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SBL 2 > Dermatologic Pharmacology Wolff > Flashcards

Dermatologic Pharmacology Wolff Flashcards

1
Q

Differentiate between creams and ointments?

A

Creams:

  • Half water half oil with emulsifier
  • Water evaporates and it is washed off by water
  • Well absorbed
  • Spread easily
  • Better for oozing skin conditions

Ointments:

  • 20% water 80% oil
  • Feels greasy
  • Not well absorbed, stays on the skin
  • Best used on dry skin as they trap moisture
  • Less likely to cause allergic reaction
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2
Q

What are the benefits of alcohol based disinfection?

A
  • Faster than soap and water
  • More effective against gram + and - bacteria
  • Effective on bacteria
  • NOT EFFECTIVE FOR C. DIFF
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3
Q

What is an emolliant?

A
  • Moisture component that forms an oily laer on top of the skin trapping water inside
    • Miinieral oil
    • Petrolatum
    • Lanolin
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4
Q

What is a humectant?

A
  • draws water into skin
    • glycerin
    • lecithin
    • propylene glycol
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5
Q

What is a horny substance softener?

A
  • Moisture component
  • Loosening of bonds btw stratum corneum
  • Helps skin retain water and gives it smoother feeling
    • Alpha hydroxyacids
    • Salicyclic acid
    • Allatoin
    • Urea
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6
Q

What is the difference between sunscreen and sunshade?

A
  • Sunscreen absorbs light while sunshade reflects light
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7
Q

What is Chlohexidine?

A
  • Broad spectrum antimicrobial agen widely used in homes and hospitals due to safety on skin and mucosal surfaces
    • works on spores, mycobacteria, non spores, yeasts, viruses and protozoa
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8
Q

When is soap and water better than alcohol?

A
  • With flammable compounds
  • Noxious fumes
  • Triclosan should be avoided bc it will create resistant straisns of bacteria
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9
Q

When should abx be used on wounds?

A
  • Only for wounds that look infected clinically
    • no evidence that abx speeds process of non infected wounds
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10
Q

How does glucose management impact wound healing?

A
  • Those who have poor glucose management have worse outcomes with surgical healing and healing in general
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11
Q

What is the only agent approved for treatment of chonic diabetic foot ulcers and what is its risk?

A
  • Becaplerim, a platelet derived growth factor that promotes proliferation and angiogenesis
  • Malignancy warning if you use more than 3 tubes
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12
Q

How does Bacitracin work, what does it work on, and risks?

A
  • Inhibits cell wall synthesis of Gram + organisms
  • Allergic contact dermatitis
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13
Q

How does Neomycin work, what agaisnt, risks?

A
  • Its an aminoglycoside abx that binds to the 30S subunit to inhibit protein synthesis of Gram - organisms
  • Allergic dermatitis
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14
Q

Polymixin B MOA, what does it work on, and risks?

A
  • Peptide abx that binds to phosphorlipids to alter permeability and damage membrane of Gram - organisms such as P. aeruginosa, E. coli, Enterobacter and Klemsiella
  • Rarely causes allergic rxn
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15
Q

What are the topical imidazoles and how do they work?

A
  • block ergosterol synthesis an have a wide range against dermatophytes and yeasts
  • Miconazole, Clotrimazole
  • Efinaconazole
  • Ketoconazole
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16
Q

Miconazole?

A
  • topical application cream used for vulvovaginal candidias
  • Type of topical imidazole that blocks ergostrol synthesis
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17
Q

Clotrimazole

A
  • topical cream for athletes foot or vulvovaginal candidias
  • Type of topical imidazole that blocks ergostrol synthesis
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18
Q

Efinaconazole

A
  • Type of topical imidazole that blocks ergostrol synthesis
  • onychomycosis treatment given 48 weeks complete cure in 15-18%
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19
Q

Ketoconazole

A
  • Type of topical imidazole that blocks ergostrol synthesis
  • cream for dermatophytosis and candidiasis
  • shampoo for seborrheic dermatitis
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20
Q

Ciclopirox?

A
  • Prescription synthetic broad spectrum antifungal that disrupts macromolecular synthesis
  • Active agaisnt dermatophytes candidia and malassezia
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21
Q

Terbinafine

A
  • Selectively inhibits squalene epoxidase
  • highly active against dermatophytes and less against yeasts
  • Cream can cause irritation with mucous membranes and local irritation
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22
Q

Tolnaftate?

A
  • distorts hyphae and stunts mycelial growth
  • Effective topically agaisnt dermatophyte and malessezia but not candidia
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23
Q

Nystatin?

