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Skin Lymph Blood Exam 2 > Dermatologic Pharmocology - Dr. Wolff > Flashcards

Dermatologic Pharmocology - Dr. Wolff Flashcards

1
Q

Safest antiseptic to use

A

Chlorhexidine

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2
Q

Steps that a drug gets absorbed

A
  1. Skin surface
  2. Stratum corneum
  3. Stratum Spinosum + BM zone (binds to receptor here)
  4. Subcutaneous fat : absorbed into BS
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3
Q

Creams are what

A
  1. 50:50 water : oil
  2. Emulsifier
  3. Easy spread + good absorption (large areas)
  4. off with water
  5. Good for oozing wet skin
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4
Q

Ointments are what

A
  1. 20:80 water : oil
  2. Mineral oil + petroleum jelly oil
  3. Greasy + occlusive (stay on surface and not absorbed well)
  4. Use for dry skin (trap moisture)
  5. Provides more complete absorption of an active medication
  6. NOT Likely to have allergic reactions
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5
Q

Alcohol disinfection does not kill what

A

C. Difficile (only able to come off with soaps and water)

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6
Q

Moisturizers include what things

A
  1. Emollients : oily layer to trap water
  2. Humectants : draws water out to outer layer of skin
  3. Horny substance softeners : loosen stratum corneum for any calluses that can slough off
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7
Q

Emollients ex

A

Petrolatum, lanolin, mineral oil, silicone oil

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8
Q

Humectants ex

A

Glycerin , lecithin, propylene glycol

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9
Q

Horny substance softeners ex

A

A-hydroxyacids (Citric acid, lactic acid) urea, salicylic acid

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10
Q

Moisturizer for normal skin

A 
Water based that has light + nongreasy feel 
Lightweight oils (Cetyl alcohol, silicone ingredients = cyclomethicone)
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11
Q

Moisturizer for dry skin

A

Oil based + antioxidants (grape seed oil/ dimethicone) = skin hydration
Petrolatum (very dry skin, prevent water from evaporating)

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12
Q

Moisturizer for oily skin

A

Water based labeled noncomedogenic (provide moisture while preventing acne breakouts)

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13
Q

Moisturizer for sensitive skin

A 
Soothing ingredients (chemomile aloe) + NO allergens (fragrance/ dyes)
NO acids (skin irritation)
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14
Q

Moisturizer for mature skin

A

Oil based, + petrolatum (hydration)+ antioxidants / a-hydroxyacids (combat wrinkles)

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15
Q

The 2 radiation lengths sunscreen can cover

A

UVA (280- 320 nm)+ UVB (320-400nm)

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16
Q

UVA does what

A

Erythema + sunburn, skin aging + photocarcinogenesis

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17
Q

UVB does what

A

Skin aging + cancer

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18
Q

3 active ingredients in sunscreen and what they absorb

A
  1. PABA = UVB, can cause hypersensitivity
  2. Benzophenones : 250-360nm (oxybenzone, ontocrylene + stabilizers like homosalate / octisalate)
  3. Dibenzoylmethanes : UVA(320-400nm), good for drug induced hypersensitivity and lupus, = avobenzone
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19
Q

Sunglasses have what

A

Titanium dioxide to reflect light

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20
Q

Biofilms

A

Protective layer around a climb of cells and bacteria and other microorganisms that is hard to break though, this can cause AB resistance + slow growth

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21
Q

Primary process of healing

A
  1. Neutrophils come to clean
  2. Degranulation from M, forming epithelium
  3. Extra collagen reclines in the direction of stress
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22
Q

If you have around how should you clean it

A

Antiseptic and ABs are not recommended since they are toxic to the tissues that are needed for wound healing
- only use ABs if the wound is clinically infected

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23
Q

Cadexomer iodine and silver

A

Can be used as ABs to clean wounds however and is not detrimental to the tissue around it

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24
Q

What is the main thing that can cause a wound to get not healed right

A

Hyperglycemia, can cause life threatening infections and life threatening not healing after surgery

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25
Q

What are some other factors involved in the healing process of a wound that are important

A
  • O2 and nutrition
    = when you have low Blood Volume or hypothermia, unrelieved pain ——> sympathetic overactivity = vasoconstriction = lower O2 and Nutrients
  • important to consider this for patients who have chronic diseases or GI issues
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26
Q

Removing dead tissue and wound healing

And what can be used EX

A

Promoted healing due to lower protease activity = conserving energy for healing
(Low-pressure irrigation with normal saline = flush bacteria and loosens material around

