Dermatologic Pharm Flashcards
What are creams made of?
What are ointments made of?
1) Half water/half oil with emulsifier so water evaporates
2) 20% water in 80% oil
How do creams absorb?
How do ointments absorb?
1) Well absorb and wash off with water
2) Stay on surface of skin and not well absorbed
Between ointments and creams, which product is better for dry skin?
Which product is better for oozing/wet skin conditions?
1) Ointments
2) Creams
Between creams or ointments which provides for more complete absorption of the active ingredient or medication?
Which is less likely to cause an allergic reaction?
Ointments for both
What is the single most important measure to reduce transmission of microorganisms to other areas of body or other patients?
Hand Hygiene
How long should you wash your hands for?
15-30 seconds
What is alcohol-based hand disinfection not effective against?
What should be used instead?
1) C. difficile
2) Soap and water
Emollients are a component of moisturizer that does what?
What do humectants do?
What do horny substance (keratin) softeners do?
1) Forms an oily layer on top of the skin that traps water in the skin
2) Draws water into the outer layer of the skin
3) Loosens the bonds between the top layer of cells to help dead skin cells fall off, helps the skin retain water, and gives it a smoother, softer feeling
Petrolatum, lanolin, mineral oil and dimethicone are common?
Glycerin, lecithin, and propylene glycol are common?
Urea, alpha hydroxy acids (e.g., lactic, citric, glycolic), and allantoin are common?
1) Emollients
2) Humectants
3) Horny substance (keratin) softeners
For what skin type do you want to choose a water based moisturizer that has a light, non greasy feel and contain lightweight oils, such as cetyl alcohol, or silicone-derived ingredients, such as cyclomethicone?
Normal skin
For what skin type do you want to choose a heavier, oil based moisturizer that contains ingredients such as antioxidants, grape seed oil or dimethicone?
What are preferable for severe cases of this skin type?
1) Dry skin
2) Petrolatum-based products
For what skin type do you want to choose a water-based product that is labeled “non-comedogenic”?
What is the use of these products for?
1) Oily skin
2) Provide moisture while limiting acne breakouts
For what skin type do you want to choose a moisturizer with chamomile or aloe that does not contain potential allergens (e.g., fragrances, dyes) or acids?
Sensitive skin
For what skin type do you want to choose an oil-based moisturizer that contains petrolatum as the base plus antioxidants or alpha hydroxy acids?
What are the antioxidants or alpha hydroxy acids used for?
1) Mature skin
2) Combat wrinkles
What causes most erythema/sunburn, skin aging and photocarcinogenesis?
What causes skin aging and cancer?
1) UVB radiation (280-320 nm)
2) UVA radiation (320-400 nm)
What sunscreen compound is active in UVB range?
p-aminobenzoic acid (PABA)
What sunscreen compound has a wider 250-360 nm range but less effective than PABA?
Benzophenones
What sunscreen compound is active in UVA range?
What conditions is it particularly useful for?
1) Dibenzoylmethane
2) Drug-induced photosensitivity and cutaneous lupus erythematosus
Which antiseptics MOA involves the cross-linking of proteins?
What is its target?
1) Glutaraldehyde
2) Cell envelope and cross-linked macromolecules
Which antiseptics MOA damages phospholipid bilayers?
What is its target?
1) Quaternary amines
2) Inner cytoplasmic membrane
Which antiseptics MOA affects membrane integrity and congealing of cytoplasm?
What is its target?
1) Chlorhexidine
2) Inner cytoplasmic membrane
Which antiseptics MOA causes oxidation of thiol groups to disulfides, sulfoxides or disulfoxides?
What is its target?
1) Halogens
2) Oxidizing agents
Which antiseptics MOA causes formation of free hydroxyl radicals to oxidize thiol groups in enzymes and proteins?
What is its target?
1) Hydrogen peroxide
2) Oxidizing agents
Which antiseptics MOA causes disruption of thiol groups in proteins?
What is its target?
1) Peracetic acid
2) Oxidizing agents
What is a broad-spectrum antimicrobial agent widely used in homes and hospitals due to general efficacy on skin (including oral mucosa) and low irritability?
