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dermatology Flashcards

1
Q

dermatology

A

-rule of thumb for derm conditions:
-if its wet or oozing -> make it dry
-if its dry -> make it wet or moist

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2
Q

diaper rash

A

What causes diaper rash?
-Diapers act like occlusive dressings
-Primary reason for diaper rash is urine and feces in diaper
-urea, ammonia, pH, enzymes
-Systemic antibiotics may also predispose child to diaper rash due to superinfection

-Etiology of diaper rash
-Yeast: most common cause – Mostly due to candida albicans species
-Bacterial: 2nd most common cause - Mostly due to S. aureus, group A S. pyogenes

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3
Q

how can we prevent diaper rash

A

-Keep area clean and as dry as possible
-Powder or cornstarch
-Frequent diaper changes
-Diaper should be loose fitting, ventilated
-Change to cloth if needed
-Remove diaper and leave off as time permits
-Wash with water or mild cleanser like Cetaphil
-Use cool air to dry buttocks

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4
Q

diaper rash: protective barrier

A

-A&D oint
-Petrolatum (Vaseline)
-Zinc oxide!
-Desitin (contains zinc! oxide and emollient)
-Some contain protectant + drying agent + anti-microbial + vitamins

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5
Q

topical steroids: diaper rash

A

-Do little to treat rash – they are beneficial for their anti-inflammatory effect
-Caution b/c they can cause adrenal suppression if too much gets absorbed
-not treating any fungus or bacteria

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6
Q

diaper rash tx: yeast

A

-“red satellite lesions”

-Topical antifungal
-Nystatin (Mycolog) – powder, cream, oint
-Nystatin + triamcinolone (Mycolog II) – cream , oint
-Clotrimazole (Lotrimin) - cream
-Clotrimazole + betamethasone (Lotrisone) – cream

-NEW combination product
-Zinc oxide, petrolatum & 0.25% miconazole (Vusion)

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7
Q

diaper rash tx: bacteria

A

-(usually staph or strep) – “yellowish, fluid-filled pustules, honey-colored, crusty”
-Mild infections – may benefit from topical product like bacitracin (1st) or mupirocin (2nd) !
-More severe infections – Must treat with appropriate systemic (PO) antibiotics (beta-lactams are very effective)
-Combination therapy (Topical AND PO) is most effective and is often utilized in clinical practice

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8
Q

butt paste

A

-Includes the following ingredients
-Zinc oxide
-Aquaphor, A&D oint or petrolatum
-Cholestyramine (Questran)
-Cholestyramine binds uric acid, keeps pH at normal levels, zinc and A&D provide protective barrier.
-NOT for prevention -> For treatment only

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9
Q

poisons

A

-3 main types:
-ivy
-sumac
-oak
-tx for all types is similar
-if you are sensitive to one type - you are sensitive to all

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10
Q

poisons- ivy, oak, sumac

A

-Rhus Dermatitis – delayed hypersensitivity rxn occurring 12 – 72 hrs after exposure

-Urushiol – chemical secreted by bruised plants
-Primary exposure – direct contact to bruised portion of plant that exudes urushiol
-Secondary exposure – contact with exposed pets, contaminated clothing, smoke from burning plants

-Not transmitted via fluid vesicles/blisters
-The condition is self-limiting ->14-20 d

-Symptoms include:
-Severe itching
-Burning sensation

-Secondary infection can occur
-Caused by scratching – bacteria enter broken skin

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11
Q

poisons- ivy, oak, sumac: tx goals

A

-Protect damaged skin
-Relieve pain and itching, Prevent secondary infection
-Wash area immediately w/ soap and alcohol
-Reduce pain and/or itch

-Barrier products
-Bentoquatam (Ivy Block)
-Zanfel – OTC wash – not recommended

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12
Q

poison ivy, oak, sumac tx: soaks, baths, mild dressings

A

-tx depends on severity
-tx of mild and moderate cases:

-Colloidal oatmeal (Aveeno) – bath, transient relief
-Aluminum acetate (Burrow’s soln) – moist/wet dressings, reduce itch, mild astringent
-If there are facial lesions – Use moist/wet dressings – NOT lotions (difficult and painful to remove once dry)

