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GI/Skin Therapeutics > Exam 1: eyes & skin > Flashcards

Exam 1: eyes & skin Flashcards

1
Q

exacerbating factors for atopic dermatitis (eczema)

A

stress, anxiety, heat, low humidity, contact allergens

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2
Q

mild/moderate tx for atopic dermatitis

A

1st line: topical corticosteroids
Low potency: Desonide 0.05% BID x2-4 weeks
High potency: Triamcinolone acetonide ointment 0.5% 1-2 weeks & taper down
For face/flexures: low potency qd x5-7 days or Tacrolimus 0.03% & 0.1% or Pimecrolimus 1% BID
-Crisaborole: use in pts 2+ yrs

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3
Q

Severe disease tx for atopic dermatitis

A

1- soak & smear then apply high potency steroid
2- wet wraps
Drugs: Dupilumab, cyclosporine, methotrexate, Azathioprine, MMF mycophenolate mofetil

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4
Q

characteristics of allergic contact dermatitis

A

erythematous, indurated, scaly plaques

-can be caused by latex, poison ivy, poison sumac or oak, metals, topical antibiotics,

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5
Q

Treatment of allergic contact dermatitis

A

1st line: topical corticosteroids

  • high potency on thick skin or non face/flexural areas
  • medium potency on face or flexures - NOT LONGER THAN 2 WEEKS
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6
Q

when do you use topical calcineurin inhibitors in allergic contact dermatitis?

A

for chronic, localized ACD or ACD involving face or intertriginous areas (does NOT work for urushiol rashes)

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7
Q

when are systemic corticosteroids used in allergic contact dermatitis?

A

for pts with ACD >20% of BSA or for acute ACD of face, feet, hands or genitalia

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8
Q

what are some drying and soothing agents that are used in allergic contact dermatitis?

A
  • drying: aluminum acetate soaks

- soothing: oatmeal baths, calamine lotion

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9
Q

what is toxicodendron dermatitis caused by?

A

-poison ivy, oak, sumac = redness, itching, swelling & blisters (URUSHIOL)

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10
Q

How to treat toxicodendron dermatitis:

A

-soothing measures
-calamine lotion
-topical astringents (aluminum acetate, aluminum sulfate calcium acetate)
-high potency topical corticosteroids
-for severe, facial, genital exposures: prednisone taper over 2-3 weeks
DO NOT use antihistamines or topical CIAs

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11
Q

What is seborrheic dermatitis caused by?

A
  • inflammatory reaction to Malassezia (yeast)

- incidence: in infants 2weeks-12 months

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12
Q

Management of seborrheic dermatitis

A
  • topical anti-fungal agents: ketoconazole 2%, selenium sulfide 2.5%, zinc pyrithione 1% shampoos, ciclopirox 1% or .77% ointment
  • systemic anti-fungals: (severe) itraconazole, ketoconazole, fluconazole & terbinafine
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13
Q

what is cradle cap and how do you treat it?

A
  • asymptomatic & non-inflammatory accumulation of greasy scales on the scalp
  • treat with baby shampoo & remove the scales with a soft brush or used mineral oil and then baby shampoo
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14
Q

What are causes/signs of bacterial conjunctivitis?

A

(s aureus, s pneumoniae, h influenzae & m catarrhalis)

-morning crusting–> thick “pus”, yellow, white or green

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15
Q

What are the treatment for bacterial conjunctivitis?**

A

1-Erythromycin 5 mg/g oint 1/2 inch QID x 5-7 days
2-Trimethoprim/polymyxin B .1%-1000 u/g drops: 1-2 drops qid x5-7 days
(for contact wearers: ofloxacin 0.3% or ciprofloxacin 0.3%)

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16
Q

New born ocular infections: Neisseria gonorrhoeae

A

-purulent conjunctivitis, profuse exudate, swelling of eyelid
SYSTEMIC tx: single dose IV or IM ceftriaxone

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17
Q

Newborn ocular infections: Chlamydia trachomatis

A

SYSTEMIC tx: PO erythromycin 50mg/kg/day in 4 divided doses x 14 days or azithromycin 20mg/kg/day x 3 days

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18
Q

Viral conjunctivitis (pink eye) signs& symptoms

A
  • fever, pharyngitis, URI
  • burning, sandy, gritty feeling
  • injection, watery or mumcoserous discharge
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19
Q

