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SBL Exam 2 > Dermatologic Pharm (Wolff) > Flashcards

Dermatologic Pharm (Wolff) Flashcards

1
Q

What are the variables that affect cutaneous absorption of drugs?

A

Regional (ie, axilla more permeable than forearm)
Concentration gradient
Dosing schedule
Vehicles/Occlusion (both can maximize drug penetration)

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2
Q

What layers of the skin do the cutaneous drugs bind to receptors?

A

Stratum Spinosum

Basement Membrane Zone

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3
Q

At what point in the skin layers does the drug become absorbed into the bloodstream?

A

Subcutaneous Fat

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4
Q

Creams are a mixture of what?

A

Half water, half oil (oil in water) with emulsifier (ie, cetyl alcohol)

***Water evaporates

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5
Q

(CREAMS/OINTMENTS) spread easily, are well absorbed, and wash off with water. They are too thick to pump, so packaged in tub or tube.

A

Creams

***Lotions are similar to creams, just less viscous!

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6
Q

Creams are better than ointments for what type of skin conditions?

A

Oozing or wet skin conditions

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7
Q

Ointments are a mixture of what?

A

20% water in 80% oil

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8
Q

The oil component of ointments is made from _________ such as mineral oil or petroleum jelly.

A

Hydrocarbons

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9
Q

Ointments are greasy and are ________, meaning they stay on the surface of the skin and are not well absorbed.

A

Occlusive

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10
Q

Ointments are best for what type of skin?

A

Dry skin, since they trap moisture

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11
Q

Ointments are (MORE/LESS) likely to cause an allergic reaction than creams, which contain preservatives.

A

Less

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12
Q

What are gels made of?

A

Polyionic colloids expanded with water

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13
Q

What are pastes made of?

A

Mixtures of oil, water, and powder

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14
Q

What is the single most important measure to reduce transmission of microorganisms to other areas of body or other patients?

A

Hand Hygiene

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15
Q

What are the “Five Moments for Hand Hygiene”?

A
    • Before touching a patient
    • Before clean/aseptic procedures
    • After body fluid exposure/risk
    • After touching a patient
    • After touching patient surroundings
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16
Q

How long should you wash your hands?

A

15-30 seconds

***Many don’t wash long enough!

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17
Q

T/F. Scented soap should be used for hand washing, but this does not reliably prevent microbial transmission.

A

False. Plain soap should be used!

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18
Q

Frequent hand washing may cause skin damage and irritation, so an alternative is an alcohol-based hand disinfection (hand sanny). It is rapidly effective against gram-positive, gram-negative, and viral pathogens but does not work against….

A

C. difficile (must use soap and water for this)

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19
Q

This is a component of moisturizer that forms an oily layer on top of the skin that traps water in the skin.

A

Emollients

  • **Common ones are:
    • Petrolatum
    • Lanolin
    • Mineral oil
    • Dimethicone
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20
Q

This is a component of moisturizer that draws water into the outer layer of the skin.

A

Humectants

  • **Common ones are:
    • Glycerin
    • Lecithin
    • Propylene glycol
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21
Q

This is a component of moisturizer that loosens the bonds between the top layer of cells, helping dead skin cells fall off. It also helps the skin retain water, and gives it a smoother, softer feeling.

A

Horny substance (keratin) softeners

  • **Common ones are:
    • Urea
    • Alpha hydroxy acids (ie, lactic, citric, glycolic)
    • Allantoin
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22
Q

What is the skin type based on the following description of a specific moisturizer?

– Water-based moisturizer that has a light, nongreasy feel.

– Often contain lightweight oils, such as cetyl alcohol, or silicone-derived ingredients, such as cyclomethicone.

A

Normal skin

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23
Q

What is the skin type based on the following description of a specific moisturizer?

– Heavier, oil-based moisturizer that contains ingredients such as antioxidants, grape seed oil or dimethicone, which helps keep your skin hydrated.

– Petrolatum-based products are preferable for worse cases of this skin type, because they prevent water from evaporating.

A

Dry skin

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24
Q

What is the skin type based on the following description of a specific moisturizer?

– Water-based product that is labeled “noncomedogenic” to provide moisture while limiting acne breakouts.

A

Oily skin

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25
Q

What is the skin type based on the following description of a specific moisturizer?

– Has soothing ingredients such as chamomile or aloe that does not contain allergens (ie, fragrances or dyes) or acids to minimize skin irritation.

