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424 Pharmacology > Integumentary > Flashcards

Integumentary Flashcards

1
Q

Topical antibiotics

Benzoyl peroxide

Indication & Pharmacodynamics

A

first line for mild acne

  • Antibacterial activity against P.acnes - Release of active or free radical oxygen capable of oxidizing bacterial production
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2
Q

Topical antibiotics

Benzoyl peroxide

Caution/contraindications: pregnancy, peds, and other considerations

A
  • Pregnancy: Safe
  • Peds: OK for 12+
  • Other considerations: Should not be applied at the same time as a topical retinoid; can bleach clothes and towels; Drying effect, removes excess sebum, causes mild desquamation and may cause photosensitivity
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3
Q

Topical antibiotics

Erythromycin and clindamycin

Indication

A

Often in combination together or individually with benzoyl peroxide to reduce bacterial resistance; for mild-moderate acne

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4
Q

Topical antibiotics

Erythromycin and clindamycin

Pharmacodynamics

A

Interrupt protein synthesis at the 50s ribosomal subunit

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5
Q

Topical antibiotics

Clindamycin

Contraindication, what to monitor for

A
  • Contraindicated: hx of Crohn disease, ulcerative colitis and antibitoic-associated colitis
  • monitor for diarrhea - sign of colitis
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6
Q

Topical antibiotics

Azelaic acid

Pharmacodynamics

A
  • Inhibits microbial cellular protein synthesis
  • Decreases inflammation and the concentration of bacteria on the skin, may normalize keratinization, leading to an anti-comedonal effect, as well as decreased microcomedone formation
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7
Q

Topical antibiotics

Azelaic acid

Caution/contraindications: caution, interactions

A
  • Caution: patients with darker skin pigmentation, will lighten skin irreversibly
  • Interactions: Additive irritation if used with benzoyl peroxide
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8
Q

Salicylic acid

pharmacodynamics

A

exfoliant, clears comedones, mild anti-inflammatory effects

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9
Q

Topical retinoids

Trentoin

Pharmacodynamics

A

reduces cohesion between keratinized cells, acts specifically on microcomedones, causing expulsion and conversion of closed comedones to open; prevents new comedones

Can enhance penetration of other topical agents

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10
Q

Topical retinoids

Adapalene

pharmacodynamics

A

decreases microcomedone formation, modulator of cellular differentiation, keratinization and inflammatory processes

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11
Q

Topical retinoids

Tazarotene

Pharmacodynamics & pregnancy consideration

A
  • normalizes epidermal differentiation, reduces influx of inflammatory cells into the skin
  • Pregnancy: avoid
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12
Q

Topical retinoids

General caution/contraindications (5)

A
  1. All retinoids should be avoided in patients with eczema, sunburn or skin abrasions at the site of application
  2. Contraindicated in lactating patients
  3. Should not be used at the same time as topical antibiotics
  4. Acne may worsen before it improves, can take 6-8 weeks before benefits appear
  5. Sunscreen important
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13
Q

Topical Retinoids

adverse fx (8)

A

peeling, flaking dry skin, burning, erythema, pruritis, sunburn, hypo or hyperpigmentation

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14
Q

Oral antibiotics

Tetracyclines, azithromycin, erythromycin or Bactrim (others if tetracyclines are contraindicated)

Indication and pharmacodynamics

A
  • Indication: moderate to severe acne, inflammatory acne resistant to topical therapies
  • Pharmacodynamics: active against P.acnes, prevent future rather than existing lesions
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15
Q

Systemic retinoids

Isotrentoin

Pharmacodynamics, caution/contraindications: avoid, pregnancy, interaction, adverse fx (12)

A
  • Pharmacodynamics: reduces sebum production by reducing sebaceous gland size, normalizing follicular keratinization and indirectly reducing P.acnes and its inflammatory sequela
  • Caution/contraindications
    • Avoid: patients at risk for osteoporosis
    • Pregnancy: avoid
    • Interactions: alcohol
  • Adverse effects: cheilitis, dry skin and fragility, hypertriglyceridemia, elevation of glucose levels, headache, lethargy, fatigue, arthralgia, myalgias, visual disturbances, GI reactions
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16
Q

What combination of medications are indicated for:

