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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
Adverse effects of Topical Retinoids
Skin Irritation Photosensitivity Teratogenicity
26
Examples of Topical Retinoids
Tretinoin (Retin-A) Adapalene (Differin) Tazarotene (Tazorac)
27
Benzoyl Peroxide Mechanism of Action
Lipophilic oxidizing agent Penetrates pilosebacious follicle and releases free radicals which oxidize bacterial proteins Activity against P.acnes Peeling and Comedolytic effects
28
Benzoyl Peroxide Use
Mild to Moderate Inflammatory Acne Commonly combined with other agents (ABX) More effective than Salicylic Acid Acne Rosacea Synergist
29
Azelaic Acid Mechanism of Action
Inhibits the effect of conversion of testosterone to dihydrotestosterone Mild anti-inflammatory properties Anti-microbial activity against P. acnes
30
Azelaic Acid Use
Adjunct medication for post-inflammatory hyperpigmentation Alternative to topical ABX or Benzoyl Peroxide Acne Rosacea
31
Benzoyl Peroxide Adverse Effects
Skin Irritation 2.5% as effective as 10% solution Bleaching agent Inactivation of Topical Retinoids
32
Azelaic Acid Adverse Effects
Skin Irritation Hypopigmentation (Vitiligo) Hypertrichosis (excessive hair growth)
33
Bacitracin
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
Polymyxin B Sulfate
Gram Negative: Pseudomonas, E. coli, Enterobacter, Klebsiella May need to avoid with sulfa allergy Gram Positive, Proteus, and Serratia = Resistant
35
Neomycin
Generally should be avoided 25% have an allergic reaction Aminoglycoside Gram Negatives: E. coli, Proteus, Klebsiella, Enterobacter Usually found as a combo
36
Mupirocin
Most Gram Positive Aerobes (including MRSA) treats impetigo (staph aureus & GAS) Intranasal to eliminate carriage of staph aureus
37
Clindamycin
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
Erythromycin
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
Metronidazole
MetroGel may inhibit Demodex brevis may have inflammatory activity some carcinogenic activity in rats ADR: dryness, burning, cream better tolerated
40
Miconazole (Monistat)
vaginal cream for vulvovaginal candidiasis
41
Clotrimazole (Lotrimin)
vaginal cream or lotion
42
Ketoconazole (Nizoral)
Cream for dermatophytosis and candidiasis Shampoo or foam for seborrheic dermatitis
43
Clotrimazole-Betamethasone dipropionate cream
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
Nystatin
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
Imiquimod (Aldara)
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
Permethrin
1% cream (Lice) - up to 80% failure rate rinse after 10 minutes 5% cream (Scabies) rinse off after 8-14 hours
47
Ivermectin (Sklice)
Lice 0.5% lotion (6 months and older) Apply for 10 minutes and then rinse do not repeat use
48
Dermatophytoses
Tinea corpus = body Tinea captitis = head Tinea cruris = groin Tinea pedis = feet Tinea unguium = nail Treat with -azoles Nails need systemic oral ABX
49
Pityriasis or Tinea Versicolor
Yeast infection = Malasezzia furfur yeast blocks UV light = hypo-pigmented Lifeguards
50
Tinea Versicolor treatment
Selenium Sulfide (Selsun Blue Shampoo) Will be lifelong (suppression during summer)
51
Pruritus Ani
Perianal itching and discomfort Treatment: Keep area clean and dry High potency topical corticosteroid
52
Lanolin
Prevent nipple irritation Oil that is in wax form Emollient action
53
Nipple Fissure and Severe Trauma
All-Purpose Nipple Oil: Mupirocin Betamethasone Clotrimazole

Pharmacology Unit 2 (3 decks)

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