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13
Q

poison ivy, oak, sumac tx: topical

A

-mild to moderate:
-Calamine (calamine, Fe oxide, Zn oxide) -> make you pink
-Local anesthetics (ie. Caladryl = calamine + pramoxine)

-Antihistamines (Benadryl cream):
-May sensitize skin
-!!!!!!Generally not effective – diphenhydramine does not penetrate skin & may irritate further

-Camphor, menthol, phenol, EtOH:
-Promotes drying of vesicles
-Camphor & menthol - “cooling” effect
-Phenol & EtOH - Antibacterial

-Aluminum acetate solutions
-Steroids

-Do NOT use ointments while vesicles are present and/or weeping b/c they can form a barrier and seal moisture in - the vesicles need to dry

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14
Q

poison ivy, oak, sumac tx: severe

A

-widespread or eye involvement

-Oral Antihistamines – anti-itch
-Diphenhydramine – 25-50mg PO qid prn
-ADR: sedation, dry mouth

-Oral Glucocorticosteroids – anti-inflammatory
-Common dose: Prednisone PO 7-21 d, taper off
-Some practitioners might use in moderate cases
-ADRs - see glucocorticosteroids handout

-Oral Antibiotics - If infections occurs
-Treat for staph (most common in skin infections) – cephalosporins and penicillins mainstay,

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15
Q

acne

A

-Acne is stimulated by testosterone and its metabolite - dihydrotestosterone
-Pathogenesis is multifactorial
-Bacterial - P. acnes

-Irritants
-Touching your face
-Makeup (lanolin and emollients trap dirt)
-Foods (certain individuals)

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16
Q

acne general treatment

A

-Cleanse skin BID w/ mild cleanser (Cetaphil) and pat dry
-Use coarse cloth or other sponges to exfoliate skin
-Astringent – closes pores helps prevent dirt from entering
-Medication as necessary

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17
Q

pharm tx of acne: choices

A

Topical Benzoyl Peroxide
Topical Salicylic Acid
Topical Retinoids
Miscellaneous topicals
Topical antibiotics
Oral Antibiotics
Oral isotretinoin (Accutane)
Oral contraceptives

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18
Q

acne: benzoyl peroxide

A

-MOA - Causes desquamation – increase turnover of epithelial cells, promotes healing, May be bacteriostatic or bacteriocidal
-Precautions - Do not use around mouth, eyes or lips. Some pts are hypersensitive.

-ADRs
-Drying, Peeling, Stinging
-May bleach clothing or linens (use white pillow cases)

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19
Q

acne: salicylic acid

A

-clearisil pads
-MOA - Keratolytics – helps remove upper layer of dead cells

-ADRs
-Drying, peeling
-Other indications: higher concentrations of salicyclic acid (10-15%) are used for wart removal

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20
Q

acne: retinoids

A

-vitamin A derivatives
-MOA - increases epithelial cell proliferation, reduces comedo formation
-Precautions - AVOID sun – use SPF 30-45 – minimize exposure. Do not use too close to eyes, mouths, lips.

-ADRs – erythema, dryness , peeling, scaling, itching, crusting, photosensitivity, pigmentation changes (bleaching).

-Examples:
-Tretinoin (Retin-A, Renova, Avita) (D) gel and cream
-Tazarotene (Tazorac) (X) gel and cream

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21
Q

acne: adapalene

A

-(Differin 1% gel) (C)
-otc
-mild to moderate acne
-MOA - Retinoid-like compound, binds to different retinoid type receptors
-ADRs – similar to other retinoids, local skin irritation, not shown to be teratogenic in rodents, but no human studies

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22
Q

acne: azelaic acid

A

-MOA - not fully determined, but may have antimicrobial activity against P. acnes and blocks conversion of testosterone to dihydrotestosterone
-ADRs - erythema, dryness

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23
Q

acne: topical antibiotics

A

-MOA - antimicrobial activity against causative organisms
-ADRs - Burning stinging, drying, peeling, erythema
-Dosed – 2-6xd – resistance rare due to minimal systemic absorption
-resistance if pt is not consistent

