Dermatology

Question 1

What class is hydrocortisone in and what is it used to treat?

Answer 1

steroid; dermatitis and psoriasis

Question 2

What are the side effects of hydrocortisone applied locally?

Answer 2

Atrophy/thinning of skin (collagen), stretch marks, talangiectasias, acne, cataract or glaucoma if applied near eye
May be permanent

Question 3

What are the systemic side effects of hydrocortisone?

Answer 3

effects hypothalamic-pituitary-adrenal axis causing growth retardation

Question 4

How many classes of hydrocortisone are there and which are the strongest and weakest?

Answer 4

7 classes; 1 strongest, 7 weakest

Question 5

What class is cyclosporine and what is it used to treat?

Answer 5

immunosuppresant; inflammatory conditions like psoriasis

Question 6

What are the side effects of cyclosporine?

Answer 6

Raise blood pressure, damage kidneys if used long-term

Question 7

What class is methotrexate and what is its mechanism of action?

Answer 7

folate analog; inhibits DHFR

Question 8

What is methotrexate used to treat?

Answer 8

Inflammatory conditions like psoriasis, and conditions needing immunosuppression

Question 9

What are the side effects of Methotrexate?

Answer 9

Hepatotoxicity (develops slowly, can give up to 4.5 g over life), pulmonary toxicity, leukopenia, rarely, renal toxicity, nausea and vomitting

Question 10

What types of drugs can cause methotrexate toxicity and by what mechanism?

Answer 10

any drug increasing unbound protein (sulfa, salicylates, TCN, phenytoin)

Question 11

What is the mechanism of the biologics?

Answer 11

Blocks TNF-a

Question 12

What are the biologics used to treat?

Answer 12

Inflammatory conditions, arthritis

Question 13

What are some side effects of the biologics?

Answer 13

may unmask neurologic disease, latent infections (must do PPDs), and malignancies

Question 14

What is the mechanism of action of UV light therapy (UVA, UVB, UVC)?

Answer 14

Immunosuppression of T-cells via type I or type II reactions leading to mono- or bifunctional adducts in DNA

Question 15

What is UV light used to treat?

Answer 15

ONLY Inflammatory conditions: atopic dermatitis, CTCL, lichen planus, psoriasis

Question 16

What are some side effects of UV light therapy?

Answer 16

skin cancer, thinning/leathering of skin

Question 17

What other drug is UV light therapy usually used with?

Answer 17

Usually used with psoralens (photosensitizing agents that increase efficacy); phenothiazines, thiazides, sulfonamides, NSAIDs, tetracycline, benzodiazapenes also sensitize skin to light therapy

Question 18

What is the mechanism of action of isoretinoin and acitretin?

Answer 18

Stimulate epithelial cell turnove and anti-inflammatory

Question 19

What is Isoretinoin used to treat?

Answer 19

Acne (this is accutane)

Question 20

What are some side effects of isoretinoin?

Answer 20

teratogenic effects (wash out in 3 weeks)

Question 21

Name to retinoid drugs.

Answer 21

Isoretinoin (accutane) and Acitretin (soriatane)

Question 22

What is Acitretin used to treat?

Answer 22

Psoriasis

Question 23

What are some side effects of Acitretin and how is it different from Isoretinoin?

Answer 23

teratogenic effects (stays in fat stores for up to 3 years, isoretinoin washes out in 3 weeks)

Question 24

Are the retinoids commonly used as primary treatment or as adjunctive therapy?

Answer 24

adjunctive therapy

Question 25

Passage through what layer of the skin is the rate limiting step?

Answer 25

stratum corneum

Question 26

By what mechanism are topicals absorbed?

Answer 26

passive diffusion

Question 27

Rank the following from strongest hydrating to strongest drying: gel, cream, ointments and lotions

Answer 27

ointments, creams, lotions, gels