A

Sensitive skin

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26
Q

What is the skin type based on the following description fo a specific moisturizer?

– Oil-based moisturizer that contains petrolatum as the base to keep skin hydrated plus antioxidants or alpha hydroxy acids to combat wrinkles.

A

Mature skin

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27
Q

(UVA/UVB) radiation causes most erythema/sunburn and skin aging and photocarcinogenesis.

A

UVB (280-320 nm)

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28
Q

(UVA/UVB) radiation causes skin aging and cancer.

A

UVA (320-400 nm)

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29
Q

These are chemical compounds that absorb UV light.

A

Sunscreen

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30
Q

In sunscreen, _______ and its esters are active in UVB range (280-320 nm).

A

PABA (p-aminobenzoic acid)

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31
Q

In sunscreen, ________ have a wider range of 250-360 nm but are less effective than PABA.

A

Benzophenones

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32
Q

In sunscreen, _________ are active in UVA range, particularly useful for conditions such as drug-induced photosensitivity and cutaneous lupus erythematosus.

A

Dibenzoylmethanes

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33
Q

This is the term for opaque materials that reflect light, a classic example being titanium oxide.

A

Sunshades

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34
Q

What is Sun Protection Factor (SPF)? What is the highest it can be?

A

SPF = Ratio of minimal erythema dose with sunscreen to the minimal erythema dose without sunscreen

Limited to 50+ by FDA

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35
Q

This is a broad-spectrum antimicrobial agent widely used in homes and hospitals due to general efficacy on skin (including oral mucosa) and low irritability.

A

Chlorhexidine

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36
Q

What is the target and mechanism of action of Chlorhexidine?

A

Cytoplasmic (inner) membrane

Low concentrations will affect membrane integrity.
High concentrations cause congealing of cytoplasm.

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37
Q

What action does Chlorhexidine have on bacterial spores?

A
    • Prevents development of spores

- - Inhibits spore outgrowth but not germination

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38
Q

What action does Chlorhexidine have on mycobacteria?

A

– Mycobacteriostatic (mechanism unknown)

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39
Q

What action Chlorhexidine have on other non-sporulating bacteria?

A

– Membrane-active agent causing protoplast and spheroplast lysis

– High concentrations cause precipitation of proteins and nucleic acids

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40
Q

What action does Chlorhexidine have on yeasts?

A

– Membrane-active agent causing protoplast lysis and intracellular leakage

– High concentrations cause intracellular coagulation

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41
Q

What action does Chlorhexidine have on viruses?

A
    • Low activity against many viruses

- - Lipid-enveloped more sensitive than non-enveloped

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42
Q

What action does Chlorhexidine have on protozoa?

A

– Has activity against trophozoites (less toward cysts)

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43
Q

What is the list of organisms from most resistant to least resistant of antiseptics and disinfectants?

A 
Prions (most resistant)
Coccidia 
Spores
Mycobacteria
Cysts
Small non-enveloped viruses
Trophozoites
Gram-negative bacteria
Fungi
Large non-enveloped viruses
Gram-positive bacteria 
Lipid-enveloped viruses (least resistant)
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44
Q

Describe wound healing by first intention (cut).

A

1) Inflammatory Phase – 24 hours, scab forms and neutrophils and clot is present.
2) Proliferative Phase – 3-7 days, macrophages and other cells are present. Mitoses occurs and new capillary is forming.
3) Remodeling Phase – Weeks, fibrous union of the skin back together.

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45
Q

Describe wound healing by second intention (gouge).

A

Process are basically the same as first intention, but the injury is filling from the bottom up.

– Larger scab (clot)

– Inflammation more intense because of more necrotic debris, exudate, and fibrin to remove.

– Larger amounts of granulation tissue – larger defect (scar).

– Involves wound contraction.

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46
Q

Are antiseptic wash solutions such as dilute iodine, chlorhexidine, or hydrogen peroxide effective against bacteria?

A

Generally not necessary to use because they minimal action. Could potentially impede wound healing through toxic effects on normal tissue.

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47
Q

T/F. Antibiotic therapy should be reserved for wounds that appear clinically infected. No evidence shows that antibiotic use as prophylaxis or healing of non-infected wounds is improved.

A

True

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48
Q

In primary closure of surgical wounds in high-risk patients, poor _______ ______ is significantly associated with worse outcomes.