Chlorhexidine
Which type of microorganism does chlorhexidine not kill but instead prevents its growth?
Which type cause protoplast and spheroplast lysis and at high concentrations cause precipitation of proteins and nucleic acids?
Which type causes protoplast lysis and intracellular leakage, high concentrations cause intracellular coagulation?
1) Bacterial spores and mycobacteria
2) Non-sporulating bacteria
3) Yeasts
While chlorhexidine has low activity against many viruses, it is more sensitive to which type?
Lipid enveloped viruses
How does chlorhexidine affect the activity against protozoa?
Affects trophozoites but not protozoa in cystic form
What effect does antiseptics and disinfectants have on cryptosporidium, Bacillus, and C. Difficile?
None, b/c they’re resistant to
What effect does antibiotics have on biofilms?
1) Limited penetration
2) Antibiotic neutralization
3) Slow growth
Why is the use of antiseptic wash solutions such as dilute iodine, chlorhexidine or hydrogen peroxide generally not necessary?
When should antibiotic therapy be reserved for?
1) Potentially impede wound healing through toxic effects on normal tissue
2) Infected wounds
In primary closure of surgical wounds in high-risk patients, poor control of what is significantly associated with worse outcomes?
Glycemic control
What type of debridement should be routine since it flushes bacteria and removes loose material?
What type is appropriate for removing large areas of necrotic/infected tissue?
What type uses products such as collagenase to promote endothelial cell and keratinocyte migration for angiogenesis and epithelialization?
What type uses maggot therapy which results in liquefaction of necrotic tissue while leaving healthy tissue intact?
1) Low-pressure irrigation with normal saline
2) Surgical debridement
3) Enzymatic debridement
4) Biologic debridement
What platelet derived growth factor is used in wound healing because it promotes cell proliferation and angiogenesis?
Becaplermin
What is becaplermin the only agent approved for?
Treatment of chronic diabetic foot ulcers
What does becaplermin have a black box warning for?
Malignancy
What are the general principles for wound dressings?
How do occluded wounds heal?
1) Wounds should be kept moist, and should not be exposed to air
2) Heal faster and have less scarring
During wound dressing, what should be used for the debridement stage?
What’s used for the granulation stage?
What’s used for the epithelialization stage?
1) Hydrogels
2) Foam and low-adherence dressings
3) Hydrocolloid and low-adherence dressings
What topical antibacterial agent inhibits bacterial cell wall synthesis?
What bacteria is it active against?
1) Bacitracin
2) Gram positive
What topical antibacterial agent binds to 30S ribosomal subunit to inhibit protein synthesis?
What bacteria is it active against?
1) Neomycin
2) Gram negative
What topical antibacterial agent binds to phosphor-lipids to alter permeability and damage bacterial cytoplasmic membrane?
What bacteria is it active against?
1) Polymyxin B
2) Gram negative
What blocks ergosterol synthesis and has a wide range of activity against dermatophytes and yeasts?
Topical imidazoles
What imidazole antifungal is a topical application as a cream or lotion used for vulvovaginal candidiasis?
Which is used for onychomycosis treatment?
Which is a cream for topical treatment of dermatophytosis and candidiasis, and is a shampoo or foam for seborrheic dermatitis?
1) Miconazole and Clotrimazole
2) Efinaconazole
3) Ketoconazole
Which topical antifungal agent disrupts macromolecular synthesis?
How does it affect dermatophytes, Candida and Malassezia?
1) Ciclopirox
2) Affects them all
Which topical antifungal agent inhibits squalene epoxidase, a key enzyme for the synthesis of ergosterol?
How does it affect dermatophytes and yeasts?
1) Terbinafine
2) Highly active against dermatophytes but less active against yeasts
Which topical antifungal agent distorts hyphae/stunts mycelial growth?
How does it affect dermatophytes, Candida and Malassezia?
1) Tolnaftate
2) Effective against various dermatophyte and malassezia infections but not Candida
Which topical antifungal agent binds to fungal sterols and alters membrane permeability?
How does it affect Candida?
