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Therapeutics Final > Lecture 74,75,76 > Flashcards

Lecture 74,75,76 Flashcards

Dermatology, Scott

1
Q

Questions to ask

A

onset, duration, getting better or worse
part(s) of body involved
isolated vs symmetrical
symptoms local vs systemic
exposure to new drugs or irritants

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2
Q

consider when choosing vehicle

A

condition of the skin and desired effect from base (dry/moisturize)
area of application
patient acceptability
nature of the incorporated medication (bioavailability, stability, compatibility)

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3
Q

vehicle on hair bearing skin

A

solution/spray
foam
gel
cream

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4
Q

ointments

A

PROS – best for hydration, best for drug delivery, removes scales
CONS – greasy, low patient acceptance, not ideal for hairy areas

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5
Q

Cream

A

PROS – good for hydration, good for drug delivery, can apply to most areas (hairy, groin, face), high patient acceptances

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6
Q

Lotion

A

PROS – watered down creams, easy to apply, good patient acceptance
CONS – requires frequent applications, not ideal for very dry skin

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7
Q

Gel

A

PROS – excellent for EtOH soluble drugs, can apply to most areas (hairy, groin, face), high patient acceptance, non-greasy
CONS – can be drying

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8
Q

Solution/Foam/Spray

A

PROS – can apply to most areas, easy to apply in hairy and groin areas, not ideal for drug delivery
CONS – can be drying, not ideal for hydration, requires frequent applications

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9
Q

dry skin presentation

A

rough, dry, scales, and cracks on the feet, lower, legs, hands, elbows, or face
triggered by the fall/winter weather, being elderly, and frequent bathing

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10
Q

dry skin treatment

A

emollients (first line –> restores barrier/skin function, follow rule of 3)
agents for itching (menthol/camphor, pramoxine, aluminum acetate, hydrocortisone)
alter bathing habits

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11
Q

acute dermatitis presentation

A

red patches or plaques, pebbly surface or blisters, itching is intense
contact dermatitis –> irritant vs allergic
example - poison ivy

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12
Q

subacute dermatitis presentation

A

dry, less red, crusting/oozing, mild thickening, itching is common but less intense
examples - atopic dermatitis, eczema

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13
Q

chronic dermatitis presentation

A

epidermal thickening, exaggerated skin markings, excoriations, fissures, scaling, lichenification, and less itching
examples –> static dermatitis, any long standing acute or subacute dermatitis, irritation and trauma worsen itching

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14
Q

stepwise atopic dermatitis treatment

A

non-pharm measures
topical therapy
systemic therapy

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15
Q

non-pharm atopic dermatitis treatment

A

lukeworm or tepid baths
emollients
eliminate irritants, modify environment, and avoid triggers
trim fingernails and wear non-irritating clothing

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16
Q

topical atopic dermatitis treatment

A

topical corticosteroids (TCS)
topical calcineurin inhibitor therapy
topical JAK inhibitor (if prefer no steroidal)
strength and duration are based on severity

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17
Q

systemic atopic dermatitis therapy

A

phototherapy
oral immunosuppressant therapy
oral JAK inhibitor
injectable biologic agents

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18
Q

acute flare atopic dermatitis treatment

A

medium potency topical corticosteroid BID for up to 3 days beyond clearance of lesions

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19
Q

refractory atopic dermatitis treatment

A

phototherapy or immunosuppressive therapy
if inadequate response to all therapies, consider emerging biologic agents

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20
Q

maintenance atopic dermatitis treatment

A

basic measures and daily application of a low potency topical corticosteroid OR
2-3 times a week application of topical corticosteroids or other topical anti-inflammatory agent
follow written action plan

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21
Q

primary acne lesions

A

non-inflammatory –> white heads and blackheads
inflammatory –> papules, pustules, ruptured contents

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22
Q

secondary acne lesions

A

excoriations
erythematus macules
hyperpigmented macules
scars

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23
Q

acne triggers

A

oil-based cosmetics
emotional stress
irritation/physical pressure
drugs –> androgenic steroids, corticosteroids, lithium, anti-epileptics (phenytoin), tuberculosatatic drugs, and oral contraceptives

24
Q

keratolytic drugs

A

compounds that break down the outer layers of the skin to decrease the thickness and promote sloughing
example - salicylic acid, urea, a-hydroxy acids

25
Q

comedolytic drugs

A

medication that inhibit the formulation of comedones
example – trentinoin, adapalene, azelaic acid

26
Q

acne treatment for all patients

A

follow a regular skin cleansing regimen using a mild facial soap twice a day
minimize the use of products that cause irritation and stinging (aftershave, alcohol based cleansers)
use tepid, not hot, water to clean affected areas
no quick fix –> takes weeks to months

