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Pharm: Endocrine and Derm > Dermatology > Flashcards

Dermatology Flashcards

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Dermatology Board Prep flashcards
1
Q

Characteristics to consider when choosing a particular vehicle?

A

Solubility of active drug
Ability to hydrate stratum corneum
Stability of drug in vehicle
Ability to retard evaporation from the skin (least with tinctures)

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2
Q

Baths Characteristics

A

Completely water soluble
Colloidal
Soothing

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3
Q

Lotions Characteristics

A

Mostly water
Evaporation gives cooling action
Vasoconstriction decreases inflammation

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4
Q

Gel Characteristics

A

Semi-solid colloidal solutions and suspensions
Contain alcohol
Enhance absorption through the skin

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5
Q

Powder Characteristics

A

Absorbent
Can cause crusting
Aspiration
Caution with corn starch (can cause yeast infection or worsen)
Sometimes can have anti-fungal qualities like Nystatin

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6
Q

What is a disadvantage for use of powder in babies and elderly?

A

Aspiration that can lead to pneumonitis

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7
Q

Paste Characteristics

A

Thick ointment containing powder
very adhesive
Don’t need to put on additional addressing (sometimes have to, to keep in place)
Not commonly used

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8
Q

Creams Oil in Water Characteristics

A

Mix with serous discharges (primarily aqueous)
Washable
Will not stain clothing

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9
Q

Creams Water in Oil Characteristics

A

Vehicle for fat-soluble substances

Do not mix with serous discharges

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10
Q

Ointment types and characteristics

A

Water-soluble:
Improve penetration of drugs
PEG (poly ethanol glycol)

Emulsifying:
Mix with water and exudate
Allows for more uniform penetration in the area being treated

Non-emulsifying:
Occlusive dressing, enhance hydration, can help with faster wound healing

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11
Q

Atopic Dermatitis Treatment Options

A
  1. Reduce contact with irritants (soap substitutes)
  2. Reduce exposure to allergens
  3. Emollients
  4. Topical Steroids
  5. Antihistamines
  6. Antibiotics (a last resort, when start seeing a secondary infection)
  7. Steroid sparing
  8. Other (herbals, soaps)
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12
Q

How to reduce contact with irritants

A

Avoid overheating: lukewarm baths, 100% cotton clothes, & keep bedding to minimum

Avoid direct skin contact with rough fibers, particularly wool, & limit/eliminate detergents

Avoid dusty conditions & low humidity

Avoid cosmetics (make-ups, perfumes) as all can irritate

Avoid soap- use soap substitute

Use gloves to handle chemicals and detergents

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13
Q

Soap Substitutes

A

Cetaphil- soap substitute- far less drying and irritating than soap
Cleansing & moisturizing formulations, all OTC
Lotion, bar, ‘soap’, cream, sunscreen
(Costs about $8-9 for 16 oz.)

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14
Q

Emollients

A

Soften the skin and reduce itching.

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15
Q

Moisture trapping effectiveness from best to least

A

Best: Oils (e.g. Petroleum Jelly)
Moderate: Creams
Least: Lotions

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16
Q

When do you apply emollients?

A

after bathing and times when the skin is unusually dry (e.g. winter months).

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17
Q

How to Use Emollients Oils

A

Consider using bath oil or mineral oil-based lotions in lukewarm bath water
Add to tub 15 minutes into bath

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18
Q

Corticosteroid Forms and Common Use

A

Topical steroids very effective
Ointments for dry or lichenified skin
Creams for weeping skin or body folds
Lotions or scalp applications for hair-areas.

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19
Q

How to use Cortcosteroids

A

Once under control, intermittent use of topical corticosteroid may prevent relapse

Systemic steroids may bring under rapid control, but may precipitate rebound

Once daily probably most cost effective

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20
Q

When is antibiotics use acceptable for eczema

A

When secondarily colonized with bacteria.
Use oral antibiotics in recalcitrant or widespread cases.
Usually only need a weeks worth

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21
Q

Antihistamine use

A

Oral antihistamines can reduce urticaria & itch

Non-sedating antihistamines less side effects but more expensive

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22
Q

Alternative medications some patients may use for eczema

A 
Licorice
Calendula
Echinacea
Golden Seal
Nettle 
Oats
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23
Q

What type of soap is recommended for derm?