-Examples:
-Erythromycin (B)
-Erythromycin + benzoyl peroxide (C)
-Sodium Sulfacetamide (C)
-Clindamycin (B) gel, cream, lotion, soln, disposable pads
-Combo w/ benzoyl peroxide (Duac Gel)

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24
Q

acne: oral antibiotics

A

-MOA - antimicrobial activity against causative organisms
-moderate to severe
-Precaution - May increase risk of resistance due to chronic usage

-ADRs include
-Nausea, vomiting, diarrhea and many others (more detail to be provided in antimicrobial lecture)
-Vertigo (primarily with minocycline)
-Contraceptive failure of BC pills (use alternate form of BC)

-Examples
-Tetracyclines:
-Doxycycline (D)
-Minocycline (D) *- go to QD

-Macrolides- Erythromycin (B)- less likely - if pregnant

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25
Q

acne: isotretinoin

A

-oral retinoid
-MOA - reduce sebaceous gland size, regulates cell proliferation and differentiation
-DOSE: 0.5 – 1 mg/kg/day for 15-20 weeks. May repeat x 1 after 2 months off
-ADR’s - dryness & itching of skin and mucous membrane, HA, depression, hyperlipidemia, increase LFT’s, alopecia, myalgia, hematologic ADRs, ocular ADRs, photosensitivity, increase suicide risk
-Used only for severe cases – best treatment
-Need to sign informed patient consent prior to receiving and cannot be pregnant or get pregnant
-cystic acne

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26
Q

acne: OCP

A

-females only
-MOA - Increased estrogen helps counterbalance the high testosterone levels which cause acne
-Estrogen alone or Estrogen / Progesterone combo
-With combo want high estrogenic activity and low androgenic activity (tricycline brands are good)

-ADRs – PMS like symptoms, bloating, weight gain
-Use for women >18yo, not planning pregnancy

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27
Q

drugs that CAUSE acne

A

-Hormones -Gonadotropins, Anabolic steroids, Corticosteroids
-Anti-epileptic drugs
-TB drugs- INH, Rifampin
-Miscellaneous- Lithium, Cyclopsorine, Iodine

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28
Q

psoriasis

A

-No cure for psoriasis
-Treatment can be defined as acute or chronic
-Factors influencing treatment selection
-Age of patient
-Type of psoriasis
-Site and extent of involvement
-Previous treatment
-Coexisting diseases
-Treatment goals include:
-Reduce severity
-Palliative treatment

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29
Q

tx of acute psoriasis

A

-Treat the severely erythematous lesions
-Goal is to soothe irritation, use non-medicated topicals
-Aquaphor
-Cold cream
-Lac-hydrin
-Eucerin

-May also use topical steroids

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30
Q

tx of chronic psoriasis

A

-Topical Corticosteroids
-Anti-inflammatory
-Antipruritic
-Vasoconstrictor
-Immunosuppressive

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31
Q

tx of chronic psoriasis: topical corticosteroids

A

-Start with super high potency (class 1 or 2) BID x 2-3wks
-After high potency treatment, change to Pulse treatment (2 days on then 5 days off) OR change to lower potency steroid
-Halogenated or fluorinated steroids improve absorption -> !DO NOT use on face, perineum or mucus membranes
-Non-Fluorinated steroids can be used on face, eyelids, perineum and mucous membranes

-Super potent – do not use on children or elderly due to increased systemic absorption (children: skin not keratinized, elderly: skin is thin)
-Super Potent - Avoid use in flexural areas: groin, axilla, popliteal and antecubital fossa (areas tend to be warm and moist – added absorption) – if used minimize to less than 2wks, switch to lower potency
-Super potent – may inhibit HPA axis

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32
Q

topical corticosteroids: psoriasis: ADRs

A

-Thinning
-Tearing (due to thinning)
-Bruising of skin
-Acne
-Hypopigmentation -blanching due to vasoconstriction
-Infection (immune system suppressed)
-Contact dermatitis

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33
Q

tx of chronic psoriasis: coal tar

A

-Available as oint, lotion, soap, shampoo
-Use alone or w/ Low Potency steroids
-Applied HS and washed off in AM
-May be used with UVB light therapy
-Non-compliance problems
-Cosmetically non-appealing – staining of clothes, bedding, hair
-for mild

