Medication + Investigations

Question 1

How do you investigate skin disease

Answer 1

Charcoal swab + MC+S
Viral swab PCR of vesicle / bull
Fungal nail clipping / hair sample + CULTURE
Biopsy

Question 2

When would you not do a charcoal swab

Answer 2

Cellulitis as infection in blood

Venous ulcer

Question 3

How affected absorption of topical medication

Answer 3

Concentration 
Vehicle - pharmacologically inert but chemically stable substance that carriers active drug 
Chemical properties
Striatum thickness 
Temperature 
Skin site

Question 4

What topical agents is there to treat skin disease

Answer 4

Steroids 
Vit A Analogue
Antibiotics / fungals / viral 
Parasitidicies
Chemo
Coal tar
Dithranol

Question 5

What do steroids do

Answer 5

Anti-inflammatory + immunosuppressive
Suppress fibroblasts / leucocytes 
Vasoconstrict 
Regulate cytokines
Inhibit vascular permeability

Question 6

How do you measure amount of topical agent

Answer 6

Finger tip unit (0.5g) 
Potency over %
Mild = hydrocortisone 
Mod = Eumovate
Potent = Betonovate
Highly potent = Dermovate

Question 7

What are the SE of steroids

Answer 7

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

Question 8

What are common systemic agents

Answer 8

Retinoids
Immunosuppressant
Biologics

Question 9

What are retinoids

Answer 9

Vit A analogues

Question 10

What do retinoids do

Answer 10

Normalise keratinocyte function
Anti-inflammatory
Decrease skin turnover

Question 11

What are the SE of retinoids

Answer 11

Dry lips and skin
TERATOGENIC - must be on contraceptive
Increased transaminase / abnormal LFT - monitor with regular blood test
Psychiatric / bone / eye = rare

Question 12

When are retinoids indicated

Answer 12

Acne
Psoriasis
T cell lymphoma
Hand eczema

Question 13

What are common immunosuppressants

Answer 13

Steroid 
Cyclosporin
Azathropine
Methotrexate 
MMF

Question 14

What is needed if on immunosuppressants and why

Answer 14

Regular blood monitoring - FBC, U+E, LFT

Risk of malignancy / infection

Question 15

What are biologics

Answer 15

Genetically engineered proteins which inhibit specific parts of the immune system
Expensive

Question 16

What have biologics revolutionised the Rx of

Answer 16

Melanoma

Question 17

If biologic end in - cept

Answer 17

Receptor fusion protein

Question 18

If biologic end in -mab

Answer 18

Monoclonal Ab

Question 19

What are the SE of biologics

Answer 19

Infection
Malignancy
TB reactivation
TNF inhibitor so risk of demyelination

Question 20

What are types of monoclonal Ab

Answer 20

HUmanised
Chimeric
Fully human
Immunomodualtory

Question 21

When are biologics used

Answer 21

Melanoma
Urticaria
Plaque psoriasis

Question 22

What must you avoid if on a biologic

Answer 22

Live vaccine

Question 23

What are examples of emollients

Answer 23

Aqueous cream
Emulsifying ointment
Liquid parafin

Question 24

What is indication

Answer 24

Rehydrate skin

Used for dry scaling conditions and as soap substitute

Question 25

What are SE

Answer 25

Can have irritant or allergic reaction if preservative/ perfume in cream

Question 26

What are SE of oral acyclovir

Answer 26

GI upset Raised liver enzyme Haemaotlogical disorder Reversible neurological

Question 27

What are SE of anti-histamine

Answer 27

Sedation | Anti-cholinergic - blurred vision / dry mouth / retention and constipation

Question 28

Types of anti-histamine

Answer 28

``` Sedating - CHlorphenamine Non-sedating - Cetrizine - Loritidine ```

Question 29

When are they used

Answer 29

Type1 hypersensitvity Eczema Pruritus as block histamine receptors

Question 30

What are topical Ax

Answer 30

Fusidic acid Neomycin Dapsone

Question 31

What are oral Ax

Answer 31

``` Penicillins Cephalosporin Gentamicin Macrolides Nitrofurantoin ```

Question 32

When are they indicated

Answer 32

Bacterial skin infection | Acne

Question 33

What are SE

Answer 33

``` Local skin irritation GI upset Rashes Anaphylaxis Vaginal candidiasis C.diff ```

Question 34

What are topical anti-septic

Answer 34

CHlorhexidine

Question 35

When is it indicated

Answer 35

Prevent skin infection

Question 36

SE

Answer 36

Irritant / allergy

Question 37

Indication for oral retinoid

Answer 37

Severe acne | Psoriasis

Question 38

SE

Answer 38

``` Dry skin, lips and eyes Disordered liver function Hypercholesterol Myalgia Arthralgia Depression Teratogenic - one month before and after contraception needed ```