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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
comedolytic drugs
medication that inhibit the formulation of comedones example -- trentinoin, adapalene, azelaic acid
26
acne treatment for all patients
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
comedonal, non-inflammatory acne treatment
first choice --> topical retinoids (adapalene) alternatives --> BP and azelaic acid in lower strengths
28
mild to moderate papulopustular inflammatory acne treatment
first choice --> adapalene and BP or clindamycin and BP alternatives --> retinoids; adapalene and OA for more widespread disease
29
severe papulopustular or moderate nodular acne treatment
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
nodular or conglobate acne treatment
first choice --> oral isotrentinoin alternatives --> OA + azelaic acid; other topical agents or oral antiandrogens can be substituted for azelaic acid
31
maintenance acne treatment
first choice --> adapalene alternatives --> tazarotene; trentinoin; azelaic acid; BP
32
low cost acne treatment
topical retinoids (BP, Azelaic acids, adapalene due to being available in OTC formulations)
33
medium cost acne treatments
oral antibiotics (OA) anti-androgens (expensive if on a monthly basis) oral corticosteroids
34
high cost acne treatment
isotrentinoin anti-androgens tazarotene
35
acne follow up
2-6 months to determine if successful lengthening acne free periods is key
36
rocsacea presentation
common, chronic, progressive inflammatory dermatosis based upon vascular instability, facial flushing/blushing, facial erythema, papules, pustules, and telangiectasia
37
triggers of rosacea
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
types of rosacea
telangiectatic papulopustular phytmatous ocular
39
telangiectatic rosacea
visibly dilated blood vessels very red skin
40
papulopustular rosacea
resembles acne often called adult acne
41
phytmatous rosacea
enlarged sebaceous glands especially on the nose more common in males
42
life style modifications for rosacea
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
mild rosacea treatment
avoid triggers topical antibiotics (metronidazole) topical retinoids
44
moderate rosacea treatment
oral antibiotics topical retinoids
45
severe rosacea treatment
oral isotrentinoin laser treatment
46
psoriasis presentation
thickened, red patches covered by silvery-white scales considered severe if covers more than 10% of BSA types --> plaque (raised), scalp, and psoriatic
47
psoriasis locations
scalp face armpit elbows trunk butt groin/genitals nails knees
48
psoriasis etiology
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
general psoriasis treatment
increase sun exposure baths emollients keratolytics
50
general approach to psoriasis
topical therapy (first line, 70% of patients) UV phototherapy Systemic therapy biologic therapy
51
topical psoriasis treatment
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
UV phototherapy psoriasis treatment
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
systemic psoriasis treatment
apremilast azothiaprine cyclosporine methotrexate mycophenolate mofetil tofacitinib
54
biologic psoriasis treatment
dupixent TNF and T-cell activation inhibitors
55
treatment of severe psoriasis
biologic therapy (TNF/T-cell activation inhibitors are first line) systemic therapy (oral retinoids, cyclosporine, and methotrexate are second line)
56
role of biologics
very expensive require PA/step therapy before usage avoid use of live virus vaccines while using

Therapeutics Final (5 decks)

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