-ADRs
-Folliculitis
-Photosensitivity
-Irritation
-Scaling
-Itching
-Inflammation

-Mild or mild to moderate plaque psoriasis
-Consider for patients who can’t afford prescription options

34
Q

tx of chronic psoriasis: psoralens: methoxsalen

A

-!Methoxsalen (oxsoralen) (PO, lotion) (C)
-Follow with UVA light tx 2 hrs post
-Combo referred to as PUVA

-ADRs
-Pruritis, dry skin, loss of pigmentation
-Nausea
-Blistering
-Painful erythema

-Drug-food interaction: Avoid furocoumarin-containing foods

35
Q

chronic psoriasis: retinoids: etretinate

A

-(PO) (X)
-Normalizes expression of keratin
-Suppresses chemotaxis
-Decreases stratum corneum cohesiveness
-Half life = 100 days (can be found in plasma 2-3 years after discontinuation)
-dont drink EtOH
-cant donate blood for 3 years
-must take Birth Control
-Should be utilized 1 month pre and during therapy
-Must use BC for 3 years post!!!!
-When combined with PUVA – called – RE-PUVA

-ADRs (similar to acutane)
-LFT abnormalities!
-Alopecia
-Exfoliation
-Hyperlipidemia (cholesterol and TG)!
-Myalgia
-Arthralgia
-beware in pts on statins- cause high LFTs -> switch to PSK-9

36
Q

chronic psoriasis: retinoids: acitretin

A

-PO (X)
-Same precautions and ADRs as etretinate
-Half life = 49 hrs
-used with phototherapy, biologics, potent corticosteroids, or calcipotriene (calcipotriol) for disease that is too severe, refractory, or extensive for topicals
-e.g., severe disease of palms, soles, or scalp; involvement of 10% or more of body surface area)
-Nail psoriasis (second-line)

37
Q

chronic psoriasis: retinoids: tazarotene

A

-topical (X)
-Mild plaque psoriasis.
-Nail psoriasis (second-line)
-Recommended for use with topical corticosteroid to reduce side effects (irritation, atrophy) and improve efficacy
-In resistant cases, can alternate tazarotene/corticosteroid (evening) with calcipotriene/corticosteroid (morning)
-alternative to using a steroid

38
Q

chronic psoriasis: antimetabolites: methotrexate

A

-Methotrexate (PO) (D) – chemo drug
-Disease that is too severe, refractory, or extensive for topicals
-e.g., severe disease of palms, soles, or scalp
-involvement of 10% or more of body surface area)
-Alternative to biologics for pts who prefer cheaper, oral option
-Nail psoriasis (second-line)

39
Q

chronic psoriasis: immunosuppressant: cyclosporine A

A

-Cyclosporine A (Neoral) (PO) (C)
-Disease that is too severe, refractory, or extensive for topicals (e.g., severe disease of palms, soles, or scalp; involvement of 10% or more of body surface area)
-Alternative to biologics for patients who prefer cheaper, oral option
-Can consider for severe or refractory nail involvement, especially if patient has psoriasis on other body parts

40
Q

chronic psoriasis: topical immune modulators

A

-Tacrolimus (Protropic) (topical) (C)
-Pimecrolimus (Elidel) (topical) (C) -> Facial, flexural, or genital areas, especially for maintenance
-sirolimus (PO) (C)- usually for organ transplant
-alternative to steroids

41
Q

chronic psoriasis: Vitamin D3 analogs

A

-Calciprotriene (Dovonex) (C) – topical
-Calcipotriene (calcipotriol)/betamethasone dipropionate suspension & Ointment
-vitamin D3- calcitriol ointment
-Effects equal to class II or III steroids
-Vit D3 analog, therefore no steroid SE
-MILD
-need to use combo for moderate
-can use on large areas

-SE’s
-Local irritation
-Skin reactions

-Do NOT use on face, eyelids, perineum or skin folds

-Mild disease (first-line)
-moderate to severe disease (combo product)
-nail psoriasis (first-line)
-palmoplantar psoriasis (calcipotriene first-line)
-scalp psoriasis (first-line)
-Consider for maintenance; slow onset, sustained remission.
-Can combine with topical steroid, or alternate with topical steroid or steroid/calcipotriene combo, to improve efficacy and reduce side effects

-alternative to steroids!

