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Pharmacology > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Topical Retinoids Examples

A
  1. Tretinoin/Retin-A - 1st gen

2. Adapalene/differin - 3rd gen

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2
Q

Oral Retinoids examples

A

isotretinoin/accutane - 1st gen

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3
Q

what are Retinoids?

A

vitamin A derivatives

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4
Q

special considerations with Accutane/Isotretinoin

A
  1. extremely teratogenic (category X) - causes craniofacial abnormalities, CNS structural malformations, cardiovascular abnormalities
  2. need to be part of iPledge program to prescribe and take - can only give 30 days at a time
  3. should avoid pregnancy for 3 years after acitretin is discontinued
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5
Q

general Retinoids MOA

A

increase growth factors –> causes epidermal hyperplasia and thickened skin –> subsequent desquamation and peeling of skin

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6
Q

Isotretinoin/Adapalene Indications

A
  1. acne

2. photoaged skin

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7
Q

Indications for retinoids in general

A
  1. acne
  2. photoaged skin
  3. severe psoriasis not responsive to other treatments
  4. cutaneous T cell lymphoma
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8
Q

Retinoids CI

A
  1. pregnancy - must have extensive conversation

2. tetracycline coadministration - risk of increased intracranial HTN

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9
Q

who are you most concerned about pseudotumor cerebri? how does it present?

A
  1. females, early adolescents to 20s - taking oral retinoids and tetracycline
  2. new onset headache and blurred vision
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10
Q

Retinoids MOA in acne

A
  1. decreases sebum secretion and sebaceous gland size
  2. reduces abnormal follicular epithelial differentiation and desquamation
  3. reduces comedogenesis (comedone is blackhead)
  4. reduces colonization of proprioibacterium
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11
Q

Retinoids MOA in photoaged skin

A

partial restoration of markedly reduced levels of collagen

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12
Q

instructions on how to take oral retinoids

A
  1. take with meals, fatty foods to increase absorption

2. take will full glass of water

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13
Q

Retinoids metabolism

A

liver

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14
Q

Retinoids SE

A
  1. mucocutaenous side effects
    - cheilitis
    - xeroderma
    - skin peeling
    - sicca (dry eyes)
    - epistaxis
  2. myalgias
  3. photosensitivity
  4. depression / changes in mood
  5. hyperostosis (excessive bone growth) after 5 years of treatment
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15
Q

Retinoids patient education

A
  1. side effect of dryness is common, would expect to see it
  2. combat w/ lip balm, vasaline, eye drops, sugarless candy, saline nasal spray
  3. may get worse before you get better
  4. don’t donate blood if taking oral isotretinoin
  5. pregnancy
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16
Q

Retinoids less common SE

A
  1. reversible increase in liver enzymes
  2. elevated cholesterol
  3. transient loss of color or night vision
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17
Q

Retinoids rare SE

A
  1. pseudotumor cerebri
  2. psychosis
  3. IBD
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18
Q

labs to do with isotretinoin

A

baseline LFTs and follow every 1-2 months

urine pregnancy test monthly

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19
Q

keratolytic examples

A
  1. alpha hydroxyl acids
  2. salicyclic acid
  3. benzoyl peroxide (mild) - Benzac
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20
Q

keratolytic MOA

A

break down keratin in skin

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21
Q

keratolytic indications

A
  1. acne (mild keratolytics)
  2. hyperkeratotic lesions - warts, psoriasis, eczema
  3. cosmetic - chemical peels
22
Q

keratolytic CI

A

open wound

23
Q

benzoyl peroxide MOA

A

oxidizes bacterial proteins and deceases anaerobic bacteria in follicles

24
Q

keratolytic formulations

A
  1. cream
  2. ointment
  3. plasters
25
Q

what percentage does salicyclic acid start to become destructive to tissue

A

6%

26
Q

how to apply plasters

A
  1. apply for 4-5 days and then removed

2. occlusive dressing is commonly applied over topical agent to prevent it from being washed away, increases absorption

