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Advanced Pediatric Pharmacology Exam 1 > Dermatology 2 > Flashcards

Dermatology 2 Flashcards

1
Q

Mild Acne Initial Treatment Choices (5)

A
  1. Benzoyl Peroxide
  2. Or a topical retinoid

or

  1. Topical combination of BP and Antibiotic
  2. Or Retinoid and BP
  3. Or Retinoid, + antibiotic = BP
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2
Q

Mild Acne Treatment if initial did not work (3)

A
  1. Add BP or retinoid if not already in use
  2. Or change topical retinoid concentration
  3. Type and formulation
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3
Q

Moderate Acne Initial Treatment Choices (5)

A
  1. Topical combination of BP and retinoid
  2. Or Retinoid and BP
  3. Or Retinoid, +antibiotic = BP

OR

  1. Oral Antibiotic + Topical retinoid + BP
  2. Or topical retinoid=antibiotic + BP
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4
Q

Moderate Acne Treatment if initial did not work (5)

A
  1. Change topical retinoid concentration
  2. Type and formulation And/or Change Topical combination Therapy
  3. Or add or change oral antibiotic
  4. Hormonal therapy in female
  5. Or Accutane
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5
Q

Over The Counter Topical Medications for Acne (5)

A

Most patient have have tried at least one product
For early disease, there can be effective

They include

  1. Benzoyl Peroxide (2.5%-10%)
  2. Salicylic Acid
  3. Sulfur
  4. Alpha Hydroxy Acid (not tested)
  5. Herbal (not tested)
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6
Q

Adjunctive Acne Treatment (8)

A

Most patients like the products

  1. Neutrogenia is effective if skin gets too dry
    - Effectiveness is debatable “ Products include
  2. Washes and rubs
  3. Masks
  4. Abrasives
  5. Astringents
  6. Pore cleaners
  7. Cover ups and cosmetics with a green base
  8. Vibrating or heating devices
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7
Q

Comedomal Acne First Line and 3 Alternative Tx

A

First line: Topical retinoid (TR)

Alternatives:

  1. Salicylic acid
  2. BPO
  3. Azelaic Acid
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8
Q

Mild papular/ pustular Acne First Line and 2 Alternative tx

A

First line: TR +/- BPO or topical antibiotic (TA)/BPO

Alternatives:

  1. Sulfur/sodium sulfacetamide
  2. Azelaic Acide
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9
Q

Moderate papular/pustular Acne First Line and Alternative tx

A

First line: TR and oral antibiotic (OA) + BPO or TA/BPO

Alternatives: (for female patients only)
1. Hormonal therapy and TR +/- BPO or TA/BPO

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10
Q

Moderate nodular Acne First Line and 2 Alternative tx

A

First line: TR +OA+BPO or TA/BPO

Alternatives:

  1. Oral isotretinoin
  2. For female patients only: Hormonal therapy +TR +/- BPO or TA/BPO; oral isotretinoin if refractory
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11
Q

Severe nodular/cystic Acne First Line and 2Alternative tx

A

First line: Oral isotrentoin

Alternatives:

  1. OA =TR + BPO or TA/BP
  2. For female patients only: HT +TR +/- BPO or TA/BPO
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12
Q

Patient Education for Acne Treatment (6)

A
  1. EXPLAIN WHAT ACNE IS – Each acne lesion is in its own stage
  2. EXPLAIN HOW TO USE THE MEDICATION – Takes 4-8 weeks, Peak benefit may take 3-4 months
  3. How to use topicals
  4. EXPLAIN WHY
  5. Compliance issue: reason for combinations and
    compliance issues
  6. Ask about picking: obsessive compulsive disorder
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13
Q

Acne and Diet

A

Most significant difference is in intake of unrefined traditional foods (fruits and vegetables, millet, brown rice) vs. carbohydrates that yield high glycemic loads (rice krispies, sugar, Mars bars, bagels, white bread)

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14
Q

Contact Dermatitis

A

Common source of medication-related contact dermatitis: neomycin in antibiotic ointments.
* Quite severe, rivaling that of poison ivy.