Viral conjunctivitis (pink eye) treatment**

A
  • Naphazoline/Pheniramine 1-2 gtt qid
  • azelastine (optivar) 1 gtt bid
  • ketotifen (zaditor). 1 gtt bid
  • olopatadine (patanol)
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20
Q

allergic conjunctivitis signs

A

-intense itching, hyperemia, tearing, chemises & eyelid edema

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21
Q

allergic conjunctivitis treatment

A

(same as pink eye)

  • na/ph
  • AKO
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22
Q

toxic conjunctivitis signs & tx

A
  • direct damage to the ocular tissues : redness, edema, mucus discharge, swollen/thickened eyelids
  • treat with: loteprednol
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23
Q

treatment for fleas

A

-ice pack, calamine, oral antihistamines & topical corticosteroids

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24
Q

treatment of bedbugs

A
  • low or medium potency topical corticosteroid

- systemic antihistamine

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25
Q

treatment of pediculuc humanus capitis (head lice)**

A
  • permethrin 1% (> 2 month olds)
  • Pyrethrins & piperonyl butoxide: > 2 year old
  • trimethoprim-sulfamethoxazole + permethrin (oral, for resistant cases)
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26
Q

treatment of pubic lice

A
  • topical permethrin 1% or pyrethrins + piperonyl butoxide (retreat 9-10 days after)
  • treat sexual partner as well
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27
Q

treatment of ciliaris lice (eyelashes)

A
  • manual removal or ophthalmic grade vaseline bid-qid x 10days
  • alts: oral ivermectin, permethrin 1% cream rinse, lindane 1% lotion, malathion 1% shampoo
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28
Q

classical scabies treatment*

A
  • permethrin 5% cream (apply 1-2 weeks later)

alts: ivermectin 200 mcg/kg x1 (repeat 14 days later), crotamiton 10% cream

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29
Q

crusted/norweigian scabies treatment*

A

-permethrin 5% cream + oral ivermectin

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30
Q

Chiggers treatment

A

-skin disease secondary to the bites of mites
-treat with vigorous soap & water (repel with DEET)
sytemic treatment: topical menthol or calamine lotion, topical corticosteriods, oral sedating antihistamines

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31
Q

Mosquitoes

A
  • inject anticoagulant saliva = welts, pain & itching
  • vectors for spreading west nile, chikugunya and zika virus
  • treat (if needed) with antihistamines, topical and oral glucocorticoids
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32
Q

Ticks

A
  • takes ~36 hours to transmit lymes disease
  • rocky mounted spotted fever: headache, rash, high fever, extreme exhaustion
  • long term complications: neurologic, cardiovascular, musculoskeletal & arthritis
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33
Q

DEET

A
  • do not use for more than 4-8 hours
  • children use concentrations less than 30%
  • age indications for use > 2 months old
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34
Q

Bites (self care things)

A
  • wash with soap&water then ice for 10 mins
  • camphor/menthol: do not use < 2yo or more than 7 days
  • can use pramoxine and benzyl alcohol
  • do not use dibucaine, hydrocortisone or topical diphenhydramine (for more than 7 days)
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35
Q

Exclusions for self care (bites)

A
  • hypersensitivity to bites
  • < 2 years old
  • suspected spider bite
  • signs of secondary infection
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36
Q

Stings (self care things)

A
  • -can use camphor/menthol, pramoxine and benzyl alcohol

- diphenhydramine po 15-50mg may help with itching

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37
Q

Exclusions for self care (stings)

A
  • hives, swelling etc
  • previous sting by honeybee, wasp or hornet
  • previous severe reaction to insect bites
  • fam hx of allergies
  • < 2 year old
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38
Q

what is the normal pH of skin?