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27
Q

Surgical debridement

A

Removes large areas of necrotic or infected tissue

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28
Q

Enzymatic debridement

A

Can promote endothelial cell and keratinocytes migration and angiogenesis and epithelialization (mixed results)

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29
Q

Biological debridement

A
  • perception
    However liquefies necrotic tissues and leaves healthy tissues intact
  • however makes no difference in healing time
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30
Q

Growth factors for wound healing 2 of them

A
  1. Becaplermin : plt-derived GF promoting proliferation and angiogenesis = chronic diabetic foot ulcers , has black box warning (3 tubes = 4x higher risk of malignancy)
  2. Epidermal growth factor : not work
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31
Q

How should an ideal wound healing environment be like

A

Moist and not exposed to air,

Occlusion (like by ointment) helps heal 40% faster and less scarring

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32
Q

What exact thing to use at different stages of healing of a wound

A
  1. Debridement : hydrogens
  2. Granulation : foam + low-adherence dressing
  3. Epithelialization : hydrocolloid and low - adherence dressing
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33
Q

Neosporin is it needed and what is the 3 ABs in it

A

No

  1. Bacitracin : gram + (dermatitis)
  2. Neomycin : gram - (dermatitis)
  3. polymixin B : gram - (allergy)
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34
Q

Antifungal infectons are working how

A

Imidazoles, block ergosterol synthesis (dermophytes and yeasts)

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35
Q 
Anti-fungal EXs and for what
Miconazole
Clotrimazole
Efinaconazole
Ketoconazole
A
  1. Miconazole : cream for vulvovaginal candidiasis
  2. Clotrimazole : cream for athletes foot, tablets for vulvovaginal candidiasis
  3. Efinaconazole : onychomycosis (nail fungus), low cure
  4. Ketoconazole : cream for dermaphytosis, volvovaginal candidiasis, seborrheic dermatitis
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36
Q

How often to use antifungals

A

1-2 times a day 2-3 weeks

= stinging, pruritus, redness, irritation

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37
Q

Anti-fungal EXs and for what
Ciclopirox
Terbinafine
Tolnaftate

A
  1. Ciclopirox : disrupting macromolecules synthesis, dermatophytes, candida, malassezia
  2. Terbinafine : inhibit epoxidase = no ergosterol , dermophytes
  3. Tolnaftate : dermatophytes, malessezia
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38
Q

Anti-viral EXs and for what

Acyclovir

A 
Herpes 1 and 2 
For orolabial (face herpes)virus infections
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39
Q

Anti-fungal EXs and for what
Nystatin
Amphotericin B

A
  1. Nystatin : alters membrane permeability, candida (for oral infection usually)
  2. Amphotericin B : alters membrane permeability, candida especially amphoterrible in IV form systemic infections = fever, chills, cramps, arrhythmia, V/N, can also cause skin discoloration
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40
Q

Generalized pruritis

A

Usually ringworm, tinea mannum (palms), Nail infection

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41
Q

Scalp pruritis

A

Seborrheic dermatitis

Head lice

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42
Q

Back pruritus

A

Grover disease (transient acantholytic dermatitis)

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43
Q

Hand pruritus

A

Pompholyx (eczema)

Hand dermatitis

44
Q

Genital groin pruritus

A

Vulvovaginal candida
Pubic lice
Lichen sclerosis
Jock itch (Tinea cruris)

45
Q

Legs pruritus

A

Gravitational eczema

46
Q

feet itchy pruritus

A

Athletes foot

47
Q

Face Neuropathic localized pruritus

A

Trigeminal trophic syndrome

48
Q

Arm Neuropathic localized pruritus

A

Brachioradial pruritus

49
Q

Back Neuropathic localized pruritus

A

Brachioradial pruritus

50
Q

Vulva Neuropathic localized pruritus

Anal Neuropathic localized pruritus

A

Pruritus vulvae

Pruritus ani

51
Q

Any dermatome Neuropathic localized pruritus

A

Herpes Zosters shingles

52
Q

How to treat pruritus (itch) without medication

A 
Cool moist environment is good 
Light weight clothing 
Lukewarm showers
Cooling lotions (calamine, methanol)
X wool clothing 
Lower stress
Don’t itch
53
Q

