Dermatologic Pharmocology - Dr. Wolff Flashcards
(105 cards)
1
Q
Safest antiseptic to use
A
Chlorhexidine
2
Q
Steps that a drug gets absorbed
A
- Skin surface
- Stratum corneum
- Stratum Spinosum + BM zone (binds to receptor here)
- Subcutaneous fat : absorbed into BS
3
Q
Creams are what
A
- 50:50 water : oil
- Emulsifier
- Easy spread + good absorption (large areas)
- off with water
- Good for oozing wet skin
4
Q
Ointments are what
A
- 20:80 water : oil
- Mineral oil + petroleum jelly oil
- Greasy + occlusive (stay on surface and not absorbed well)
- Use for dry skin (trap moisture)
- Provides more complete absorption of an active medication
- NOT Likely to have allergic reactions
5
Q
Alcohol disinfection does not kill what
A
C. Difficile (only able to come off with soaps and water)
6
Q
Moisturizers include what things
A
- Emollients : oily layer to trap water
- Humectants : draws water out to outer layer of skin
- Horny substance softeners : loosen stratum corneum for any calluses that can slough off
7
Q
Emollients ex
A
Petrolatum, lanolin, mineral oil, silicone oil
8
Q
Humectants ex
A
Glycerin , lecithin, propylene glycol
9
Q
Horny substance softeners ex
A
A-hydroxyacids (Citric acid, lactic acid) urea, salicylic acid
10
Q
Moisturizer for normal skin
A
Water based that has light + nongreasy feel Lightweight oils (Cetyl alcohol, silicone ingredients = cyclomethicone)
11
Q
Moisturizer for dry skin
A
Oil based + antioxidants (grape seed oil/ dimethicone) = skin hydration
Petrolatum (very dry skin, prevent water from evaporating)
12
Q
Moisturizer for oily skin
A
Water based labeled noncomedogenic (provide moisture while preventing acne breakouts)
13
Q
Moisturizer for sensitive skin
A
Soothing ingredients (chemomile aloe) + NO allergens (fragrance/ dyes) NO acids (skin irritation)
14
Q
Moisturizer for mature skin
A
Oil based, + petrolatum (hydration)+ antioxidants / a-hydroxyacids (combat wrinkles)
15
Q
The 2 radiation lengths sunscreen can cover
A
UVA (280- 320 nm)+ UVB (320-400nm)
16
Q
UVA does what
A
Erythema + sunburn, skin aging + photocarcinogenesis
17
Q
UVB does what
A
Skin aging + cancer
18
Q
3 active ingredients in sunscreen and what they absorb
A
- PABA = UVB, can cause hypersensitivity
- Benzophenones : 250-360nm (oxybenzone, ontocrylene + stabilizers like homosalate / octisalate)
- Dibenzoylmethanes : UVA(320-400nm), good for drug induced hypersensitivity and lupus, = avobenzone
19
Q
Sunglasses have what
A
Titanium dioxide to reflect light
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
21
Q
Primary process of healing
A
- Neutrophils come to clean
- Degranulation from M, forming epithelium
- Extra collagen reclines in the direction of stress
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
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
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
25
What are some other factors involved in the healing process of a wound that are important
- 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
26
Removing dead tissue and wound healing
| And what can be used EX
Promoted healing due to lower protease activity = conserving energy for healing
(Low-pressure irrigation with normal saline = flush bacteria and loosens material around
27
Surgical debridement
Removes large areas of necrotic or infected tissue
28
Enzymatic debridement
Can promote endothelial cell and keratinocytes migration and angiogenesis and epithelialization (mixed results)
29
Biological debridement
- perception
However liquefies necrotic tissues and leaves healthy tissues intact
- however makes no difference in healing time
30
Growth factors for wound healing 2 of them
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
31
How should an ideal wound healing environment be like
Moist and not exposed to air,
| Occlusion (like by ointment) helps heal 40% faster and less scarring
32
What exact thing to use at different stages of healing of a wound
1. Debridement : hydrogens
2. Granulation : foam + low-adherence dressing
3. Epithelialization : hydrocolloid and low - adherence dressing
33
Neosporin is it needed and what is the 3 ABs in it
No
1. Bacitracin : gram + (dermatitis)
2. Neomycin : gram - (dermatitis)
3. polymixin B : gram - (allergy)
34
Antifungal infectons are working how
Imidazoles, block ergosterol synthesis (dermophytes and yeasts)
35
```
Anti-fungal EXs and for what
Miconazole
Clotrimazole
Efinaconazole
Ketoconazole
```
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
36
How often to use antifungals
1-2 times a day 2-3 weeks
| = stinging, pruritus, redness, irritation
37
Anti-fungal EXs and for what
Ciclopirox
Terbinafine
Tolnaftate
1. Ciclopirox : disrupting macromolecules synthesis, dermatophytes, candida, malassezia
2. Terbinafine : inhibit epoxidase = no ergosterol , dermophytes
3. Tolnaftate : dermatophytes, malessezia
38
Anti-viral EXs and for what
| Acyclovir
```
Herpes 1 and 2
For orolabial (face herpes)virus infections
```
39
Anti-fungal EXs and for what
Nystatin
Amphotericin B
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
40
Generalized pruritis
Usually ringworm, tinea mannum (palms), Nail infection
41
Scalp pruritis
Seborrheic dermatitis
| Head lice
42
Back pruritus
Grover disease (transient acantholytic dermatitis)
43
Hand pruritus
Pompholyx (eczema)
| Hand dermatitis
44
Genital groin pruritus
Vulvovaginal candida
Pubic lice
Lichen sclerosis
Jock itch (Tinea cruris)
45