A

mild or hypoallergenic

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24
Q

Which brand of soap is the worse?

A

Pure Ivory is very drying and irritating

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25
Q

Diaper Dermatitis: usual pathogen and risks?

A

Irritant dermatitis usually caused by Cutaneous Candidiasis infection (C. Albicans )

Risks: areas where warmth and moisture lead to maceration of skin or mucous membranes

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26
Q

Diaper Dermatitis Clinical Presentation

A

Pruritus, pain
Erythematous papules/vesicles, edema
Satellite lesions to peri-genital, peri-anal, inner thigh, buttocks

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27
Q

Diaper Dermatitis Management

A

Topical antifungal agents such as nystatin, miconazole, or clotrimatzole (“no good reason to use a systemic antifungal”)

Topical corticosteroids (can possibly increase severity)

Educate care givers

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28
Q

Pimercrolimus (Elidel) and Tacrolimus (Protopic) MOA and Indication

A

Inhibit inflammatory cytokine release

Minimal systemic immunosuppression

Indicated for atopic dermatitis and contact dermatitis

Alternative to corticosteroids

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29
Q

Imiquimod (Aldara) MOA and Indication

A

Immunomodulator

Treatment of external genital and perianal warts and actinic keratitis

Stimulates peripheral mononuclear cells to release interferon alpha

Stimulate macrophages to produce interleukins and TNF alpha

*can be used for Molluscum

30
Q

Topical Antivirals Names and Indication

A

Acyclovir (Zovirax)
Pencyclovir (Denavir)
Treatment of Herpes

31
Q

What do you have to be careful with when using topical antivirals for herpes?

A

If the vesicles burst after application of the med, then you are helping spread of the herpetic infection

32
Q

What are the species of Pediculosis?

A

Infestation by human lice
Pediculosis capitis-head
Pediculosis corporis-body
Pediculosis pubis- pubic or crab

33
Q

Pediculosis symptoms

A

Pruritis and Excoriation

34
Q

Pediculosis is a vector for what other diseases

A

Typhus

Recurrent Fever

35
Q

Pediculosis Capitis Treatment

A 
Pediculicides
Hand pick or comb nits out
Launder bed linens & vacuum
Seal items in plastic bags for 14 days
Repeat above in 10-14 days
36
Q

Pediculosis Capitis Etiology and Signs

A

More common in women

Sides and back of scalp

Assess for
Visible white flecks (nits)
Matting and crusting of scalp
Foul odor

37
Q

Pediculosis Corporis Etiology and Signs

A

Lice live and lay eggs in clothing

Itching

Assess for excoriation on:
Trunks
Abdomen
Extremities

38
Q

Pediculosis Pubis Characteristics

A 
Intense pruritis
Vulvar region
Peri-rectal 
More compact
Crab-like appearance
39
Q

Pediculosis Pubis Etiology and other areas that may be effected

A

Contracted from:
Infested bed linens
Sexual intercourse

May also infest:
Axilla
Eyelashes
Chest

40
Q

Pediculosis Pubis Treatment

A 
Chemical killing
Clean linens with hot water and soap
Dry-clean
Fine-tooth comb
Treat social contacts
41
Q

Pediculosides Drugs

A

Lindane (not in California)
Hepatotoxic and neurotoxic

Permethrin (Nix)

42
Q

Scabies Etiology

A 
Contagious skin disease
Mite infestation
Transmitted by close-prolonged contact with
Infested companion
Infested bedding
43
Q

Scabies is characterized by

A

Epidermal curved or linear ridges

Follicular papules

Pruritus Palms

More intense and unbearable at night

White visible epidermal ridges by mite burrowing into outer layers of skin

44
Q

Scabies Clinical Findings

A

Hypersensitivity reaction

Excoriated erythematous papules

Pustules, crusted lesions:
Elbows 
Axillary folds
Lower abdomen
Buttocks, thighs
Between fingers
Genitalia
45
Q

Scabies Treatment

A 
Topical sulfur preparations
Crotamiton (Eurax)
Permethrin 5% (Elimite)
Launder personal items
No disinfectant
46
Q

