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Pharmacology Unit 2 > Dermatology Medications > Flashcards

Dermatology Medications Flashcards

1
Q

Low potency topical corticosteroids

A

Hydrocortisone (0.25-2.5%)
Hydrocortisone Acetate (0.5-1.0%)
Triamcinolone Acetonide (0.025%)

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2
Q

Medium or intermediate potency topical corticosteroids

A

Hydrocortisone valerate (0.2%)
Mometasone furoate (0.1%)
Betamethasone velrate (0.1%)
Triamcinolone acetonide (0.1%)

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3
Q

High potency topical corticosteroids

A

Fluocinonide (0.05%)
Betamethasone dipropionate (0.05%) - cream
Triamcinolone acetonide (0.5%)

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4
Q

Very high potency topical corticosteroids

A

Betamethasone dipropionate (0.05%) - ointment
Clobetasol propionate (0.05%)

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5
Q

What locations and populations should low potency topical steroids be used for?

A

Face
Intertriginous areas (groin and axillae)
Children
Elderly

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6
Q

When should medium potency topical corticosteroids be used

A

Adults
Majority of Areas

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7
Q

When should high potency topical corticosteroids be used

A

Adults with thick plaques not responding to low potency
Palms of hands and soles of feet
Small amount, for short duration over small areas

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8
Q

What pathologies do you use topical corticosteroids for?

A

Atopic Dermatitis
Eczema
Seborrheic Dermatitis
Contact Dermatitis
Psoriasis

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9
Q

Topical corticosteroids mechanism of action

A

Depress the formation, release, and activity of chemical mediators of inflammation
- Anti-mitotic effects may reduce cell turnover
- Vasoconstrictive properties

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10
Q

Pharmacokinetics and Pharmacodynamics of topical corticosteroids

A

Topical corticosteroids are minimally absorbed by normal skin
Absorption is markedly increased in inflamed skin and exfoliative diseases such as psoriasis

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11
Q

Benefits of occlusion therapy

A

increases potency by 10-100 fold

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12
Q

Rapid decreased response (tolerance) to a drug with prolonged exposure

A

Tachyphylaxis
recovery usually occurs after 3-4 days rest
try one week on, one week off

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13
Q

Topical corticosteroids local adverse drug reactions

A

Skin atrophy
Corticoid Rosacea
Perioral Dermatitis
Steroid Acne
Allergic Contact Dermatitis
Secondary Skin Infections

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14
Q

Topical corticosteroids systemic adverse effects

A

Iatrogenic Cushing’s Syndrome
- Weight gain (buffalo hump and moon face)
Hypertension
Hypokalemia
Hyperglycemia
Osteoporosis
Peptic Ulcer Disease
Myopathy

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15
Q

Maximum amount of time to use very high potency topical steroids for?

A

2 - 3 weeks

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16
Q

What medications are used to treat Acne Vulgaris

A

Salicylic Acid
Topical Retinoids
Benzoyl Peroxide
Azelaic acid
Topical Clindamycin

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17
Q

Moderate inflammatory acne treatment

A

Topical Retinoid (QHS)
Topical ABX in the morning
Oral ABX
Benzoyl Peroxide

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18
Q

Hormone-Related Acne Refractory to previous treatment in Non-pregnant female treatment

A

Combined oral contraceptive
Topical Retinoid
Benzoyl Peroxide

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19
Q

Severe or Cystic/Nodulocystic or Resistant Disease
(Acne)

A

Dermatology Referral
Oral ABX and Topical therapy
Oral Retinoid if scarring or failed above

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20
Q

Salicylic Acid

A

Keratolytic Agent
3-6% Concentrations
Mild and Noninflammatory Acne
Higher than 6% used for corn/wart removal
Skin irritation
Photosensitivity

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21
Q

What medication may cause a cross-sensitivity if used with salicylic acid?

A

Aspirin

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22
Q

Topical Retinoids Mechanism of Action

A

Keratolytic agents (Vitamin A derivative)
Decreases cohesiveness of follicular epithelial cells
Convert closed comedones to open ones
Increased follicular turnover

23
Q

Topical Retinoids Use

A

Mild to severe non-inflammatory acne
Inflammatory acne

24
Q

How long does it take to see an improvement in skin with the use of a topical retinoid?

