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Pharm 2-2 Flashcards

1
Q

What are the 1st Generation Antihistamines?

A 
Dr Pepper, Cycho Chic Hit Me Bro
Diphenhydramine- OTC sleep, Preg Cat B
Promethazine- NV
Cyproheptadine- SSyndrome
Chlorpheniramine- ACOG Cat B
Hydroxyzine- hives
Meclizine- vertigo
Brompheniramine
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2
Q

What are the 2nd Generation Antihistamines?

A 
Dos Foxy Ladies Love Construction
Desloratadine
Fexofenadine
Loratadine- non-sedating pregnancy-B
Levocetirizine
Cetirizine- low sedating, pregnancy-B
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3
Q

What are the Intranasal 2nd Generation Antihistamines

A

A-Ohhh
Azelastine- systemic absorption, crosses BBB
Olopatadine- H1 selective, fewer s/e

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4
Q

What are the Decongestants

A

POP

Phenylephrine- 4hrs,

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5
Q

What are the 3 Decongestant Alternatives?

A

IN Case
Intranasal Saline
Nasal strips
Coricidin- Chlorpheniramine is typical ingredient, abuse potential

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6
Q

What is the name of the Leukotriene Antagonist

A

Montelukast

Inhibits cysteinyl leukotriene on target cells
Comparable to anti-histamines, less than INS; Pregnancy Cat B
S/e= HA, Mood/SIs

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7
Q

What are the names of the Intranasal Steroids

A 
Moms Fat Belly Tried Flinging Boogers Far
Mometasone
Fluticasone Pro. 
Budesonide- preferred INS in pregnancy
Triamcinolone
Flunisolide- Dec growth velocity
Beclomethasone- Dec growth velocity
Fluticasone Fur.
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8
Q

What is the name of the Intranasal Steroid combo?

What is the name of the Anticholinergic med used for congestion and the MOA, Use and Adverse

A

Azelastine and Fluticasone propiona

Ipratropium
Muscarinic antagonist to decrease secretions
Pregnancy B and relief of rhinorrhea from common cold in PTs +5y/o
Epistaxis, dry mouth/nose

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9
Q

What is the name of the spray form of Mast Cell Stabilizer?

What is the name of the ocular form of Mast Cell Stabilizer?

Due to their slow onset, what step is taken to speed up relief?

A

Cromolyn Sodium
Prevents release of histamine and leukotrienes, best as preventative measure and preferred DOC for pregnancy rhinorrhea and sneezing

Cromolyn
Lodoxamide
Nedocromil

Taken w/ ocular anti-histamine

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10
Q

What are the names of the 2 non-selective ocular anti-histamines

What are the names of the 2 selective ocular anti-histamines?

A

Azelastine
Levocabastine

Ketotifen
Olopatadine

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11
Q

What are the names of the 3 ocular decongestants?

A

NOT
Naphazoline
Oxymetazoline
Tetrahydrozoline

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12
Q

What is the name of the ocular NSAID?

What is the name of the ocular steroid?

A

Ketoralac

Loteprednol

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13
Q

How do NSAIDs/ASA inihibit prostaglandin, Thromboxane, or Prostacyclin formation?

Where/how do corticosteroids exert their effect?

A

Stops cyclo-oxygenase

Prevent phospholipase from converting into arachidonic acid

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14
Q

How is Allergic Rhinitis: Intermittents Sxs managed?

A

1- Avoidance
2- PIdL (PO Anti-hist, InNasal Anti-hist +/- decon, LTRA)
3- PIaLInMast

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15
Q

How is Allergic Rhinitis Persistent Sxs managed?

A

1- Avoidance
2- PIaLInMast
3- INS; PO Ant/LTRA; Rhino= Ipra; Block= PO D/CCS burst

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16
Q

How is allergic conjunctivitis treated?

A

1- Avoidance
2- PO/Ocular anti-histamine, artificial tears, cold compress
3- DAMN (D-redness;N-itch)
4- ocular steroids and referral

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17
Q

What are the 4 characteristics Sxs of Allergic Rhinitis

What are the two forms of Allergic Rhinitis?

A

CRIS
Congestion, Rhinorrhea, Itching, Sneezing

Acute- HOID
Hormones, Object, Infection, Drugs

Chronic- Allergic: Intermittent/Persistent
Nonallergic: NARES, anatomic

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18
Q

Which immunoglobulin drives allergic rhinitis cases and what are the 5 main triggers of it?