A

Glycemic Control

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49
Q

Postoperative hyperglycemia is frequent after elective _________ surgery in nondiabetic patients. Even a single postoperative elevated glucose value is adversely associated with morbidity and mortality.

A

Colorectal

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50
Q

It’s important to ensure adequate oxygenation. Usual reason for inadequate oxygenation is local vasoconstriction due to sympathetic overactivity. Common causes of this are…

A
    • Blood volume deficit
    • Unrelieved pain
    • Hypothermia
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51
Q

T/F. It’s important to ensure adequate nutrition. We would most often suspect malnutrition in patients with chronic illnesses, inadequate societal support, multi systemic trauma, or GI or neurons problems that may lead to impaired intake. We must address protein-calorie malnutrition and deficiencies of vitamins and minerals.

A

True

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52
Q

Wound debridement removes dead tissue and debris, and promotes wound healing by limiting ________ production and conserving the local resources needed for healing.

A

Protease

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53
Q

This type of wound debridement should be routine since it flushes bacteria and removes loose material.

A

Low-Pressure Irrigation with Normal Saline

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54
Q

This type of wound debridement is appropriate for removing large areas of necrotic/infected tissue.

A

Surgical Debridement

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55
Q

This type of wound debridement uses a variety of products and gives mixed results. Collagenase may promote endothelial cell and keratinocyte migration for angiogenesis and epithelialization.

A

Enzymatic Debridement

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56
Q

This type of wound debridement uses maggots. Maggot therapy has negative perceptions, but does result in liquefaction of necrotic tissue while leaving healthy tissue intact. However, pressure ulcer healing time is not consistently reduced.

A

Biologic Debridement

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57
Q

This is a platelet-derived growth factor that promotes cell proliferation and angiogenesis. It is the ONLY agent approved for treatment of chronic diabetic foot ulcers.

A

Becaplermin

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58
Q

Becaplermin has a black box warning for malignancy when how much is used?

A

Use of >3 tubes increases risk of malignant complications by about 4x

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59
Q

Epidermal growth factor (DOES/DOES NOT) significantly improve epithelialization.

A

Does Not

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60
Q

What is the general principle for wound dressings?

A

Wounds should be kept moist, and should NOT be exposed to air (as done historically)

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61
Q

Occluded wounds heal 40% faster and have less scarring. The wounds are exposed to their own fluid, a mix of…

A

Metalloproteases and Cytokines

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62
Q

Hydrogels are best used for the _________ stage.

A

Debridement

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63
Q

Foam and low-adherence dressings are used for the _________ stage.

A

Granulation

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64
Q

Hydrocolloid and low-adherence dressings are used for the _________ stage.

A

Epithelialization

65
Q

This topical antibacterial agent is a peptide antibiotic, and inhibits bacterial cell wall synthesis. It is active against gram-positive organisms, anaerobic cocci, neisseriae, tetanus bacilli, and diphtheria bacilli.

A

Bacitracin

66
Q

Bacitracin is poorly absorbed through the skin, so systemic toxicity is rare. It does often cause allergic contact ________.

A

Dermatitis

67
Q

This topical antibacterial agent is an aminoglycoside antibiotic that binds to 30S ribosomal subunit to inhibit protein synthesis.

A

Neomycin

68
Q

Neomycin is active against _________ organisms and often causes allergic contact dermatitis, and cross-sensitization to other ahminoglycosides can occur. Also poorly absorbed through skin, so systemic toxicity is rare.

A

Gram-Negative

69
Q

This topical antibacterial agent is a peptide antibiotic, and binds to phosphor-lipids to alter permeability and damage bacterial cytoplasmic membrane.

A

Polymixin B

70
Q

Polymixin B is effective against _________ organisms, including P. aeruginosa, E. coli, Enterobacter, and Klebsiella. Rarely causes allergic reaction.

A

Gram-Negative

71
Q

This type of topical anti fungal agent blocks ergosterol synthesis and has a wide range of activity against dermatophytes and yeasts.

A

Topical Imidazoles

72
Q

What are the different topical imidazoles?

A
    • Miconazole
    • Clotrimazole
    • Efinaconazole
    • Ketoconazole
73
Q

This topical imidazole is a topical application as a cream or lotion. They can also be a vaginal cream or suppositories for use in vulvovaginal candidiasis.

A

Miconazole

74
Q

This topical imidazole is a topical application to the skin as a cream or lotion. Vaginal cream and tablets are for use in vulvovaginal candidiasis.

