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Dermatology Drugs > Dermatology drugs > Flashcards

Dermatology drugs Flashcards

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Dermatology Board Prep flashcards
1
Q

What are Topical Vehicles

A

In order of moisturizing to drying:

Ointment
Pastes
Creams
Foams
Powders
Aerosols
Gels
Lotions
Wet Dressings
Tinctures

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2
Q

Which Vehicle is more appropriate

A

Use moisturizing if skin is dry; xerosis, lichenification, scaling.

Use drying if the skin is wet; weeping, oozing, vesicular, crusting.

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3
Q

Administration differences

A

Hairy areas my be best to use tinctures, aerosols, lotions, gels.

Pt preference for look and feel ; creams rub in and feel better than ointments.

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4
Q

General use for steroids

A

Anti-inflamatory, anti-pruritic;

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5
Q

Low-Medium dose Steroids

A

Eczema, irritant dermatitis, seborrhea, AD

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6
Q

Low Dose Corticosteroids

A

Alclometasone dipropionate .05%
Hydrocortisone base or acetate .25-2.5%
Triamcinolone .025%
Desonide .05%

*Know in general that triamcinolone is a common topical that varies in potency based on strength.

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7
Q

Intermediate Str Corticosteroids

A

Fluticasone propionate 0.005% - 0.05%
Hydrocortisone Valerate 0.2%
Mometasone 0.1%

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8
Q

High Dose Corticosteroid Usage

A

Psoriasis, Lichen planus, Allergic CD

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9
Q

High Does Corticosteroid Drugs

A

Amcinonide 0.1%
Halcinonide 0.1%

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10
Q

Very High Dose

A

Clobetasol
Halobetasol

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11
Q

What are the Topical Corticosteroid ADRs

A

Cutaneous atrophy; can have purpura and telangiectasia; resolves some months after cessation.

Striae, Acne, refractory rosacea, hypopigmentation, hypertrichosis, glaucoma, alopecia.

Adrenal suppression and iatrogenic Cushing’s

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12
Q

Safety Considerations of Top Steroids

A

CI w/ infection + hypersensitivity

Caution in pregnancy, Children <12

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13
Q

Tx Considerations

A

Use lower does one area of higher absorption

Occlusive dressings - Caution with low-mid; CI in high; AVOID DIAPER AREA

Ointments have the highest effects

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14
Q

What are some considerations for Very High Potency Drugs

A

Do not abruptly stop; swap to a lower potency

No more than 3 weeks

No more than 50 grams per week

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15
Q

What are the 3’s of Top steroids

A

Very High no longer than 3 weeks

Low to high no longer than 3 months

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16
Q

What are some additional prescribing considerations

A

Hydration improves absorption; consider dosing s/p showers.

Most are once or twice a day.

Fingertip = 0.5g = two hands = 2% BSA

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17
Q

What About Psoriasis

A

Typically going to be a very high does medication (betafish) in an ointment vehicle for penetration, and may be BID.

Can Use Vitamin D analogues (calcipotriene)

Retinoids (tazarotene)

These are first line used in mild disease, calcipotriene + corticosteroids most effective.

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18
Q

What about Vitamin D analogues (psoriasis)

A

Calcipotriene - ADR photo-sensitivity, increase to Ca levels, Very irritating (burning, stinging, peeling).

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19
Q

What About Retinoids (psoriasis)

A

Tazarotene - ADR Photo-sensitivity, Cat X, Very irritating (burning, stinging peeling).

This is the only retinoid for psoriasis.

20
Q

What about Calcineurin (psoriasis)

A

Tacrolimus, pimecrolimus - ADRS Local stinging and buring, but less so than vit D analogues and retinoids.

Good for face and folds

21
Q

Steroid free options (psoriasis)

A

Generally good for long term use, anywhere on the body.

22
Q

Non Oral Biologics (psoriasis)

A

Methotrexate - CI in pregnancy, caution in hepatic dysfunction

Soriatane (retinoid) - CI in Pregnancy, Avoid pregnancy x3years after d/c; Causes significant Dryness.

Cyclosporine - CI in uncontrolled HTN and renal DF, Hx of malignancy, phototherapy; Has many drug interactions with 3A4 metabolism

Otezla - My cause weight loss, diarrhea, H/A

23
Q

Important Pearls for oral Nonbiologics

A

Frequent labs for methotrexate, cyclosporine, Soriatane. -especially pregnancy tests.

Concern for drug interactions with Methotrexate/cyclosporine

24
Q

Biological Injectables for (psoriasis)

A

Mab’s - Adalimumab, Ustekinumab, Ixekizumab, Risankizumab

Have BBW with concern of srs infections; Very expensive.

25
Q

Phytotherapy (psoriasis)

A

Is an option

26
Q

Urticaria

A

Antihistamines!

2nd gen - Cetirizine, levocetirizine, loratadine, fexofenadine

1st gen - Benedryl (diphenhydramine) doxylamine. Drowsiness!

27
Q

Mild to Moderate AD

A

Top steroids - main stay, prevent and treat flares.