  • non-inflammatory comedonal acne
  • inflammatory papulopustular acne
  • severe inflammatory acne
A
  • Non-inflammatory comedonal acne: topical retinoid or benzoyl peroxide
  • Inflammatory papulopustular acne: topical combination therapy of topical antibiotic or retinoid plus benzoyl peroxide
  • Severe inflammatory
    • Oral antibiotic combined with topical combination therapy of topic antibiotic or retinoid plus benzoyl peroxide (or all three)
    • Oral isotretinoin
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17
Q

Topical corticosteroids

indications (2)

A

dermatitis, psoriasis

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18
Q

Topical corticosteroids

pharmacodynamics (3)

A
  1. anti-inflammatory, antipruritic, vasoconstrictive properties
  2. depress the formation, release and activity of endogenous chemical mediators of inflammation (histamines, prostaglandins)
  3. inhibit migration of macrophages and leukocytes into the affected area by reversing vascular dilatation and permeability - reduction of edema, erythema and pruritis
19
Q

There are several preparations of topical corticosteroids. What are each typically recommended for?

A
  • Ointments are more occlusive and potent: good for dry and scaly lesions
  • Creams less occlusive and potent: good for oozing lesions on intertriginous areas
  • Lotions are least potent: good for hair bearing areas
20
Q

Topical corticosteroids

caution and contraindications: area to avoid, pregnancy, peds

A
  • Area to avoid: Do not use high-potency agents on face, groin or axilla
  • Pregnancy: caution, only if benefits outweigh risks
  • Peds: OK but need lowest strength
21
Q

Topical corticosteroids

adverse fx (4)

A
  • Local skin irritation, increase risk for secondary infections; tolerance may occur in prolonged use
  • Adrenal function and growth should be monitored in children who require moderate to high potency steroids (growth can be stunted)
22
Q

Topical calcineurin inhibitors

Pimecrolimus (Elidel) and Tacrolimus (protopic)

What are the indications of each?

A

Pimecrolimus: mild-moderate atopic dermatitis

Tacrolimus: moderate to severe atopic dermatitis

Both: Resistance to steroids, sensitive areas like face, skin folds, steroid induced atrophy or long-term uninterrupted topical steroid use

23
Q

Topical calcineurin inhibitors

Pimecrolimus (Elidel) and Tacrolimus (protopic)

Pharmacodynamics

A

suppresses cellular immunity by inhibiting T cell activation by binding to intracellular proteins including calcineurin dependent proteins - results in inhibition of inflammatory cytokines and mediators from mass cells

24
Q

Topical calcineurin inhibitors

Pimecrolimus (Elidel) and Tacrolimus (protopic)

Caution/contraindications: when to avoid, black box warning, pregnancy, peds

A
  • Avoid: immunosuppression, site of active cutaneous viral infection
  • Black box warning: long-term safety concern due to rare cases of malignancy
  • Pregnancy - caution; lactation - avoid
  • Peds: avoid
25
Q

Topical calcineurin inhibitors

Pimecrolimus (Elidel) and Tacrolimus (protopic)

Adverse fx (7)

A

burning, pruritis and tingling, headache, fever, flu-like symptoms, acne and folliculitis

26
Q

Topical antihistamine and antipruritics

Diphenhydramine

Pharmacodynamics

A
  • provides local relief of itching and swelling due to effects on H1 receptors; suppresses formation of edema and pruritis - closed skin reaction
  • May also provide a local anesthetic quality by blocking transmission of nerve impulses
27
Q

Topical antihistamine and antipruritics

Diphenhydramine

Indications

A

local reaction to insect bites, stings, minor skin cuts and burns and rashes

28
Q

Topical antihistamine and antipruritics

Diphenhydramine

Caution/contraindications: when to avoid, other considerations, pregnancy, peds & Adverse fx (1)

A
  • Avoid: use greater than 7 days
  • Other considerations: Increased risk of systemic effects if applied to large surface area
  • Pregnancy - safe; lactation - caution
  • Peds: OK 2+
  • Adverse fx: May cause skin irritation
29
Q

Topical antihistamine and antipruritics

Doxepine

Pharmacodynamics

A

Histamine blocking action of H1 and H2 receptors inhibiting activation of histamine receptors

30
Q

Topical antihistamine and antipruritics

Doxepine

Indications

A

short-term management of moderate to severe pruritis

31
Q

Topical antihistamine and antipruritics

Doxepine

Caution/contraindications: caution, avoid, pregnancy, peds, other considerations & Adverse fx (1)