A

~4.75-5.7

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39
Q

drugs that cause “acne-like” lesions

A

lithium, phenytoin, glucocorticoids, oral contraceptives, androgens, high dose vitamin B & D, valproic acid, Isoniazid, cyclosporine, Azathioprine, disulfiram, phentermine, Iodides, bromides, danazol

40
Q

Mild acne treatment

A
  • <10 papules

- topical benzoyl peroxide/retinoid

41
Q

moderate acne treatment

A

10-40 papules

-topical bp + oral antibiotic

42
Q

Severe acne treatment

A

40+ papules

-oral Isotretinoin

43
Q

Targeted treatment factors: follicular hyper proliferation

A

-oral/topical retinoids, azelaic acid, salicylic acid, hormonal therapies

44
Q

Targeted treatment factors: increased sebum production

A

-oral retinoids, hormonal therapies, clascoterone cream

45
Q

Targeted treatment factors: C. acnes proliferation

A

-benzoyl peroxide, antibiotics, azelaic acid, dapsone topical

46
Q

Targeted treatment factors: Inflammation

A

-oral/topical retinoids, oral tetracyclines, azelaic acid, clascoterone cream, dapsone topical

47
Q

Clascoterone cream

A
  • androgen receptor inhibitor

- store at 2-8C prior to dispensing, discard 180 days after dispensing or 30 days after opening

48
Q

topical retinoids

A
  • included as initial management in most pts
  • normalize follicular hyperkeratosis
  • may take up to 8-12 weeks to work
  • use a pea sized amount to entire affected area
  • tretintoin NOT applied at the same time as benzoyl peroxide
49
Q

topical retinoids (drugs)

A

Atralin 0.05%, Adapalene, tazarotene, TWYNEO (tretinoin/bp), trifarotene, Epiduo Forte (adapalene and BP), & veltin (clinda + tretinoin)

50
Q

topical antimicrobials

A
  • decrease inflammation & # of C. acnes colonizing skin
  • combo therapy with topical retinoid = more effective
  • to prevent resistance, use with benzoyl peroxide
  • *BP in combo with many things –> if skin/hair bleaching occurs, use clindamycin 1.2%/tretinoin 0.025%
51
Q

Azelaic acid

A
  • helps improve inflammation
  • limits melanin production via inhibitory effect on tyrosine
  • use once daily - burning, itching, redness, hives, anaphylaxis (v rare)
52
Q

Oral antibiotics

A
  • limit duration, if stopped- restart the same one if effective, don’t combine oral & topical, use with BP or other topical retinoids
  • -> tetracycline, doxycycline (both cause photosensitivity)
53
Q

Benzoyl Peroxide

A
  • comedolytic & antibacterial
  • benefits 3-12 weeks
  • start at 2.5% and increase if needed
  • AEs: erythema, scaling, xerosis, stinging/burning, bleaching of hair
54
Q

salicylic acid

A
  • desquamating agent: able to penetrate pilosebaceous follicle
  • synergistic effect with benzoyl peroxide
55
Q

alpha hydroxy acids

A
  • remove top layer of dead skin cells, improve post-inflammatory properties
  • may work synergistically with retinoids
56
Q

tea tree oil

A

melaleuca alternifolia 5%

  • toxic if used internally
  • slower mechanism of action than BP
57
Q

Ethinyl Estradiol/Progestin

A
  • suppress androgen production
  • used to suppress/inhibit sebum production
  • side effects = embolism
  • abx (rifampin) decreases COC efficacy
58
Q

Spironolactone & Drospirenone

A
  • competitively inhibit the binding of androgens to receptors on pilosebaceous unit
  • AEs: menstrual irregulatities, breast tenderness,
  • CI with renal insufficiency –> monitor K+ 4-6 weeks later
59
Q

examples of isotretinoin

A

zenatane, amnesteem, claravis, sotret, absocrica, absorical LD
-used for severe and recalitrant acne

60
Q

CIs of Isotretinoin

A

pregnancy!, underlying psychiatric conditions, concomitant use with tetracyclines/doxycycline/minocycline –> pseudotumor cerebri

  • do not take vitamin supplement = vitamin A toxicity
  • take a baseline LFT & FLP
61
Q

Doses of oral Isotretinoin

A

-0.5 to 1 mg/kd/day in divided dose with food

Micronized dose: 0.4-0.8 mg/kg/day in divided doses

62
Q

iPledge things

A
  • rxs that are more than 30 days beyond the date of the office visit or more than 7days beyond the pregnancy test date will NOT be approved
  • no automatic refills & no more than 30 day supply
  • # of prego tests over course of therapy = n+4 (n = months on drug)
  • must be on TWO forms of contraception
63
Q

acne conglobata

A
  • inflammatory, acne nodules & cysts grow together deep below skin = severe scarring
    tx: isotrentinoin, systemic abx, steroids
64
Q

