Dermatology drugs Flashcards
What are Topical Vehicles
In order of moisturizing to drying:
Ointment
Pastes
Creams
Foams
Powders
Aerosols
Gels
Lotions
Wet Dressings
Tinctures
Which Vehicle is more appropriate
Use moisturizing if skin is dry; xerosis, lichenification, scaling.
Use drying if the skin is wet; weeping, oozing, vesicular, crusting.
Administration differences
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.
General use for steroids
Anti-inflamatory, anti-pruritic;
Low-Medium dose Steroids
Eczema, irritant dermatitis, seborrhea, AD
Low Dose Corticosteroids
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.
Intermediate Str Corticosteroids
Fluticasone propionate 0.005% - 0.05%
Hydrocortisone Valerate 0.2%
Mometasone 0.1%
High Dose Corticosteroid Usage
Psoriasis, Lichen planus, Allergic CD
High Does Corticosteroid Drugs
Amcinonide 0.1%
Halcinonide 0.1%
Very High Dose
Clobetasol
Halobetasol
What are the Topical Corticosteroid ADRs
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
Safety Considerations of Top Steroids
CI w/ infection + hypersensitivity
Caution in pregnancy, Children <12
Tx Considerations
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
What are some considerations for Very High Potency Drugs
Do not abruptly stop; swap to a lower potency
No more than 3 weeks
No more than 50 grams per week
What are the 3’s of Top steroids
Very High no longer than 3 weeks
Low to high no longer than 3 months
What are some additional prescribing considerations
Hydration improves absorption; consider dosing s/p showers.
Most are once or twice a day.
Fingertip = 0.5g = two hands = 2% BSA
What About Psoriasis
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.
What about Vitamin D analogues (psoriasis)
Calcipotriene - ADR photo-sensitivity, increase to Ca levels, Very irritating (burning, stinging, peeling).
What About Retinoids (psoriasis)
Tazarotene - ADR Photo-sensitivity, Cat X, Very irritating (burning, stinging peeling).
This is the only retinoid for psoriasis.
What about Calcineurin (psoriasis)
Tacrolimus, pimecrolimus - ADRS Local stinging and buring, but less so than vit D analogues and retinoids.
Good for face and folds
Steroid free options (psoriasis)
Generally good for long term use, anywhere on the body.
Non Oral Biologics (psoriasis)
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
Important Pearls for oral Nonbiologics
Frequent labs for methotrexate, cyclosporine, Soriatane. -especially pregnancy tests.
Concern for drug interactions with Methotrexate/cyclosporine
Biological Injectables for (psoriasis)
Mab’s - Adalimumab, Ustekinumab, Ixekizumab, Risankizumab
Have BBW with concern of srs infections; Very expensive.