Most of these PTs will also have what issues?

A

IgE; DIMMP
Dander, Insects, Mold, Mites, Pollen

40%- asthma
80%- chronic sinusitis

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19
Q

What are the Sxs of the Early Phase Reactants?

What are the Sxs of the Late Phase Reactants?

A

Congestion, Rhinorrhea, Pruritis, Sneezes

Congestion, Sneezes, Rhinorrhea

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20
Q

What are 4 exterior Sxs that could be seen on a PE for a PT with Allergic Rhinitis

Criteria for intermittent and persistent Sxs?

A

Shiners, Allergic salute, Nasal creases, Dennie Morgan lines

Intermittent: <4 days/wk, <4 wks
Persistent: 4 or more days/wk for 4 or more wks

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21
Q

Criteria for mild and mod/severe Sxs of Allergic Rhinitis

What are the four treatment fgoals for Allergic Rhinitis?

A

Mild- normal sleep; no trouble w/ Sxs, sleep, work
Mod/Sev- issues w/ sleep, life, work, Sxs

Improve QoL
Reduce Sxs
Prevent long term complications
Avoid adverse medication s/e

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22
Q

Anti-histamine use is contraindicated in ? PT populations?

Decongestants are AKA ?

A

Glaucoma, BPH

Sympathomimetics

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23
Q

Caution needs to be exercised when using decongestants w PTs that have what adrenergic stimulation sensitive conditions?

What drug is preferred because of this precaution?

A

D HN BCT
CAD, HTN, Thyroid Dz, DM, NA Glaucoma, BPH

PO Phenylephrine > Pseudoephedrine due to decrease CV s/e

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24
Q

Since INS are the most effective drugs for relieving CRIS, what steps are taken during dosing to ensure max relief?

A

Clear nasals w/ saline/decongestant first

Avoid blowing nose x 10m

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25
Q

What is the triad of allergic conjunctivitis

What non-pharm steps can be taken to relieve Sxs?

A

Itching, Redness, Chemosis

Cold compress- itching
Tears- dilutes/flushes eyes

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26
Q

What are the adverse effects of Ocular steroids?

Why is Loteprednol unique?

A

Cataracts, Inc IOP, Inc risk of Infxn

Only ocular steroid approved for use in seasonal allergic conjunctivitis; Lacks ketone on C-20 allowing for rapid conversion to metabolite and decreased absorption

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27
Q

What are the steps of administerring eye drops?

A

Wash hands
Tilt back, pull down w/ index to form pocket
Hold dropper close to eye and brace
Squeeze drop into lower lid
Hold eye closed x 2-3min w/ head down
Place finger near duct and apply pressure to minimize systemic absorption
Wipe excess w/ tissue
Wait 5min before applying second drop to same eye

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28
Q

What is the function of Glucocorticoids and what is the major one?

What are the two functions of Mineralcorticoid and what is the major one?

A

G- effects metabolism and immune function
Cortisol (hydrocortisone) w/ some mineralcorticoid effects

M- sodium retaining activity and feedback regulation of pituitary corticotropin
Aldosterone

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29
Q

What are the 3 layers of the adrenal cortex and the major compound made there?

What hormone controls the secretion of the inner and part of the outter layers of the adrenal cortex?

What is the negative feedback inhibitor of this process?

A

Outter- Glomerulosa: Aldosterone
Middle- Fascicuata: Cortisol
Inner- Reticularis: Adrenal androgens

ACTH from anterior pituitary

Glucocorticoids inhibit ACTH and CRH

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30
Q

What controls aldosterones presence and effects in the body?

What is the forward process of the HPA axis and where is the negative feedback process seen?

A

Angiotensin II

Hypothalamus - CRH - Ant Pituitary - ACTH - Adrenal Cortex - CORT

CORT inhibits Ant Pituitary and Hypothalamus

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31
Q

Which glucocorticoid follows a normal circadian rhythm?

What does this timing mean for dosing?

A

ACTH- peaks in AM and post-meals

Systemic glucorticoids are dosed in the AM and w/ meals

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32
Q

How much cortisol is secreted by a non-stressed adult per day?

What causes these levels to be increased?

A

10-20mg w/ T1/2 60-90min

Hydrocortisone administered in large amounts, stress, hypothyroid or active liver dz

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33
Q

90% of corticosteroids are bound to ?

What causes this transporter to be increased or decreased?

