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Derm Pharm > NonInfectious Skin Disorders > Flashcards

NonInfectious Skin Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the primary cause of non infectious skin disorders

A

Drug induced

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2
Q

What concerns are there for pediatric skin and use of topical drugs

A

Thinner skin, higher rate of drug absorption and risk for systemic rxns

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3
Q

Functions of the skin

A

regulates body temperature, prevents dehydration, sense organ, vitamin D production/absorption

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4
Q

What clinical signs indicate a simple maculopapular eruption

A

Exanthematous without fever, lesions within 7-10 days of starting drug, resolve 7-14 days after drug stopped

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5
Q

What clinical signs indicate a hypersensitivity syndrome reaction

A

Exanthematous with fever, lesions start 1-4 weeks after starting drug, may be fatal

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6
Q

What clinical signs indicate urticaria/angioedema

A

Urticaria without fever

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7
Q

What clinical signs indicate serum sickness

A

Urticaria with fever

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8
Q

What clinical signs indicate a fixed drug eruption

A

Blistering without fever

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9
Q

What clinical signs indicate SJS/TEN

A

Blistering with fever, lesions within 7-14 days of drug exposure that spread rapidly and are confluent.

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10
Q

What clinical signs indicate Acneiform

A

Pustules without fever

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11
Q

What clinical signs indicate AGEP

A

Pustules with fever

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12
Q

Which cutaneous drug eruption is the most serious?

A

Urticarial hives

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13
Q

4 types of drug related cutaneous drug eruptions

A

Exanthem, urticaria, Blisters, Pustules

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14
Q

Tx for maculopapular eruption or drug hypersensitivity syndrome

A

Antihistamine (Benadryl), Analgesic, refer to ED if severe

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15
Q

Systemic syx of SJS/TEN

A

fever, headache, respiratory syx

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16
Q

Tx for SJS/TEN

A

send to ED/IP, antihistamine, stop drug, fluids, analgesics, wound care

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17
Q

2 causes of contact dermatitis

A

irritants (chemicals), or allergic sensitizers

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18
Q

Main pathology of irritant contact dermatitis and Tx

A

inflammation, Tx with steroids/anti-inflammatories

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19
Q

Main pathology of allergic contact dermatitis and Tx

A

Histamine release, Tx with antihistamines

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20
Q

Is Tx for contact dermatitis PO or topical?

A

Topical

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21
Q

If a patient is taking Bactrim and PCN and develops an allergic rxn, which drug do you discontinue first?

A

Bactrim

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22
Q

Management options for Diaper Dermatitis

A

air drying, gentle cleansing, use of barriers

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23
Q

What barrier creams are suggested to help treat diaper dermatitis

A

Desitin (zinc oxide), Petrolatum

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24
Q

If there is a yeast infection along with diaper rash what Tx should be used?

A

Topical antifungal (Imidazole) + barrier (Desitin)

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25
Q

What agent can be added if the diaper rash is severe?

A

very low potency topical corticosteroid (0.5-1% Hydrocortisone cream)

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26
Q

What are the topical treatments indicated for superficial BCC?

A

Imiquimod (Aldara), 5-Fluorouracil

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27
Q

What are the topical treatments available for Malignant Melanoma?

A

Temozolomide, Decarbazine

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28
Q

MOA for imiquimod (Aldara)

A

immune response modifier with unknown MOA

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29
Q

MOA for 5-fluorouracil

A

pyrimidine antimetabolite, blocks DNA synthesis by blocking methylation of deoxyuridylic acid by inhibiting TS or by being incorporated into RNA

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30
Q

SE of 5-fluorouracil

A

photosensitivity to sunlight

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31
Q

Which of Temozolomide or Decarbazine a prodrug?

A

Both are prodrugs

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32
Q

MOA of Temozolomide

A

nonenzymatically converted to alkylating agent MTIC in all tissues its distributed to

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33
Q

SE of Temozolomide and Decarbazine

A

Nausea, Vomiting, avoid in pregnancy

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34
Q

DOC for mild-moderate acne

A

Benzoyl peroxide, retinoids, salicylic acid

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35
Q

MOA of benzoyl peroxide

A

keratolytic, antibaterial against P. acnes

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36
Q

SE of benzoyl peroxide

A

irritation, burning, redness, drying, peeling

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37
Q

Classes of drugs utilized in Tx for acne

A

Keratolytics, Retinoids, Antiandrogens, Abx

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38
Q

MOA of Retinoids

A

decreases cohesiveness of hyperproliferative keratinocytes, vitamin A analogs

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39
Q

When should topical retinoids be applied

A

Nighttime, starting with every other night for the first 2 weeks

40
Q

Which retinoid is the most effective oral therapy for acne?

A

Isotretinoin (Accutane)

41
Q

What are 3 topical retinoids available for Tx of acne

A

Retina A, Differin, Tazorac

42
Q

Can retinoids be used with pregnancy?

A

NO

43
Q

SE of Differin and Tazorac

A

photoIRRITANTS, avoid sun and need use of sunscreen

44
Q

MOA of antiandrogens

A

reduces sebum production

45
Q

What are two antiandrogens used in combination with O.C. for Tx of acne

A

Spironolactone (Aldactone), Finasteride

46
Q

What is Finasteride also used for Tx in

A

BPH, androgenic alopecia

47
Q

specific MOA for Spironolactone

A

K+ sparing diuretic

48
Q

specific MOA for Finasteride

A

inhibits steroid type II 5alpha reductase that converts androgen testosterone into DHT

49
Q

Tx for moderate-severe acne

A

reduce P.acnes and inflammation; benzoyl peroxide, topical/oral Abx, Retinoids

50
Q

What topical Abx can be used for Tx of acne

A

Clindamycin

51
Q

What oral Abx can be used for Tx of acne

A

Erythromycin, TTX, Minocycline

52
Q

Tx for severe acne

A

reduce sebaceous activity; Antiandrogens, Isotretinion, Topical/PO Abx

53
Q

Alteranative Tx for Acne

A

tea tree oil, tea lotion, glycolic acid, hydroquinone, azelaic acid

54
Q

Etiology of Psoriasis

A

T lymphocyte mediated inflammation due to genetic and environmental factors

55
Q

What associated diseases are commonly found with psoriasis?