A
  • Caution: elderly
  • Avoid: untreated narrow-angle glaucoma and urinary retention (medication has anticholinergic fx)
  • Pregnancy - safe; lactation - avoid
  • Peds: avoid
  • Other considerations: do not occlude; if excessive drowsiness occurs decrease body surface area treated or reduce number of applications
  • Adverse fx: Burning and stinging sensation when applied
32
Q

Pediculicides

Pyrethrin (RID) OTC

Indication & Pharmacodynamics

A
  • Indication: lice
  • Pharmacodynamics: absorbed through the exoskeleton of arthropods, causing paralysis and death
33
Q

Pediculicides

Pyrethrin (RID) OTC

Caution/contraindications: when to avoid, pregnancy, peds, other considerations & Adverse fx (3)

A
  • Avoid in chrysanthemum or ragweed allergy
  • Pregnancy/lactation: compatible
  • Children: OK 2+
  • Other considerations: Works best on dry hair, active only when applied
  • Adverse effects: localized burning, pruritis, skin irritation
34
Q

Scabicides and pediculicides

Permethrin

Indication & Pharmacodynamics

A
  • Indication: lice and scabies
    • Note for scabies: first line treatment; treat all family members who have been in contact with patient
  • Pharmacodynamics: absorbed through exoskeleton of arthropods, causing paralysis and death
    • Residual activity against lice for up to 10 days
35
Q

Scabicides and pediculicides

Permethrin

Caution/contraindications: where to avoid application, pregnancy, peds & Adverse fx (3)

A
  • Avoid use near eyes
  • Pregnancy/lactation: compatible
  • Peds: OK 2 months +
  • Adverse drug effects: localized burning, pruritis, skin irritation
36
Q

What can be used for adults with a contraindication to permethrin?

A

Croamiton (Eurax)

37
Q

Pediculicides

Malathion

Indication & Pharmacodynamics

A
  • Indication: 2nd line if not able to use permethrin for lice
  • Pharmacodynamics
    • inhibits cholinesterase activity in vivo
    • Pediculicidal and ovicidal
    • Residual activity for up to 7 days
38
Q

Pediculicides

Malathion

Caution/contraindications: other considerations, pregnancy, peds & adverse fx (3)

A
  • Other considerations: Flammable
  • Pregnancy/lactation: avoid
  • Peds: OK 6+
  • Adverse effects
    • Organophosphate poisoning and severe respiratory distress if ingested
    • Localized burning, skin irritation
39
Q

Pediculicides

Benzyl alcohol

Indication & Pharmacodynamics

A
  • Indication: first FDA approved non-neurotoxin treatment for head lice
  • Pharmacodynamics: stuns lice, leading to ability to penetrate respiratory mechanism, which leads to asphyxiation; used in active lice infestation
40
Q

Pediculicides

Benzyl alcohol

Caution/contraindications: peds, pregnancy & adverse fx (2)

A
  • Peds: 6 months +
  • Pregnancy/lactation: ok
  • Adverse effects: pruritis, erythema
41
Q

Pediculicides

Ivermectin

Indication & Pharmacodynamics

A
  • Indication: head lice
  • Pharmacodynamics
    • Interferes with function of nerve and muscle cells, resulting in parasite paralysis and death
    • Single application of topical ivermectin is effective for eradication of head lice
42
Q

Pediculicides

Ivermectin

Caution/contraindications: pregnancy, peds & adverse fx (3)

A
  • Pregnancy/lactation: avoid
  • Peds: 6 months +
  • Adverse effects: dry skin, burning sensation, eye irritation
43
Q

How do you choose therapy for lice/scabies? Several considerations - what do you start with? Who else needs to be considered for lice vs. scabies? What else can be done that is a non-pharm intervention?

A
  • Start with permethrin, use ivermectin if needed
  • Consider patient family members
    • Lice: check for infestation and treat infected members
    • Scabies: prophylactically treat members
  • Sexual partners should be treated concurrently if pubic lice present
  • Nit or fine-tooth comb should be used to remove any dead lice or eggs
  • Clothing and bedding should be washed in hot water
44
Q

Corticosteroids: what are the different classes of corticosteroid strength?

A

Low strength: Class 6-7

Intermediate strength: Class 4-5

High strength: Class 2-3

Very high strength: Class 1

424 Pharmacology (12 decks)

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