Dermatologic Pharmacology (Part 2) Flashcards
what can be said about repeated use of antiseptic wash solutions?
repeated use of dilute iodine, chlorhexidine, or hydrogen peroxide is generally not necessary- they have a minimal lasting action against bacteria and they potentially impede wound healing through toxic effects on normal tissue
what are the exceptions to antiseptic and antibiotic use in wound treatment?
cadexomer iodine and silver–> reduces bacterial load
what 3 things are super important to consider in a patient’s wound healing process?
their glycemic control, adequate oxygenation, and nutrition
what are the usually reasons that cause inadequate oxygenation during wound healing?
blood volume deficit, unrelieved pain, and hypothermia lead to sympathetic overactivity which causes local vasoconstriction
why does removing dead tissue and debris promote wound healing?
it decreases protease production which conserves local resources needed for healing
what are the 4 different types of wound debridement?
low-pressure irrigation with normal saline; surgical debridement; enzymatic debridement; biological debridement
which wound debridement is routine?
low-pressure irrigation with normal saline
what is an example of a growth factor used for wound healing?
becaplermin: a platelet-derived growth factor that promotes cell proliferation and angiogenesis; it is the only agent approved for treatment of chronic diabetic foot ulcers
what is the black box warning on becaplermin?
for malignancy: use of more than 3 tubes increases risk of malignant complications x4
what are the general principals associated with wound dressings?
woulds should be kept moist and should not be exposed to air
why should wounds not be exposed to air?
occluded wounds heal 40% faster and have less scarring; wounds are then exposed to their own fluid, a mix of metalloproteases and cytokines
there are different recommendations for wound dressings at different stages of the wound healing process. What are these recommendations?
hydrogels should be used for the debridement stage; foam and low-adherence dressing should be used for the granulation stage; hydrocolloid and low-adherence dressing should be used for the epithelialization stage
topical antibacterial agents are not often needed, but they have been around for a long time. What is in these agents?
bacitracin, neomycin, and polymixin B
what is bacitracin?
it is a peptide antibiotic that is active against gram positive organisms; poorly absorbed through the skin
what is neomycin?
aminoglycoside antibiotic that binds to the 30S ribosomal subunit; active against gram negative organisms; poorly absorbed
what is polymixin B?
peptide antibiotic; active against gram negative organisms
how do topical imidazoles work?
they block ergosterol synthesis–> they have a wide range of activity against dermatophytes and yeasts
what are 4 examples of topical imidazoles?
miconazoles, clotrimazole, efinaconazole, and ketoconazole
what is miconazole?
topical application as a cream/lotion; vaginal cream for use in vulvovaginal candidiasis
what is clotrimazole?
topical application to skin as cream/lotion for athletes foot; vaginal cream for use in vulvovaginal candidiasis
what is efinaconazole?
onychomycosis (fungal infection of the nail) treatment given for 48 weeks
what is ketoconazole?
cream for topical treatment of dermatophytosis and candidiasis, shampoo or foam for seborrheic dermatitis
what are the common adverse local reactions associated with topical imidazoles?
stinging, pruritus, erythema, and local irritation
what is ciclopirox?
a topical antifungal agent; a prescription synthetic broad-spectrum topical antimycotic agent that disrupts macromolecular synthesis
what is ciclopirox active against?
dermatophytes, candida, and malassezia
what is terbinafine?
a topical antifungal agent that selectively inhibits squalene epoxidase
what is terbinafine active against?
dermatophytes but less active against yeasts
what are the adverse reactions associated with terbinafine?
cream can cause local irritation; avoid contact with mucous membranes
what is tolnaftate?
it is a topical synthetic antifungal compound, the mechanism of action is uncertain
what is tolnaftate effective against?
various dermatophytes and Malessezia infections BUT NOT CANDIDA
what is nystatin?
a topical antifungal agent that binds to fungal sterols and alters membrane permeability
what is nystatin used for?
it is limited to topical treatment of cutaneous and mucosal candida infection (hold in mouth before swallowing) because of its narrow spectrum and negligible absorption from the GI tract following oral administration
what is amphotericin B?
topical antifunal agent that binds to fungal sterols and alters membrane permeability
what is amphotericin B used for?
it is limited to topical treatment of cutaneous candida infections
what is amphotericin B considered to be when administered intravenously and why?
considered to be “amphoterrible” because of serious systemic infections due to adverse effects: fevers/chills, cramps, muscle pains, arrhythmia, nausea, and vomiting
what was the one topical antiviral agent we discussed?
acyclovir
what is acyclovir?
a topical antiviral agent- synthetic guanine analog with inhibitory activity against HSV 1 and 2
what is acyclovir used for?
the treatment of recurrent orolabial herpes simplex virus infection in immunocompetent adults