A

Clotrimazole

75
Q

This topical imidazole is an onychomycosis treatment that is given for 48 weeks. There is complete cure in 15-18% of patients.

A

Efinaconazole

76
Q

This topical imidazole is a cream for topical treatment of dermatophytosis and candidiasis. Also available in shampoo or foam for seborrheic dermatitis.

A

Ketoconazole

77
Q

This topical anti fungal agent is a prescription synthetic broad-spectrum topical antimycotic agent. It disrupts macromolecular synthesis and works against dermatophytes like Candida and Malassezia. It has low incidence of adverse reactions and contact dermatitis.

A

Ciclopirox

78
Q

This topical anti fungal agent contains allylamine, which selectively inhibits squalene epoxidase, a key enzyme for the synthesis of ergosterol. It is highly active against dermatophytes but less active against yeasts. The cream can cause local irritation, so avoid contact with mucous membranes.

A

Terbinafine

79
Q

This topical anti fungal agent is a synthetic anti fungal compound. Its mechanism is uncertain but it distorts hyphae/stunts mycelial growth. It is effective topically against various dermatophyte and malassezia infections but NOT candida. Rarely causes irritation or allergic contact dermatitis.

A

Tolnaftate

***Tough Actin Tinactin (for athletes foot)!

80
Q

This type of topical anti fungal agent binds to fungal sterols and alters membrane permeability. It is limited to topical treatment of cutaneous and mucosal candida infections (hold in mouth before swallowing) because of its narrow spectrum and negligible absorption from the GI tract following oral administration. Can cause mild nausea and diarrhea if swallowed.

A

Nystatin

81
Q

This type of topical anti fungal agent binds to fungal sterols and alters membrane permeability. It is limited to topical treatment of cutaneous candida infections. It is well tolerated, but may cause temporary yellow staining of the skin.

A

Amphotericin B

82
Q

This topical antiviral agent is a synthetic guanine analog with inhibitory activity against HSV types 1 and 2. Used for treatment of recurrent orolabial HSV infection (herpes labials) in immunocompetent adults. Ointment, cream, and buccal tablet formulations available.

A

Acyclovir

83
Q

What are some general causes of pruritus?

A

– Localized itchy rashes (ie, jock itch, athletes foot, ringworm, etc.)

– Neuropathic localized pruritus (without rash) due to compression or degeneration of nerves in skin, en route to spine or in the spine itself

– Systemic disorders can cause pruritus (ie, kidney disease, diabetes, leukemia, etc.)

84
Q

What are some non-pharmacologic interventions for pruritus?

A
    • Skin moisturization
    • Cool environment
    • Cooling lotions (ie, calamine)
    • Avoidance of skin irritants (ie, wool clothing)
    • Stress reduction
    • Physical interventions (keep fingernails trimmed, occlude areas)
85
Q

For topical steroids, where should low- and high-potency mediations be used?

A

– Low-potency on face, genitals, and skin folds

– Everywhere else start with high-potency to gain control and titrate down for maintenance

86
Q

This medication is a substance derived from chili peppers that has been used for the treatment of chronic pain and pruritus. It is particularly used in neuropathic itch.

A

Capsaicin

87
Q

The mechanism of action for Capsaicin involves its ability to activate ________, an ion channel in cutaneous nerve fibers. This stimulates neurons to release and eventually deplete certain neuropeptides, including substance P. Also induces lasting desensitization.

A

TRPV1 (heat)

88
Q

Like Capsaicin, cold is sensed and menthol cools (rather than heats) by activating a similar receptor, _______.

A

TRPM8

89
Q

This medication has been known since ancient times for its anti-inflammatory activities. It’s a COX inhibitor and is a natural source of unripe fruits.

A

Salicylic Acid

90
Q

Also found in many skin-care products, Salicylic Acid causes epidermal cells to shed more readily (keratolytic), has antibacterial properties, and opens clogged pores. Applied in more concentrated solutions to calluses. Treated areas are _________ and need protection from sun.

A

Photosensitized

***Prolonged use can cause salicylate toxicity, especially in children and those with reduced kidney or liver function!

91
Q

This medication is NaSSA (alpha2-antagonist) an antidepressant that is useful in nocturnal pruritus. May cause increased weight and appetite.

A

Mirtazapine (7.5 to 15 mg at night)

92
Q

These medications are SSRIs, an antidepressant, that we would consider in psychiatric patients with pruritus and paraneoplastic pruritus.

