Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Pharmacology I > Dermatology > Flashcards

Dermatology Flashcards

1
Q

How are drugs absorbed into the skin?

A

By concentration gradient, via Fick’s law

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does the concentration gradient work?

A

The higher the concentration gradient on the outside of the membrane, the faster the drug will absorb through to the other side.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does the skin extend the half-life of a medication?

A

By acting as a reservoir.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What drugs are most easily absorbed?

A

Lipophillic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you determine which vehicle to use?

A

Drug solubility, ability to hydrate stratum corneum, and stability of drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

To increase penetration, what layer of skin must be hydrated?

A

Stratum Corneum; its harder to get through dry skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tinctures, lotions, gels, and aerosols – Convenient for what type of area?

A

Hairy areas; Avoid ointments and creams.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are wet dressings used?

A

They provide evaporative cooling and cause vasoconstriction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal saline and acetic acid - provide what benefit?

A

Wet dressings; evaporative cooling and vasoconstriction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What vehicle provides drying and cooling along with moisture absorption, which creates more surface areas for evaporation?

A

Powders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What vehicle is a suspension or solution of a powder in a water vehicle that is both drying and cooling?

A

Lotion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a solution?

A 
Substance dissolved (solute) in another substance (solvent). 
Stability depends how well its dissolved.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a gel? What does it contain?

A

Clear, nongreasy, nonstaining, nonocclusive, and quick drying semisolid emulsions.

Contain propylene glycol; good for hair covered areas or the face where patients want to avoid greasy look after application.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If lesion is wet, acute, oozing, crustin, or has vesiculations, what must you do?

A

DRY it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a lesion is dry, chronic, scaling, xerotic, or licheenified, what must you do?

A

WET it - creams and ointments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is used in severe dryness?

A

Ointments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common vehicle used?

A

Creams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What vehicle is not very occlusive, but is rubbed in until it vanishes and is suited for non-irritable dermatoses?

A

Cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe an ointment.

A

Most are oil in water based.
Used to relieve dryness and brittleness.
Not use in hair covered areas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Your patient presented with a fissured area. What’s the best vehicle to protect area?

A

Ointment. Good for damaged skin to provide occlusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a disadvantage of aerosols?

A

Expensive and less efficient than topical methods.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is an advantage of aerosols?

A

Application doesn’t require contact.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What vehicle is most drying?

A

Tinctures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What vehicle is least drying?

A

Ointment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Your patient has oozing, vesiculous, and crusting lesion. You decide an ointment is the best choice. Are you correct?

A

No; ointments are for scaling, lichenified, and xerotic lesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Your patient presents with a scaling, lichenified, and xerotic lesion. You decide a tincture is the best choice. Are you correct? Why?

A

No, tinctures will exacerbate the dryness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

You have prescribed a cream for your patients lesion. Describe the lesions most likely characteristics:

A

Scaling, lichenified, and xerotic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the pharmacologic advantage of a cream?

A

Leaves concentrated drug on the skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the pharmacologic advantage of an ointment?

A

Leaves protective, oily film on the skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the pharmacologic advantage of a gel?

A

Non-staining and gets rid of greasy appearance because it dries fast.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How can the make up of a vehicle contribute to microbial growth?

A

The higher the water content, the more microbes that have the opportunity to grow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Emulsions

A

Oil in water - greater occlusion than lotion, but less than ointment.
Used on dry skin.

Water in oil - easier to apply; where dry skin predominates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the drug of choice for all inflammatory and pruritic eruptions? i.e. Allergic contact dermatitis, atopic eczema, seborrheic dermatitis.

A

Topical Corticosteroid agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are CI of topical corticosteroid agents?

WHY?

A

Exacerbates acne vulgaris, warts, fungal infections, and ulcers.

Depresses the immune system so can’t be used for warts or fungus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are ADR of topical corticosteroid agents?

A

Skin atrophy, fine hair, bruising, striae – ONLY seen when high potency is used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Your patient presents with acne vulgaris and tinea pedis – Would you prescribe a corticosteroid for this?

