NonInfectious Skin Disorders

Question 1

What is the primary cause of non infectious skin disorders

Answer 1

Drug induced

Question 2

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

Answer 2

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

Question 3

Functions of the skin

Answer 3

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

Question 4

What clinical signs indicate a simple maculopapular eruption

Answer 4

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

Question 5

What clinical signs indicate a hypersensitivity syndrome reaction

Answer 5

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

Question 6

What clinical signs indicate urticaria/angioedema

Answer 6

Urticaria without fever

Question 7

What clinical signs indicate serum sickness

Answer 7

Urticaria with fever

Question 8

What clinical signs indicate a fixed drug eruption

Answer 8

Blistering without fever

Question 9

What clinical signs indicate SJS/TEN

Answer 9

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

Question 10

What clinical signs indicate Acneiform

Answer 10

Pustules without fever

Question 11

What clinical signs indicate AGEP

Answer 11

Pustules with fever

Question 12

Which cutaneous drug eruption is the most serious?

Answer 12

Urticarial hives

Question 13

4 types of drug related cutaneous drug eruptions

Answer 13

Exanthem, urticaria, Blisters, Pustules

Question 14

Tx for maculopapular eruption or drug hypersensitivity syndrome

Answer 14

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

Question 15

Systemic syx of SJS/TEN

Answer 15

fever, headache, respiratory syx

Question 16

Tx for SJS/TEN

Answer 16

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

Question 17

2 causes of contact dermatitis

Answer 17

irritants (chemicals), or allergic sensitizers

Question 18

Main pathology of irritant contact dermatitis and Tx

Answer 18

inflammation, Tx with steroids/anti-inflammatories

Question 19

Main pathology of allergic contact dermatitis and Tx

Answer 19

Histamine release, Tx with antihistamines

Question 20

Is Tx for contact dermatitis PO or topical?

Answer 20

Topical

Question 21

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

Answer 21

Bactrim

Question 22

Management options for Diaper Dermatitis

Answer 22

air drying, gentle cleansing, use of barriers

Question 23

What barrier creams are suggested to help treat diaper dermatitis

Answer 23

Desitin (zinc oxide), Petrolatum

Question 24

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

Answer 24

Topical antifungal (Imidazole) + barrier (Desitin)

Question 25

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

Answer 25

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

Question 26

What are the topical treatments indicated for superficial BCC?

Answer 26

Imiquimod (Aldara), 5-Fluorouracil

Question 27

What are the topical treatments available for Malignant Melanoma?

Answer 27

Temozolomide, Decarbazine

Question 28

MOA for imiquimod (Aldara)

Answer 28

immune response modifier with unknown MOA

Question 29

MOA for 5-fluorouracil

Answer 29

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

Question 30

SE of 5-fluorouracil

Answer 30

photosensitivity to sunlight

Question 31

Which of Temozolomide or Decarbazine a prodrug?

Answer 31

Both are prodrugs

Question 32

MOA of Temozolomide

Answer 32

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

Question 33

SE of Temozolomide and Decarbazine

Answer 33

Nausea, Vomiting, avoid in pregnancy

Question 34

DOC for mild-moderate acne

Answer 34

Benzoyl peroxide, retinoids, salicylic acid

Question 35

MOA of benzoyl peroxide

Answer 35

keratolytic, antibaterial against P. acnes

Question 36

SE of benzoyl peroxide

Answer 36

irritation, burning, redness, drying, peeling

Question 37

Classes of drugs utilized in Tx for acne

Answer 37

Keratolytics, Retinoids, Antiandrogens, Abx

Question 38

MOA of Retinoids

Answer 38

decreases cohesiveness of hyperproliferative keratinocytes, vitamin A analogs

Question 39

When should topical retinoids be applied

Answer 39

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

Question 40

Which retinoid is the most effective oral therapy for acne?

Answer 40

Isotretinoin (Accutane)

Question 41

What are 3 topical retinoids available for Tx of acne

Answer 41

Retina A, Differin, Tazorac

Question 42

Can retinoids be used with pregnancy?

Answer 42

NO

Question 43

SE of Differin and Tazorac

Answer 43

photoIRRITANTS, avoid sun and need use of sunscreen

Question 44

MOA of antiandrogens

Answer 44

reduces sebum production

Question 45

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

Answer 45

Spironolactone (Aldactone), Finasteride

Question 46

What is Finasteride also used for Tx in

Answer 46

BPH, androgenic alopecia

Question 47

specific MOA for Spironolactone

Answer 47

K+ sparing diuretic

Question 48

specific MOA for Finasteride

Answer 48

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

Question 49

Tx for moderate-severe acne

Answer 49

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

Question 50

What topical Abx can be used for Tx of acne

Answer 50

Clindamycin

Question 51

What oral Abx can be used for Tx of acne

Answer 51

Erythromycin, TTX, Minocycline

Question 52

Tx for severe acne

Answer 52

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

Question 53

Alteranative Tx for Acne

Answer 53

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

Question 54

Etiology of Psoriasis

Answer 54

T lymphocyte mediated inflammation due to genetic and environmental factors

Question 55

What associated diseases are commonly found with psoriasis?

