Dermatology Flashcards
When is drug absorption increased?
broken, damaged skin, dry or wet skin, inflammation, large surface area, thinner skin
when is drug absorption decreased?
hairiness, small surface area, thicker skin
What are the risk factors of xerosis?
cold weather, dehydration, elderly, endocrine disorders, frequent hand washing
Xerosis treatment
reduce risk factors, emollients, humectants, urea, allantoin
When should xerosis treatment be administered?
everyday, every other for prevention
Topical acne treatments
retinoic acid, adapalene, adapalene/benzoyl peroxide, dapsone
What are the antibiotics of choice for antibiotics?
clindamycin, doxycycline, erythromycin, minocycline, sulfamethoxazole/trimethoprim
What is the dosage of isotretinoin
1-2 mg/kg divided in two doses daily for 4-5 months
What is considered to be the most efficacious for acne?
isotretinoin (Accutane)
What is the cause of seborrheic dermatitis
unknown but due to fungal infections
What is the treatment of seborrheic dermatitis?
selenium sulfide, cortisone, diphenydramine, cetrizine, fexofenadine, loratadine, ketoconazole, urea, coal tar
Examples of psoriasis meds
hydrocortisone, salicylic acid, urea, eucerin, aquaphor, calamine, coal tar, lactic acid
What are the RX steroids for psoriasis
triamcinolone, betamethasone
Adverse effects of steroids in psoriasis
dermatitis, atrophy, systemic side effects
What is the class 1 steroid?
clobetasol
Calcipotriene, calcitriol for plaque psoriasis
synnthetic vit D3, up to 8 weeks of therapy, ADRs- burning, itching, irritation
Tazarotene treatment of psoriasis
retinoid prodrug, anti-inflammatory,, antiproliferative, once daily
Systemic treatment of psoriasis
acitretin (Soriatane), methotrexate
Acitretin pearls
retinoid metabolite, effective in pustular psoriasis, 25-50 mg daily, ADR- liver failure, high cholesterol, teratogenic
Methotrexate pearls
immunosuppressant, antifolate, must give folic acid, dosed weekly to limit toxicity, ADR- abdominal, nausea, immunosuppression, liver failure, renal failure
What are contraindications of methotrexate?
pregnancy, hepatitis, renal impairment, thrombocytopenia, leukemia
Biologic treatment for psoriasis
hymire, enbrel, infliximab
Adalimumab (Humira) dosage
80 mg SQ, then 40 mg every other week
Etanercept (Enbrel)
50 mg SQ twice weekly x3 months, then 50 mg weekly
Infliximab (remicade)
5 mg/kg/IV infusion, repeated at week 2 and 6 then every 8 weeks
ADRs of biologic
serious infections, increased risk of lymphoma, require negative TB test prior to initiation
OTC dermatitis treatment
cortisone, Benadryl, zyrtec, allegra, Claritin, eucerin, aquaphor, tecnu
Dermatitis prescription treatment
phototherapy, tacrolimus, pimecrolimus
Tacrolimus (Prograf)
suppresses inflammation, apply twice daily until skin is clear, available as .03% and .1%, ADR of burning and local irritation
Pimecrolimus (Elidel)
suppresses inflammation, apply twice daily until skin is clear, is available in 1% cream, ADR- burning and local irritation
OTC wart treatment
freeze away, compound-W, caustic pencil (silver nitrate)
Salicylic acid in wart treatment
solubilize cell surface protein that keep the stratum corneum intact, keratolytic at concentrations 3-6%, ADR- urticaria, local irriation, inflammation, salicylism
Urea in wart treatment
breaks hydrogen bonds that keep the stratum corneum intact, 20% concentration is keratolytic
Genital wart treatment options
surgical removal, cryosurgery, laser treatment, imiquimod (Aldara), Sinecatechins (Veregen), podophyllum resin, podofilox
Imiquimod (Aldara)