A

4-12 weeks
apply to clean, dry skin at night

25
Q

Adverse effects of Topical Retinoids

A

Skin Irritation
Photosensitivity
Teratogenicity

26
Q

Examples of Topical Retinoids

A

Tretinoin (Retin-A)
Adapalene (Differin)
Tazarotene (Tazorac)

27
Q

Benzoyl Peroxide Mechanism of Action

A

Lipophilic oxidizing agent
Penetrates pilosebacious follicle and releases free radicals which oxidize bacterial proteins
Activity against P.acnes
Peeling and Comedolytic effects

28
Q

Benzoyl Peroxide Use

A

Mild to Moderate Inflammatory Acne
Commonly combined with other agents (ABX)
More effective than Salicylic Acid
Acne Rosacea
Synergist

29
Q

Azelaic Acid Mechanism of Action

A

Inhibits the effect of conversion of testosterone to dihydrotestosterone
Mild anti-inflammatory properties
Anti-microbial activity against P. acnes

30
Q

Azelaic Acid Use

A

Adjunct medication for post-inflammatory hyperpigmentation
Alternative to topical ABX or Benzoyl Peroxide
Acne Rosacea

31
Q

Benzoyl Peroxide Adverse Effects

A

Skin Irritation
2.5% as effective as 10% solution
Bleaching agent
Inactivation of Topical Retinoids

32
Q

Azelaic Acid Adverse Effects

A

Skin Irritation
Hypopigmentation (Vitiligo)
Hypertrichosis (excessive hair growth)

33
Q

Bacitracin

A

Gram Positive:
(Staph, Pnuemo, Strep)
Most Anaerobes:
(Nisseriae, tetanus, diphtheria bacilli)
Can be ointment alone, Neosporin, or Polymyxin B
Decrease Staph in Nares
Poorly Absorbed = Rare Toxicity

34
Q

Polymyxin B Sulfate

A

Gram Negative:
Pseudomonas, E. coli, Enterobacter, Klebsiella
May need to avoid with sulfa allergy
Gram Positive, Proteus, and Serratia = Resistant

35
Q

Neomycin

A

Generally should be avoided
25% have an allergic reaction
Aminoglycoside
Gram Negatives:
E. coli, Proteus, Klebsiella, Enterobacter
Usually found as a combo

36
Q

Mupirocin

A

Most Gram Positive Aerobes (including MRSA)
treats impetigo (staph aureus & GAS)
Intranasal to eliminate carriage of staph aureus

37
Q

Clindamycin

A

Mild to Moderate cases of inflammatory acne
P. acnes
10% absorbed (systemic reactions rare)
Foam = drying and irritation
Lotion and Gel = better tolerated
Solo or Combo
(BenzClin = Benzoyl Peroxide and Clindamycin)

38
Q

Erythromycin

A

Mild to Moderate Inflammatory Acne
assumed to inhibit P. acnes
Can see antibiotic-resistant staph = stop and treat with oral ABX
Water-based gel is less irritating

39
Q

Metronidazole

A

MetroGel
may inhibit Demodex brevis
may have inflammatory activity
some carcinogenic activity in rats
ADR: dryness, burning, cream better tolerated

40
Q

Miconazole (Monistat)

A

vaginal cream for vulvovaginal candidiasis

41
Q

Clotrimazole (Lotrimin)

A

vaginal cream or lotion

42
Q

Ketoconazole (Nizoral)

A

Cream for dermatophytosis and candidiasis
Shampoo or foam for seborrheic dermatitis

43
Q

Clotrimazole-Betamethasone dipropionate cream

A

Anti-fungal + corticosteroid = more rapid symptom relief
Very strong (should only be used in advanced cases)
“Fungus on Steroids” = may make fungal component worse

44
Q

Nystatin

A

Candida albicans
Cutaneous and mucosal due to narrow spectrum
Paronychial and interiginous treatments need BID-TID
Oral Thrush 5mL suspension QID
ADR: nausea, diarrhea, vomiting

45
Q

Imiquimod (Aldara)

A

5% cream for:
genital and perianal warts
actinic keratose (face and scalp)
BCC (trunk, neck, extremities)
Apply to warts 3x a day (wait 6-10 hours)
Use until warts are gone (no more than 16 weeks)

46
Q

Permethrin

A

1% cream (Lice) - up to 80% failure rate
rinse after 10 minutes

5% cream (Scabies)
rinse off after 8-14 hours

47
Q

Ivermectin (Sklice)

A

Lice
0.5% lotion (6 months and older)
Apply for 10 minutes and then rinse
do not repeat use

48
Q

Dermatophytoses

A

Tinea corpus = body
Tinea captitis = head
Tinea cruris = groin
Tinea pedis = feet
Tinea unguium = nail
Treat with -azoles
Nails need systemic oral ABX

49
Q

Pityriasis or Tinea Versicolor

A

Yeast infection = Malasezzia furfur
yeast blocks UV light = hypo-pigmented
Lifeguards

50
Q

Tinea Versicolor treatment

A

Selenium Sulfide (Selsun Blue Shampoo)
Will be lifelong (suppression during summer)

51
Q

Pruritus Ani

A

Perianal itching and discomfort
Treatment:
Keep area clean and dry
High potency topical corticosteroid

52
Q

Lanolin

A

Prevent nipple irritation
Oil that is in wax form
Emollient action

53
Q

Nipple Fissure and Severe Trauma

A

All-Purpose Nipple Oil:
Mupirocin
Betamethasone
Clotrimazole

Pharmacology Unit 2 (3 decks)

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