A

Paroxetine (10-40 mg/day)

Fluvoxamine (25-150 mg/day)

93
Q

This medication is an SSRI, an antidepressant, that is useful in cholestatic pruritus.

A

Sertraline (75-100 mg/day)

94
Q

This medication is an u-opioid receptor antagonist. It is useful in patients with cholestatic and CKD-associated pruritus.

A

Naltrexone (25-50 mg/day)

95
Q

This medication is a K-opioid receptor agonist/u-opioid receptor antagonist. It is useful in nocturnal and intractable pruritus.

A

Butorphanol (1-4 mg intranasally per day)

96
Q

These medications are anticonvulsants that are useful in neuropathic pruritus.

A

Gabapentin (100-3600 mg/day)

Pregabalin (150-300 mg/day)

97
Q

This medication is a substance P antagonist that is more commonly used to control nausea/vomiting of chemo, but has shown benefits in patients with intractable pruritus.

A

Aprepitant (80 mg/day)

98
Q

This medication is an alpha2-adrenergic agonist applied as a topical gel. It vasoconstricts by stimulating post-synaptic vascular alpha2 receptors. Used for rosacea.

A

Brimonidine

99
Q

This medication is a mixed alpha1A/alpha2-adrenergic agonist vasoconstrictor applied as a topical cream, approved in 2017.

A

Oxymetazoline

100
Q

These medications are for eyedrops, which are all adrenergic receptor agonists.

A
    • Naphazoline
    • Tetrahydrozoline
    • Phenylephrine
    • Oxymetazoline
101
Q

This is a topical agent that kills ectoparasites. It is an organophosphate cholinesterase inhibitor.

A

Malathion

102
Q

This is a topical agent that kills ectoparasites. It binds to insect Na+ channels and blocks membrane repolarization.

A

Permethrin

103
Q

This is administered orally and kills ectoparasites. It binds to glutamate-gated Cl- channels in invertebrates, hyperpolarizes the nerve and muscle cells.

A

Ivermectin

104
Q

This is a topical agent that kills ectoparasites. Due to its toxicity, it is used only after other agents fail. It disrupts GABAergic transmission in insects.

A

Lindane

105
Q

What are open and closed comedones?

A 
Open = Black head
Closed = White head
106
Q

Inflammatory acne can often lead to __________ of the skin afterwards.

A

Hyperpigmentation

107
Q

If a patient has mild, comedonal acne, what is the first choice treatment?

A

Topical retinoid

108
Q

If a patient has mild, mixed and papular/pustular acne, what is the first choice treatment?

A

Topical retinoid + Topical antimicrobial

109
Q

If a patient has moderate, mixed and papular/pustular acne, what is the first choice treatment?

A

Oral antibiotic + Topical retinoid +/- BPO

110
Q

If a patient has moderate, nodular acne, what is the first choice treatment?

A

Oral antibiotic + Topical retinoid + BPO

111
Q

If a patient has severe, nodular/conglobate acne, what is the first choice treatment?

A

Oral isotretinoin

112
Q

This is a topical retinoid that can be used once daily, at bedtime. It comes in creams or gels. Adverse effects include local skin irritation, dryness, and flaking. Also sun sensitivity.

A

Tretinoin

113
Q

This is a topical antimicrobial that can be used twice daily. Can cause local skin irritation and may bleach hair or clothing.

A

Benzoyl Peroxide

***Comes in multiple 2.5 to 10% gels, lotions, creams, pads, masks, and cleansers.

114
Q

This is a topical antimicrobial that can be used twice daily, or once daily in foam form. Comes in 1% gel, lotion, pledget, solution, and foam. Rare risk of pseudomembranous colitis.

A

Clindamycin

115
Q

This topical antimicrobial can be used twice daily and is 2% gel, solution, or pledget.

A

Erythromycin

116
Q

This is a dicarboxylic acid that is a white powder found in wheat, rye, and barley where it is involved in the plant defense response to an infection. It kills acne bacteria and decreases the production of keratin.

A

Azaleic Acid

117
Q

What is Azaleic Acid used for?

A

Mild to moderate acne, and also treats post-inflammatory hyperpigmentation

***Use twice daily, 20% cream or 15% gel

118
Q

This is an oral antibiotic that can be taken 500 mg twice daily. Adverse effects include photosensitivity and GI distress. It is contraindicated in pregnancy and young children because it can cause teeth discoloration.