42
Q

chronic psoriasis: anthralin

A

-topical
-use for short term tx
-apply for 1 hr or <, then wash off

-SEs:
-staining on furniture, bathroom
-irritation of un-involved skin

-permanent brown color staining of clothing and bathroom fixtures

43
Q

whats a tx for mild psoriasis

A
44
Q

chronic psoriasis: apremilast

A

-PDE-4 inhibitor!!!!!!!!!!
-otezla
-Moderate to severe psoriasis in patients who are candidates for phototherapy or systemic therapy (i.e., disease that is too severe, refractory, or extensive for topicals, such as severe disease of palms, soles, or scalp; involvement of 10% or more of body surface area)
-Recommended for pts with significant skin and nail disease
-systemic
-Consider for pts who prefer an oral treatment with no lab monitoring

45
Q

chronic psoriasis: keratolytics

A

-Soften keratin layer of skin
-Enhance absorption of other agents!!
-Phenol and Salicylic acid used – mixed with Aquaphor, cold cream, emollients, coal tar

46
Q

chronic psoriasis: phototherapy

A

-Sunlight
-Photochemotherapy- PUVA = psoralens + UVA light
-Phototherapy- UVB light therapy

47
Q

chronic psoriasis: TNF-alpha blockers

A

-Adalimumab (Humira), Etanercept, Infliximab
-Moderate to severe disease (first-line), severe scalp psoriasis (adalimumab or etanercept) Palmoplantar psoriasis
-Can consider for severe or refractory nail psoriasis with plaque psoriasis affecting other areas (adalimumab, etanercept, or infliximab)

48
Q

chronic psoriasis: interleukin IL-17A blockers

A

-Secukinumab (Cosentyx)
-Moderate to severe disease

-Brodalumab (Siliq)
-Moderate to severe disease

-Ixekizumab (Taltz)
-Moderate to severe disease

49
Q

chronic psoriasis: interleukin IL-23 blockers

A

-Guselkumab (Tremfya, Tremfya One-Press)
-Risankizumab (Skyrizi)
-Tildrakizumab (Ilumya; U.S. only)

-Moderate to severe disease in adults who are candidates for systemic or phototherapy

50
Q

chronic psoriasis: interleukin IL-12 and IL-23 blocker

A

-Ustekinumab (Stelara)
-Moderate to severe disease

-Immunosuppresants
-Sirolimus (rapamune) (PO) (C)
-Usually for organ transplant

51
Q

rosacea: topicals

A

-Creams, lotions, oint and gels
-Antibiotics
-Azelaic acid
-Sulfur lotions
-Benzoyl peroxide – limited data on effectiveness

52
Q

rosacea: topical antibiotics

A

-Metronidazole (Metrogel, Metrocream)
-!!Treatment of choice for Rosacea
-Also an antiprotozoal agent

-Sulfur products (Novacet, Sulfacet-R)
-Avoid in sulfa allergy

-Clindamycin and Erythromycin
-Not as effective as other topical antibiotics or azelaic acid

53
Q

rosacea: topical azelaic acid

A

-Antibacterial, comedolytic, anti-inflammatory
-One small study – as effective as Metrogel
-Products:
-Finacea Gel 15% - for rosacea
-Azelex or Finevin Cream 20% - for acne
-can do combo with metro

-ADRs – local skin irritation

54
Q

weening off steroids

A

-HPA axis
-feedback inhibition
-when you abruptly stop -> body stopped making corticosteroids -> steroid withdrawl

55
Q

rosacea: oral antibiotics

A

-moderate to severe
-Tetracyclines (D)- Most commonly used
-Erythromycin (B)
-Clarithromycin (Biaxin) (C)
-Sulfamethoxazole/Trimethoprim (Bactrim, Septra)
-Metronidazole (Flagyl)
-can combine with topicals