Calcineurin inhibitors - Tacrolimus, pimecrolimus; ADRs local burning and stinging good for face and folds.

Top phosphodiesterase-4 Inhibitors - Eucrisa

*All non steroids are good for long term use and any body part.

28
Q

Risk v Benefit of Calcineurnin Inhibitors

A

Tacrolimus, pimecrolimus

Okay for any body part and long term use; only local ARDs burning and stinging.

There is a BBW for skin CA and lymphoma but not set in stone.

29
Q

Injectables for AD

A

Very expensive;

Dupixent (dupilumab)

30
Q

First line medications for Acne

A

Mild - BPO/Top retinoid

Moderate - Top retinoid + Oral ABX with or w/o BPO

Severe - Oral Isotretinoin

31
Q

Acne Keratolytics

A

BPO, Salicyclic Acid

BPO - oxidizes bacterial, an effective topical antimicrobial w/ no resistance. OTC

32
Q

Considerations for Keratolytics

A

Formulation - gels penetrates better than creams; want oil free; Alcohol increases ADRs

Strength - Equally effective at all doses

ADR -skin irritations, CD, Dryness, erythema, peeling, stinging, photo-sensitivity. BPO bleaches

33
Q

Acne Topical Retinoids

A

Adapalene (3rd generation) - Least irritating, availible in combo with BPO, 1% gel OTC

Tararotene - Accumulates under upper dermis, good for psoriasis too; ADR: photosensitivity, Cat X. Burning, Stinging, peeling

Trifarotene - against gamma subtype; $$$, selectively targets one type of retinoic receptor - less severe ADR

Tretinoin (1st gen) - OG

Do not contribute to bacterial resistance; Daily or BID

34
Q

More on Topical Retinoids

A

Gels, creams, solutions, lotions; solutions are the most irritating.

Consider Pt skin type, preference, and previous usage.

ADEs: skin peeling, dryness, burning, pruritus, photosensitivity

CAT X

Counseling: use a daily moisturizer with sunscreen

apply to the entire affected area

Sx may worsen with initiations, takes about 8 weeks to see benefits.

Shortened contact time and applying to dry skin will lessen irritation.

35
Q

Antimicrobials for Acne

A

Minocycline top/oral

Doxycycline PO

Sarecycline PO

Do not use PO more than 3 months

Should not be a monotherapy, use multiple MOA Not two ABX

36
Q

Isotretinoin

A

Vit A derivative that reduces sebum production, comedone formation, c acnes colonization, inflammation.

ADRs - Excessive drying, burning, and inflammation of the skin; H/A, inflammation of the lips, dyslipidemia, arthralgias,myalgias, my increase suicidality, ophthalmic ADRs

Need to monitor LFTs, and CBC

CI with pregnancy; IPLEDGE

37
Q

OTC Pediculocides

A

Permethrin, and pyrethrins (nix and rid).

Apply to damp hair for 10 min; Reapply 7-10 days

If there is resistance to one the other will not work.

If after 8 - 12 hours there are no dead lice, there is resistance.

Ivermectin is an OTC ovicidal. Applied similarly; good for >6y/o Pt where resistance is suspected

38
Q

Pediculocides

A

Linedane - ovacidal - BBW for neurologic toxicity (seizures), use only when 1st line fail.

Benzyl Alcohol 5% - apply to dry hair for 10 min; suffocates lice. Reapply x1 week

Malathion - ovacidal - apply to dry hair 10 min

Spinosad - ovacidal - apply to dry hair for 10 min; high ovacidal activity; no need to reapply unless you see living lice still.

Xeglyze - ovacidal - apply to dry hair for 10 min.

39
Q

Scabicide

A

Permethrin 5% cream

Applied from next to soles.

wash off 8-14 hours later, repeat in 48 hours.

Adult dose is usually 30 grams; no more than 2 ounce tube per person, can be used >2y/o

40
Q

Fungal infections

A

Tx is Top/PO depending on location

Topical is sufficient for tinea corporis, tinea pedis, tinea cruris, and tinea versicolor.

Tinea capitis and unguium need oral.

41
Q

Antifungals Imidazoles, triazoles

A

clotrimazole OTC

Ketoconazole OTC (shampoos) RX (cream)

Fluconazole Rx

42
Q

Antifungals Allylamines

A

Butenafine OTC

Terbinafine Rx/OTC

Ciclopirox Rx

43
Q

Topical Antibacterial Agents

A

gm+ : bacitracin

gm - : polymycin b, neomycin

IMPETIGO: Mupirocin (Bactroban)

44
Q

When considering Cellulitis

A

Empiric Tx will be based on purulent v nonpurulent

The organism

Other health conditions: DM, opioid use disorder, renal functions, drug allergies.

45
Q

Mild to moderate non-purulent Cellulitis

A

PO for streptococci - pen VK, cephalexin, dicloxacillin, clindamycin

PO for MRSA - Bactrim, Doxycycline, linazolid.

Increased resistance risk from infections from nasal colonization, recent hosp stays, long term care facilities, ABX use, IV drug use, Immunosuppression, sharing of sports equipment.

Dermatology Drugs (3 decks)

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