A

Corticosteroid binding globulin

Estrogen/pregnancy= increased
Hypothyroidism, protein deficiency= decreased

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34
Q

MOA of Glucocorticoids

What effect do they have on metabolism, hematopoietic and anti-inflammation

A

Bind to receptors in cytoplasms; 20% of gene regulation is due to glucocorticoids

Increases lipolysis to create hyperglycemia
Causes WBC migration to lymph tissue
Blocks release of arachidonic acid to reduce progstaglandins and leukotrienes

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35
Q

What glucocorticoid is used for Addison’s Dz

What glucocorticoid is used for Asthma

A

Hydrocortisone (and Fludrocortisone if mineracorticoid activity is needed)

Prednisone, Prednisolone- less mineral activity

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36
Q

What glucocorticoid is used for acceleration of lung maturation

What glucocorticoid is used for COPD

A

Dexamethasone or Metamethasome IM

Methylprednisolone, Prednisone

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37
Q

What glucocorticoid is used for CT/Rheumatic d/os

What glucocorticoid is used for post-op/chemo N/V

A

Prednisone- well absorbed and cheap; can substitute w/ Methylprednisolone or Prednisolone

Dexamethasone IV- most commonly used/studied

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38
Q

What glucocorticoid is used for poison oak/ivy/sumac

What drug interactions does glucocorticoids have?

A

Prednisone- do not use pre-packaged corticosteroids

CYP450 inducers- increase metabolism and decreased efficacy
OCP, Itraconazole, Macrolides- decreased clearance
K-depleting drugs/diuretic- increased risk of hypokalemia

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39
Q

What are the adverse effects of inhales glucocorticoids?

When d/c these meds, how long of a taper period is needed?

A

Thrush, Dysphonia, Dry mouth
Growth suppression

Use longer than 2wks= 5-20% per 1-2wks (inc dose if Flu Sxs/Dz flare occurs)
Switch to Prednisone
Consolidate daily doses to single morning dose
Consider cortisol therapy prior to d/c

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40
Q

What are the short term s/e of glucocorticoid usage?

Suppression of the HTA by these meds is unlikely if they were taken for what time frame?

HPA suppression is likely if taken for ?

Unknown risks if meds are taken for ?

A

Weight gain, Hyperglycemia, Acne, Moods

<3wks or every other day dosing

> 20mg of prenisone or equivalent >3wks
5mg or more of prednisone or equivalent at bed >3wks
Any PT w/ Cushingoid appearance

10-20mg of prednisone equivalent for >3wks

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41
Q

When are topical glucocorticoids used?

When are they contraindicated?

A

DOC for dermal flares- Allergic contact dermatitis, Atopic eczema, Seborrheic dermatitis

Acne vulgaris, Rosacea, Warts, Fungal infections, Ulcers

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42
Q

What are the Very High, High, Medium and Low potency glucocorticoids

A

Very- Betameth dipro 0.05% ointment/gel
High- Betameth dipro 0.05% lotion/cream
Med- Betameth dipro 0.05% lotion/cream
Low- Desonide, Hydrocortisone/acetate

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43
Q

Pros/Cons of topical ointments, creams, lotion/gel, and foam/shampoos

A

Oint- more lube/occlusion= improves absorption, most useful for dry/thick hyperkeratotic lesions, NOT for hairy areas
Cream- PT preference, disappearances in skin, less potent than ointment, best for acute exudtative inflammation
Lotion/Gel- lowest grease/occlusion of all topicals, best for hairy areas, good for poison ivy
Foam/Shampoo- scalp/hairy areas but more $

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44
Q

What are the potency ranges for glucocorticoids

A

1 Very High, don’t d/c abruptly (Clobetasol)
2 High, avoid occlusive dressings (Fluocinonide)
3-5 Med, large surface areas/non-face, less than 3mon (Triamcinolone)
6-7 Low, Kids, Pregnant, Old w/ large areas in sensitive parts (Hydrocortisone)

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45
Q

How are glucocorticoid dosages measured out?

A

Finger tip= 500mg/0.5g and covers both sides of adult hand w/ fingers closed

46
Q

Clinical use of Cortisone

Clinical use of Hydrocortisone

A

Primary/Secondary adrenal cortical insufficiency (Addisons)

Addison’s, UC, Asthma, Joint injections

47
Q

What is the most prescribed oral med for short term therapy for inflammatory d/os?

What are 6 intermediate acting PO Glucocorticoids?