Topical therapies for pruritus

Calamine lotion

A

Calamine lotion = cools

54
Q

Topical therapies for pruritus

Menthol + Camphor

55
Q

Topical therapies for pruritus

Capsaicin

A

Transient burning to tx neuropathic itch

56
Q

Topical therapies for pruritus

Topical corticosteroids

A

Anti-inflammatory

57
Q

Topical therapies for pruritus

Anti-histamines

A 
Bug bites  (avoid in children) 
Blocks H1 receptor
58
Q

Topical therapies for pruritus

Local anesthetic

A

Pruritus on face or CKD associated

59
Q

Salicylic acid Topical therapies for pruritus

A

COX inhibitor de lichen simplex

60
Q

Capsaicin works how

A

Activated heat receptor TRPV-1

61
Q

menthol + camphor works how

A

Cold activation of TRPM-8 receptor

62
Q

What potency should you give for steroids against pruritus

A

Highest potency and then lower to maintain

EXCEPT for face genitals, skin folds = low potency

63
Q

Salicylic acid works how and for what

A

COX inhibitor (unripe fruits have this)
Treats acne, dandruff, calluses, warts, lichen simplex chronicus
EX : Compound W
(Toxic to kidney and liver problem patients)

64
Q

Rosacea treats what and 2 types of it

A

Get rid of red

  1. brimonidine : a2 -adrenergic agonist = vasoconstriction (stimulate A2 receptors)
  2. Oxymetazoline : A1 +A2 -adrenergic aginaist = vasoconstriction
65
Q

Eye removal of redness done how

A

Naphazoline, tetrahydrozoline, phenylephrine, oxymetazoline (vasoconstriction)

66
Q

Killing ectoparasites 4 medications

A
  1. Malathion : topical agent (cholinestease inhibitor)
  2. Permethrin : topical agent, block Na+ channels blocks repolarization of insects
  3. Ivermectin : activates Cl- channels = hyperpolarizes nerves and muscles of invertebrates
  4. Iindane : blocks GABA transmission in insects ,toxic so only if others dont work
67
Q

Acne vulgaris is what

A

Buildup, Infection and eventually rupture or a pore in the skin

68
Q

Acne causes a lot of inflammation and after it heals it can cause what

A

Post-inflammatory hyperpigmentation

69
Q

1st choice to for comedonal (not much at all) acne

A

Topical retinoid

70
Q

1st choice tx for mild mixed papular pustular

A

Topical retinoid + topical antimicrobial

71
Q

1st choice for moderate mixed papular pustular

A

Oral ABs
Topical Retinoid
(If needed BPO)

72
Q

1st choice tx Moderate nodular acne

A

Oral ABs
TR
BPO

73
Q

1st choice severe nodular and conglobate acne

A

Oral isobetinoin (NOT if pregnant, or

74
Q

Topical Retinoids

A

Tretinoin, 1 time a day
Can cause dryness, sensitivity of skin
(Adapalene, Tazarotene)
= people with fish allergies can cause sensitivity and allergic reactions (atralin)

75
Q

3 most common topical ABs

A
  1. Benzoyl peroxide
  2. Clindamycin
  3. Erythromycin
76
Q

Azelaic acid

A

From wheat, rye, barley, plant defense response to an infection
= kills acne bacteria + decreases keratin production
= for post-inflammatory hyperpigmentation + moderate acne

77
Q

Tetracycline

A

Oral ABs for acne (500mg 2 times per day)

Photosensitive, GI issues

78
Q

Doxycycline

A

Oral ABs for acne
50mg-100mg 2 times a day
Photosensitive and GI issues

79
Q

Minocycline

A

Oral ABs for acne

Dizziness and lupus, skin discoloration

80
Q

Erythromycin

A

500mg 2 times a day

Oral ABs for acne (GI issues)

81
Q

Azithromycin

A

Intermittent and personalized dosing

Oral ABs for acne (GI issues)

82
Q

Trimethoprimsulfamethoxazole

A

Oral ABs for acne

Steven-Johnson’s syndrome, toxic epidermal necrolysis can happen

83
Q

Oral contraceptives and acne

A

Lowers hormones E and P

84
Q

Spironolactone

A

Hormonal agent for acne
Esp women with period induced acne
Can be combined with oral contraceptives
(NOT is pregnancy, hypotension, hyperkalemia, dizziness)

85
Q

Oral Isotretinoin

A

Oral retinoid
0.5mg a day

NOT in pregnancy = teratogenic,
hyper-TAGs

86
Q

Retinoid MOA

A

Bind to RXR inside the nucleus of cells that dimerize as a result
Then these bind to RARE to transcribe
1. Normalize follicular keritinization
2. Lower cohesiveness of keratinocytes
3. Lowers follicular occlusion + microcomedone formation