A

No, topical corticosteroids aren’t used for fungal infections or acne.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What do you consider when selecting form of corticosteroid to use?

A

Lesion location and type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are minimum and maximum applications for topical corticosteroids?

A

At least BID but up to QID to recieve maximum benefit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When applying topical corticosteroids to an area of thinner skin, what should you consider?

A

Absorption will be higher, must prescribe a lower potency.

Areas: scrotum, axillae, face.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What potency topical is used on forearm?

A

Medium to high potency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

If a pt has oily skin, would you choose cream or ointment?

A

Cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Why would you choose an ointment for dry skin over a cream?

A

Ointments are more occlusive and better absorbed than creams. Preferred on dry skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Where would you want to use a low potency TC?

A

Face, scrotum, vulva, and skin folds.

LOW potency needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Hydrocortisone valerate is a salt form of hydrocortisone. What potency does this salt form have?

A

Medium potency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Name 2 low potency TC?

A

Hydrocortisone 1%

Desonide 0.05% (Trideslion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Your patient has lesions on the folds of his skin, what is a good medication to use?

A

Hydrocortisone 1%

Desonide 0.05% (Trideslion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Name a popular medium potency agent used to treat eczema and psoriasis.

A

Triamcinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When is it okay to use a high potency TC?

A

Lesions that are recalcitrant to medium potency steroids. Also used for flare ups.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is Fluocinonide 0.05%?

A

High potency TC used for flare ups.

50
Q

Why are ultra high potency TC often not used?

A

Cause severe inflammation.

Risk to benefit ratio.

51
Q

What is Clobetasol 0.05%?

A

ULTRA high potency TC ointment.

Comes as a cream too - Temovate.

52
Q

MOA Topical Immunomodulators

A

Inhibits T cell, mast cell, and keratinocytes activation.

53
Q

TIM’s are DOC for?

A

atopic dermatitis and chronic inflammatory skin disease.

54
Q

TIMs medications are used as an alternative to TC. Why are they preferred?

A

Better side effects.

Topical steroids can cause skin to thin and atrophy, cause discoloration, acne, adrenal suppression, and osteoporosis.

55
Q

Pimecrolimus cream (EIDEL) and Tacrolimus (PROTOPIC) ointment are examples of?

A

Topical immunomodulators

56
Q

What is another use for Tacrolimus ointment?

A

PO version can help prevent organ rejection in transplant patients; it decreases transcription of inflammatory mediators.

57
Q

What TIMs can cause lymphoma if taken orally, but is not known to cause it in topical form?

A

Tacrolimus, PO version was black-boxed for causing T cell lymphoma.

58
Q

Tacrolimus - potency?

A

Medium

59
Q

Pimecrolimus - potency?

A

Low

60
Q

ADR TIMs?

A

Skin burning and warmth in 25-50% of patients. Must avoid sun exposure and use sunscreen.

61
Q

CI TIMs?

Why are they used?

A

Not good for those with weak immune systemics.

This is a first line steroid sparking agent for atopic dermatitis BID in patients who can’t tolerate topical steroids.

62
Q

Your patient is unable to tolerate topical corticosteroids, you choose to place him on topical immunomodulators. Is this the correct course of action?

A

Yes, as they are considered a first line steroid sparing agent for atopic dermatitis.

63
Q

25-50% of patients using TIMs experience, what?

A

Skin burning and warmth

64
Q

Your pt has a localized contact dermatitis reaction. What should be your initial go to class of medications?

A

Topical Hydrocortisone

65
Q

Your patients dermatitis presents with weeping lesions. What vehicle type would you prescribe?

What would you want to avoid?

A

Prescribe a gel.

Avoid an ointment.

66
Q

What type of conditions require systemic corticosteroid treatment via the PO route?

A

Widespread, progressive, and chronic.

67
Q

What type of agent is used to dry mucous secretions, shrink cells, and cause blanching?

A

Astringents

68
Q

Name two types of astringents.

A

Calamine lotion

Zinc oxide

69
Q

The culture of your pt’s itchy lesions come back positive for MRSA.

