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H+N and Dermatology > Intro to Derm and Derm Pharmacology + Prescribing > Flashcards

Intro to Derm and Derm Pharmacology + Prescribing Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the structure of normal skin?

A
  • Subcutis: fat
  • Dermis: collagen + elastin matrix w mucopolysaccharide gel -> immune cells (fibroblasts, dermal dendritic cells, macrophages) -> atrophies as you get older - skin gets more fragile
  • Epidermis: outer layer -> keratinocytes (majority), langerhans cells, melanocytes
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2
Q

What are the 3 stages of the hair growth cycle?

A
  • Anagen: active growing phase -> 80-90% of hair
  • Catagen: transition phase
  • Telogen: resting phase -> roughly 10% of hairs -> hair sheds (nb. pregnancy)
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3
Q

What is the function of normal skin?

A
  • Thermoregulation
  • Skin immune system
  • Barrier
  • Sensation
  • Vitamin D synthesis
    (7-dehydrocholesterol -> cholecalciferol (vit D3))
  • Interpersonal communication (ie. physical appearance, smell, self-identity)
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4
Q

What can sk

A
  • 5 D’s*
  • Disfigurement
  • Discomfort
  • Disability
  • Depression
  • Death
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5
Q

What are the external causes of skin disease?

A
  • Temperature
  • UV
  • > photosensitivity (ie. due to meds (NSAIDs, abx, HT meds)
  • Chemical (allergen or irritant)
  • > ie. cold injury (frostbite, chillblains)
  • Infection
  • Trauma
  • > ie. Dermatitis Artefacta
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6
Q

What are the internal causes of skin disease?

A
  • Systemic disease
  • Genetics
  • > ie. neurofribromatosis, icthyosis
  • Drugs:
  • > vary in severity
  • > think of OTC drugs
  • > take a good drug history
  • Infection
  • Autoimmune
  • > Bullous Pemphigoid
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7
Q

What is a Macule?

A
  • Small, flat circumscribed area <5mm

- Non-palpable change in skin colour with distinct borders

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8
Q

What is a Patch?

Example/s?

A
  • Larger, flat circumscribed area >5mm
  • Non-palpable change in skin colour with distinct borders
  • Hyper-pigmentation = congenital melanocytic naevus
  • Hypo-pigmentation = vitiligo
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9
Q

What is a Papule?

Example/s?

A
  • Small raised area, <1cm in diameter

- Palpable solid lesion

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10
Q

What is a Plaque?

Example/s?

A
  • Larger raised area, >1cm in diameter
  • Palpable, solid lesion
  • ie. Untreated psoriasis
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11
Q

What is a Nodule?

Example/s?

A
  • Palpable lesion, taller than it is wide

- ie. Neurofribromatosis, Rheumatoid nodules

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12
Q

What is a Vesicle?

Example?

A
  • Small, fluid-filled, superficial, thin-walled cavity, <1cm in diameter
  • ie. insect bite
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13
Q

What is a Bulla?

Example?

A
  • Large, fluid-filled, superficial, thin-walled cavity, >1cm in diameter
  • ie. Bullous Pemphigoid
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14
Q

What is a Pustule?

Example?

A
  • Small, pus-filled, superficial, thin-walled cavity

- ie. Acne

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15
Q

What is an Abscess?

A
  • Large, pus-filled, thick-walled cavity
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16
Q

What is an Erosion?

Example?

A
  • Skin defect causing loss of Epidermis
  • Heals w/o scarring (bc only confined to the Epidermis)
  • ie. Toxic Epidermal Necrolysis
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17
Q

What is an Ulcer?

Example?

A
  • Skin defect causing loss of Epidermis and Dermis
  • Does not heal w/o scarring (as it affects all 3 layers)
  • ie. Pyoderma Gangrenosum (ie. IBD (UC, CD), Arthritis)
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18
Q

What is the distribution of Acanthosis Nigricans, and what is it associated with?

A
  • Flexural distribution
  • > (ie. axillae, neck, elbow/knee creases
  • Associated with: Insulin Resistance, Obesity, Malignancy
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19
Q

How would you describe the markings of Acanthosis Nigricans?

A
  • Hyperkeratosis and Hyperpigmentation papules

- “Velvety” appearance

20
Q

What is Pre-tibial Myxoedema associated with?

A
  • Grave’s disease
21
Q

What investigations might you arrange if you suspect a bacterial skin infection?

A
  • Charcoal swab!!
  • ask for MC+S!!
  • > (Microscopy, Culture and Sensitivities)
22
Q

What investigations might you arrange if you suspect a viral skin infection?

A
  • Viral swab for PCR!!
  • > swab the vesicle/bulla if vesicular eruption
  • > if systemic illness -> VTS
23
Q

What investigations might you arrange if you suspect a fungal skin infection?

A
  • Skin scraping
  • Nail clipping
  • Hair sample
  • send for Fungal cultures!! (mycology)
24
Q

How are medicines licensed in the UK?

A
  • MHRA - Medicines and Healthcare Products Regulatory Agency
  • EMA - European Medicines Agency
  • agree whether or not his medication is suitable to be used and get a license*
25
Q

What is the SMC?