1) Nystatin and Amphotericin B
2) Limited to cutaneous and mucosal candida infections
Which topical antiviral agent is a synthetic guanine analog with inhibitory activity against herpes simplex types 1 and 2?
Acyclovir
Topical calcineurin inhibitors are particularly useful in what type of pruritus?
Anogenital pruritus
Capsaicin and lidocaine patches are particularly useful in what type of pruritus?
Neuropathic pruritus
Pramoxine is useful for what type of pruritus?
Pruritus on face and that associated with CKD
What channel does the topical therapy for pruritus capsaicin activate?
What does menthol activate?
1) TRPV1 (heat)
2) TRPM8 (cold)
What does capsaicin do?
1) Releases substance P
2) Induces lasting desensitization
What is salicylic acid?
COX inhibitor
Mirtazapine is useful for what type of pruritus?
Nocturnal pruritus
Sertraline is useful for what type of pruritus?
Cholestatic pruritus
Naltrexone is useful for what type of pruritus?
Cholestatic and CKD associated pruritus
Butorphanol is useful for what type of pruritus?
Nocturnal and intractable pruritus
Gabapentin and pregabalin are useful for what type of pruritus?
Neuropathic pruritus
What does brimonidine and oxymetazoline treat?
What is each an agonist of?
1) Rosacea
2) Alpha 2
Which topical agent is used to treat ectoparasitic infections by acting as an organophosphate cholinesterase inhibitor?
Which topical agent is used to treat ectoparasitic infections by binding to insect Na+ channels and blocking membrane repolarization?
Which oral agent is used to treat ectoparasitic infections by binding to glutamate-gated Cl- channels in invertebrates, hyperpolarizes the nerve and muscle cells?
Which topical agent is used to treat ectoparasitic infections by disrupting GABAergic transmission in insects?
1) Malathion
2) Permethrin
3) Ivermectin
4) Lindane
What topical acne medication causes local skin irritation, dryness, flaking, sun sensitivity, and may cause an allergic reaction to fish?
What category of acne medication is it?
1) Tretinoin
2) Retinoid
What topical acne medication causes local skin irritation and may bleach hair or clothes?
What category of acne medication is it?
1) Benzoyl peroxide
2) Antimicrobial
What acne medication kills acne bacteria and decreases the production of keratin?
Azelaic acid
What acne medication is absolutely contraindicated in pregnancy?
Oral isotretinoin
What is the MOA for retinoid in acne treatment?
1) Decreased cohesiveness of keratinocytes
2) Reduced follicular occlusion and microcomedone formation
What is the initial choice for mild to moderate psoriasis?
What are the initial choices for moderate to severe psoriasis?
1) Emollients and corticosteroids
2) UVB and PUVA
What is the MOA of apremilast?
What are its effects?
What are its clinical applications?
How is it administered?
1) Inhibits PDE4 which increase cAMP levels
2) Decrease NO synthase, TNF-alpha, IL-23 while increasing IL-10
3) Plaque psoriasis and psoriatic arthritis
4) Orally
What is the MOA of ustekinumab?
What are its clinical applications?
What toxicity may it cause?
1) Blunts IL-12 and IL-23 effects
2) Plaque psoriasis and psoriatic arthritis
3) Increases risk for infections
What is the MOA for secukinumab?
What are its clinical applications?
What toxicity may it cause?
1) Blunts IL-17A effects
2) Plaque psoriasis and psoriatic arthritis
3) Increases risk for infections
What treatment option for Actinic Keratosis inhibits thymidylate synthetase in order to blunt DNA synthesis of fast-growing dysplastic cells?
Topical 5-Fluorouracil
What is the conventional chemotherapy for treating melanoma?
Dacarbazine
What MAP kinase pathway inhibitors is used to treat melanoma with BRAF v600D gene mutation?
Vemurafenib
What treatment for male pattern baldness causes vasodilation due to K+ -channel opening?
Minoxidil
What treatment for male pattern baldness is an oral inhibitor of dihydrotestosterone (DHT) production?
Finasteride
What is the treatment for Alopecia Areata?
1) Topical corticosteroids
2) Topical immunotherapy such as DPCP (diphenylcyclopropenone)
