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SMS Week 3 > Dermatology Therapeutics > Flashcards

Dermatology Therapeutics Flashcards

1
Q

in general, what is the most common therapy used in dermatology?

A

topical

creams, gels, lotions, powders, sprays, foams

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2
Q

Since the skin’s role is mainly as a barrier to outside sutbstances, what is drug delivery dependant on?

A
  1. skin type (thinner skin easier than thicker skin)
  2. Skin condition (inflamed, cracked, broken skin will more readily take up med)
  3. Lipid vs. water-based vehicle
  4. charge
  5. concentration gradient
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3
Q

What layer of skin is the “rate limiting step” to topical therapy absorption?

A

stratum corneum

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4
Q

How can we increase the penetrance of a topical med?

A

Hydrate the skin first

use a vehicle with higher occlusiveness and absorption - ointments better than creams, creams better than lotions, lotions better than gels, etc..

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5
Q

What are the actions of corticosteroids?

A

anti-inflammatory

immunosuppressive

anti-proliferative

vasoconstrictive

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6
Q

What are some of the dermatological uses for corticosteroids?

A

eczema, contact dermatitis, psoriasis, lichen planus

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7
Q

What are the adverse effects of corticosteroids?

A

skin atrophy (especially over thing skin like the groin)

striae

acne

suppression of the HPA axis

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8
Q

How are corticosteroids classified by strength?

A

1 to 7 with 7 being the mildest

based on standardized lab vasoconstriction assay

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9
Q

What are retinoids and what do they do?

A

vitamin A analogs

bind to nuclear receptors on DNA and alter gene transcription to regulate cell growth, inhibit carcinogenesis and alter enzymes involved with cellular differentiation

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10
Q

What are three topical retinoids?

A
  1. tretinoin (retin-A)
  2. tazarotene (tazorac)
  3. adapalene (differin)
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11
Q

What are the uses for retinoids?

A

acne

psoriasis

cosmetic skin improvement (wrinkles)

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12
Q

What is the main side effect of the retinoids?

A

dry skin

irritation

sun sensitivity

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13
Q

Specifically what type of acne responds well to retinoid use?

A

comedonal acne

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14
Q

What is Calcipotriene?

A

a vitamin D analog that acts through DNA receptors to alter skin differentiation (similar to the retinoids)

(also called Dovonex)

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15
Q

What is calcipotriene used for?

A

psoriasis

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16
Q

WHat are the 2 side effects of calcipotriene?

A

irritation and increased serum calcium

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17
Q

What are some topical antimicrobials we use?

A

clindamycine or erythromycin gel

benzoyl peroxide gel

tervinafine, oxiconazole (antifungals)

metronidazoles gel (for rosacea!)

bacitracin or mupirocin (on wounds)

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18
Q

What do topical calcineurin inhibitiros (TCIs) do?

A

they are considered the nonsteroidal anti-inflamatory drugs

they work through calcineurin to alter T-cell activation, so they’re good for T-cell mediated diseases like contact dermatitis

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19
Q

What are two TCIs we talked about?

A

tacrolimus (protopic)

pimicrolimus (Elidel)

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20
Q

On what part o the body would you want to use a TCI?

A

On thin skin where it’s better to avoid the steroids

like the eyelids and groin

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21
Q

in terms of sunscreens, which ones actually BLOCK the sun?

A

the metals -

titanium dioxide and zinc oxide

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22
Q

What ist he lowest SPF that can claim reducing skin cancer risk?

A

SPF 15

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23
Q

What term on a sunscreen bottle will mean they cover UVA and UVB?

A

broad spectrum

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24
Q

How does Imiquimod (Aldara) cream work?

A

It’s an immune response modifier that actually INCREASES inflammation
through toll-like receptors

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25
Q

What do we use imiquimod (aldara) for?

A

warts

actinic karatosis

BCC (in situ)

molluscum

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26
Q

What other topical drug can be used in the same situations as Imiquimod?

A

topical 5-fluorouracil

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27
Q

What will happen to Aktinic keratoses during treatment with either imiquimod or 5-FU?

A

THey will get WORSE before they resolve because it’s bringing in the immune response

28
Q

Current research suggest what for wound care?

A

We should keep it covered with a nonstick dressing to allow natural cytokines to facilitate healing

monitor for infection

airing out wounds slows healing and increases likelihod of scarring

29
Q

What are the systemic retinoids?

A
  1. isotretinoin (accutane, sotret ,amnesteem, claravis)
  2. acitretin (soriatane)
30
Q

What are the main concerns with systemic retinoid use

A

dryness

hyperlipidemia

teratogenicity (have to be on birth control)

hepatitis

hair loss

depression?

So in labs you need to monitor lipids, liver function and pregnancy

31
Q

What might we use systemic retinoids for?

A

acne

psoriasis

ichthyosis (“fish skin” issue with holding on to keratinized cells too long)

32
Q

What does Dapsone (sulfone) do?

A

inhibits myeloperoxidase in neutrophils with an affect on CD11a and CD18

so we use it for diseases that are neutrophil rich

33
Q

What conditions do we use Dapsone for?

A

dermatitis herpetiformis

linear IgA disease

bullous lupus

Sweet’s syndrome

spider bites

any neutrophilic skin diagnosis

34
Q

What are the main concerns with dapsone?

A

can cause hemolysis especially in people with G6PD deficiency

ALso methemaglobinemia and motor neuropathy

so check CBC and G6PD in labs

35
Q

How does methotrexate work?