A

Prednisone

Prednisone, Prednisolone, Methyprednisolone, Methylpred Acetate, Methylpred Soduim Succinate, Triamcinolone

48
Q

What is the long acting PO Glucocorticoid

What is the corticosteroid antagonist and what is the MOA, Use and Adverse facts of it

A

Dexamethasone
Resp/Derm/GI/Eye Dzs

Ketoconazole
Inhibits adrenal gonadal synthesis and dec synthesis of corticosteroids
Cushings Dz if surgery isn’t possible

Adrenal suppression, Gynecomastia, Inc cholesterol, Hypo thyroid

49
Q

What is the MOA and Use for Aldosterone

When treating Addison’s Dz, what can Cortisol and Aldosterone deficiency be supplemented with?

A

Na, BiCarb and Water reabsorption in CD/DT
Addison Dz

Hydrocortisone and Fludrocortisone

50
Q

What is the MOA and Use of Fludrocortison

MOA and Use of Spironolactone and Eplerenone

A

Exogenous, 15x the glucocorticoid activity than hydrocortisone
Used to replace aldosterone in Addison’s Dz

Aldosterone antagonist
CHF diuretic, Tx of hyperaldosteronism (primary)

51
Q

What are the 5 risks for osteoporosis?

A 
Low Estrogen
Age= red Ca reabsorption
Ca deficiency
Vit D deficiency
Inc PTH from adenoma or Vit D deficiency
52
Q

What are the 5 classes of drugs and names used for osteoporosis

A 
Bisphosphonates- RAIZ
SERMS- Raloxifene, Conjugated estrogen/bazedoxifene
PTH- Teriparatide
Calcitonin- salmon nasal spray
Denosumab- full human monoclonal Ab
53
Q

How much Ca and Vit D are needed each day?

What is D3, D2, Calcidiol, Calcitriol

A

Ca- 1200mg
Vit D- 800IU

D3- cholecalciferol
D2- ergocalciferol
diol- liver to kidney
triol- kidney to gut/bone

54
Q

What is the first line class of drug for treating osteoporosis and Paget’s dz

This type of therapy is recommended to last for 5yrs, but can be extended if a PTs T score is below ?

A

Bisphosphonates- reduce vertebral and non-vertebral Fx, except- Ibandronate- only vertebral Fx

-3.5, extend to 10yrs

55
Q

When is Estrogen replacement therapy contraindicated

A

SrCr <30

56
Q

MOA, Use, and C/C of ERT

A

Inhibits resorption and promotes bone formation

Started during menopause
Lowest dose for Tx of Vasomotor Sxs

VTE
Pregnant/on hormones
Breast/ednometrial CA
UnDx genital bleeding

57
Q

MOA, Use, Adverse, and C/C of Bisphoosphonates

A

Dec -clast activity to inc bone density and prevent Fxs

1st line for PTs w/ osteoporosis and Paget’s Dz

GI, Jaw Necrosis, Atypical Fxs, Esophageal CA

SrCR <30ml/min
30 min wait w/ 8oz H2O
1hr if on Ibandronate (only for spine Fxs)

58
Q

What are the two most common conditions that fall under COPD

A

Chronic bronchitis- excess mucus secretion for most days for 3mon for more than 3yrs

Emphysema- abnormal enlargement of bronchiole air spaces

59
Q

Facts of COPD

Facts of Emphysema

A

C- clinical Dx of daily productive cough
Over weight, cyanotic, Inc Hgb, rhonchi/wheezing and peripheral edema

E- pathological Dx of permanent enlargement/destruction of air spaces
Older/thin, dyspnea, quiet chest, flat diaphragm on x-ray

60
Q

COPD is an imbalance of what 3 things that involve what cells?

A

Inflammatory- neutrophils, macrophages, CD8/TNF-a, IL-8, LT-B4
Protease imbalance
Oxidative stress- inc markers= hydrogen peroxide and NO

61
Q

What type of blood gas irregularity is seen in COPD

A

Hypoxemia- dec pO2, low V/Q ratio, hypercapnia, normal pH

V= lung ventilation
Q= perfusion
62
Q

Define COPD Gold levels

A

Mild= 80% or higher
Mod= 50-80%
Sev= 30-50%
Very Sev= <30% or FEV1 <50% w/ chronic respiratory failure

63
Q

What are the Sxs of the four COPD Gold levels

What are the indications/reasons to admit a PT with COPD?