A
  • Alterns membrane permeability by binding to sterols
  • Limited to topical treatement of cutaneous and mucosal candidia
  • Minld nausea/diarrhhea if swallowed
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24
Q

Amphotericin B

A
  • alters membrane permeabiltiy by binding sterols
  • Limited to topical tx of candidia infections
  • Potentially stains skin and bad systemic side effects when given IV
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25
Q

Acyclovir?

A
  • synthetic guanine with inhibitiory activity against HSV 1/2
  • Orolabial HSV
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26
Q

What are non pharmacologic interventions to treat pruritis?

A
  • Skin moisturization
  • Cool environment
  • Avoidance of skin irritants
  • Stress reduction
  • Physical intervention
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27
Q

What is calamine lotion used for and what is it

A
  • Mix of Zn and Fe oxidie that cools
  • Used for pruritis
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28
Q

What are methanol and camphor used for and how do they work?

A
  • Used for pruritis
  • TRPM8 agonist that cools
29
Q

Capsaicin?

A
  • Used for pruritis
  • TRPV1 agonnist thats used for neuropathic itch or pain
30
Q

Hydrocortisone?

A
  • not directly antipruritic but may be useful due to inflammatory skin dermatomes
31
Q

Doxepin?

A
  • Useful for histamine induced itching
32
Q

What are the local anesthethic Na channel blockers?

A
  • Pramoxine and OTC topical for pruritis on face and also that assoc with CKD
  • Lidocaine patch used for neuropathic pruritis
33
Q

What are the topical calcineurin inhibitors and use?

A
  • blocks lymphohcyte expansion
  • Tacrolimus and Pimecrolimus
  • useful in anogenital prurits
34
Q

Salicyclic acid

A
  • cox inhibitor and keratolytic useful in lichen simplex chronicus
  • topical therapy for pruritis
35
Q

What are the agents used for ectoparasitic infections?

A
  • Malathion
  • Permethrin
  • Ivermectin
  • Lindane
36
Q

Malathion?

A
  • Ectoparasitic infection
  • Topical organophosphate cholinesterase inhibitor
37
Q

Permethrin?

A
  • Ectoparasitic infection
  • Topical agent that binds to insect Na channels blocking membrane repolarization
38
Q

Ivermectin?

A
  • Ectoparasitic infection
  • Orally given agent that binds glutamate gated Cl channels in invertebrates that hyperpolarizes the nerve and muscle cells
39
Q

Lidane?

A
  • Topical agent very toxic last ditch effort that disrupts GABAergic transmission in insects
  • Ectoparasitic infection
40
Q

Topical retinoids for acne vulgaris and risks?

A
  • Tretinoin a pill taken once daily at beditime
  • local skin irritation, dryness, flaking and sun sensitivity
41
Q

Topical antimicrobials for acne vulgaris?

A
  • Benzoyl peroxide:
    • BID, local irritation, bleach hair/clothes
  • Clindamycin:
    • QD or BID, rare risk of psuedomembranous colitits
  • Erythromycin:
    • BID
    • NO adverse effects
42
Q

Azaleic acid?

A
  • Used for acne vulgaris
  • BID
  • plant defense response to an infection white powder found in wheat rye and barley, Kills acne bacteria and decreases keratin production
43
Q

Oral abx for acne vulgaris?

A
  • Tetracycline
  • Doxycycline
  • Minocycline
  • Erythromyycin
  • Azighromycin
  • Trimethoprimsulfamethoxazole
44
Q

Tetracycline?

A
  • BID
  • photosensitivity, GI distress, contraindicated in kids and pregnant women
  • oral antibiotics acne vulgaris
45
Q

Doxycycline

A
  • QD or BID
  • photosensitivity GI distress, contraindicated in kids and pregnancy
  • oral antibiotics acne vulgaris
46
Q

Minocycline?

A
  • BID or extended release
  • Adverse effects dizziness drug induced lupus skin discoloration
  • contraindicated in kids and pregnancy
47
Q

Erythromycin

A
  • oral antibiotics acne vulgaris
  • BID
  • GI distress
48
Q

Azithromycin

A
  • oral antibiotics acne vulgaris
  • intermittent dosing dt long half life
  • GI distress
49
Q

Trimethoprimsulfamethoxazole?

A
  • oral antibiotics acne vulgaris
  • QD or BID
  • Stevens Johnson syndrome or toxic epidermal necrolysis
50
Q

Hormonal agents for acne vulgaris

A

Oral contraceptives

Spironalactone

51
Q

Spironalactone?

A
  • useful in women with menstrual cycle releated breakouts
  • Dosing varies
  • Contraindicated for pregnancy, menstrual irregularities, breasat tenderness, GI symptoms, orthostatic hypotension, hyperkalemia, dizziness, HA, fatigue
52
Q

How does the oral retinoid, oral isotretinoin, work and risks?