A

Tetracycline

119
Q

Combination oral contraceptives are hormonal agents made of ________ or ________. Taken once daily, and can have adverse effects of nausea, breast tenderness, weight gain, and thromboembolic events.

A

Estrogen

Progestin

120
Q

This is a hormonal agent that is especially useful for adult women with menstrual cycle-related breakouts of acne on their lower face.

A

Spironolactone

***25-200 mg/day in one or two equally divided doses.

121
Q

This is an oral retinoid that is used for the severest forms of acne. It’s given in 0.5 mg/kg/day, increasing to 1 mg/kg/day in one or two equally divided doses. It is absolutely contraindicated in pregnancy because it can cause teratogenicity.

A

Oral isotretinoin

122
Q

What is the result of the retinoid (vitamin-A like compounds) mechanism of action?

A

Events contribute to the:

    • Normalization of follicular keratinization
    • Decreased cohesiveness of keratinocytes
    • Leads to reduced follicular occlusion and microcomedone formation
123
Q

What are some of the home skin care recommendations?

A

– Apply a gentle synthetic detergent cleanser (ie, Cetaphil or Dove sensitive skin bar)

– Gently massage skin with fingertips (don’t aggressively scrub)

– Use water-based lotions, cosmetics, and hair products

124
Q

In psoriasis treatment, what is a major thing we can’t overlook?

A

Psychological effects, it can easily lead to depression!

125
Q

These topical therapies are the initial choice for mild to moderate psoriasis.

A

Emollients

Corticosteroids

126
Q

This topical therapy for psoriasis has an unclear mechanism, but it reduces keratinocyte proliferation.

A

Topical Vitamin D analogs (calcipotriene and calcitriol)

127
Q

This topical therapy for psoriasis is an ancient remedy. The mechanism is unknown but has some anti-proliferative effects. It is stinky!

A

Tar

128
Q

This is a good initial choice for moderate to severe psoriasis.

A

UV light therapies

129
Q

This type of UV light therapy for psoriasis will use radiation to the point of erythema. Done 3x per week +/- topical tar. Thought to work via immunomodulation.

A

UVB radiation (290-320 nm)

130
Q

This type of UV light therapy for psoriasis will use radiation under strict medical supervision, which penetrates deeper into the skin without causing sunburn.

A

PUVA (photochemotherapy UVA radiation)

131
Q

For PUVA, patients typically ingest the plant ________ ________ about 2 hrs before treatment and will do that 3x/week until remission. Must be protected from sun exposure, and have increased risk of melanoma.

A

Photosensitizer psoralen

132
Q

This systemic therapy for psoriasis is a PDE4 inhibitor and results in increased cAMP levels in cells. Short-term diarrhea is a common side effect.

A

Apremilast (Otezla)

133
Q

This is a PDE4 inhibitor that was recently approved as topical therapy for dermatitis.

A

Crisaborole

134
Q

This systemic therapy is a biologic agent that is a human monoclonal Ab. It targets pro-inflammatory cytokines IL-12 and IL-23. This leads to decreased NK cells, CD4+ T cells, etc. Good for plaque psoriasis, psoriatic arthritis, and Crohn disease. Given subQ at 8-12 week intervals. Costs over $13k/dose. Well-tolerated but increases risk for infections.

A

Ustekinumab (Stalera)

135
Q

This systemic therapy are biologic agents that are human monoclonal Abs. They target pro-inflammatory cytokine IL-17A. This results in decreased ability of IL-17A to induce production of many other pro-inflammatory signaling molecules. Good for ankylosing spondylitis, plaque psoriasis, and psoriatic arthritis. Administered SubQ and costs over $3k/150 mg. Well tolerated but increases risk for infections.

A

Secukinumab (Cosentix)

Ixekuzumab

136
Q

These are cutaneous neoplasms that develop on sun-damaged skin, thought to be on a continuum with cutaneous squamous cell carcinoma.

A

Actinic Keratosis

137
Q

What are treatment options for Actinic Keratosis that do NOT include pharmacotherapy?

A
    • Liquid nitrogen cryotherapy (freeze off)
    • Surgical therapy
    • Photodynamic (Red Light) therapy
    • Dermabrasion
    • Chemical peels
138
Q

What are the pharmacotherapy options for treatment of Actinic Keratosis?