A

CV disease, stroke, diabetes, psoriatic arthritis, HTN, dyslipidemia, depression

56
Q

In what conditions should low potency corticosteroids be used instead of high potency?

A

infants, lesions on face, intertriginous, areas with thin skin

57
Q

SE for topical steroids

A

skin atrophy, acne, contact dermatitis, hypopigmentation, striae, telangiectases, purpura

58
Q

What are the primary effects corticosteroids have?

A

antiinflammatory, antiproliferative, immunosuppressive, vasoconstrictive

59
Q

Drugs used in the Tx of psoriasis

A

Calcipotriol, Tazarotene, Anthralin, Acitretin, Methotrexate, Cyclosporine, Alefacept, Ustekinumab, TNF inhibitors

60
Q

MOA of Calcipotriol

A

inhibits vitD receptors to inhibit keratinocyte proliferation and differentiation

61
Q

What additional supplement should be encouraged when prescribing Calcipotriol?

A

2000 mg VitD3 supplement

62
Q

SE of Calcipotriol

A

irritant contact dermatitis, burning, pruritus, edema, peeling, dryness, erythema

63
Q

MOA of Tazarotene

A

topical retinoid, decreases keratinocyte hyperproliferation and removes inflammatory infiltrate

64
Q

SE of Tazarotene

A

irritation at application site

65
Q

Are the SE of Tazarotene dose or class dependent?

A

Dose dependent, reducing dose will decrease extent of irritation

66
Q

Which pregnancy category is Tazarotene?

A

Pregnancy Category X

67
Q

MOA of Anthralin

A

keratinocyte antiproliferative, may reduce mitotic activity, prevents T lymphocyte activation

68
Q

When and how is Anthralin used for psoriasis Tx?

A

not commonly used, SCAT is preferred method by wiping off ointment after 2 hrs of being on plaque

69
Q

What else should be prescribed with Anthralin ointment to reduce its high irritability to the skin?

A

Zinc oxide ointment to the surrounding healthy skin

70
Q

What is Acitretin and when is it used in Tx for psoriasis

A

Retinoid, used in combination with topical calcipotriol/phototherapy

71
Q

SE of acitretin

A

hypertriglyceridemia, mucous dryness and burning, retinoid dermatitis

72
Q

What substance should be avoided with Acitretin Tx during and 2 months after drug discontinued?

A

Ethanol, increases the half life of acitretin by converting to etretinate

73
Q

What is the primary Tx for moderate-severe psoriasis?

A

Methotrexate

74
Q

MOA of Methotrexate

A

antimetabolite, inhibits dihydrofolic acid reductase to interfere with DNA synthesis

75
Q

What supplement must be provided along with prescribing Methotrexate?

A

Folic Acid

76
Q

What lab levels must be checked while on Methotrexate?

A

ALT/AST, hepatotoxic

77
Q

Drug class for cyclosporine

A

immunomodulator, systemic calcineurin inhibitor

78
Q

What should be checked prior to prescribing Cyclosporine?

A

Renal function, drug is renally cleared

79
Q

SE of cyclosporine

A

renal toxicity, HTN, hypertriglyceridemia

80
Q

What is the first BRM to be approved for Tx of psoriasis?

A

Alefacept

81
Q

MOA of Alefacept

A

blocks binding of LFA3 and CD2, decreases CD4 T activation

82
Q

What lab levels must be monitored when prescribing Alefacept

A

CD4 levels, can deplete CD4 count

83
Q

What is the newest BRM indicated for Tx of psoriasis

A

Ustekinumab, a IL-12/23 monoclonal Ab

84
Q

What age group is Ustekinumab indicated for Tx for psoriasis

A

adults 18 and older

85
Q

Is Ustekinumab indicated for mild or mod-severe psoriasis Tx

A

mod-severe psoriasis

86
Q

What are the three TNF inhibitors indicated for Tx of psorias?

A

Etanercept (Humira), Adalimumab (Enbrel), Infliximab (Remicade)

87
Q

What is the most common SE of TNF inhibitors

A

Increased infections of the upper respiratory tract since they are immunosupressants

88
Q

What pregnancy category are TNF inhibitors

A

Category B, safe in pregnancy

89
Q

In what patients should the use of TNF inhibitors be avoided?

A

CHF patients

90
Q

Which TNF inhibitor has the lowest risk of TB infections?

A

Etanercept (Humira)

91
Q

Which TNF inhibitor has the highest risk of TB infections?

A

Infliximab (Remicade)

92
Q

What are some alternative therapies for Tx of psoriasis?

A

Mahonia aquifolium, fish oil, climatotherapy, stress reduction techniques

93
Q

Definition of atopic dermatitis

A

skin inflammation that causes itching, scales, and erythema with unknown etiology

94
Q

What is the most potent topical steroid?

A

Betamethasone Dipropionate

95
Q

What is the least potent topical steroid?

A

Hydrocortisone

96
Q

What drugs can cause urticaria/angioedema?

A

ACEI/ARB

97
Q

What drugs can cause serum sickness

A

Cefaclor

Derm Pharm (2 decks)

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