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Pharm: Endocrine and Derm > Dermatology > Flashcards

Dermatology 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
Diaper Dermatitis: usual pathogen and risks?
Irritant dermatitis usually caused by Cutaneous Candidiasis infection (C. Albicans ) Risks: areas where warmth and moisture lead to maceration of skin or mucous membranes
26
Diaper Dermatitis Clinical Presentation
Pruritus, pain Erythematous papules/vesicles, edema Satellite lesions to peri-genital, peri-anal, inner thigh, buttocks
27
Diaper Dermatitis Management
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
28
Pimercrolimus (Elidel) and Tacrolimus (Protopic) MOA and Indication
Inhibit inflammatory cytokine release Minimal systemic immunosuppression Indicated for atopic dermatitis and contact dermatitis Alternative to corticosteroids
29
Imiquimod (Aldara) MOA and Indication
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
Topical Antivirals Names and Indication
Acyclovir (Zovirax) Pencyclovir (Denavir) Treatment of Herpes
31
What do you have to be careful with when using topical antivirals for herpes?
If the vesicles burst after application of the med, then you are helping spread of the herpetic infection
32
What are the species of Pediculosis?
Infestation by human lice Pediculosis capitis-head Pediculosis corporis-body Pediculosis pubis- pubic or crab
33
Pediculosis symptoms
Pruritis and Excoriation
34
Pediculosis is a vector for what other diseases
Typhus | Recurrent Fever
35
Pediculosis Capitis Treatment
``` 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
Pediculosis Capitis Etiology and Signs
More common in women Sides and back of scalp Assess for Visible white flecks (nits) Matting and crusting of scalp Foul odor
37
Pediculosis Corporis Etiology and Signs
Lice live and lay eggs in clothing Itching Assess for excoriation on: Trunks Abdomen Extremities
38
Pediculosis Pubis Characteristics
``` Intense pruritis Vulvar region Peri-rectal More compact Crab-like appearance ```
39
Pediculosis Pubis Etiology and other areas that may be effected
Contracted from: Infested bed linens Sexual intercourse May also infest: Axilla Eyelashes Chest
40
Pediculosis Pubis Treatment
``` Chemical killing Clean linens with hot water and soap Dry-clean Fine-tooth comb Treat social contacts ```
41
Pediculosides Drugs
Lindane (not in California) Hepatotoxic and neurotoxic Permethrin (Nix)
42
Scabies Etiology
``` Contagious skin disease Mite infestation Transmitted by close-prolonged contact with Infested companion Infested bedding ```
43
Scabies is characterized by
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
Scabies Clinical Findings
Hypersensitivity reaction Excoriated erythematous papules ``` Pustules, crusted lesions: Elbows Axillary folds Lower abdomen Buttocks, thighs Between fingers Genitalia ```
45
Scabies Treatment
``` Topical sulfur preparations Crotamiton (Eurax) Permethrin 5% (Elimite) Launder personal items No disinfectant ```
46
Acne Types
Comedones (keratin plugs in sebaceous duct opening) Papules Pustules - MC Nodules Cysts Scars (last 3 are more common in adults and more severe)
47
Acne Pathogens
Propionibacterium acnes Staphylococcus spp. Androgenic stimulation of sebaceous gland
48
Acne Treatment
Keratolytics: Benzoyl peroxide Selenium sulfide
49
Acne Cyst Treaments
Retinoic acid derivatives (a keratolytic): Tretinoin (Retin-A) - topical Isotretinoin (Accutane) –oral
50
What must be done for someone to be able to use | Isotretinoin (Accutane)
Restricted distribution system (iPLEDGE program) | Numerous side effects
51
Acne Antibacterial Topical Treatments
erythromycin clindamycin (Cleocin) Azelaic acid (Azelex, Finacea)
52
Acne Antibacterial Oral Treatments
tetracyclines | erythromycin
53
Rosacea Treatment
Azelaic acid | Metronidazole
54
Psoriasis Topical Treatment
Keratolytics (those that are more potent than benzoperoxide): Coal tar Salicylic acid Corticosteroids (potent) - penetrate through stratum cornea and go to dermal infiltrate
55
Psoriasis Systemic Treatment
Corticosteroids Methotrexate Hydroxyurea (Hydrea)- was a chemotherapeutic agent Cyclosporine (decreases infiltration of inflammatory cells) Infliximab (Remicade)
56
Mild Psoriasis Treatment
Topical (keratolytics, corticosteroids) | Phototherapy
57
Mild psoriatic arthritis Treatment
NSAIDs | Intra-articular injections of corticosteroids
58
Moderate to severe psoriasis and psoriatic arthritis Treatment
``` DMARDs: Methotrexate Cyclosporine Gold Antimalarials ``` Systemic corticosteroids - in more sever cases, MC is prednisone Biologics
59
Criteria for Using Biologics
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
Psoriasis T-Cell Inhibitor Biologics
Alefacept (Amevive) | Efalizumab (Raptiva)
61
Psoriasis TNF Inhibitor Biologics
Etanercept (Enbrel)- Injection Adalimumab (Humira)- Injection Infliximab (Remicade) -IV
62
What is a precaution for use of TNF inhibitors?
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
What glucocorticoid steroid potency can you apply on the face?
Want to make sure only mild corticosteroid is used on the face, no more than .5%
64
Sunscreens strength
Filter UVA and UVB Mild (<10) Moderate (10-15) Strong (>15)
65
``` List the potency of the following glucocorticoids: Hydrocortisone Triamcinolone Desonide Mometasone ```
Hydrocortisone - mild Triamcinolone- intermediate Desonide- potent Mometasone- ultra potent
66
Hair Loss Drug Options
Minoxidil (Rogaine): Vasodilatation Effect not predictable or permanent Finasteride (Propecia)
67
What potency of glucocorticoid is used for psoriasis?
Potent and Ultra Potent
68
Fungal Skin Infection Topical Treatment Options
Clotrimazole (Mycelex) Miconazole (Monistat) Terbinafine (Lamisil) - also good for onychomycosis Ketoconazole (Nizoral) - also available as shampoo Tolnaftate (Tinactin) Nystatin (Mycostatin)
69
Fungal Skin Infections Systemic Treatment
Ketoconazole (Nizoral) Itraconazole (Sporanox) Terbinafine (Lamisil)- also good for onychomycosis Griseofulvin (Grisactin)
70
What is an ADE of both Terbinafine and Griseofulvin
Hepatotoxicity

Pharm: Endocrine and Derm (6 decks)

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