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15
Q

Irritant Contact Dermatitis (7)

A
  1. Child at risk: Everyone
  2. Mechanism of response: Nonimmunologic: Physical and Chemical alteration of epidermis
  3. Exposures to gain response: Few to many, depending upon barrier maintenance
  4. Concentration of substance: Usually high
  5. Onset: Gradual as barrier is compromised
  6. Distribution: boarders are indistinct
  7. Management: Protection and reduce incidence of exposure
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16
Q

Allergic Contact Dermatitis (7)

A
  1. Child at risk: Genetically predisposed
  2. Mechanism of response: Delayed hypersensitivity reaction
  3. Exposures to gain response: One of several to cause sensation
  4. Concentration of substance: May be low
  5. Onset: If sensitized, within 12-48 hours
  6. Distribution: may correspond to exact contact
  7. Management: complete avoidance
17
Q

Top Offending Allergic Dermatitis Allergens (10)

A
  1. Nickel
  2. Cobalt chloride
    Paints, dyes, metal plated objects, braces, amalgam, vitamin B 12
  3. Thimerosol
  4. Gold
  5. Fragrant Mix
  6. Neomycin
  7. Balsam of Peru, found in lotions, cleansers, cosmetic perfumes
  8. Colophony
    Found in adhesives, eye shadows, concealer creams, nail polish and diapers
  9. Formaldehyde
    swimming goggles, wetsuits, sin guards
  10. Lanolin
18
Q

Allergic Dermatitis Mechanism of Action (4)

A
  1. Diffuse across cell membrane and induce cutaneous vasoconstriction depending on potency
  2. Inhibit the migration of macrophages and leukocytes into the area by reversing vascular dilation and permeability of small vessels in the upper dermis
  3. Topical route is used when local effect is preferred
  4. Protein bound, metabolized by the liver and excreted in bile and urine
19
Q

Allergic Contact Dermatitis Tx (2)

A
  1. Oral Steroids if extensive or not responding to local steroids
  2. Most commonly treated orally
20
Q

Topical Steroid Facts (9)

A
  1. Initiate with the lowest needed
  2. PATCH TES; Put it on for 10 hours on a small spot before putting it elsewhere to make sure you aren’t allergic; Always apply sparingly (tissue test)
  3. Group 1 and 2 need to be reserved for severe contact or soles or palms
  4. Potency is an important variable
  5. A drug from each level needs to learned
  6. The dose of one steroid does not correlate the dose of
    anther
  7. Steroids that are potent are used for severe condition is it is well localized
  8. Apply product sparingly—tissue test
  9. Triamcinalone 0.5% is a medium strength that is generic
21
Q

Topical Steroids Class I (5)

A
  1. VERY HIGH POTENCY, all are 0.05% strength
  2. Augmented betamethasone dipropionate (Diprosone)
    * Ointment
  3. Clobetasol propionate (Temovate)
    * Ointment, cream, foam, or solution
  4. Diflorasone diacetate
    * Ointment
  5. Halobetasol propionate
    * ointment and cream
22
Q

Topical Steroids Class II (3)

A
  1. High Potency
  2. Betamethasone dipropionate cream
  3. Betamethasone valerate ointment 0.1%(valisone)
23
Q

Topical Steroids Class III (3)

A
  1. Medium potency
  2. Betamethasone dipropionate lotion
  3. Betamethasone valerate cream 0.1%
24
Q

Topical Steroids Class IV (3)

A
  1. Lower potency
  2. Hydrocortisone ointment
  3. Synalar 0.01 (fluocinolone acetonide (cream, solution)
25
Q

Topical Steroids Class V (3)

A

Low potency

  1. Alclometasone dipropionate (0.05%)
  2. Desonide (0.05%)
  3. Fluocinolone acetonide (0.01%)
26
Q

Topical Steroids Class VI (3)

A

Lowest potency

  1. Dexamethasone 0.1%
  2. Hydrocortisone 0.25%, 0.5%, and 1%
  3. Hydrocortisone acutane 0.5%-1%
27
Q

Topical Steroids Class VII

A

Available OTC

28
Q

ADEs of Topical Steroids (6)

