Dermatologic Flashcards
Which area of the skin will have the most permeation and absorption?
#1 groin #2 face
Bacitracin-Neomycin-Polymyxin B (Neosporin) class
Topical antimicrobial
Bacitracin-Neomycin-Polymyxin B (Neosporin) indications
Superficial bacterial skin infx, eyes and external ear infx
can be used prophylactically against bacterial contamination of abrasions, burns, skin grafts or incisions
Bacitracin-Neomycin-Polymyxin B (Neosporin) MOA
polymyxin disrupts the structure of the bacterial cell membrane by interacting with phospholipids; bacitracin interferes with the peptidoglycans of the bacterial cell wall
Do not use Bacitracin-Neomycin-Polymyxin B (Neosporin) is __________
allergic to systemic aminoglycosides
Drugs of choice to tx impetigo
Mupirocin (Bactroban)
When to use topical therapy with tx impetigo
only if there is a limited # of lesions
Mupirocin (Bactroban) class
topical antibiotic
Mupirocin (Bactroban) MOA
inhibits bacterial protein synthesis
T/F: Mupirocin (Bactroban) can be used to tx MRSA colonization
TRUE
should be applied to nares to eradicate nasal carriage of infx
Mupirocin (Bactroban) local s/e
irritation
What is the MC type of Tinea?
Tinea pedis
Drug of choice to tx Tinea
Ketoconazole (Nizoral)
Ketoconazole (Nizoral) class
topical antifungal
Ketoconazole (Nizoral) MOA
inhibits sterol synthesis, a component of fungal cell membranes
Ketoconazole (Nizoral) local s/e
skin irritation
Commonly encountered conditions in which topical corticosteroids are used?
1) Atopic dermatitis/Eczema
2) Contact/allergic dermatitis - environmental exposure
3) Psoriasis
Potency of topical corticosteroids is based on
vasoconstriction effects (not on the anti-inflammatory effects)
Very high potency (Class I) corticosteroid considerations
1) do not discontinue abruptly - switch to lower potency agent
2) tx duration should not exceed 2-4 wks
High potency (Class II-III) corticosteroid considerations
avoid occlusive dressings with betamethasone dipropionate, use with caution in other high potency agents
Low potency (Class VI-VII) corticosteroid considerations
1) consider these agents for children, pregnant women, elderly, and pt. w/ large areas to be treated
2) preferred agents for face, groin, armpits, or skinfolds
potency classes of topical corticosteroids
Very high = Class I
High = Class II-III
Medium = Class IV-V
Low = Class VI-VII
cutaneous adverse rxn to topical corticosteroids
skin atrophy (thinning), telangiectasia, hypopigmentation, steroid acne, increased hair growth
________ topical corticosteroids can be systemically absorbed
Very high (Class I) and High (Class II-III) potency
systemic/LT s/e of topical corticosteroids
insomnia, hyperglycemia, osteoporosis, impaired wound healing
last line therapy for tx of atopic dermatitis/eczema, used if pt. have failed to respond to topical corticosteroids
Topical Calcineurin Inhibitors
Tacrolimus (Protopic) ointment class
Topical Calcineurin Inhibitors
Pimecrolimus (Elidel) cream class
Topical Calcineurin Inhibitors
Topical Calcineurin Inhibitors local s/e
local stinging, burning
Treat pruritis/hives with
systemic antihistamines
Loratadine (Claritin) class
systemic antihistamines
Cetirizine (Zyrtec) class
systemic antihistamines
T/F: topical antihistamines can be used to treat pruritus/hives
FALSE
they are ineffective & topical doxepin carries risk of local contact dermatitis
What are pharmacologic options for tx acne?
1) salicylic acid
2) benzoyl peroxide
3) topical retinoids
4) antibacterial agents
5) antisebum agents
Which antibacterial agents are used to tx acne?
1) Erythromycin, clindamycin
2) azelaic acid
3) dapsone
Which antisebum agents are used to tx acne?
1) oral contraceptives
2) spironolactone
3) isotretinoin
Isotretinoin (Accutane) class
Vitamin A derivative
Isotretinoin (Accutane) indications
acne, acne rosacea, and hidradenitis supperativa
Isotretinoin (Accutane) MOA
1) reduction of hyperkeratinization
2) reduction in # of sebaceous glands and sebum production
3) reduction of Propionbacterium acne, the organism believed to contribute to acne-associated inflammation
Isotretinoin (Accutane) ADRs
1) **Teratogenicity (1’ in first 3 wks)
2) Depression
3) Psychosis
4) Myalgias
5) Hyperlipidemia
What is the iPLEDGE program?
that Isotretinoin (Accutane) Rx requires registration from: physician, patient, pharmacy, and wholesaler
goals: no female pt. starts Isotretinoin (Accutane) if pregnant and no female pt. on Isotretinoin (Accutane) becomes pregnant
T/F: LT use of topical corticosteroids can cause systemic s/e such as insomnia, hyperglycemia, osteoporosis, and impaired wound healing
False
although depends on potency of steroid
Treatment options for psoriasis
1) topical corticosteroids
2) topical vitamin D analog
3) topical vitamin A analog/retinoid (i.e. tazarotene)
4) phototherapy
5) systemic therapy
Which systemic therapies are used to tx psoriasis?
1) oral steroids,
2) chemotherapy agents (methotrexate)
3) TNF-a inhibitors (Infliximab/Remicade and Etanercept/Enbrel)
Cacipotriene (Dovonex) class
Vitamin D analog
Cacipotriene (Dovonex) MOA
inhibits epidermal proliferation and stimulation of differentiation
Cacipotriene (Dovonex) indications
plaque psoriasis, scalp psoriasis
T/F: the vitamin D analog, Cacipotriene (Dovonex, is as effective as topical corticosteroids but has more frequent adverse effects
TRUE
Cacipotriene (Dovonex) s/e
- photosensitivity
- hypercalcemia
- may worsen psoriasis
- skin irritation
Cacipotriene (Dovonex) is potentially more effective in tx psoriasis when used with _________
Betamethasone
Tazarotene (Tazorac) class
topical retinoid
Tazarotene (Tazorac) indications
plaque psoriasis, acne
Tazarotene (Tazorac) s/e
skin burning, irritation, stringing
Tazarotene (Tazorac) is recommended to use with _______ for improved efficacy and tolerability when tx psoriasis
topical corticosteroids
What is phototherapy?
use of UVA & UVB as therapeutic agents
What is photochemotherapy?
adding an agent such as a psoralen drug (e.g. methoxsalen) to phototherapy tx
PUVA
psoralen (P) + UVA
phototherapy s/e
- nausea
- painful erythema and blistering
- chronic use associated w/ incr. risk of skin cancer