56
Q

rosacea: glycolic acid

A

-peels q2-4 weeks
-washes and creams

57
Q

miscellaneous treatments

A

-topical tretinoin
-isotretinoin- severe cases, off label use

58
Q

rosacea: eye problems tx

A

-Doxycycline - PO
-Minocycline - PO
-Tetracycline - PO

59
Q

rosacea tx for redness and flushing

A

-Anti-inflammatory meds – steroid creams
-Electrosurgery
-Intense light therapy
-Vascular lasers

60
Q

rosacea: rhinophyma

A

-Dermabrasion
-Electrosurgery
-Laser surgery

61
Q

rosacea: overall tx approach

A

-Overall Goal – minimize flare ups
-Avoid rubbing, scrubbing, massaging face – irritates
-Use mild cleansers, moisturizers and sun screen
-Avoid triggers – hot drinks, spicy foods and EtOH
-SPF 15 or > and protective clothing
-Protect skin form extreme heat or cold – irritate = flare up
-Avoid cosmetics, soaps, moisturizers, etc which contain EtOH and fragrances
-Medication use as appropriate
-wait for creams to dry before putting on another

62
Q

eczema

A

-MC symptoms: dry, red, extremely itchy patches on skin
-occurs on any part of body
-usually appears during infancy

63
Q

prevention of eczema

A

-Moisturize
-Avoid rapid temperature changes
-Reduce stress
-Avoid scratchy materials (wool)
-Avoid harsh soaps, detergents
-Avoid triggers – allergens
-Be aware for foods that cause outbreak and avoid them

64
Q

eczema tx

A

-Prevent scratching
-Creams and lotions to moisturize
-Cold compresses- Relieve itch
-Topical Corticosteroids - OTC or Rx -> Anti-inflammatory
-Topical and PO antibiotics -> Only if infected skin
-Oral Antihistamines – OTC or Rx -> Reduce itch
-Coal tar
-Phototherapy
-Cyclosporine A (PO) (Neoral, Sandimune, Restasis) (C) – only for resistant eczema -> Immune modulator - immunosuppressant

-Topical Immune Modulators:
Tacrolimus (Protropic) (topical) (C)
Pimecrolimus (Elidel) (topical) (C)

65
Q

eczema prevention and tx in kids

A

-Moisturize
-Avoid temp changes
-Keep bedroom and play area – dust free
-Mild soaps – cetaphil
-Breathable clothing – cotton
-Topical Hydrocortisone - low potency
-Topical Immune Modulators
-PO steroids
-PO Antihistamines – OTC or Rx
-PO or topical Antibiotics

66
Q

actinic keratoses

A

-Early beginning of skin cancer
-Common lesions of epidermis-> Caused by long sun exposure (most common)
-Appear approx 40-50yo – chronic sun exposure -> FL, southern CA – teens to 20’s
-Increased risk in fair skin individuals
-Definition – cutaneous dysplasia of epidermis

67
Q

actinic keratosis: tx

A

-Cryosurgery - most common treatment
-Surgical excision and biopsy -> Suspect squamous cell carcinoma
-Retinoids – topical and PO
-Topical Chemotherapy -> 5-Fluoruracil (Efudex, Fluoroplex) (topical) (X) -> 1, 2 and 5%
-Chemical Peels

-Dermabrasion
-Laser skin resurfacing
-Electrosurgical skin resurfacing

68
Q

melanoma

A

-skin CA in melanocytes
-melanin- cells produce brown pigmentation
-potentially lethal skin CA
-Localized - surgical excision

-Higher stages
-Interferon injection
-Interleukin injection
-Combination chemotherapy

69
Q

ectoparasites

A

-Parasite that lives outside the body
-Includes lice (head, body or pubic) and mites (scabies)
-Treatment:
-Eradicate the causative organism and provide symptomatic relief to patients
-TREATMENT OF CHOICE for all is permethrin

70
Q

lice and scabies

A

-malathion is a step up

71
Q

permethrin

A

-MOA/kinetics - pediculicide, scabicide
-Derived form flowers of Chrysanthemum cinerariifolium plant
-Available in different dosage forms and strengths for treatment of lice/scabies. Also used as pesticide
-Precaution – pts w/ ragweed or Chrysanthemum allergy
-SAFE FOR KIDS
-ADRs – local itching, burning, stinging and tingling

