Medication + Investigations Flashcards
How do you investigate skin disease
Charcoal swab + MC+S
Viral swab PCR of vesicle / bull
Fungal nail clipping / hair sample + CULTURE
Biopsy
When would you not do a charcoal swab
Cellulitis as infection in blood
Venous ulcer
How affected absorption of topical medication
Concentration Vehicle - pharmacologically inert but chemically stable substance that carriers active drug Chemical properties Striatum thickness Temperature Skin site
What topical agents is there to treat skin disease
Steroids Vit A Analogue Antibiotics / fungals / viral Parasitidicies Chemo Coal tar Dithranol
What do steroids do
Anti-inflammatory + immunosuppressive Suppress fibroblasts / leucocytes Vasoconstrict Regulate cytokines Inhibit vascular permeability
How do you measure amount of topical agent
Finger tip unit (0.5g) Potency over % Mild = hydrocortisone Mod = Eumovate Potent = Betonovate Highly potent = Dermovate
What are the SE of steroids
Thinning / atrophy of skin Striae Hirsutism Telengiectasia Acne Peri-oral dermatitis Allergic contact dermatitis May exacerbate skin infection
If systemic
- Glaucoma / Cataract
- Cushing
- DM
- Immunosuppression
- HTN
- Osteoporosis
What are common systemic agents
Retinoids
Immunosuppressant
Biologics
What are retinoids
Vit A analogues
What do retinoids do
Normalise keratinocyte function
Anti-inflammatory
Decrease skin turnover
What are the SE of retinoids
Dry lips and skin
TERATOGENIC - must be on contraceptive
Increased transaminase / abnormal LFT - monitor with regular blood test
Psychiatric / bone / eye = rare
When are retinoids indicated
Acne
Psoriasis
T cell lymphoma
Hand eczema
What are common immunosuppressants
Steroid Cyclosporin Azathropine Methotrexate MMF
What is needed if on immunosuppressants and why
Regular blood monitoring - FBC, U+E, LFT
Risk of malignancy / infection
What are biologics
Genetically engineered proteins which inhibit specific parts of the immune system
Expensive
What have biologics revolutionised the Rx of
Melanoma
If biologic end in - cept
Receptor fusion protein
If biologic end in -mab
Monoclonal Ab
What are the SE of biologics
Infection
Malignancy
TB reactivation
TNF inhibitor so risk of demyelination
What are types of monoclonal Ab
HUmanised
Chimeric
Fully human
Immunomodualtory
When are biologics used
Melanoma
Urticaria
Plaque psoriasis
What must you avoid if on a biologic
Live vaccine
What are examples of emollients
Aqueous cream
Emulsifying ointment
Liquid parafin
What is indication
Rehydrate skin
Used for dry scaling conditions and as soap substitute
What are SE
Can have irritant or allergic reaction if preservative/ perfume in cream
What are SE of oral acyclovir
GI upset
Raised liver enzyme
Haemaotlogical disorder
Reversible neurological
What are SE of anti-histamine
Sedation
Anti-cholinergic - blurred vision / dry mouth / retention and constipation
Types of anti-histamine
Sedating - CHlorphenamine Non-sedating - Cetrizine - Loritidine
When are they used
Type1 hypersensitvity
Eczema
Pruritus as block histamine receptors
What are topical Ax
Fusidic acid
Neomycin
Dapsone
What are oral Ax
Penicillins Cephalosporin Gentamicin Macrolides Nitrofurantoin
When are they indicated
Bacterial skin infection
Acne
What are SE
Local skin irritation GI upset Rashes Anaphylaxis Vaginal candidiasis C.diff
What are topical anti-septic
CHlorhexidine
When is it indicated
Prevent skin infection
SE
Irritant / allergy
Indication for oral retinoid
Severe acne
Psoriasis
SE
Dry skin, lips and eyes Disordered liver function Hypercholesterol Myalgia Arthralgia Depression Teratogenic - one month before and after contraception needed