87
Q

Home Skin care recommendations

A

Cleanser (synthetic detergent) rinse with hot water
(Soap has higher pH, so prefer to use detergents like dove for sensitive skin to minimize skin irritation, dryness, peeling)
- gentle massage
- use water based lotions and cosmetics and hair product

88
Q

The secret ingredient in most solutions for skin care

A

Benzoyl peroxidase

Hyaluronic acid, Salicylic acid, Glycic acid

89
Q

Psoriasis mild topical therapy

A

Emollients

Corticosteroids q

90
Q

How to reduce keratinocytes proliferation from psoriasis

A

Vit D analogue topical (calcipotriene, calcitriol)

91
Q

Ancient anti-proliferation for keratinocytes

92
Q

Anti-inflammatory for psoriasis

A 
Calcineurin inhibitors (tacrolimus, pimecrolimus)
Anthralin
93
Q

TX for moderate to severe psoriasis

A

UV Light therapy
1. UVB (290-320nm) right at site and 3X a week + topical tar
Esp 311nm which causes optimal apoptosis of t-cells
- expensive
-sunburn
2. PUVA : UVA penetrates deeper, more caution, can cause melanoma
- no sunburn
- photosensitizer psoralen 2hrs before
- 3X week

94
Q

Apremilast

A

MOA : inhibits Phosphodiesterase 4 (PDE4) = high cAMP
Cause : low NO, TNF-a, IL-23, HIGH IL-10 (anti-inflammatory)
When : moderate to severe psoriasis, psoriasis arthritis, (55% get 75% reduction)
How : orally
Side Effects: D, N, V, H, Weight loss, suicide

95
Q

Ustekinumab

A

MOA : Ab against pro inflammatory IL-12, IL-23
Effects: X IL12/IL23 = low NKcells, CD4, MCP,TNF-a, CXCL-10, IL-8
What: Psoriasis arthritis, plaque psoriasis, Crohn’s disease
How : 8-12 weeks subQ, expensive
Side Effects : incense risk infection

96
Q

Secukinumab

A

MOA : Ab against IL-17A
Effects : X IL-17 = lowers all pro inflammatory cytokines
What : ankylosing Spondylosis, psoriasis, psoriasis arthritis
How : subQ, 150mg first 4 weeks (1 time per week, then ever 4 weeks after)
Side Effects: infection risk

97
Q

Ixekuzumab

A

Similar to secukinumab

IL-17

98
Q

Actinic Keratosis TXs

A

Liquid Nitrogen
Surgery
Drugs
Red light

99
Q

Actinic Keratosis drugs

A
  1. Topical 5-fluorouracil
  2. Imiquimod : inflammatory cell infiltration, stimulates cytokines, also works for warts
  3. Ingenol mebutate : disrupts cell membrane = necrosis (chemoablation*), N mediated AB dependent cellular cytotoxicity
  4. Topical diclofenac : NSAID, for skin carcinogen
  5. Retinoids
100
Q

Topical 5-fluorouracil

A 
MOA : inhibits thymidylate synthase *makes DNA
= X DNA in fast growing cells + prevents proliferation 
TX over 90% of AKs
4-6 weeks, 
1. Redness
2. Blistering
3. Necrosis
4. Erosion
5. Repithelialization
101
Q

TX squamous cell carcinoma

A

Surgery
Imiquimod / 5-fluorouracil
Vismodegib / sonidegib : oral SHH inhibitors

102
Q

Tx melanoma

A

Surgery with 1-2cm margins
Chemotherapy : dacarbazine
MAP kinase inhibitor : vemurafenib = if BARF V600D mutation

103
Q

TX male alopecia

A

Surgery : transplant hair follicle form an area that grows hair
Minoxidil : opens K+ channel to vasodilation (enlarge follicle and elongate growth phase)
Finasteride : ——I DHT, can casue sexual dysfunction

104
Q

Female Alopecia TX

A
  1. Minoxidil : opens K+ channels and cause vasodilation (increase follicle size and enlarge growth time)
  2. Anti-androgens : if minoxidil doesn’t work, ——I androgens + DHT (spironlactone, finasteride, flutamide)
105
Q

TX of chronic immune related inflammatory alopecia

A

Alopecia areata

  1. 50% regrow withou tx
  2. Corticosteroids
  3. Topical immunotherapy : give them DPCP a contact allergen causing dermatitis = hair growth for unknown reason

Skin Lymph Blood Exam 2 (9 decks)

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