Legs pruritus
Gravitational eczema
46
feet itchy pruritus
Athletes foot
47
Face Neuropathic localized pruritus
Trigeminal trophic syndrome
48
Arm Neuropathic localized pruritus
Brachioradial pruritus
49
Back Neuropathic localized pruritus
Brachioradial pruritus
50
Vulva Neuropathic localized pruritus
| Anal Neuropathic localized pruritus
Pruritus vulvae
| Pruritus ani
51
Any dermatome Neuropathic localized pruritus
Herpes Zosters shingles
52
How to treat pruritus (itch) without medication
```
Cool moist environment is good
Light weight clothing
Lukewarm showers
Cooling lotions (calamine, methanol)
X wool clothing
Lower stress
Don’t itch
```
53
Topical therapies for pruritus
| Calamine lotion
Calamine lotion = cools
54
Topical therapies for pruritus
| Menthol + Camphor
Cooling
55
Topical therapies for pruritus
| Capsaicin
Transient burning to tx neuropathic itch
56
Topical therapies for pruritus
| Topical corticosteroids
Anti-inflammatory
57
Topical therapies for pruritus
| Anti-histamines
```
Bug bites (avoid in children)
Blocks H1 receptor
```
58
Topical therapies for pruritus
| Local anesthetic
Pruritus on face or CKD associated
59
Salicylic acid Topical therapies for pruritus
COX inhibitor de lichen simplex
60
Capsaicin works how
Activated heat receptor TRPV-1
61
menthol + camphor works how
Cold activation of TRPM-8 receptor
62
What potency should you give for steroids against pruritus
Highest potency and then lower to maintain
| EXCEPT for face genitals, skin folds = low potency
63
Salicylic acid works how and for what
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
Rosacea treats what and 2 types of it
Get rid of red
1. brimonidine : a2 -adrenergic agonist = vasoconstriction (stimulate A2 receptors)
2. Oxymetazoline : A1 +A2 -adrenergic aginaist = vasoconstriction
65
Eye removal of redness done how
Naphazoline, tetrahydrozoline, phenylephrine, oxymetazoline (vasoconstriction)
66
Killing ectoparasites 4 medications
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
Acne vulgaris is what
Buildup, Infection and eventually rupture or a pore in the skin
68
Acne causes a lot of inflammation and after it heals it can cause what
Post-inflammatory hyperpigmentation
69
1st choice to for comedonal (not much at all) acne
Topical retinoid
70
1st choice tx for mild mixed papular pustular
Topical retinoid + topical antimicrobial
71
1st choice for moderate mixed papular pustular
Oral ABs
Topical Retinoid
(If needed BPO)
72
1st choice tx Moderate nodular acne
Oral ABs
TR
BPO
73
1st choice severe nodular and conglobate acne
Oral isobetinoin (NOT if pregnant, or
74
Topical Retinoids
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
3 most common topical ABs
1. Benzoyl peroxide
2. Clindamycin
3. Erythromycin
76
Azelaic acid
From wheat, rye, barley, plant defense response to an infection
= kills acne bacteria + decreases keratin production
= for post-inflammatory hyperpigmentation + moderate acne
77
Tetracycline
Oral ABs for acne (500mg 2 times per day)
| Photosensitive, GI issues
78
Doxycycline
Oral ABs for acne
50mg-100mg 2 times a day
Photosensitive and GI issues
79
Minocycline
Oral ABs for acne
| Dizziness and lupus, skin discoloration
80
Erythromycin
500mg 2 times a day
| Oral ABs for acne (GI issues)
81
Azithromycin
Intermittent and personalized dosing
Oral ABs for acne (GI issues)
82
Trimethoprimsulfamethoxazole
Oral ABs for acne
| Steven-Johnson’s syndrome, toxic epidermal necrolysis can happen
83
Oral contraceptives and acne
Lowers hormones E and P
84
Spironolactone
Hormonal agent for acne
Esp women with period induced acne
Can be combined with oral contraceptives
(NOT is pregnancy, hypotension, hyperkalemia, dizziness)
85
Oral Isotretinoin
Oral retinoid
0.5mg a day
NOT in pregnancy = teratogenic,
hyper-TAGs
86
Retinoid MOA
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
Home Skin care recommendations
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
The secret ingredient in most solutions for skin care
Benzoyl peroxidase
| Hyaluronic acid, Salicylic acid, Glycic acid
89
Psoriasis mild topical therapy
Emollients
| Corticosteroids q
90
How to reduce keratinocytes proliferation from psoriasis
Vit D analogue topical (calcipotriene, calcitriol)
91
Ancient anti-proliferation for keratinocytes
Tar
92
Anti-inflammatory for psoriasis
```
Calcineurin inhibitors (tacrolimus, pimecrolimus)
Anthralin
```
93
TX for moderate to severe psoriasis
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
Apremilast
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
Ustekinumab
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
Secukinumab
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
Ixekuzumab
Similar to secukinumab
| IL-17
98
Actinic Keratosis TXs
Liquid Nitrogen
Surgery
Drugs
Red light
99
Actinic Keratosis drugs
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
Topical 5-fluorouracil
```
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
TX squamous cell carcinoma
Surgery
Imiquimod / 5-fluorouracil
Vismodegib / sonidegib : oral SHH inhibitors
102
Tx melanoma
Surgery with 1-2cm margins
Chemotherapy : dacarbazine
MAP kinase inhibitor : vemurafenib = if BARF V600D mutation
103
TX male alopecia
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
Female Alopecia TX
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
TX of chronic immune related inflammatory alopecia
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