A 
1= chronic cough/sputum
2= SOB w/ exertion
3= reduced exercise tolerance
4= failure, edema, inc JVP
High risk comorbidity (pneumonia, arrhythmia, CHF, DM, RF, HF)
Poor OutPT response
Worsening dyspnea
Can't eat/sleep
Hypoxemia/Hypercapnia
AMS
Uncertain Dx
64
Q

How often should COPD PTs exercise?

How much supplemental O2 can be used?

A

3-7x/wk @ 70% of max

1-2L/min
>15hrs/day increases PT survival

65
Q

COPD Pts can get what 2 vaccinations?

What are the steps to COPD management?

A

Influenza and Penumococcal

SABA/SAMA
LABA/LAMA
LABA/LAMA combo
Inhaled CCS in severe Dzs
Roflumist- FEV1<50%
66
Q

What do A-D COPD severity categories get for meds?

A 
A= any
B= LAMA or LABA
C= LAMA
D= LAMA or LABA
67
Q

What drug class is central to symptomatic management of COPD?

What 4 does this include?

A

Bronchodilators

B2 agonists
Anticholinergics
Theophylline
Combo therapy

68
Q

What are the 3 SABAs?

What are the 4 LABAs?

A

Levalbuterol, Albuterol, Terbutaline

Salmeterol, Olodaterol, Formoterol, Arformoterol

69
Q

What are the 2 ultra-long acting B2 agonists?

What is the SAMA?
What are the four LAMAs?

A

Indacaterol and Indacaterol/Glycopyrrolate

Ipratropium Bromide

Glycopyrronium bromide, Aclidinium bromide, Umedclidinium, Tiotropium

70
Q

Inhaled corticosteroids improve what 3 things in COPD PTs?

What are the risks of these drugs?

A

Sxs, Function, QoL

Pneumonia, Thrush, Exacerbation induced withdrawal, NO modification of FEV1 decline
Do NOT decrease mortality

71
Q

What are the benefits of using inhaled CCS and LABAs together?\

What is a drawback/risk of this combo?

What med as an additive is even additionally beneficial?

A

More effective
Improved lung function and health
Reduced exacerbation

Pneumonia

Tiotropium

72
Q

If PT taking inhaled CCS develops Candidiasis infection, how are they treated?

What are the 4 inhaled CCS combos that can be used?

A

Treat w/ appropriate anti-fungal while continuing therapy w/ inhaler

Formoterol/Budesonide
Formoterol/Mometasone
Salmeterol/Fluticasone
Vilanterol/Fluticasone

73
Q

What are the two Methylxanthines used for COPD?

What is the PDE-4 inhibitor used in COPD?

A

Aminophylline and Theophylline

Roflumilast

74
Q

COPD PTs can get what two vaccines and how often?

What type of ABX can they receive?

A

Influenza- annually
Pneumococcal- at Dx and 65 or older if last vaccine was more than 5yrs ago

Macrolides- Azithromyin and Azithromycin

75
Q

What drives COPD PTs need to breathe?

What caution needs to be taken when correcting and what needs to be monitored?

A

Low O2
Normal PT is elevated CO2

Inc O2 can induce respiratory distress and failure, pCO2 and ABG

76
Q

What COPD PTs are not candidates for NPPV treatments?

What type of bronchodilator is typically avoided in COPD PTs but can be used as an alternative?

A

AMS, pH<7.25, Respiratory arrest, CV instability

Theophylline

77
Q

What 3 drugs are used for COPD exacerbations?

If one of these is used for _ days, taper is needed?

A

Bronchodilator- SABA
CCS- Prednisone or IV equivalent if NPO
ABX- if 2 of 3 cardinal Sxs are present (Dyspnea, Sputum Volume/Purulence) x 7-10 days

CCS use for 14 days or longer to prevent HPA axis suppression

78
Q

Define an Uncomplicated COPD Exacerbation and how is it Tx

A

<4 exacerbations/year
FEV1>50%

Macrolide, Cephalosporin, Doxy

79
Q

Define a Complicated COPD exacerbation and how is it treated?

A

65 or older
>4 exacerbations/year
FEV1 <50 but >35%

Amoxocillin, Fluroquinolone

80
Q

Define a complicated COPD exacerbation with risk of Pseudomonas infxn

A 
Chronic bronchial sepsis
Need for chronic CCS
Nursing home resident
> 4 exacerbations/year
FEV1 >35%

IV therapy w/ B lactamase resistant penicillin

81
Q

Acute asthma management in PTs 12y/o or older

What 3 drugs can be used prior to exercise to prevent asthma

A

Inhaled B-agonists: albuterol or Levalbuterol PRN

Inhaled B-agonist, Montelukast, Nedocromil

82
Q

How are persistent asthma cases handled?