A
  • For acne
  • normalization of folllicular keratinization decreased cohesiveness of keratinocytes, reducese follicular occluision and micromedone formation
  • Mucocutaneous effects and hypertrigllyceridemia and teratogenicity in pregnancy are risks
53
Q

What are home skin care recommendations for those with acne?

A
  • Apply gentle sysnthetic detergent cleanser with fingers and rinse with warm water BID
  • Gently massage skin not aggressive scrubbing
  • Antimicrobial soaps not proven to help
  • Water based lotions, cosmetics, and hair products
54
Q

What is the initial choice of drugs for milkd to moderate psoriasis?

A

Emolliants and corticosteroids

55
Q

With moderate to severe psoriasis, what two therapies are used?

A
  • UVB:
    • radiation to the point of erythema up to 3x a wekk +/- tar causing apoptosis of T cells, bulbs are expensive though and limited availability
  • PUVA:
    • Uses UVA radiation that peneterates deeper in the skin without causing sunburn
    • Ingest photosensitizer psoralen 2 hrs before tx 3x a week until remission
56
Q

Systemic therapies for psoriasis?

A
  • Apremilast
  • Ustekinumab (stelara)
  • Secukinumab (Cosentyx)
57
Q

Apremilast?

A
  • systemic therapy for psoriasis
  • inhibits phosphodiesterase 4 which increases cAMP in cells decreasing NOS, TNF-a, IL-23, IL-10
  • Suppresses inflammatory cytokines stimulating anti inflammatory
58
Q

Ustekinumab (stelara)?

A
  • Monoclonal ab that targets IL 12 IL 23 (proinflammatory) and decreases NK activation, CD4 t cell differentiation and various other pro inflammatory cycokines
  • Increases risk for infections but usually well tolerated
59
Q

Secukinumab (cosentyx)?

A
  • monoclonal ab that targets IL-17a decreasing production of proinflammatory signaling molecules
  • Used for ankylosing spondylitis, plaque psoriasis, psoriatic arthritis
  • Increases risk for infections
61
Q

Imiquimod?

A
  • Stimulates local cytokine induction causing inflammatory cell infiltration
  • works against actinic keratosis and genital warts
62
Q

Ingenol mebutate?

A
  • Comes from euphorbia peplus plant used against actinic keratosis and warts
  • Stage 1: disruption of cell plasma membrane and mitochondria leading to cell necrosis
  • Stage 2: neutrophil mediated ab dependent cellular cytotoxicity that gets rid of remaining tumor cells
63
Q

Topical 5-Fluorouracil

A
  • Inhibits thymidylate synthatase and enzyme needed for DNA synthesis, this prevents cell proliferation and causes cell death
  • used for actinic keratosis and warts
  • Causes inflammation and destruction of lesions
  • 4-6 weeks skin will go from erythema, through bilstering, necrosis with erosion to re epithelization
64
Q

Tx of BCC/SCC?

A
  • surgical removal/ablation
  • Topical meds such asa imiquimod or 5-flourouracil
  • Advanced BCC uses Vesmodegib or sonidegib
65
Q

Melanoma tx?

A
  • Surgical excision 1-2 cm with sentinal node biopsy
  • Dacarbazine conventional chemo
  • MAP kinase inhibitors
  • If mutation is BRAF V600D use Vemurafenib
66
Q

Male pattern baldness medications and MOA?

A
  • Minoxidil: vasodilates by K channel opening
    • promotes hair growth by increasing duration of anagen phase and shortening of telogen phase and enlarging mini follicles
  • Finasteride: oral inhibitor of DHT production
    • Causes sexual dysfunction and increases hair count
  • Surgery
67
Q

Female hair loss medications?

A
  • minoxidil is the first line treatment
  • If minoxidil fails anti androgens are second line
68
Q

What is alopecia areata?

A
  • chronic relapsing immune ,ediated infalmmatory DO affecting hair follicles resulting in non scarring hair loss
  • Tx intralesional or topicalcorticosteroids or topical immunotherapy such as DPCP which causes contact dermatitis that causes hair growth
69
Q

What drugs can induce skin or eye discoloration?

A
  • Rifampin: tears/urine orange
  • Prostaglandins: iris color
  • Minocycline: sclera blue and dyspigmentation along body length
  • Patchy discoloration:
    • amiodarone
    • daunorubicin
    • gold
    • methotrexate
    • psoralens
    • 5-flourouracil
  • Iron silver or topical hydroquinone or hydroxyurea can cause palms soles mucous membranes or teeth to change color

SBL 2 (9 decks)

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