A
  1. The most common complication is suppression of the Hypothalamus-pituitary axis which is not associated with symptoms until the steroid is stopped (suppression of HPA)
  2. Thinning of the skin—atrophy and striae
  3. Vascular lesions—purpura, telangiectasia
  4. Perioral dermatitis
  5. Steroid rosacea
  6. Glaucoma and cataracts may develop with prolonged use of steroids around the eye
29
Q

Risk of Topical Steroid ADEs (3)

A
  1. Increase when topical steroids are used for a long time
  2. When they are used under occlusion
  3. When they are used in intertriginous locations or on face
30
Q

Prescribing Pearls for Steroids (8)

A
  1. The dose of one steroid dose does not correlated with the dose of another; For example, diprosone 0.05 is stronger than hydrocortisone cream 2.5%
  2. Potent steroids should be used on a small an area as possible for the shortest period of time
  3. Do not discontinue treatment abruptly
  4. New guidelines on chronic atopic dermatitis state to use a lower dose hydrocortisone twice a week even when skin is quiet
  5. Time to peak concentration is 12 to 24 hours
  6. Symptoms of Cushing syndrome include hyperglycemia and glycosuria
  7. Monitor for superinfection; Herpes simplex superinfected on atopic dermatitis (Eczema herpeticum)
  8. Lower dose of steroid (wean) if using it for more than ten days
31
Q

Moisturizers for atopic dermatitis (10)

A
  1. Vanicream; contains no preservatives or perfumes
  2. Eucerin
  3. Aquaphor
  4. Eucerin calming cream; great for an itch but contains alcohol and lanolin
  5. Aveeno
  6. Cerave; contains minimal preservatives
  7. Cetaphil
  8. Moisurinses
  9. Dove body wash/soap
  10. Vaseline; Don’t use vaseline on african americans; will clog pores and cause bumps
32
Q

Calcineurin inhibitor for atopic dermatitis (5)

A
  1. An immunosuppressanat drug
  2. Blocks the production of proinflammatory
    cytokines by T lymphocytes and prevents release of inflammatory mediators from cutaneous mast cells and basophils
  3. Less likely than topical corticosteroids to cause immunosuppression
  4. No skin atrophy
  5. Use around the eye for atopy in this area is a good use
  6. BBW of lymphoma on mice
33
Q

Topical Immunosuppresant Drugs for Atopic Dermatitis (2)

A
  1. Tacrolimus (Protopic)
  2. Pimecrolimus (Elidel)

Minimal absorption through the skin even when applied to large inflamed areas.

34
Q

Topical Immunosuppresant Drugs for Atopic Dermatitis ADEs (5)

A
  1. Transient local irritation
  2. mild to moderate burning,
  3. warmth,
  4. itching
  5. erythema
35
Q

Timolol Topical Solution and Gel for Infantile Hemangiomas (4)

A
  1. Timolol is available in a topical solution and a gel-forming solution in concentrations of 0.25% and 0.5%.
  2. Mode of action is similar to that of propranolol
    - beta blockade leading to vasoconstriction, inhibition of angiogenesis, and induction of apoptosis
3. Major advantages of topical timolol 
A. Ready availability
B. Cost
C. Ease of administration
D. minimal risk of drug-related adverse events.
  1. Superior to oral corticosteroid for treatment of IH
36
Q

Topical Therapies for Partial-thickness burns (4)

A
  1. Bacitracin Pro
    - Inexpensive
    - OTC
    - provides a moist environment for reepithelialization
  2. Bacitracin Cons
    - Prolonged use leads to yeast
    - Does not cover pseudomonas
  3. Silver sulfadiazine cream Pro
  4. Provodone iodine solution Pro
37
Q

Silver sulfadiazine cream Pro (5)

A
  1. Inexpensive; for partial thickness burns
  2. Nonpainful/soothing
  3. Broad spectrum (VRE, MRSA, P aeruginosa
  4. Provides a moist environment
  5. Cons: Best for extensive burns with possible pseudomonas infection
38
Q

Provodone iodine solution Pro (2)

A
  1. Broad spectrum without risk of resistance
  2. Cons
    - Allergenic
    - Pruritic
    - May delay wound healing
    - Systemic absorption can have renal side effect and thyroid hormone changes

Advanced Pediatric Pharmacology Exam 1 (8 decks)

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