Acne fulminans

A
  • rare, severe, painful, ulcerating, hemorrhagic, +/- fever or polyarthritis, +/- bone lesions
  • can occur spontaneously or after Isotretinoin
    tx: stop isotretinoin, systemic oral steriods
65
Q

Post inflammatory hyperpigmentation (PIH)

A
  • hypermelanosis of skin d/t inflammation commonly from acne, eczema or burn
  • grey/blue when in dermis
66
Q

1st line tx for PIH

A

first line: hydroquinone 2% BID –> reduces formation & melanization of melanosomes
AEs: halo of hypopogmentation around affected area, exogenous ochronosis “sooty pigmentation*

67
Q

2nd line meds for PIH

A
  • retinoids (tretinoin, tazarotene or adapalene)
  • azelaic acid 20%
  • Tri-lima cream
  • chemical peels or laser resurfacing
68
Q

Maculopapular Rash

A

-most common type
-starts within 7-10 days of drug & resolved within 7-14 days when drug is stopped
offending agents: penicillins/cephalosporins, sulfonamides, anticonvulsants

69
Q

DRESS: drug reaction with eosinophilia & systemic symptoms

A

-exanthematous eruption + FEVER, lymphadenopathy, hematologic abnormalities
-multiorgan involvement: liver, kidneys, lungs
-delayed onset of 1-6 weeks after starting drug
Offending agents: ALLOPURINOL, sulfonamides, anticonvulsants (lamotrigine), dapsone

70
Q

DRESS caused by allopurinol

A

risk factors: excessive allopurinol dose, renal dysfunction, thiazide diuretic use, hypertension, Chinese
kidney dosing: 1.5mg x eGFR

71
Q

DRESS treatment

A

-stop offending drug
-valproic acid is good alt for lamotreigene
-fluid, electrolyte & nutrition management
-no organ involvement: high potency topical steroids
organ involvement: systemic, .5-2mg/kg.day prednisone tapered over 8-12 weeks

72
Q

high class of steriods

A
  • flucinonide 0.05%
  • halcinonide 0.1%
  • betamethasone diproprionate 0.05%
  • triamcinolone cream 0.5%
  • desoximetasone 0.05%
73
Q

medium class of steroids

A
  • triamcinolone cream 0.1%

- mometasone 0.1%

74
Q

Urticaria

A
  • type 1 hypersensitivity- IgE
  • onset within min to hours
  • offending agents: penicillins, sulfonamides, aspirin, opiates, latex
75
Q

Serum Sickness-like reaction

A
  • urticaria, FEVER, arthalgias
  • onset 1-3 weeks after starting drug, symptoms will resolve 1-2 weeks after stopping drug
  • offending agents: penicillins/cephalosporins, sulfonamides
76
Q

Fixed drug eruptions

A
  • SAME spot, simple eruptions with pruritic, erythematous, raised lesions that can blister
  • offending agents: tetracyclines, barbiturates, sulfonamides, codeine, phenolphthalein, acetaminophen & NSAIDs
77
Q

SJS/TEN

A
  • severe, life-threatening - painful bulbous formations with fever, headache, respiratory symptoms, mucous membrane involvement
  • onset 7-14 days after drug exposure
78
Q

SJS/TEN risk factors/ offending agents

A

risk factors: HIV infection, lupus, malignancy, UV light
Offending agents: #1: sulfonamides (Bactrim), penicillins, anticonvulsants, NSAIDS (-oxicams), allopurinol
Sequelae: fluid loss, electrolyte imbalance, hypotension, secondary infections

79
Q

SJS/TEN drug options

A

1- prednisone 1-2mg/kg/day from 3-5 days –> risk is infection, use early on
2- IVIG: does not increase risk of infection, may benefit
3-cyclosporine: 3-5mg/kg/day had been shown to slow down progression- used as 2nd line to pts intolerant of IVIG

80
Q

hyperpigmentation

A
  • phenytoin: increased melanin
  • tetracyclines, silver, mercury, antimalarials: direct deposit
  • AMINODARONE: direct deposition and/or dermal lipofucsinosis
81
Q

photosensitivity

A
  • offending agents: sulfonamides, tetracyclines, amiodarone, coal tar
  • prevention! : education and spf 30
82
Q