A
    • Topical 5-fluorouracil
    • Imiquimod
    • Ingenol mebutate
    • Topical diclofenac
    • Retinoids
139
Q

This is a treatment for Actinic Keratosis. It inhibits thymidylate synthetase, a critical enzyme in the synthesis of DNA. The lack of DNA synthesis in fast-growing dysplastic cells prevents cell proliferation and causes cell death. Effective in >90% who can tolerate it. After 4-6 weeks skin will have progressed from erythema through blistering, necrosis with erosion, and then re-epithelialization.

A

Topical 5-Fluorouracil

140
Q

This is a treatment for Actinic Keratosis. It is a topical immune response modifier that stimulates local cytokine induction. It is an effective therapy.

A

Imiquimod

141
Q

This is a treatment for Actinic Keratosis. It is a substance derived from the sap of Euphoria peplus plant and is an effective treatment. It has two stages:

1) initial disruption of cell plasma membrane and mitochondria leading to cell necrosis (chemoablation)
2) neutrophil-mediated antibody dependent cellular cytotoxicity that eliminates remaining tumor cells.

A

Ingenol mebutate

142
Q

This is a treatment for Actinic Keratosis. It is an NSAID, benefits suggest PG’s may be important for skin carcinogenesis.

A

Topical diclofenac

143
Q

What are treatment options for BCC or SCC?

A
    • Surgical removal/ablation

- - Topical medications (Imiquimod and 5-fluorouracil)

144
Q

These treatments are used for advanced BCC. They are both oral “hedgehog” signaling pathway inhibitors.

A

Vismodegib

Sonidegib

145
Q

What are the possible treatments for melanoma?

A

– Surgical excision (with 1-2 cm margins depending on size, often combined with sentinel node biopsy)

– Conventional chemotherapy

– MAP kinase pathway inhibitors

146
Q

This is a drug used for conventional chemotherapy in melanoma. It is FDA-approved.

A

Dacarbazine

147
Q

Dacarbazine (chemo drug for melanoma) can be used with or without what groups of drugs?

A

– Carmustine and Tamoxifen

OR

– Cisplatin and Vinblastine

148
Q

This drug is used for melanoma treatment, and is a MAP kinase pathway inhibitor. If there is a BRAF V600D gene mutation in this patient (seen in about 60%) then this drug will inhibit and cause apoptosis.

A

Vemurafenib

149
Q

This is a common, progressive form of hair loss occurring over several years. It is distinguished by the reduction of terminal hairs on the scalp in a characteristic distribution (anterior scalp, mid scalp, temporal scalp, and vertex of the scalp).

A

Male Pattern Baldness

150
Q

This treatment for male pattern baldness vasodilates due to K+-channel opening. It promotes hair growth by increasing the duration of anagen (growth phase), shortening telogen (rest phase), and enlarging miniaturized follicles.

A

Minoxidil (Rogaine)

151
Q

This treatment for male pattern baldness is a 5-alpha-reductase inhibitor, which results in the inhibitor of DHT production. It is taken orally, and can cause sexual dysfunction. Use increases hair count.

A

Finasteride

152
Q

Explain what is done with surgery to treat male pattern baldness.

A

Transplantation of hair follicle units (about 4 hairs) from regions resistant to hair loss into regions of hair loss.

153
Q

Female pattern hair loss (androgenetic alopecia in women) will use ________ as its first-line treatment. When this fails, _________ are used as a second-line.

A

Minoxidil (Rogaine)

Anti-androgens

154
Q

This type of anti-androgen for female hair loss is an androgen partial agonist.

A

Spironolactone

155
Q

This type of anti-androgen for female hair loss will block DHT synthesis (like in males).

A

Finasteride

156
Q

This type of anti-androgen for female hair loss is an androgen antagonist.

A

Flutamide

157
Q

This is a chronic, relapsing immune-mediated inflammatory disorder affecting hair follicles resulting in non-scarring hair loss. Disorder ranges from small patches of alopecia on any hair-bearing area to the complete loss of scalp, eyebrow, eyelash, and body hair.

A

Alopecia Areata

***Untreated, about 50% will grow hair back in <1 year, but recurrence is likely!

158
Q

What are the treatments for Alopecia Areata?

A

– Intralesional or topical corticosteroids

– Topical immunotherapy - contact allergen such as DPCP (diphenylcyclopropenone) is used to cause contact dermatitis, which causes hair growth for unknown reason

SBL Exam 2 (7 decks)

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