A
  • Scottish Medicines Consortium

- decides where a drug is used in the NHS

26
Q

What is an “unlicensed” drug?

A
  • Not approved for use in the UK
27
Q

What is an “off-label” drug?

A
  • A licensed medication that is being used for an unlicensed indication
28
Q

What is a “specials” drug?

A
  • Unlicensed dermatological preparations

- Long history of use, no strong evidence base but clinically effective (ie. crude coal tar)

29
Q

What are the common causes of prescription errors?

A
  • Lack of knowledge
  • > ie. about the pt., the med, and allergies
  • Mistake writing/generating the prescription
  • > ie. mg vs. mcg, % not written clearly
  • Poor communication
  • No local or national guidelines
  • > ie. it is a rare medication
30
Q

What are the factors associated with poor adherence?

A
  • Psychiatric co-morbidities
  • Slower-acting agents
  • Multiple applications/day
  • Lack of pt. education
  • Cosmetic acceptability of treatments
  • Unintentional non-adherence
  • > ie. pt. may need information leaflet so they can self-manage their meds at home
31
Q

What Pharmacodynamic factors do you need to be aware of when prescribing?

A
  • basically pt. factors*
  • Age of pt.
  • Pregnancy risk
  • Drug interactions
  • Pharmacogenetics
    ie. pt. may genetically have lower levels of a certain enzyme, which alters drug metabolism
32
Q

What Pharmacodynamic factors do you need to be aware of when prescribing?

A
  • route of Administration
  • > topically where possible
  • > if oral, optimal absorption important (ie. some meds need to be taken with a fattier meal to optimise absorption)
  • Distribution - where the drug goes
  • Metabolism - esp. in Liver disease
  • Excretion - esp. in Renal disease
33
Q

What factors affect Topical Absorption?

A
  • Concentration
  • Base/vehicle
  • Chemical properties of the drug
  • Thickness and hydration of stratum corneum
  • Temperature
  • Skin site
  • Occlusion (ie. wrapping something around the area that the cream is applied to)
34
Q

What type of topical therapy is best for feet?

A
  • Spray powder!!
35
Q

What type of topical therapy is best for the scalp?

A
  • Shampoo!!
36
Q

What type of topical therapy is best for the finger?

A
  • Wart paint!!
37
Q

What is the mode of action of Topical Steroids?

A
  • Regulates pro-inflammatory cytokines
  • Suppresses fibroblasts, endothelial and leukocyte function
  • Vasoconstriction
  • Inhibits vascular permeability
38
Q

What is the Finger Tip Unit? What does it equate to?

What surface area does it cover?

A
  • Unit of measurement used for the application of topical steroids
  • about 0.5g (to the distal skin crease)
  • Should treat an area double the size of one hand
39
Q

What are the Side-effects of Topical Steroids?

A
  • Skin thinning/atrophy
  • Striae
  • Bruising
  • Hirsutism
  • Telangiectasia
  • Acne/Rosacea/Peri-oral Dermatitis
  • Glaucoma
  • Cataracts
  • Systemic absorption
40
Q

What is the mechanism of action of Retinoids?

A
  • Vitamin A analogues

- Normalise keratinocyte function

41
Q

What are the indications for Retinoids?

A
  • 4 different molecules used orally in Dermatology*
  • Acne -> isotretnoin (roaccutane)
  • Psoriasis -> acitretin
  • Cutaneous T cell Lymphoma -> bexarotene
  • Hand eczema -> alitretinoin
42
Q

What are the adverse effects of Retinoids?

A
  • Teratogenic
  • > don’t use in pregnant pts/women of child-bearing age
  • Chellitis (dry lips), Xerosis (dry skin)
  • Increased transaminases and triglycerides
  • rarely: Psychiatric, eye, bone side effects
  • therefore can only be prescribed in hospitals as needs monitoring, NOT by GPs!!*
43
Q

What are the adverse effects of Immunosuppressants?

A
  • ie. oral steroids, azathioprine, ciclosporin, methotrexate, mycophenolate mofetil*
  • Risk of malignancy and serious infection
  • Need regular blood monitoring: esp. FBC (methotrexate, azathioprine), Renal function (ciclosporin) and Liver function (methotrexate)
44
Q

What are the adverse effects of Immunosuppressants?

A
  • Psoriasis
  • Hidradenitis suppurativa
  • Chronic Spontaneous Urticaria
  • Atopic Eczema
  • Pemphigus
  • MELANOMA
45
Q

What are the adverse effects of Biologics?

A
  • Risk of infection
  • > TB reactivation
  • > serious infection
  • > avoid live vaccines
  • Risk of malignancy
  • TNF inhibitors - risk of demyelination (nb. FH of MS)
46
Q

Where can you get reliable information about different drugs used in Dermatology?

A
  • SPC - Supplementary Protection Certificates
  • SMC - Scottish Medicines Consortium
  • BNF
  • BAD guidelines - British Association of Dermatologists
  • Local Formulary

H+N and Dermatology (16 decks)

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