27
Q

comedonal, non-inflammatory acne treatment

A

first choice –> topical retinoids (adapalene)
alternatives –> BP and azelaic acid in lower strengths

28
Q

mild to moderate papulopustular inflammatory acne treatment

A

first choice –> adapalene and BP or clindamycin and BP
alternatives –> retinoids; adapalene and OA for more widespread disease

29
Q

severe papulopustular or moderate nodular acne treatment

A

first choice –> oral isotrentinoin
alternatives –> OA and adapalene; OA and adapalene and BP; OA and azelaic acid; OA and oral anti-androgens; anti-androgens and topicals

30
Q

nodular or conglobate acne treatment

A

first choice –> oral isotrentinoin
alternatives –> OA + azelaic acid; other topical agents or oral antiandrogens can be substituted for azelaic acid

31
Q

maintenance acne treatment

A

first choice –> adapalene
alternatives –> tazarotene; trentinoin; azelaic acid; BP

32
Q

low cost acne treatment

A

topical retinoids (BP, Azelaic acids, adapalene due to being available in OTC formulations)

33
Q

medium cost acne treatments

A

oral antibiotics (OA)
anti-androgens (expensive if on a monthly basis)
oral corticosteroids

34
Q

high cost acne treatment

A

isotrentinoin
anti-androgens
tazarotene

35
Q

acne follow up

A

2-6 months to determine if successful
lengthening acne free periods is key

36
Q

rocsacea presentation

A

common, chronic, progressive inflammatory dermatosis based upon vascular instability, facial flushing/blushing, facial erythema, papules, pustules, and telangiectasia

37
Q

triggers of rosacea

A

temperature, food, weather, beverages, medication conditions, emotional influences, physical exertion, skin products
drugs –> vasodilators, topical corticosteroids, nicotinic acid, ace inhibitors, calcium channel blockers, statins

38
Q

types of rosacea

A

telangiectatic
papulopustular
phytmatous
ocular

39
Q

telangiectatic rosacea

A

visibly dilated blood vessels
very red skin

40
Q

papulopustular rosacea

A

resembles acne
often called adult acne

41
Q

phytmatous rosacea

A

enlarged sebaceous glands
especially on the nose
more common in males

42
Q

life style modifications for rosacea

A

avoid triggers known to exacerbate
avoid excessive sun exposure
use mild soap and cleansers
stress adherence to topical medications
topical medications should be allowed to penetrate the skin for 5-10 minutes before applying make-up

43
Q

mild rosacea treatment

A

avoid triggers
topical antibiotics (metronidazole)
topical retinoids

44
Q

moderate rosacea treatment

A

oral antibiotics
topical retinoids

45
Q

severe rosacea treatment

A

oral isotrentinoin
laser treatment

46
Q

psoriasis presentation

A

thickened, red patches covered by silvery-white scales
considered severe if covers more than 10% of BSA
types –> plaque (raised), scalp, and psoriatic

47
Q

psoriasis locations

A

scalp
face
armpit
elbows
trunk
butt
groin/genitals
nails
knees

48
Q

psoriasis etiology

A

T-lymphocyte mediated disease
keratinocyte proliferation
results from a rapid skin growth that it seven times faster than normal
triggers –> stress, environment (cold), injury, infection, smoking, drugs (NSAIDs, ACE, lithium), and diet

49
Q

general psoriasis treatment

A

increase sun exposure
baths
emollients
keratolytics

50
Q

general approach to psoriasis

A

topical therapy (first line, 70% of patients)
UV phototherapy
Systemic therapy
biologic therapy

51
Q

topical psoriasis treatment

A

first-line
emollients – used for all patients
corticosteroids (cort) – high potency ointment preferred for scaly lesions; economical choice
calipotriene/calipotriol – vit d analongs
cort + vit d analog
cort + tazarotene
calcineurin inhibitor

52
Q

UV phototherapy psoriasis treatment

A

used in mild to moderate diseases who do not completely respond to topical agents
may be used in combination with systemic or biologic treatment in severe cases
plays role in maintenance therapy
SE –> skin aging and squamous cell skin cancer

53
Q

systemic psoriasis treatment

A

apremilast
azothiaprine
cyclosporine
methotrexate
mycophenolate mofetil
tofacitinib

54
Q

biologic psoriasis treatment

A

dupixent
TNF and T-cell activation inhibitors

55
Q

treatment of severe psoriasis

A

biologic therapy (TNF/T-cell activation inhibitors are first line)
systemic therapy (oral retinoids, cyclosporine, and methotrexate are second line)

56
Q

role of biologics

A

very expensive
require PA/step therapy before usage
avoid use of live virus vaccines while using

Therapeutics Final (5 decks)

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