-Directions for use:
-Topical lotion for lice: Wash hair w/ shampoo, towel dry. Saturate hair and scalp with lotion or crème rinse, leave on for 10 minutes then rinse. Remove remaining nits. May repeat in in 9 days x 2 more times if lice or nits still present. (total = 3 doses) Cure rate 90-97%
-Cream for scabies: Wash and scrub body. Apply cream from head to toe, leave on for 8-14 hours before washing off with water. Cure rate 90%

72
Q

malathion

A

-MOA/kinetics – pediculicide, scabicide.
-Organophosphate cholinesterase inhibitor. -Must be activated in body by conversion to oxygen analogs. This occurs rapidly in insects and vertebrates
-they are rapidly metabolized
-Precautions
-2nd line agent
-Organophosphate -> pesticide
-Directions for use for lice: Apply to dry hair and leave on for 8-12 hours. Then shampoo hair. Repeat in 7-9 days if necessary

73
Q

lindane

A

-MOA/kinetics - pediculicide, scabicide. Can be absorbed and concentrate in fatty tissues, especially the brain
-Precautions – 2nd or 3rd line
-CNS and hematological toxicity
-Do not use in premature infants or in pts with known seizure disorders.

-Directions for use:
-Shampoo for lice: Apply to clean, dry hair. Massage into hair for 4 minutes. Rinse hair then remove nits w/ comb. Use 30-60 ml.
-Lotion for scabies: Apply thin layer on body, bathe and remove the drug after 8-12 hours

74
Q

crotamiton

A

-MOA – not fully understood, may also have some antipruritic properties.
-3rd line agent
-Directions for use for scabies: Apply to body in two applications (24 hours apart). Take a cleansing bath 48 hours after last application.

75
Q

ivermectin PO

A

-MOA – antihelminthic agent
-SCABIES- PO (not lice)
-2nd or 3rd line agent
-Precautions: Mazzoti reaction in pts with onchocerciasis (allergic and inflammatory response due to the death of the microfilariae – often affects eyes)
-Dose: 200mcg/kg x 1 dose

76
Q

topical antibacterial preparations

A

-Uses:
-Preventing infection in clean wounds (cuts, scrapes)
-Early treatment of infected dermatoses and wounds
-Reducing colonization of staph in nares

-Efficacy:
-Varies amongst agent

-Spectrum:
-Varies amongst agent
-Combo products with broader spectrum to cover for mixed infections or infections due to undetermined pathogen

77
Q

topical antibacterial preparations examples

A

-bacitracin: Mostly gram + coverage. Available alone or in combo w/ neomycin and polymyxin - OTC

-gramicidin: Mostly gram + coverage. Available in combo w/ neomycin, polymyxin, bacitracin and nystatin

-mupirocin: (Bactroban): Effective against MRSA. Preferred agent for IMPETIGO and to eliminate nasal carriage of S. aureus.

-Polymyxin B: Mostly gram – coverage. Available as combo product

-neomycin/gentamcin: Topical aminoglycosides w/ gram – coverage, incl pseudomonas. Neomycin available in combo products, gentamicin in combo or alone

78
Q

doxepin hydrochloride

A

-Topical antipruritic used to treat pruritus associated with atopic dermatitis or lichen simplex chronicus
-MOA - blocks H1 and H2 receptors
-ADRs - local burning and stinging, sedation, anticholinergic side effects (didnt go over this)

79
Q

pramoxine

A

-Topical anesthetic available alone or in combo with hydrocortisone
-Used to provide temporary relief form pruritus associated with mild eczematous dermatoses and hemorrhoids! (for external use only)
-ADRs - local burning and stinging

80
Q

drug induced photosensitivity

A

-benzocaine (Americaine)- can cause allergic rxn in sun (an anesthetic)
-coal tar
-hexachlorophene
-isotretinoin (Accutane)
-methoxsalen (Uvadex, Oxsoralen)
-tacrolimus (Prograf, Protopic)
-tazarotene (Tazorac)
-retinoin (Retin-A)
-Sunscreen agents: PABA, cinnamates, benzyphenones

Neurology (8 decks)

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