Your pt also had an organ transplant 3 years ago. You decide to treat with Clindamycin and a medium potency topical corticosteroid. Is your treatment correct?

A

Clindamycin- YES

Steroid- NO due to immunosuppression

70
Q

Your patient’s nasal culture comes back for MRSA, what is your drug of choice?

A

Bactroban.

71
Q

What systemic antibiotics should be used for 7 days for a more involved impetigo disease?

A

Dicloxacillin

Cephalexin

72
Q

What are the two main causes of impetigo?

A

Staph and strep

73
Q

What is the MOA for Bactroban?

A

Binds bacterial tRNA, preventing protein synthesis.

74
Q

How does Alatbax’s MOA treat MRSA?

A

Inhibits the ribosome

75
Q

What medication is used for impetigo is a potential skin irritant and has possible decreased the penetration?

A

Altabax

76
Q

What is important about the differential Dx for impetigo?

A

Ensure that its not facial contact dermatitis.

77
Q

When would you use topical corticosteroidsin impetigo?

A

Never, there is no place for it in the treatment.

78
Q

What is a fatty lubricant secreted by the skin and what condition will it cause?

A

Sebum

Acne

79
Q

How do abnormal keratinization and increased sebum cause acne?

A

Synergistically, plus the sebaceous follicle.

80
Q

What is the name of the gram positive organism that colonizes the hair follicle?

A

Propionbacterium Acne (Acne Bacillus)

81
Q

What are the four cases of acne?

A

Increased sebum production, increased keratinization, Bacterial colonization,
Immune mediated inflammatory response.

82
Q

Your pt is highly sexually active, eats lots of fast food, only believes in showering 3 times a week cuz she’s a filthy hippie and deals with a large amount of psychological stress because her fragile liberal mind needs safe spaces. What would you tell her about how those conditions contribute to her acne?

A

None of those things contribute to her acne.

83
Q

Your pt feels that steroids will finally give him the muscles that all the ladies want despite the fact he cant chew gum and walk at the same time. How would this impact his acne?

A

Androgens will activate and worsen acne.

84
Q

Explain how physiologic stress impacts acne?

A

Increased stress will increase glucocorticoid secretion, worsening acne.

85
Q

During what seasons will acne worsen and improve?

A

Worsen in winter, improve in summer

86
Q

Explain the five pathogenic steps of acne formation.

A

Pooling of sebum creates anaerobic conditions allowing P.Acne to increase

T-cells respond to this by causing inflammation

The lipase secreted from the bacteria hydrolyze triglycerides into fatty acids

This increases keratinization and comedome formation

Cytokine and chemokines production generates pus

87
Q

Give an example of non-inflammatory acne lesion.

A

open and closed comedomes

88
Q

Give an example of an inflammatory acne lesion.

A

Papulopustular or nodular lesions.

89
Q

What is the curative treatment for acne?

A

There isn’t one, only treatment is to reduce severity.

90
Q

It has only been one week since you started your patient on acne medication. She is upset because prom is two weeks away and there hasn’t been much improvement. What do you tell her?

A

Treatment takes time and she has to allow 1-2months of treatment before modification or seeing results.

91
Q

Name six goals of acne treatment.

A

Realizing this is chronic and requires early, aggressive and maintenance therapy

Reduce the # and severity of lesions

Slow progression of signs and symptoms

Limit duration

Prevent long term disfigurement

Avoid psychological suffering

92
Q

Your patient has been on systemic corticosteroid tx for about 7 weeks now. She develops pustular inflammation of the trunk. What condition does she have?

A

Drug induced acne

93
Q

Name three other types of medications that lead to drug induced acne.

A

Anti-epileptics
Tuberculosis
Lithium

94
Q

What is a critical target for the treatment of acne?

A

The microcomedome to eliminate follicular occlusion in order to arrest the pathologic cascade.

95
Q

What pathogenic steps of acne do you want to target?

A

All of them.

96
Q

What drug is effective at treating all the pathologic steps of acne?