Acne Types

A

Comedones (keratin plugs in sebaceous duct opening)
Papules
Pustules - MC
Nodules
Cysts
Scars
(last 3 are more common in adults and more severe)

47
Q

Acne Pathogens

A

Propionibacterium acnes
Staphylococcus spp.
Androgenic stimulation of sebaceous gland

48
Q

Acne Treatment

A

Keratolytics:
Benzoyl peroxide
Selenium sulfide

49
Q

Acne Cyst Treaments

A

Retinoic acid derivatives (a keratolytic):
Tretinoin (Retin-A) - topical
Isotretinoin (Accutane) –oral

50
Q

What must be done for someone to be able to use

Isotretinoin (Accutane)

A

Restricted distribution system (iPLEDGE program)

Numerous side effects

51
Q

Acne Antibacterial Topical Treatments

A

erythromycin
clindamycin (Cleocin)
Azelaic acid (Azelex, Finacea)

52
Q

Acne Antibacterial Oral Treatments

A

tetracyclines

erythromycin

53
Q

Rosacea Treatment

A

Azelaic acid

Metronidazole

54
Q

Psoriasis Topical Treatment

A

Keratolytics (those that are more potent than benzoperoxide):
Coal tar
Salicylic acid

Corticosteroids (potent) - penetrate through stratum cornea and go to dermal infiltrate

55
Q

Psoriasis Systemic Treatment

A

Corticosteroids
Methotrexate
Hydroxyurea (Hydrea)- was a chemotherapeutic agent
Cyclosporine (decreases infiltration of inflammatory cells)
Infliximab (Remicade)

56
Q

Mild Psoriasis Treatment

A

Topical (keratolytics, corticosteroids)

Phototherapy

57
Q

Mild psoriatic arthritis Treatment

A

NSAIDs

Intra-articular injections of corticosteroids

58
Q

Moderate to severe psoriasis and psoriatic arthritis Treatment

A 
DMARDs:
Methotrexate
Cyclosporine
Gold
Antimalarials

Systemic corticosteroids - in more sever cases, MC is prednisone

Biologics

59
Q

Criteria for Using Biologics

A

18 years or older

Moderate to severe psoriatic arthritis AND:
At least one comorbidity
Inadequate control with DMARD alone
Failed other therapies

No active infection

Normal liver function

60
Q

Psoriasis T-Cell Inhibitor Biologics

A

Alefacept (Amevive)

Efalizumab (Raptiva)

61
Q

Psoriasis TNF Inhibitor Biologics

A

Etanercept (Enbrel)- Injection
Adalimumab (Humira)- Injection
Infliximab (Remicade) -IV

62
Q

What is a precaution for use of TNF inhibitors?

A

TNF inhibitors have been associated with the development of blood cancers, so advise pt about this possible problem.
Always check lymph nodes during exam.

63
Q

What glucocorticoid steroid potency can you apply on the face?

A

Want to make sure only mild corticosteroid is used on the face, no more than .5%

64
Q

Sunscreens strength

A

Filter UVA and UVB
Mild (<10)
Moderate (10-15)
Strong (>15)

65
Q 
List the potency of the following glucocorticoids: 
Hydrocortisone 
Triamcinolone
Desonide 
Mometasone
A

Hydrocortisone - mild
Triamcinolone- intermediate
Desonide- potent
Mometasone- ultra potent

66
Q

Hair Loss Drug Options

A

Minoxidil (Rogaine):
Vasodilatation
Effect not predictable or permanent

Finasteride (Propecia)

67
Q

What potency of glucocorticoid is used for psoriasis?

A

Potent and Ultra Potent

68
Q

Fungal Skin Infection Topical Treatment Options

A

Clotrimazole (Mycelex)
Miconazole (Monistat)
Terbinafine (Lamisil) - also good for onychomycosis
Ketoconazole (Nizoral) - also available as shampoo
Tolnaftate (Tinactin)
Nystatin (Mycostatin)

69
Q

Fungal Skin Infections Systemic Treatment

A

Ketoconazole (Nizoral)
Itraconazole (Sporanox)
Terbinafine (Lamisil)- also good for onychomycosis
Griseofulvin (Grisactin)

70
Q

What is an ADE of both Terbinafine and Griseofulvin

A

Hepatotoxicity

Pharm: Endocrine and Derm (6 decks)

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