A

it’s a dihydrofolate reductase inhibitor that disrupts DNA synthesis

also immunosuppressive

36
Q

What do we use methotrexate for?

A

psoriasis

CTCL

lupus

37
Q

What are the concerning side effects of methotrexate?

A

hepatotoxicity (so check LFT -live biopsy?)

myelosuppression (so check CBC)

pneumonitis

38
Q

The newest generation of systemic therapy for psoriasis psoriatic arthritis, and RA are what? How do they work?

A

the biological therapies

they are biogenetically engineered proteins that disrupt focused portions of the immune system involved in psorasis

have fewer side effects!

39
Q

What are some of the biological therapies?

A

Amevive - inhibit T memory cells

Enbrel - inactivates TNF

Remicade (inhibits TNF and some cytokines)

Humira (inhibits TNF)

Stelara (binds to p40 subunit of IL-12 and IL-23)

40
Q

WHat does UV light therapy do?

A

It forms pyrimidine dimers in DNA and reduces langerhans cells and leukocytes - thus it’s anti-inflammatry and immunosuppressive

41
Q

What are the 3 versions of UV light therapy?

A

UVB

Narrow band UVB (less likely to burn or cause cancer)

PUVA (Psoralen plus UVA)

42
Q

What are the uses for UV light therapy?

A

psoriasis

pruritus

eczema

CTCL

43
Q

WHat is Minoxidil? What is it used for?

A

It’s Rogaine!

Is acts through vasodilation and direct stimulation of hair shaft growth

Used for alopecia

44
Q

What is Finasteride? What is it used for?

A

Finasteride = Propecia

It blocks the 5-alpha reductase enzyme in follicles to inhibit the conversion of testosteorn to diydrotesterone.

This works better for androgenetic alopecia than minoxidil

45
Q

What do we use liquid nitrogen for?

A

it freezes tissue of warts, actinic keratoses, small skin cancers

46
Q

In moisturizers, what do the following do?

Occlusives?

Humectats?

Emollients?

A

Occlusives trap moisture in

humectants bind water

emollients give skin a smooth feel

47
Q

We don’t we like soaps for cosmetic products?

A

they are made from animal fats and have a negative charge, thus they tend to strop of fnatural skin barrier of lipids resulting in drying.

minimize their use and use non-soap cleansers like Purpose

48
Q

What are alpha hydroxy acids used for?

A

cosmetic effects

they exfoliate, thicken epidermis, stimulate collagen growth and increase skin profusion

this results in fewer wrinkles, more pliable skin and better hydrations

this is what’s used in chemical peels

49
Q

What is alopecia?

A

hair loss

50
Q

What is pediculosis?

A

lice infestation

51
Q

How do scarring and nonscarring alopecias differ?

A

scarring is usually due to an inflamatory process whereas nonscarring is more do to poblems with the hair growth cycle itself (anagen, catagen, telogen)

52
Q

Describe androgenetic alopecia.

A

this is the simple baldness, hereditary alopecia, or pattern alopecia

it’s nonscarring

It’s caused by genetically determined miniaturization of follicles triggered by androgens

More on the top of scalp

More sommon in males, but also in women soemtimes (men tend to get it earlier)

Treat with minoxidil or finasteride

53
Q

What is telogen effluvium?

A

It’s stress hair loss

nonscarring

you get distrupted growth cycle of hairs causing a premature shift from anagen to telogen and the hair falls out in clumps

triggered by pregnancy, surgery, high fever, extreme diet, etc.

54
Q

What is the treatment for relogen effluvium?

A

Once the trigger is removed, it just takes time and reassurance

55
Q

What is alopecia areata?

A

It’s an autoimmune disease where T-cells attack the hair bulbs

You lose circular pathces on the scalp or beard (can end up losing all the hair on the scalp or even on the entire body)

56
Q

What are the treatment options for alopecia areata?

A

It’s difficult

watch and wiat first, then you can use topical or IL steroids

Try minoxidil

57
Q

What is secondary alopecia?

A

It’s diffuse hair thinning as a complication of an existing mediation or medical problem

often from chemotherapy meds, thyroid problems, iron deficiency, nutritional disorders, renal/hepatic failure

58
Q

What is the most common cause of tinea capitis?

Who is affected most often?

A

trichophyton tonsurans

african american kids

59
Q

What is the standard treatement for trichophyton tonsurans?

A

oral griseofulvin

also terinafine or itraconazole

60
Q

What are the two general forms of pediculosis?

A

pediculus humanus capitus (head lice)

Pthirus pubic (pubic lice)

61
Q

What are the treatment options for pediculosis?

A

permethrin (Nix or elimite)

Malathion

Vaseline (for eyelids)

Cetaphil cleanser

remove the nites

HOT water and dryer for clothes and bedding.

Put unwashables in a bag for 2 weeks

62
Q

What is paronychia?

A

inflammation of the nail folds

can be infectious or noninfectious

63
Q

How can you avoid/treat ingrown nails?

A

always cut nails straight across

don’t tear of pull them

wear proper fitting shoes

soak them

take antibiotic if infections

surgery if necessary

64
Q

What is onychymycosis?

A

fungal growth on or under the nail

65
Q

What are the common organisms for onychomycosis?

A

trichophyton rubrum

trichyphyton mentagrophytes

(diagnose with nail clipping cultures)

66
Q

What is the best way to treat onchymycosis?

A

oral tervinafine or itraconazole

67
Q
A

SMS Week 3 (11 decks)

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