1st gen cephalosporins

A
  • cefazolin
  • cefalothin
  • cefaloridine
  • cefadroxil
  • cephalexin
  • cephradine
83
Q

2nd gen cephalosporins

A
  • cefoxitin
  • cefprozil
  • cefotitan
  • cefmetazole
  • cefaclor
  • cefuroxime
84
Q

primary open angle glaucoma risk factors

A
  • elevated IOP (>21)
  • age (>60, >40 for blacks)
  • family hx
  • ethnicity
  • increased cup-to-disc ratio (>.5)
  • central corneal thickness
  • ocular perfusion pressure
  • type 2 diabetes
  • myopia
85
Q

goals of POAG therapy

A
  • treat all pts with elevated IOP & confirmed disc changes/field defects
  • want to lower IOP >25% below pretreatment IOP
86
Q

Prostaglandin analogs (for glaucoma)

A
  • all reduce IOP 25-33%
  • bimatoprost (worst side effects, best efficacy), latanoprost (cheap)
  • AEs: hyperemia, hypertrichosis, infection, headaches
  • CIs: ocular inflammation/infection (keratitis, iritis, uveitis, macular edema)
87
Q

Beta blockers (for glaucoma)

A

-decrease aqueous humor production –> reduce IOP 20-25%
-betaxolol (highly selective for the eye), carteolol, levobunolol, metipranolol & timolol (QD med)
AEs: irritation, cardiac, pulmonary & CNS, tachyphylaxis
CIs: sinus bradycardia, HF, heart block (absolute), pulmonary disease (ralative)

88
Q

A2- adrenergic agnostic

A
  • use in combo, 20-25% IOP reduction
  • AEs: hyperemia, irritation, allerdic reactions, drowsiness, xerostomia & tachyphylaxis
  • -> Brimonidine-Timolol combo- lantoprost sill cheaper
89
Q

Carbonic Anhydrase Inhibitors

A
  • use as add on drug
  • reduce IOP 15-20% (20-30% oral)
  • acetazolamide, brinzolamide, dorzolamide, methazolamide,
  • -> Dorzolamide/timolol: bimatoprost still more poppin tho
90
Q

progression of glaucoma risk factors

A
  • IOP- getting higher
  • older age
  • disc hemorrhage
  • larger cup to disc ratio
  • thinner central cornea
  • lower ocular perfusion pressure
  • poorer adherence to meds!
  • progression in fellow eye
91
Q

ocular hypertension- who should be treated:

A
  • all pts with elevated IOP & confirmed disc changes/field defects
  • those with OH & risk factors: ethnicity, family hx, thin central cornea, large cup to disc ration, IOP > 25 mmHg
92
Q

normal tension glaucoma: who should be treated

A
  • all pts with elevated IOP & confirmed disc changes/field defects
  • those with OH & risk factors: ethnicity, family hx, thin central cornea, large cup to disc ration, IOP > 25 mmHg
  • those with NTG & documented progression of visual field loss
93
Q

primary angle-closure glaucoma

A
  • usually due to lens contacting iris at pupillary margin
    1) normal/high IOP, no/subacute attacks –> most cases have no issues
    2) normal/high IOP with infrequent AACC –> medical emergency! (wild IOP #s, rapid vision loss, unilateral)
94
Q

AACC signs

A
  • can be caused by rapid mydriasis
  • halo around light, edematous cornea
  • pain, headache, n/v
  • emergency!
95
Q

treatment options for AACC - INITIAL

A

1- IV or PO CAI (acetazolamide)
1- topical beta blocker (timolol OU)
1- topical alpha-agonist (apraclonidine OU)
1- topical pilocarpine OU

96
Q

treatment options for AACC- AFTER 1 HR

A

-hyperosmotics (PO glycerin or. isosorbide, IV mannitol- in hospital setting)
-repeat doses of BB, AA & pilocarpinre (timolol & apraclonide)
~may add ophthalmic steroid if there is inflammation

97
Q

Chronic PACG

A
  • use opthalmic prostaglandins & BBs
  • iridotomy (prophylactic)
  • counsel on importance of acute attacks and avoid using OTC drugs that cause pupil dilation

GI/Skin Therapeutics (3 decks)

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