27
Q

keratolytic SE

A
  1. local skin irritation - redness, itching, tenderness
  2. salicyclic acid toxicity (esp children)
  3. hyperpigmentation if high concentration
28
Q

Topical steroid examples

A
  1. Betamethasone

2. Tramcinolone

29
Q

Topical steroid indications

A
  1. psoriasis
  2. atopic dermatitis
  3. seborrheic dermatitis
  4. contact or irritant dermatitis
30
Q

Topical steroid CI

A

active infection in skin (may cause impetigo)

31
Q

Topical steroid MOA

A

anti-inflammatory effect, vasoconstrictive effect

- inhibits phospholipase A2 –> no arachidonic acid –> no prostaglandins or leukotrienes

32
Q

areas on body with thinner skin

A

face, axilla, groin

33
Q

Things that impact absorption of Topical steroid

A
  1. occlusive skin covering - increase
  2. inflammation - increase
  3. exfoliative skin - decrease
34
Q

Topical steroid potency

A
  1. graded on scale from 1 to 7 with 1 being most potent

2. most use low, medium, high, very high potency

35
Q

Topical steroid formulations

A

ointments, creams, lotions, gels, foam

36
Q

general info/pros/cons of Topical steroid ointments

A

general - water suspended in oil, apply 2-3x per day after skin has been moistened
pros - greatest absorption, good for dry lesions b/c form water barrier (occlusive effects)
cons - greasy and not useful on hairy areas

37
Q

general info/pros/cons of Topical steroid creams

A

semisolid emulsions in 20-50% water
pros - not greasy, easy to use if area is exposed or frequently touching
cons - less potent than ointments

38
Q

general info/pros/cons of Topical steroid lotions

A

general - powder in water formulations
pros - useful in hairy areas and large areas, evaporate and provide cooling and drying effect so good for moist lesions
cons - least potent

39
Q

general info/pros/cons of Topical steroid gels

A

general - oil in water emulsion w/ alcohol in base, liquify on contact with skin
pros - not greasy, useful for hair covered areas

40
Q

general info/pros/cons of Topical steroid foams

A

general - pressurized collections of gaseous bubblies in liquid film
pros - spread readily, easy to apply

41
Q

Topical steroid SE

A
  1. skin atrophy - w/in 2 weeks if high potency
  2. telangiectasia
  3. ecchymosis
  4. striae
  5. hypertrichosis (increased hair)
  6. redness
  7. pigmentation changes
42
Q

Topical steroid systemic SE

A
  1. adrenal suppression
  2. Cushing’s syndrome
  3. Na retention
  4. HTN
  5. mood changes
  6. glaucoma
43
Q

sites to use low potency steroids

A

face, genitals, axilla, neck

children!

44
Q

duration goal or steroid treatment

A

<3 weeks

45
Q

imiquimod / Aldara indications

A
  1. genital and perianal warts resistant to conventional therapy
  2. actinic keratosis
  3. basal cell carcinoma
46
Q

imiquimod / Aldara MOA

A
  1. enhances immune system and stimulates response against abnormal skin cells
  2. increases release of interferon, TNF, interleukins
  3. activates macrophages, Langerhans cells
  4. induces proliferation and maturation of B lymphocytes
  5. enhances NK cell activity
47
Q

imiquimod / Aldara CI

A

none

48
Q

imiquimod / Aldara SE

A
  1. local skin reaction - burning, stinging, itching, redness, swelling
  2. long term skin reactions - pigmentation changes
  3. skin blistering, flaking, crusting, open sores
  4. systemic reactions - fatigue, diarrhea, flu-like symptoms, HA
49
Q

next step if actinic keratosis does not respond to treatment with imiquimod / Aldara

A

biopsy to ensure no carcinoma

50
Q

first line treatment for warts

A
  1. ablation ie. cryoablation using liquid nitrogen - apply for 10-20 seconds
51
Q

5 characteristics that increase the probability that lesion is squamous cell carcinoma

A
  1. hyperkeratosis - raised
  2. full thickness
  3. surrounding induration
  4. surrounding erythema
  5. tenderness

Pharmacology (27 decks)

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