anti-proliferative, apply 3 times per week leave on 6-10 hours, ADR- pruritis, erythema, superficial erosion
Sinecatechins (Veregen)
water extract from green tea leaves, apply TID, long duration of therapy, no more than 16 weeks,, ADR- local irritation
Podophyllum resin, podofilox
cytotoxic agents, resin- apply 25% conc to wart then remove after 2-3 hours, if no improvement after 3-5 therapies consider alternative options, podofilox- apply .5% conc BID x3 days then at least 4 days of no treatment
ADRs of resin and podofilox
highly irritating, toxic if systemically absorbed, NV, muscle weakness, neuropathy
Treatment options of lice
lice comb, petroleum jelly, mayo, PB, benzyl EtOH, malathion
Rid treatment of lice
synergized pyrethrins, head+ pubic lice, apply for 10 mins then shampoo and comb, does not kill eggs so repeat in 7 days
Nix treatment of lice
permethrin, head lice only, apply washed hair, leave on for 10 mins and comb through, may repeat in 7-9 days if active lice seen
Ovide treatment of lice
malathion, head+ pubic lice, apply to dry hair, leave on 8-12 hrs, then shampoo and comb, may repeat 7-9 days, most efficacious, but$$
OTC scabies treatment
Calcmine lotion, camphor, benadryl, zyrtec, allegra, claritin
Prescription treatment of scabies
permethrin, 5%, Croamiton (eurax), lindane
Crotamiton (Eurax)
MOA unknown, 10% conc of cream or lotion, apply twice, separated by 24 hrs, ADR- dermatitis, local irritation
Lindane
single application left on for 8-12 hrs, repeat if active mites and >1 week after initial treatment, ADR- local irriation, systemic absorption leading to neurotoxicity and hematotoxicity, may be carcinogenic
Topical treatment for bacterial infections
Bacitracin/polymixin B/neomycin (Neosporin), bacitracin, gramicidin, mupirocin, retapmulin, neomycin, gentamycin
Bacitracin and gramicidin
peptide abx, ADR- allergic contact dermatitis, urticaria
Mupirocin (bactroban)
inhibits synthesis, eradication of nasal colonization of MRSA, adr- pruritis, localized burning
Retapamulin (Altabax)
inhibits protein synthesis, ADR- eczema, pruritus, irritation
Neomycin (neo-fradin)
aminoglycoside abx, activity against gram -, partial activity against gram +, ADR- allergic contact dermatitis
Gentamycin (Garamycin)
aminoglycoside abx, activity against gram -, partial activity against gram +, if applied to large SA, detectable serum conc possible, ADR- nephrotoxicity, neurotoxicity (systemic only)
OTC fungal infection products, topical
terbinafine (Lamisil), clotrimazole (Lotrimin), Ketoconazole (Nizoral), miconazole (Desenex), Tolnaftate (Tinactin), Naftifine (Naftine)
OTC fungal infection products, internal
niconazole (Monistat), tioconazole (vagistat)
Imidazole
reduce ergosterol synthesis by inhibiting fungal cytochrome P450, applied once/twice dialy for 2-3 weeks, combo w/ steroid for more rapid symptomatic improvement
Allylamines
active against dermatophytes, less against yeast, selectively inhibit squalene epixidase, a key enzyme in the synthesis of ergosterol, applied BID
Nystatin
active against yeast not dermatophytes, binds to ergosterol and forms pires, leading to potassium loss, adicofication and cell death, apply 2-4 times/ day, minimal SE, loca irritation, amphotericin B- yellow skin
Dosage of azole derivatives
Fluconazole- 100 mg, itraconazole- 200 mg, ketoconazole- 200 mg
ADR of azole deriviatives
nausea, elevations of hepatitic enzymes, hepatitis
Terbinafine (terbinex)
alters fungal cell membrane, causing cell death, 250 mg daily for 6 weeks, or 12 weeks for toe infections, ADR- hepatitc infection