Dermatology Flashcards
Describe the mechanism of action of retinoids.
-Vitamin A analogs that modulate cellular differentiation, keratinization & inflammatory processes -d/t mechanism, acne tends to worsen before improvement is seen (6-8 weeks for benefit) (PPT)
True or False. Topical retinoid is safe to use during pregnancy.
FALSE! Avoid in pregnancy d/t potential teratogenic effects
What is the PRIMARY purpose of the iPLEDGE program?
“to manage the risk of isotretinoin’s teratogenicity & to minimize fetal exposure” (iPLEDGE)
How many forms of birth control must be documented for a female patient taking isotretinoin?
2, 1 primary & 1 secondary form (iPLEDGE); -Primary ex’s (most to least effective): hormonal implant, hormonal IUD, non-hormonal IUD, tubal sterilization, male vasectomy -Secondary ex’s: male latex condoms, cervical cap/diaphragm
What test must be completed every month before a patient on isotretinoin can receive a medication refill?
Pregnancy test (iPLEDGE)
What is the name of the bacteria associated with acne?
Propionibacterium acnes (PPT notes)
List 3 topical antibiotics used in the treatment of acne.
Benzoyl peroxide, erythromycin, clindamycin, dapsone (PPT)
What route of administration (e.g. topical or oral) is preferred in the treatment of HSV?
-Nucleoside analogues are recommended for the tx of infx by the HSV commonly seen in primary care (genital herpes, herpes zoster [shingles], varicella [chickenpox], children’s gingivostomatitis); do not cure herpes infx but may shorten duration, decrease severity & reduce the incidence of sequalae cx’d by the infx (783) -PO forms of acyclovir, valacyclovir & famciclovir are all indicated for primary genital herpes -Although topical acyclovir is approved for tx of initial herpes genital infx, it’s less effective than the PO nucleoside analogues & isn’t recommended
How soon after symptom onset should antivirals be initiated to improve efficacy?
Valacyclovir works best if used w/in 48 hrs after the 1st sx or genital herpes (e.g., pain, burning or blisters) begin to appear. For recurrent outbreaks of genital herpes, valacyclovir works best if used w/in 24 hrs after sx begint to appear (MayoClinic)
Which topical antifungal available over-the-counter is considered the most efficacious?
Describe two scenarios when topical antifungals would be inappropriate.
PO agents preferred when disease is extensive, includes hair or nails, or is not responsive to topical agents (PPT)
In terms of safety, what is the primary limitation to using oral antifungals?
Although mainly inhibiting fungal CYP 450, antifungals also inhibit some CYP 450 -> potential DIs & ADRs (793)
Describe the mechanism of action of permethrin.
Paralyzes CNS of parasite, resulting in death (PPT)
What is the difference between permethrin used for lice versus scabies?
Permethrin for lice: -
OTC Nix 1% cream - apply to wet hair/scalp after shampoo (no conditioner) -Reapply 1 week later whether or not new nits or lice are present
Permethrin for scabies: -5% cream - apply entire tube from below neck to bottom of feet & leave on for 8-14 hrs before washing (PPT)
You need to prescribe permethrin for a 2 year-old with lice. Write out the prescription and describe how you would instruct the patient to use the medication.
1% OTC cream (Nix) or prescription-strength 5% cream; A cream rinse that is applied after shampooing, no conditioner (makes permethrin less effective), leave in hair for 10 min before rinsing off, repeat in 1 week regardless of signs of infestation are present (1011)
