin
- Antibiotic : Mupirocin/bactroban
MOA of antimicrobial Neomycin/neosporin
Neomycin: disrups bacterial cell membrane phospholipids
MOA of antimicrobial Bacitracin
Bacitracin: interferes with pepditoglycans of bacterial cell wall
MOA of Topical antibiotic Mupirocin/bactroban
Mupirocin/bactroban: inhibit bacterial protein synthesis
Neomycin Class
Antimicrobial: disrubt cell membrane
Bacitracin class
antimicrobial : disrupt cell wall
Mupirocin/bactroban Class
Antimicrobial: inhibit protein synthesis
Indication for Neomycin ointment
Neomycin/neosporin
- superficial skin infection,
- external ear infx
- prophylactially
Indication fo Mupirocin
- cream or ointment
Mupirocin/bactroban
- impedigo
- staph/strep
- MRSA in additon to IV
side effects of Neomycin ointment
Neomycin:
- Ototoxicity if otic solution is applied and there is a perforated TM
where should you apply Mupirocin when treating MERA
Also treat nares
Antifungals : topical
Ketoconazole/Nizarol
MOA of ketoconazole/nizarol
Ketoconazole: Inhibit sterol synthesis
Class of ketoconazole
antifungal
Indication of KEtoconalzole
- lotion, ointment, shampoo
superficial fungal infections
- Tinea
- yeast infections
- seborrheic dermatitis
why apply glucocorticoids to skin, what are their properties
- immunosupressive
- antiinflammatorie
when should topical steroids be avoided
Dont use topical steroids and abraded skin
indications for topical glucocorticoids
- dermatitis
- psoriasis
- ezcema
- bullous disease : pemphigus
- collagen vascular disease SLE
- Granulomatous : Sarcoidosis
How are topical glucocorticoids classed?
Grouped into seven classes with class 1 being the most potient and class 7 is the least potent.
what are generally the most potent corticosteroids
halogenated corticosteroids
steroid side effects
- skin atrophpy
- striae
- purpura
- perioral dermatitis *
- rosacea
- fungal overgrowth
Systemic side effects from topical steroid
- supression of HPA axis
- hyperglycemia
- osteoporosis/necrosis
what can increase systemic absorption of topical steroids
- increase amount applied
- size of treatment area
- frequency of application
- duratio nof treatment
- drug potency
- use of occlusive barrier
when are intralesional steroids used
- cystic acne
- psoriasis
- discoid lupis
- alopecia
Glucocorticoid/corticosteroid drug
Hydrocortisone/cortef
MOA or glucocoricoids
- affects gene transcription: anti inflammatory
- stimulate or repression protein synthesis
how is hydrocortizone dispensed
topical cream or ointment
- OTC 1% or halogenated
How do retinoids affect skin
Modify the following
- cell proliferation
- cell differentiation
- immune function
- inflammation
- sebum production
what are Retinoids
derivatives of retinol that exhibit vitamin A activity
indications for Retinoids
- Cystic/papular acne
- actinic keratosis
- psoriasis - same as intralesional steroids
- basal cell cancer **
- Squamous cell cancer *
- Cutaneous aging
Etiology of acne
- Folicular hyperkeratosis
- bacteria
- excess sebum produciton
- increased inflammation
- andrognes
Drug therapy for acne includes what
- topical salicylic acid
- topical benzoly peroxide
- topical antibiotics
- topical retinoids
Class of tretinoin/Retin A
Vitamin A derivative
MOA of Tretinoin/Retin A
MOA Retin A
- Reduce hyperkeratinizaation, increase epidermal thickness and collagen synthesis
side effects of Retin A
Erythema, peeling burning stingin photosynsetivity
name the Vitamin A derivatives
Tretinoin/Retin A
Isoretinoin/Accutane
MOA or Isoretinin/Accutain
MOA of isoretinin/accutain
- Reduce hyperkeratinization, sebum gland number and production, reduce bacteria
what bacteria is associated with acne
propioni-bacterium acne
indications for Tretinoin/retin A vs Isoretinin/accutaint
Trentinoin/Retin A - Acne - photodamaged skin Isoretinin/Accutane - Acne - Acne rosacea - Hidradenitis supperativa
Side effects of Accutaine
Teratogenicity - first 3 weeks of gesttion Pregnancy is absolute contraindications 2 forms of birth control - depression/ psycosis liver stuff
Psoriasis
Autoimmune dz, immune cells move to epidermis, stimulating proliferation of keratinocytes
Drug therapy for psoriasis
- Topical corticosteroids
- Topical vitamin D
- Topical vitamin A
- Phototherapy
- Systemic: steroids, chemo agents,
What does photochmotherapy implies
That some sort of drug is added to tratment
PUVA
Psoralen and ultraviolet A therapy. Geven Psoralen then reacted to UVA light
MOA of PUVA
MOA of PUVA
- antiinflammatory through immunosupression
- inhibit DNA synthesis
Uses for PUVA
- Psoriasis (retinoids, intralesional steroids)
- vitilago
- T cell lymphomas
- alopecia
- urticari pigmentosa
side iffects of PUVA
nausea, pain redness, blistering,
increased risk of skin cancer
skin aging; actinic keratosis