Answer 55

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

Question 56

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

Answer 56

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

Question 57

SE for topical steroids

Answer 57

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

Question 58

What are the primary effects corticosteroids have?

Answer 58

antiinflammatory, antiproliferative, immunosuppressive, vasoconstrictive

Question 59

Drugs used in the Tx of psoriasis

Answer 59

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

Question 60

MOA of Calcipotriol

Answer 60

inhibits vitD receptors to inhibit keratinocyte proliferation and differentiation

Question 61

What additional supplement should be encouraged when prescribing Calcipotriol?

Answer 61

2000 mg VitD3 supplement

Question 62

SE of Calcipotriol

Answer 62

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

Question 63

MOA of Tazarotene

Answer 63

topical retinoid, decreases keratinocyte hyperproliferation and removes inflammatory infiltrate

Question 64

SE of Tazarotene

Answer 64

irritation at application site

Question 65

Are the SE of Tazarotene dose or class dependent?

Answer 65

Dose dependent, reducing dose will decrease extent of irritation

Question 66

Which pregnancy category is Tazarotene?

Answer 66

Pregnancy Category X

Question 67

MOA of Anthralin

Answer 67

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

Question 68

When and how is Anthralin used for psoriasis Tx?

Answer 68

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

Question 69

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

Answer 69

Zinc oxide ointment to the surrounding healthy skin

Question 70

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

Answer 70

Retinoid, used in combination with topical calcipotriol/phototherapy

Question 71

SE of acitretin

Answer 71

hypertriglyceridemia, mucous dryness and burning, retinoid dermatitis

Question 72

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

Answer 72

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

Question 73

What is the primary Tx for moderate-severe psoriasis?

Answer 73

Methotrexate

Question 74

MOA of Methotrexate

Answer 74

antimetabolite, inhibits dihydrofolic acid reductase to interfere with DNA synthesis

Question 75

What supplement must be provided along with prescribing Methotrexate?

Answer 75

Folic Acid

Question 76

What lab levels must be checked while on Methotrexate?

Answer 76

ALT/AST, hepatotoxic

Question 77

Drug class for cyclosporine

Answer 77

immunomodulator, systemic calcineurin inhibitor

Question 78

What should be checked prior to prescribing Cyclosporine?

Answer 78

Renal function, drug is renally cleared

Question 79

SE of cyclosporine

Answer 79

renal toxicity, HTN, hypertriglyceridemia

Question 80

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

Answer 80

Alefacept

Question 81

MOA of Alefacept

Answer 81

blocks binding of LFA3 and CD2, decreases CD4 T activation

Question 82

What lab levels must be monitored when prescribing Alefacept

Answer 82

CD4 levels, can deplete CD4 count

Question 83

What is the newest BRM indicated for Tx of psoriasis

Answer 83

Ustekinumab, a IL-12/23 monoclonal Ab

Question 84

What age group is Ustekinumab indicated for Tx for psoriasis

Answer 84

adults 18 and older

Question 85

Is Ustekinumab indicated for mild or mod-severe psoriasis Tx

Answer 85

mod-severe psoriasis

Question 86

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

Answer 86

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

Question 87

What is the most common SE of TNF inhibitors

Answer 87

Increased infections of the upper respiratory tract since they are immunosupressants

Question 88

What pregnancy category are TNF inhibitors

Answer 88

Category B, safe in pregnancy

Question 89

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

Answer 89

CHF patients

Question 90

Which TNF inhibitor has the lowest risk of TB infections?

Answer 90

Etanercept (Humira)

Question 91

Which TNF inhibitor has the highest risk of TB infections?

Answer 91

Infliximab (Remicade)

Question 92

What are some alternative therapies for Tx of psoriasis?

Answer 92

Mahonia aquifolium, fish oil, climatotherapy, stress reduction techniques

Question 93

Definition of atopic dermatitis

Answer 93

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

Question 94

What is the most potent topical steroid?

Answer 94

Betamethasone Dipropionate

Question 95

What is the least potent topical steroid?

Answer 95

Hydrocortisone

Question 96

What drugs can cause urticaria/angioedema?

Answer 96

ACEI/ARB

Question 97

What drugs can cause serum sickness

Answer 97

Cefaclor