A

Retinoids

97
Q

What medications are effective at normalizing follicular keratinization

A

Retinoids
Azelaic acid
Benzoyl peroxide

98
Q

What medications are effective at decreasing sebum production?

A

Retinoids
Isotretan
Hormone modulation

99
Q

What medications are effective at suppressing bacteria?

A 
Antibiotics
Retinoids
Benzoyl peroxide
Azelaic acid
Isotretan
100
Q

What meds are effective at preventing the inflammatory response?

A

Antibiotics

Retinoids

101
Q

How do surfactant systems work in acne treatment?

A

Remove fats and oils from skin.

102
Q

What is important to remember about topical therapies?

A

They only work where applied. Most cause skin irritation which leads to patient discontinuation.

103
Q

Your patient presents iwth acne caused by P. acnes proliferation. What is your course of treatment?

A

First, benzoyl peroxide. Then, topical and oral antibiotics. Lastly, isotretinoin.

104
Q

Your patient presents with an inflammatory response of acne. What are your treatment options?

A

Intralesional corticosteroids
Oral corticosteroids
Topical and oral antibiotics

105
Q

Your patient presents with abnormal serum production. What are your treatment options?

A 
Anti-androgens
Isotretinoin
Topical and oral abx
Corticosteroids
Estrogens
106
Q

Your patient presents with an abnormal characterization of the follicle. What are your treatment options?

A

Salicylic acid
Benzoyl peroxide
Topical retinoids
Isotretinoin

107
Q

What is the MOA for Benzoyl peroxide?

A

Penetrate the stratum corneum and is then converted to benzoic acid, which has activity against P. acnes.

108
Q

What is the dosing protocol for benzoyl peroxide?

A

Start at a low concentration of 2.5% once daily and hten increase strength/freq as tolerated.

109
Q

Benzoyl peroxide will often be found in combination with what?

A

Antibiotics, such as erythromycin or clindamycin.

110
Q

What are some adverse reactions to benzoyl peroxide?

A

Bleaching of hair and clothes

skin and mucous membrane irritation.

111
Q

What is thought to be the mechanism of action for Azelaic acid?

A

It is thought to inhibit the conversion of testosterone to dihydrogen testosterone.

112
Q

What is an absolute contraindication to vitamin A usage and why?

A

Pregnant women; can lead to severe teratogenicity and don’t want to mess with vitamin A and derivates during pregnancy.

113
Q

What is the acid form of vitamin A?

A

Retinoic acid (Tretinoin)

114
Q

What is thought to be the mechanism of action for retinoic acid?

A

Correct abnormal follicular characterization.
Reduces P. acnes colonies.
Reduces inflammation.

115
Q

Your patient presents with non-inflammatory comedomal acne. What is your first line therapy?

A

Tretinoin

116
Q

You explain to your patient that tretinoin is photolabile. Your patient looks at you with a blank look bc you just used a big word. First, you go over the defintion in your head, wahat does it mean? How do you explain it?

A

Photolabile - something susceptible to chemical change during the exposure to radiant light energy, such as UV rays.

You explain it becomes unstable in sunlight and will cause severe sunburn so she needs to use high SPF sunscreen.

117
Q

Your patient is using both benzoyl peroxide and tretinoin for their acne. Your patient feelslike their condition is not impvoing. What is an important question to ask them about the use of their medication?

A

Have they ensured that they have removed all the benzoyl peroxide from the area prior to tretinoin application. Benzoyl peroxide will ianctivate tretinoin.

118
Q

What topical retinoid is stable in sunlight and with benzoyl peroxide?

A

Adapalene (Differin)

119
Q

This medication is a third generation retinoid used for acne and psoriasis and is sometimes combined with topical steroids to reduce skin irritation?

A

Tazarotene (Tazorac)

120
Q

Topical retinoid treats Kaposi’s sarcoma?

A

Alitretonin (Panretin)

121
Q

This topical retinoid is used for T-cell lymphoma

A

Bexarotene (Targretine)

Clinical Pharmacology I (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions