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DEENT > Exam 3 Material > Flashcards

Exam 3 Material Flashcards

1
Q

atopic dermatitis

A

chronic skin disease characterized by itchy, inflamed skin
more common in males, white, higher socioecon class, and urban areas
strong genetic link

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2
Q

signs and symptoms of atopic dermatitis

A

red to brownish-gray colored patches that look like chapping
pruritus
small, raised vesicles which may leak fluid and crust over
thickened, cracked or scaly skin
raw, sensitive skin from scratching
secondary bacterial infections are common
Adults: hands/feet
Children: face/scalp

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3
Q

exacerbating factors of atopic dermatitis

A

exposure to allergens
long, hot baths or showers (dries skin out)
dry skin
stress
sweating
rapid changes in temp or low humidity
solvents, cleaners, soaps, or detergents
wool

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4
Q

pathophysiology of atopic dermatitis

A

genetic component:
1) genes encoding for epidermal or other epithelial structural proteins
2) genes encoding for the major elements of the immune system

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5
Q

FLG atopic dermatitis

A

encodes for profilaggrin->degrades to filaggrins-terminal differentiation of epidermis and formation of the skin barrier; natural moisturizers

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6
Q

FLG variants/deficiency

A

results in permeability barrier dysfunction: penetration of high MW allergens in pollens, microbes, food, etc
have more persistent disease, higher incidence of eczema herpeticum, greater risk of multiple allergies
-not exactly a pure correlation btwn FLG deficiency and eczema

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7
Q

genes for cytokines (AD)

A

TH1-suppress IgE
TH2-increase IgE->causes blood eosinophilia, increased total serum IgE, and increased growth and development of mast cells

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8
Q

features of AD pathophysiology

A

skin barrier dysfunction
immune deviation toward TH2
subsequent increased IgE

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9
Q

medication classes for treating AD

A

corticosteroids
calcineurin inhibitors
PDE-4 inhibitors
IL-4ra antagonist

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10
Q

psoriasis

A

chronic disease with recurrent exacerbations/remissions of thickened, red, scaly plaques
keratinocyte hyperproliferation and incomplete differentiation caused by cytokines released from infiltrating activated T cells

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11
Q

pathophysiology of psoriasis

A

T cell mediated systemic inflammatory disease
interaction btwn genetics and environmental influences
comorbidities are consequence of chronic inflammation
defects in epidermal cell cycle
genetic predisposition
immunologic disorder

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12
Q

psoriasis defects in epidermal cell cycle

A

normal: 13 days to divide skin cells and 26 to mature
Psoriasis: 1.5 days to divide and 4 days to mature
T cells contribute to the hyperproliferation of the epidermis
altered maturation of the epidermis occurs

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13
Q

immunologic disorder psoriasis pathophysio

A

keratinocytes encounter an antigen or undergo trauma
inflammatory triggers results in recruitment of T cells to site
histocompatibility complex->release of T cell cytokines->vasodilation and new capillary formation
T cell cytokines also cause further inflammation

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14
Q

contributing factors of psoriasis

A

climate
stress
infections
trauma
-koebner response
medications: lithium, Beta blockers

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15
Q

koebner response

A

lesions begin at previous clear sites on skin as a result of trauma
trauma=friction, venipuncture, bites, surgery, or pressure

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16
Q

medication classes for treating psoriasis

A

corticosteroids
calcineurin inhibitors
cytotoxic agents
T cell and cytokine suppressors
monoclonal antibodies: T cell inhibitor, TNFa inhibitor, IL-12/IL-13 inhibitor, IL-23 inhibitor, IL-17A inhibitor, JAK inhibitor
retinoids
Vit D analogs
PDE-4 inhibitor
phototherapy

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17
Q

pathophys of acne

A

increased androgen production both sexes (puberty)->follicular hyperkeratinization, increased sebum production, proliferation of P. acnes

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18
Q

follicular hyperkeratinization

A

causes skin cells to stick together

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19
Q

sebum production

A

sebaceous gland size/# and sebum production increases with an androgen surge at puberty

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20
Q

P. acnes

A

produces lipase->glyceride from sebum into free fatty acids, which irritate follicular walls
have an antigenic effect

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21
Q

formation of acne

A

skin cells stick together and are NOT shed
channel is plugged by a combo of skin cells and sebum
normal flow of sebum is blocked

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22
Q

exacerbating factors of acne

A

environmental and physical factors:
-high humidity or sweating
-acne mechanica
-occupational acne
-acne cosmetica
stress/emotions
hormones
acne medica mentosa
genetics
high glycemic index diet

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23
Q

acne mechanica

A

anything the occludes the skin or irritates it

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24
Q

occupational acne

A

excessive dirt, vaporized cooking oil, exposure to some industrial chemicals

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25
Q

acne cosmetica

A

mild form of acne to comediogenic oils in cosmetics

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26
Q

medication classes for treating acne

A

keratolytics
antibiotics
retinoids

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27
Q

topical corticosteroids

A

treats psoriasis and AD
low potency for face and long duration maintenance therapy
medium potency for body and short term management

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28
Q

topical corticosteroids side effects

A

local skin reactions
hypothalamic-pituitary adrenal axis suppression, infections, hyperglycemia, cataracts, glaucoma, and growth inhibition

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29
Q

retinoids MOA

A

drug binds to RAR (in the RAR-RXR complex), which then binds to RARE in the nucleus to activate gene transcription

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30
Q

retinoids pharmacodynamic effects

A

decreases proliferation, promotes differentiation, increases the turnover, reduces the cohesiveness
anti-inflammatory and anti-proliferative
reduces the thickness of the stratum corneum
treats acne and psoriasis

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31
Q

tretinoin

A

acid form of Vit A (all-trans retinoic acid or ATRA)
topical
acne: more comedones during first 4-6 weeks and then optimal improvement in 8-12 weeks
apply to dry skin

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32
Q

tretinoin side effects

A

blistering, peeling, crusting, burning, edema
erythema and dryness
tumorigenic potential of UV radiation->minimize sun exposure
teratogenicity

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33
Q

adapalene

A

derivative of naphthoic acid
topical
retinoid
more comedones during first 4-6 weeks and then optimal improvement in 8-12 weeks

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34
Q

adapalene side effects

A

erythema, scaling, dryness, pruritus, and burning

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35
Q

tazarotene

A

derivative of naphthoic acid
topical
psoriasis
retinoid

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36
Q

tazarotene side effects

A

erythema, scaling, dryness, pruritus, and burning
photosensitive
no known systemic SEs

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37
Q

isotretinoin

A

PO for severe acne

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38
Q

isotretinoin pharm effect

A

decreases sebaceous gland size
decreases sebum production
reduces inflammation
reduces keratinization

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39
Q

isotretinoin dermatological side effects

A

inflammation of the lips, epistaxis, itching
skin rash, peeling, photosensitization

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40
Q

isotretinoin systemic side effects

A

arthralgia
persistent headache: pseudotumor cerebri
CNS: lethargy and fatigue; depression, suicidal ideation
ophthalmic
blood lipids
TERATOGENIC

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41
Q

acitretin

A

PO and topical
retinoid
t1/2=49 hrs
drug is still detectable in blood 1-3 years after discontinuation

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42
Q

acitretin pharm effect

A

reduces proliferation and enhances differentiation of keratinocytes
does NOT suppress sebum production

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43
Q

acitretin side effects

A

dermatological
ophthalmic
pseudotumor cerebri
TERATOGENIC

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44
Q

acitretin warnings

A

do NOT drink alcohol with this drug
do NOT use any of the retinoids in patients with AD

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45
Q

calcipotriene MOA

A

exerts its effect through VDR->drug-RXRa complex->increases expression of genes, which improves psoriatic plaques

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46
Q

calcipotriene pharm effect

A

inhibits proliferation and promotes keratinocyte differentiation
decreases inflammation by decreasing inflammatory cytokine release

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47
Q

calcipotriene side effects

A

topical: burning, itching, erythema, mild photosensitivity
systemic: hypercalcemia and hypercalciuria

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48
Q

calcineurin inhibitors

A

used to treat AD and psoriasis
reduce extent and severity of symptoms
inhibit activation of T cells and mast cells, blocking the production of proinflammatory cytokines and mediators->immunosuppressants

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49
Q

calcineurin inhibitors MOA

A

inhibit the production of IL-2 needed for T cell proliferation by inhibiting normal calcineurin activity

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50
Q

topical calcineurin inhibitors pharmacodynamics

A

pimecrolimus and tacrolimus

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51
Q

topical calcineurin inhibitors pharmacodynamics

A

inhibit the activation of key cells involved in AD, including T cells and mast cells, blocking the production of proinflammatory cytokines and mediators
relieves pruritus
tacro: decreases # and costimulatory ability of epidermal dendritic cells
pime: distribute to the skin as opposed to the systemic circulation

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52
Q

topical calcineurin inhibitors side effects

A

transient discomfort at application site
potential for local skin carcinogenesis->rec sun protection
potential for systemic effects if high blood levels are reached

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53
Q

oral calcineurin inhibitor

A

cyclosporine (treats psoriasis)

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54
Q

oral/topical calcineurin inhibitors BBW

A

increased risk of lymphoma and other malignancies
increased susceptibility to bacterial, viral, fungal, and protozoal infections

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55
Q

cyclosporine and tacrolimus side effects

A

nephrotoxicity, HTN, upper resp tract infections, cough and headache

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56
Q

cyclosporine only side effect

A

gingival hyperplasia

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57
Q

tacrolimus only side effect

A

neuropathes

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58
Q

cyclosporine drug interactions

A

with drugs metabolized by CYP3A4

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59
Q

PDE-4 inhibitors MOA

A

nonsteroidal, anti-inflammatory
cAMP is increased, get relaxation of smooth muscle and inhibition of inflammatory cells

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60
Q

PDE-4 inhibitors

A

crisaborole
apremilast

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61
Q

crisaborole

A

mild to moderate AD

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62
Q

crisaborole adverse effects

A

application site pain
hypersensitivity

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63
Q

apremilast

A

treats psoriasis
PO

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64
Q

apremilast side effects

A

diarrhea, nausea, and headache
use cautiously in depressed patients
weight loss
do NOT use with strong CYP3A4 inducers

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65
Q

keratolytics

A

benzoyl peroxide
sulfur
salicylic acid

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66
Q

benzoyl peroxide MOA

A

keratolytic
antimicrobial activity against P. acnes
peeling and comedolytic effects
penetrates stratum corneum or follicular openings then metabolized to benzoic acid

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67
Q

benzoyl peroxide pharm effect

A

loosens keratinocytes
increases turnover rate
prevents closure
antibacterial activity against P. acnes

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68
Q

benzoyl peroxide side effects

A

skin irritation
potent contact sensitizer

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69
Q

benzoyl peroxide cautions

A

AVOID contact with the eyes and mucous membranes
oxidant->bleaches hair or colored fabrics

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70
Q

sulfur MOA

A

mild keratolytic
bacteriostatic properties

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71
Q

sulfur pharm effect

A

sulfur is reduced to H2S inside the keratinocytes
causes inflammation which promotes peeling and unblocking of plugs

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72
Q

sulfur side effects

A

redness, skin irritation, peeling, comedogenic
sulfur odor

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73
Q

salicylic acid MOA

A

may solubilize cell surface proteins that keep the stratum corneum intact, thereby resulting in desquamation of keratotic debris

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74
Q

salicylic acid pharm effect

A

promote the shedding of the stratum corneum
range from peeling to desquamation

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75
Q

salicylic acid concentration

A

3-6% skin conditions: dandruff, acne, and psoriasis
6%-may cause skin damage
up to 40%: wart and corn removal

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76
Q

salicylic acid side effects

A

irritation and inflammation of normal skin
ulceration with high conc
urticaria, anaphylaxis, erythema during allergic rxn
salicylism->salicylate poisoning

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77
Q

salicylic acid caution

A

must be careful when use on extremities of diabetes or patients with peripheral vascular disease

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78
Q

tetracyclines class

A

sarecycline
minocycline
doxycycline
tetracycline

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79
Q

tetracyclines class MOA

A

inhibit protein synthesis by irreversible binding to 30S subunit of bacterial ribosome, blocking aminocyl-tRNA binding to acceptor site on mRNA ribosome complex
enter microorganisms by passive diffusion and active transport

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80
Q

tetracyclines class pharm effect

A

broad-spectrum bacteriostatic antibiotics

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81
Q

tetracycline side effects

A

GI: N/V/D
pseudomembranous colitis
bones and teeth are discolored and growth is impaired in young
photosensitivity
increased incidence of superinfections

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82
Q

clindamycin MOA

A

inhibits bacterial protein synthesis by attaching to the 50S subunit of the bacterial ribosome

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83
Q

clindamycin pharm effects

A

bacteriostatic

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84
Q

clindamycin PO side effects

A

pseudomembranous colitis
N/V/D
impaired liver function
neutropenia-rare

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85
Q

clindamycin topical side effects

A

still has a risk of pseudomembranous colitis
water based: well tolerated and less likely to cause irritation
hydroalcoholic vehicle: drying and irritation
resistance is now a problem

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86
Q

erythromycin and azithromycin MOA

A

macrolide antibiotic that attaches to the 50S ribosomal unit and prevents translocation

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87
Q

erythromycin and azithromycin pharm effect

A

bacterostatic

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88
Q

erythromycin and azithromycin PO side effects

A

N/V/D and epigastric pain
has MANY DIs

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89
Q

erythromycin and azithromycin topical side effects

A

burning and drying (esp with benzoyl peroxide)
resistance is a problem

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90
Q

trimethoprim MOA

A

inhibits bacterial production of tetrahydrofolic acid from dihydrofolic acid by reversibly inhibiting dihydrofolate reductase

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91
Q

sulfamethoxazole MOA

A

inhibits bacterial synthesis of dihydrofolic acid by competing with PABA

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92
Q

dapsone

A

antimicrobial
treats leprosy and acne

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93
Q

dapsone MOA acne

A

anti-inflammatory activity
neutrophils and neutrophil products may be a site of action for dapsone in reducing inflammation

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94
Q

metronidazole MOA

A

is unknown, but it may relate to the inhibitory effects on Demodex brevis (rosacea)
or the drug may act as an anti-inflammatory agent by direct effect on neutrophil cellular function (acne)

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95
Q

metronidazole side effects

A

water based: dry skin, redness, watering of eyes
cream and lotion may be better tolerated

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96
Q

cytotoxic agents

A

coal tar
anthralin
shale tar
selenium sulfide and zinc pyrithione

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97
Q

Coal tar MOA

A

antiproliferative and anti-inflammatory
crosslinks with DNA to inhibit cell division for antimitotic action

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98
Q

Coal tar pharm effects

A

may be anti-inflammatory and antipruritic
affect may be due to placebo effect

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99
Q

Coal tar side effects

A

irritation, stinging, and burning
folliculitis
contact dermatitis
photosensitizing
carcinogenic
systemic side effects do NOT occur
will stain light skin and hair
unpleasant odor

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100
Q

Coal tar caution

A

not studied in preg, breastfeeding, children
AVOID products in AD with vesiculation and oozing

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101
Q

anthralin MOA

A

exact MOA not known
may have a direct antiproliferative effect on epidermal keratinocytes by affecting mitochondria reducing mitotic activity
prevents T cell activation

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102
Q

anthralin pharm effect

A

suppresses hyperplastic keratinocyte cell growth

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103
Q

anthralin side effects

A

local irritation
erythema on normal skin around lesions
severe conjunctivitis with eye contact
systemic SEs do NOT occur
will stain skin, hair, clothes

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104
Q

anthralin use

A

SCAT: applied to thick plaques for < 2 hr and then wiped off; zinc oxide applied to normal skin
severe skin irritation possibility on face and intertriginous

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105
Q

shale tar

A

cytotoxic but MOA is unknown
gives symptomatic relief
less irritating and has NO photosensitizing activity
treats AD, rosacea, and acute otitis externa

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106
Q

selenium sulfide and zinc purithione

A

cytostatic and antifungal activity
MOA not known

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107
Q

t cell suppressor meds

A

methotrexate
mycophenolate

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108
Q

methotrexate MOA

A

inhibits dihydrofolate reductase (DHFR)->causes cell death
direct anti-inflammatory benefits, and a lot of other things

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109
Q

methotrexate pharm effect

A

reduces keratinocyte hyperproliferation-plaque formations
reduces the # of T cells

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110
Q

methotrexate side effects

A

cumulative liver toxicity
abortifacient and teratogenic

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111
Q

mycophenolate MOA

A

inhibitor of T and B cell activation through inhibition of IMPDH, thereby reducing GMP synthesis
preferentially inhibits type II

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112
Q

mycophenolate pharm effect

A

reduces the # of B and T cells
anti-inflammatory

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113
Q

mycophenolate side effects

A

bone marrow suppression, GI upset, flu-like symptoms

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114
Q

monoclonals and small molecule inhibitors drugs

A

abatacept
dupilumab
secukinumab
ixekizumab
broadalumab
ustekinumab
guselkumab
tildrakizumab-asmn
rsankizumab
etanercept
infliximab
adalimumab
golimumab
certolizumab pegol
tofacitinib
ruxolitinib
upadacitinib

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115
Q

abatacept MOA

A

blocks 2nd signal needed for T cell activation
inhibits T cell activation by binding to CD80/86 on APCs; CD28 on T cells therefore cannot bnd and stimulate the T cell

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116
Q

dupilumab MOA

A

binds to IL-4ra->inhibits IL-4 and 13 to decrease IgE synthesis

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117
Q

dupilumab

A

moderate to severe AD
SQ

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118
Q

dupilumab adverse effects

A

generally mild
nasopharygnitis and headache
injection site rxns, conjunctivitis, blepharitis, PO herpes, keratitis, eye pruritus, and dry eye

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119
Q

IL-17 stimulation

A

increases keratinocyte expression of inflammatory cytokines
plaque psoriasis

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120
Q

IL-17 inhibitors

A

secukinumab
ixekizumab
brodalumab

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121
Q

secukinumab MOA

A

IgG1 antibody that binds the IL-17A cytokine, inhibiting its interaction with the IL-17A receptor

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122
Q

secukinumab pharm effect

A

reduces the # and size of plaques

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123
Q

secukinumab side effects

A

risk for infection
evaluated for TB
nasopharyngitis
may exacerbate Crohn’s

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124
Q

ixekizumab MOA

A

humanized IgG4 antibody against IL-17A cytokine

125
Q

brodalumab MOA

A

IgG2 antibody that blocks the release of proinflammatory cytokines and chemokines by selectively binding to IL-17ra

126
Q

ustekinumab MOA

A

IL-12 and IL-23 antagonist; suppresses formation of proinflammatory TH1 and TH17 cells

127
Q

ustekinumab pharm effect

A

reduces the # and size of the plaques

128
Q

ustekinumab side effects

A

upper resp tract infections
serious allergic rxns
serious infections
DO NOT give live vaccines
malignancy

129
Q

guselkumab MOA

A

IgG1lambda antibody
inhibits release of proinflammatory cytokines and chemokines through binding IL-23, which inhibits the interaction of the subunit with IL-23 receptor

130
Q

tildrakizumab-asmn MOA

A

IgG1/k antibody
inhibits release of proinflammatory cytokines and chemokines through binding IL-23, which inhibits the interaction of the subunit with IL-23 receptor

131
Q

IL-23 inhibitor

A

guselkumab
tldraizumab-asmn
risankizumab

132
Q

risankizumab MOA

A

humanized IgG1 antibody
inhibits release of proinflammatory cytokines and chemokines through binding IL-23, which inhibits the interaction of the subunit with IL-23-proinflammatory effect

133
Q

risankizumab

A

SQ and IV
moderate to severe plaque psoriasis

134
Q

risankizumab side effects

A

fatigue, nasopharyngitis, headache, skin rashes, and local injection rxns
severe infections, reactivation of TB, and skin cancer

135
Q

TNFa inhibitors MOA

A

bind to TNFa, preventing it from interacting with TNF receptors on inflammatory cells
reduces the # and size of the plaques

136
Q

TNFa inhibitors BBW

A

increased risk for developing serious infections that may lead to hospitalization or death->lymphoma, malignancies

137
Q

TNFa inhibitors drugs

A

etanercept
infliximab
adalimumab
golimumab
certolizumab pegol

138
Q

etanercept

A

TNFa inhibitor
fusion protein; binds to TNF, making it inactive and preventing it from interacting with the cell-surface TNF receptors that would lead to cell activation

139
Q

etanercept side effects

A

rare
local injection site reactions
pancytopenia and neurologic demyelinating syndromes

140
Q

infliximab

A

chimeric antibody IgG1 binds to TNF and prevents its interaction with TNF receptors on inflammatory cells
TNFa inhibitor

141
Q

infliximab side effects

A

antibodies develop risk of infusion rxns
antibodies against drug may reduce efficacy
increased risk of infection
possible autoantibodies and lupus-like syndrome

142
Q

adalimumab

A

human IgG1 antibody to TNF
SQ
TNFa inhibitor

143
Q

adalimumab side effects

A

less antigenic
local injection site rxns
increased risk for infections

144
Q

golimumab

A

humanized antibody to TNFa

145
Q

certolizumab pegol

A

recombinant Fab fragment of humanized anti-TNF-a antibody
TNFa inhibitor

146
Q

certolizumab pegol side effects

A

upper resp, rash, and UTIs

147
Q

JAK inhibitors MOA

A

inhibits the production of inflammatory cytokines through the inhibition of JAK

148
Q

JAK inhibitors drugs

A

tofacitinib
ruxolitinib
upadacitinib

149
Q

tofacitinib MOA

A

inhibits the production of inflammatory cytokines through JAK inhibition

150
Q

tofacitinib BBW

A

severe infection, lymphoma, and malignancies; caution in patients who are at high risk for G perforation

151
Q

ruxolitinib MOA

A

JAK1 and JAK2 inhibitor

152
Q

upadacitinib MOA

A

we don’t know what selectivity of this drug for JAK inhibitors

153
Q

methoxsalen MOA

A

PUVA combine UVA light intercalate into the DNA strand
stimulate melanocytes and induce antiproliferative, immunosuppressive, and anti-inflammatory effects

154
Q

methoxsalen pharm effect

A

normalizes # and arrangement of keratinocytes
reorganizes cutaneous blood vessels
cytotoxic to T cells
increases melanin pigmentation

155
Q

methoxsalen side effects

A

pruritus, nausea, erythema and blistering, hyperpigmentation, increased skin aging, increased risk of skin cancer, cataracts

156
Q

UVB

A

280-320 nm
can cause sunburn, skin carcinoma, and premature aging of skin
produces vitamin D3 in the skin

157
Q

UVA

A

320-400 nm
able to penetrate further into dermis than UVB radiation
no erythema, but still has a role in skin cancer and causes aging

158
Q

factors that affect tanning

A

time, clouds, reflection (snow, water, sand), location, clothing, thickness of the epidermis and stratum corneum, pigmentation of the skin

159
Q

immediate pigmentation

A

pigment darkening starts 5-10 min after exposure
lasts 24-48 hrs

160
Q

delayed pigmentation

A

takes about 48-72 hrs to develop after exposure
peaks at 7-10 days and lasts weeks to months

161
Q

sunburn

A

histamine, cytokines, and prostaglandins are released
symptoms: mild erythema, tenderness, and edema
severe sun burns: 2nd degree burn with blisters; fever, chills, weakness, and shock

162
Q

minimal erythemal dose (MED)

A

minimal single dose of UV radiation that produces clearly marginated erythema in the irrradiated site

163
Q

sun protection factor (SPF)

A

personal time to get 1 MED
measure of UVB protection and does NOT provide info regarding UVA coverage

164
Q

the higher the SPF

A

less likely to burn
longer time that can be spent in the sun

165
Q

broad spectrum

A

both UVB and UVA

166
Q

substantivity

A

how well does product stick to skin

167
Q

best substantivity

A

waterproof, water-resistant products, sweat-resistant

168
Q

sunblocks MOA

A

inorganic particulates that scatter or reflect visible, UV, and infrared radiation

169
Q

sunblocks uses

A

prominently exposed areas like nose and ears
used when cannot or control sun exposure

170
Q

sunblocks products

A

zinc oxide and titanium oxide; broad spectrum

171
Q

sunblocks side effects

A

may occlude pores causing milaria, folliculitis, or acne
may stain clothing

172
Q

sunblocks other facts

A

not easily removed with water, but melts in hot sun
protection decreases after 2 hrs of direct sun

173
Q

sunscreens MOA

A

organic agents (chemical blockers) that absorb UV radiation n the UVB or UVA ranges, then convert it to heat energy
may be combo of products

174
Q

hydroxy acids

A

keratolytics
glycolic acid (GA)
salicylic acid (SA)

175
Q

glycolic acid (GA) chem

A

an a-hydroxy acid
hydrophilic acid
higher conc for deeper skin peels

176
Q

salicylic acid (SA) chem

A

increase hydration-low pH causes lower skin layers to swell, soften and desquamate
more lipophilic than glycolic acid

177
Q

hydroxy acids SARs

A

COOH group(s)
most possess OH on alpha-C
R-mostly alkyl

178
Q

sulfur chem

A

monotherapy or mixtures
S reacts with cysteine to produce H2S which degrades keratin

179
Q

benzoyl peroxide

A

pH lowering and free radicals
is absorbed by skin and forms benzoic acid via ester hydrolysis

180
Q

retinoids actions

A

anti-inflammatory, antiproliferative, decrease sebum production, teratogenic

181
Q

1st gen retinoids

A

non-aromatics
tretinoin
isoterinoin

182
Q

tretinoin chem

A

1st retinoid (non-aromatics) for acne
all-trans retinoic acid

183
Q

isotretinoin chem

A

13-cis retinoic acid
geometric isomer of tretinoin
1st gen retinoids (non-aromatics)

184
Q

acitretin chem

A

2nd gen retinoid (mono-aromatics)
active form of etretinate via ester hydrolysis

185
Q

3rd gen retinoids

A

poly-aromatics
adapalene
trifarotene
tazarotene
lipophilic
low systemic absorption

186
Q

azelaic acid chem

A

C9 bi-carboxylic acid
anti-inflammatory agent

187
Q

clindamycin chem

A

lincomycin
topical

188
Q

erythromycin chem

A

macrolide-macrocyclic lactone
poor PO absorpton
unstable @ pH 4 or lower
structural modifications (acid salts and esters)
-increases H2O and lipid solublities

189
Q

tetracycline chem

A

broad spectrum
chealation: metals, insoluble salts
absorption affected by food
t1/2=8.5 hrs

190
Q

doxycycline and minocycline chem

A

food does NOT affect absorption
are lipophilic and longer acting
-doxy t1/2=11-13 hrs
-mino t/12=14-22 hrs
cross reactivities due to structure similarity

191
Q

emollients chem

A

mostly H2O emulsions (prevents skin H2O loss)->decrease scaling
petrolatum
lanolin
dimethicone
cyclomethicone

192
Q

coal tar chem

A

mixture of organic molecules
may be used with YVB
is photosensitizing

193
Q

shale tars and wood tars chem

A

non-photosensitizer

194
Q

anthralin or dithranol chem

A

hydroxyanthrone
Lassar’s paste
antiproliferative
autooxidation to produce anthrayl radicals and super oxide anion

195
Q

psoralens chem

A

furanocourmarins
+ UVA=PUVA
crosslinking of base pairs (intercalation) and decreases DNA synthesis

196
Q

glucocorticoid potency rankings

A

chem structure
delivery vehicle
% conc n formulation

197
Q

calcineurin inhibitors chem

A

decrease release of inflammatory cytokines from mast cells
pimecrolimus-higher skin protein binding
tacrolimus-able to reach systemic circulation
macrocyclic lactones

198
Q

methotrexate chem

A

antiproliferative-competitvely inhibits DHFR->decreases DNA/RNA synthesis bc decrease n THF
immunosuppressant and anti-inflammatory

199
Q

Methotrexate SAR

A

pteridine ring (should remain aromatic)
PABA
glutamic acid
aromatic N-alkylation decreases activity
N-CH3-essential for activity

200
Q

cyclosporin chem

A

11 aa cyclic peptide prodrug immunosuppressant
activated by complexation with cyclophilin receptor
inhibits calcineurin phosphatase and T cell signaling
highly inactivated by CYP3A4

201
Q

mycophenolate chem

A

prodrug immunosuppressant-rapidly forms MPA after PO or IV
inhibitor of IMPDH
inhibits T and B cells proliferation
activated by ester hydrolysis to MPA
inactivated by phenolic glucuronidation to MPAG

202
Q

crisaborole chem

A

benzoxaborole soft drug
PDE-4 inhibitor (higher cAMP and decreases inflammatory cytokines)
rapid metabolism limits systemic exposure to crisaborole

203
Q

ruxolitinib chem

A

pyrrolopyrmidine
JAK inhibitors

204
Q

upadacitinib chem

A

imidazopyrrolopyridine
JAK inhibitors

205
Q

hydroquinone chem

A

topically for whitening or depigmentation of aged spots
inhibits melanin biosynthesis via tyrosinase inhibition
protect drug from light and O2

206
Q

a-OHs acids (AHAs)

A

promote dead skin cells removal and stimulate collagen production
glycolic, lactic, tartaric, malic, citric acids

207
Q

hyaluronic acid (HA)

A

endogenous mucopolysaccharides
non-antigenic and non-immunogenic
forms a viscoelastic film that maintains skin moisture
hygroscopic
MW influences skin penetration to re-est HA content
-high MW: increase time stayed on skin

208
Q

scalp FTU

A

3

209
Q

face and neck FTU

A

2.5

210
Q

one hand (front and back) including fingers FTU

A

1

211
Q

one arm including entire hand FTU

A

4

212
Q

elbows FTU

A

1

213
Q

both soles FTU

A

1.5

214
Q

one foot including toes FTU

A

2

215
Q

one leg including foot FTU

A

8

216
Q

buttocks FTU

A

4

217
Q

knees FTU

A

1

218
Q

trunk both sides FTU

A

14 (7 FTU each side)

219
Q

atopic dermatitis risk factors

A

personal or fam history of AD
-atopic triad
-atopic march
loss of function mutation in FLG gene
living in an urban an environment
smaller fam size
higher level of parental edu

220
Q

atopic triad

A

allergic rhinitis
asthma
AD

221
Q

atopic march

A

dry skin->eczema->food allergies->rhinitis/nasal allergies->asthma

222
Q

atopic dermatitis triggers

A

irritants
allergens
environment
personal factors

223
Q

irritants AD triggers

A

airborne-tobacco smoke, air pollution
cosmetics, fragrance, astringents
irritating soaps/scrubs/detergents
dyes/preservatives

224
Q

allergens AD triggers

A

food
clothing
aeroallergens

225
Q

environment AD triggers

A

extreme temps
low humidity

226
Q

personal factors AD triggers

A

stress
excessive skin washing and sanitizing

227
Q

AD clinical presentation infants (0-2 years)

A

erythematous, popular rash that tends to ooze
face, scalp, trunk, arms, and legs
onset: 3-6 months, majority by 1

228
Q

AD clinical presentation childhood (2-puberty)

A

dry, flaky, rough, cracked skin, crusting, lichenification
face, creases of the neck, elbows, wrists, knees, ankles
majority by 5

229
Q

AD clinical presentation adulthood

A

more diffuse with underlying erythema, dry, scaly skin, lichenification
less common on face; more common on the hands, neck, inner elbows, back of knees, and ankles
may have resolution of disease

230
Q

mild SCORAD score and characteristics

A

< 25
areas of dry skin, infrequent itching (with or without small areas of redness); little impact on everyday activities, sleep, and psychosocial wellbeing

231
Q

moderate SCORAD score and characteristics

A

25-50
mild characteristics with frequent itching, moderate impact on everyday activities, sleep

232
Q

severe SCORAD score and characteristics

A

> 50
widespread areas of dry skin, incessant itching, redness, thickening, bleeding, oozing, severe limitation to activities, and nightly loss of sleep

233
Q

acute AD

A

acutely inflamed papules, vesicles, exudate, and crusts

234
Q

subacute AD

A

dry, inflamed papules, patches, or plaques

235
Q

chronic AD

A

lichenified papules or plaques, fine scale, hypo/hyperpigmentation

236
Q

AD complications

A

sleep disturbances
impact quality and family’s quality of life
skin infections
-S. aureus
-prone to infections with HSV
depression

237
Q

nonpharm treatments of AD

A

bathing practices
gentle cleansers
wet wrap
soft cotton clothing
avoid known triggers
decrease stress

238
Q

AD bathing practices

A

suggest 10 min lukewarm (tepid) bath, use gentle cleansers, gentle towel dry pat
-may add oatmeal or baking soda
-may add bleach to prevent bacterial infections
occlusive moisturizers

239
Q

OTC moisturizers for AD

A

petroleum containing
ceramide containing
urea containing
emollients

240
Q

petroleum containing moisturizers

A

occlusive, can be greasy, uncomfortable
aquaphor
eucerin
lubriderm

241
Q

ceramide containing moisturzers

A

creams, provides barrier
cerave
aveeno eczema therapy

242
Q

urea containing moisturizer

A

humectant
carmol, lac-hydrin
side effects: burning, stinging, irritation on broken skin

243
Q

emollients moisturizers

A

less effective
apply 3x a day or more, after bathing/washing
cetaphil lotion, keri original, neutrogena lotion

244
Q

AD OTC self-care follow up

A

if does not improve or worsens after 2-3 days of self-treatment, refer to a physician
if atrophy occurs, discontinue and refer

245
Q

pharm treatments of AD

A

topical corticosteroids
topical calcineurin inhibitor
topical PDE-4 inhibitor
monoclonal (IL-4) antagonist injection
systemic immunosuppressants

246
Q

mild AD pharm treatment

A

basic management
-skin care
-antiseptic measure->antibiotics, if needed
-trigger avoidance

247
Q

moderate AD pharm treatment

A

basic management + topical anti-inflammatory medication
-maintenance TCS
-maintenance TCI (pimecrolimus, tacrolimus)
-crisaborole

248
Q

severe AD pharm treatment

A

basic management + referral to AD specialist
-phototherapy
-dupiblumab
-systemic immunosuppressants
-consider acute treatment

249
Q

topical corticosteroids max duration

A

max 3-7 days or until flare up is cleared, but not apply for longer than 2 weeks

250
Q

potencies of topical corticosteroids

A

ointment>creams>lotions>solutions>gels>sprays

251
Q

topical calcineurin inhibitors counseling points

A

apply to clean and dry area
apply a thin layer and rub in gently until med vanishes
do not bathe, shower, or swim right after application
store in cool, dry, room temp location
do NOT use in children < 2 years
response in weeks, continue to apply (1-8 weeks)

252
Q

topical corticosteroids counseling points

A

apply to clean and dry area
apply a thin layer and rub in gently until med vanishes
store in cool, dry, room temp location
do not apply for longer than 2 weeks

253
Q

pimecrolimus (elidel)

A

mild-moderate eczema >2 years
reduces incidence of flares
apply 2x daily

254
Q

tacrolimus (protopic)

A

moderate-severe eczema > 2 years
apply 2x daily to affected skin

255
Q

PDE-4 inhibitor crisaborole (eucrisa)

A

apply to clean and dry area
apply a thin layer and rub in gently until med vanishes
do not bathe, shower, or swim right after application
store in cool, dry, room temp location

256
Q

crisaborole (eucrisa)

A

apply a thin layer 2x daily for mild to moderate eczema
treat flares > 3 months
only when a steroid not appropriate or as an adjunct therapy

257
Q

monoclonal antibody IL-4 antagonist

A

dupilumab (dupixent)

258
Q

dupilumab (dupixent) counseling points

A

clean and dry admin site area
inject at a 90 deg angle into thigh or lower abdomen, may administer in upper arm
rotate injection sites
store in fridge, allow solution to reach room temp for 30-45 min before admin

259
Q

dupilumab (dupixent) dosing

A

adult: 600 mg LD, followed by 300 mg every other week
children (6-17): weight based dosing

260
Q

tralokinumab

A

IL-13 inhibitor
moderate to severe AD not controlled with or unable to use topical therapy
alternative to dupilumab (dupixent)
adverse events: ocular adverse events, upper resp tract infections, injection site rxns

261
Q

JAK inhibitors for AD

A

moderate-severe
abrocitinib, upadactinib, ruxolitinib

262
Q

JAK inhibitors BBW

A

serious infections, mortality, malignancies, MACE, thrombosis

263
Q

diaper rash prevention-infants

A

diaper changing freq
disposable diapers
cleaning with every change
barrier cream application
breastfeeding

264
Q

diaper dermatitis signs and symptoms

A

red in patches, red to bright red, shiny, wet-looking patches and lesions

265
Q

incontinence associated dermatitis prevention-adults

A

cleansing routine
skin hydration
barrier cream application
pressure sore prevention
good nutrition

266
Q

diaper/incontinence dermatitis prevention and nonpharm treatment

A

ABCDE
air
barrier
cleansing
diaper
education

267
Q

diaper/incontinence dermatitis prevention and pharm treatment

A

apply skin protectants
-provides physical barrier and lubrication to skin
-apply liberally to skin in diaper/perineal area->cover red areas with product
-can continue to use after rash heals to prevent recurrence

268
Q

skin protectant examples

A

zinc oxide 1-40%
petrolatum 30-100%
combo examples

269
Q

diaper dermatitis cautions

A

diaper area is a significant portion of baby’s BSA->may topical products lead to systemic side effects
DO NOT USE:
-topical antifungals, topical antibacterials, topical anesthetics, hydrocortisone or other topical corticosteroid

270
Q

diaper dermatitis follow up

A

if improved but not healed, after 7 days: continue treatment until healed
if not healed, improved, or worsened after 7 days: refer to a physician

271
Q

exclusions for self care of diaper dermatitis

A

lesions for > 7 days
secondary infection
broken skin
oozing, bleeding, pus
behavioral changes
comorbidities

272
Q

non-inflammatory acne lesions

A

normal follicle
blackhead
whitehead

273
Q

inflammatory acne lesions

A

papule
pustule
nodule/cysts

274
Q

type 1 mildly clear acne

A

rare noninflammatory lesions with no more than 1 small lesion

275
Q

type 2 mild acne

A

some noninflammatory lesions
no more than a few inflammatory lesions
(papules and pustules only, no nodules)
minimal scarring

276
Q

type 3 moderate acne

A

many noninflammatory lesions
some inflammatory lesions
no more than 1 nodules
mild scarring possible

277
Q

type 4 severe acne

A

many noninflammatory and inflammatory lesions
no more than a few nodular lesions
moderate to extensive scarring

278
Q

acne risk factors

A

age: 12-20 years old
cosmetics
family history
hydration: humidity and sweating
irritation: local skin friction
medications

279
Q

causative medications for acne

A

hormones
neuropsych drugs
vitamins
cytostatic agents
immunomodulating agents
anti-tuberculin drugs
halogens

280
Q

acne complications

A

anxiety
depression
scarring

281
Q

considerations for acne management

A

grade and classify acne lesions
presence of scarring
patient age
family history
adherence potential
treatment preferences
skin type
cost
response to previous therapy
psychologic effects

282
Q

acne exclusions for self-treatment

A

severe acne
possible rosacea
exacerbating factors: comedogenic drugs

283
Q

nonpharm treatment for acne

A

cleanse skin w/ mild soap or non-soap cleanser 2x a day
extraction strips or professional extraction
UV light/laser therapy
diet changes
stay well hydrated

284
Q

diet changes for acne

A

encourage low glycemic index foods
limit dairy products
potential benefit: fish oil, probiotics, oral zinc
mediterranean diet

285
Q

mildly clear acne 1st line treatment

A

+/- BP alone or essential oils

286
Q

mild acne 1st line treatment

A

topical single treatment
-BP or top retinoid
-or top combo treatment (BP + top antibiotic OR BP + top retinoid OR BP + top retinoid + top antibiotics)

287
Q

mild acne 2nd line treatment

A

may add (if not on):
top retinoid or BP
or consider alternate retinoid
or consider top dapsone

288
Q

moderate acne 1st line treatment

A

top combo treatment:
BP + top retinoid
or BP + top antibiotics
or BP + top retinoid + top antibiotics
OR oral antibiotics + top retinoid + BP or oral antibiotics + top retinoid + BP + top antibiotics

289
Q

moderate acne 2nd line treatment

A

consider alternate combo treatment
OR
consider change in oral antibiotics or add oral contraceptive or oral spironolactone (females only) or consider oral isotretinoin

290
Q

severe acne 1st line treatment

A

oral antibiotic + top combo treatment:
oral antibiotic + BP + top retinoid
OR oral antibiotic + BP + top antibiotic
OR BP + top retinoid + top antibiotic
OR oral isotretinoin

291
Q

severe acne 2nd line treatment

A

consider change in oral antibiotics
or add combined oral contraceptive or oral spironolactone (females only) or consider oral isotretinoin

292
Q

benzoyl peroxide

A

used alone (mild-moderate) or in combo with oral/topical antibiotics (moderate-severe)
efficacy as soon as 5 days, lesion severity and #
SE: skin irritation and will stabilize within 1-2 weeks

293
Q

retinoids

A

efficacy as soon as 5 days
SE: skin irritation and will stabilize within 1-2 weeks
apply at night after washing face or other affected areas
DO NOT USE with sulfur, resorcinol, salicylic acid, or vitamin C products
separate use from BP
> 12 years to use
use with moisturizer/sunscreen

294
Q

alpha hydroxy acids

A

glycolic, lactic, citric acids
exfoliate non-inflammatory lesions
-can be used as a chem peel to reduce acne scarring
wait 2-4 weeks btwn peels
use sunscreen

295
Q

beta hydroxy acid-salicylic acid

A

SE: drying, photosensitivity
apply 1-2x daily as a cleanser or top gel
max effectiveness and duration of use for 4-6 weeks
use sunscreen

296
Q

complementary therapy for acne

A

tea tree therapy
frankincense oil
provide anti-inflammatory benefits

297
Q

oral antibiotics for acne

A

minocycline/doxycycline
sarecycline
clindamycin
sulfamethoxazole/trimethoprim
erythromycin/azithromycin
NEED TO USE WITH BP, NOT MONOTHERAPY FOR ACNE

298
Q

minocycline/doxycycline

A

tetracycline
eradicate P. acnes
photosensitivity, fetal harm (avoid during preg), may cause permanent discoloration to teeth if used < 12

299
Q

sarecycline

A

tetracycline derivative
nonkodular moderate to severe acne

300
Q

erythromycin/azithromycin

A

macrolide
less commonly used due to resistance: topical or oral

301
Q

oral antibiotic use not

A

use for the shortest possible duration to minimize development of bacterial resistance; re-evaluate at 3-4 months

302
Q

combo oral contraceptives

A

for women who also want contraception
should be > 14 years old or over 2 years since period starts
should be non-smoker < 35 years

303
Q

combo oral contraceptives benefits

A

contraception
decreased hyper androgen symptoms
decrease risk of colorectal, ovarian, and endometrial cancers

304
Q

combo oral contraceptives increased risks

A

venous thrombotic events (clots)
myocardial infarction
breast or cervical cancer
osteoporosis/decreased bone mass

305
Q

isotretinoin treats

A

severe refractory nodular acne
acne causing significant physiological/psychological scarring

306
Q

isotretinoin BBW

A

birth defects, must not be used by women who are preg or may become preg

307
Q

isotretinoin side effects

A

dry nose, eyes, mouth, inflammation of lips
musculoskeletal, ophthalmic effects, headache, CNS effects
mood disorders, depression, suicidal ideation

308
Q

efficacy and monitoring for acne

A

patient: daily
pharm: every 4-8 weeks on therapy

DEENT (4 decks)

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