A 
Inhaled CCS is first line
Combo:
Formoterol/Budesonide
Fluticasone/Salmeterol
Mometasone/Formoterol
83
Q

Recommended long term control for asthma levels 1-6

A

1- none
2- low dose ICS
3- low dose ICS + LABA or med ICS alone
4- med dose ICS and LABA
5- High ICS and LABA, consider Omalizumab for PTs w/ allergic asthma
6- High dose ICS plus LABA plus systemic ICS and consider Omalizumab

84
Q

How is EIB managed?

A

SABA 15m prior and are DOC
LABA and Formoterol 30-60min prior
Leukotriene modifiers (Zileuton) used daily but not PRN

85
Q

Use of a SABA more than ?days/wk indicate inadequate control and need for step up treatement

What drug is the first line anti-inflammatory therapy for mild-severe persistent asthma in adults and kids?

A

> 2 days/wk

Inhaled CCS and the preferred anti inflammatory in chronic asthma

86
Q

What are the 2 most frequently used PO corticosteroids

Which one is given in IV form for PTs that are NPO

A

Prednisone and Prednisolone

Methylprednisolone

87
Q

When are systemic CCS used?

What 3 drugs can be used?

A

Mod-severe exacerbation, to prevent progression

Methylprednisolone
Prednisolone
Prednisone

88
Q

What are the adverse effects of using systemic CCS’?

What is the combo of CCS/LABA used for?

A

Inc appetite/fluid retention, HTN, Mood change

Long term prevention/suppression of Sxs and reversal of inflammation
Reduces need for PO CCS

89
Q

What are the 4 forms of CCS/LABA combos?

A

Fluticasone/Salmeterol
Budesonide/Formoterol
Mometasone/Formoterol
Flucicasone/Vilanterol

90
Q

Mild Asthma exacerbation and Tx

Moderate asthma exacerbation and Tx

A

Dyspnea w/ activity
SABA or short use of OCS

Dyspnea interferes w/ normal activity
Dr office/ED for SABA and OCS Tx

91
Q

Severe Asthma exacerbation and Tx

Life threatenting asthma exacerbation and Tx

A

Dyspnea at rest
ED visit for SABA and OCS

Too dyspneic to speak
IV CCS and little help from SABAs

92
Q

Asthma has what cells more present and predominant?

A

CD4, Inc ration of CD4/CD8, Eosinophils, Mast cells, Neutrophils in severe asthma, IL3-5

CD8, Dec ration of CD4/CD8, Neutrophils, Machophages, Eosinophils during exacerbation IL-8 and IL-1

93
Q

What are the 5 A’s of tobacco cessation?

How long can nicotine gum be used?

A

Ask, Advise, Assess, Assist, Arrange

12wks

94
Q

UV light is needed to activate for form of Vit D?

What are the 4 RF for osteoporosis

A

Cholecalciferol Vit D3

Low Estrogen
Inc age= dec Ca absorption
Ca deficiency
Vit D deficiency
Inc PTH secretion from adenoma/Vit D deficiency
95
Q

Major barrier layer of the skin is the ? layer

Passage through the ? layer is the rate limiting step of percutaneous absorption?

A

Corneum- outtermost made of dead corneyocytes (terminally differentiated keratinocytes)

Stratum- may act as reservoir and lengthen half life

96
Q

Skin permeability is inversely proportional to ?

Most derm dzs have a dysfunction in ? layer

A

Thickness of Corneum

Corneum

97
Q

What can be done prior to applying skin meds that will increase it’s absorption abilities?

What is an ideal topical agent?

A

Soak in water

Low molecular weight <600Da and soluble in water and oil

98
Q

What are ointments best used for?

A

Protects skin while penetrating chronic/thick walled lesions

Hydrocortisone ointment for scaling on non-hairy skin

99
Q

What are gels best used for?

A

Drying effect due to water/alcohol content
Least occlusive and quick drying
Acne, Exudative inflammation/oozing on scalp/hair

Testosterone 1%

100
Q

What are creams best used for?

A

Less greasy and vanish w/ rubbing
Acute exudative inflammation intertriginous areas w/ good corneum penetration

Hydrocortisone cream

101
Q

What are lotions best for?

What are aerosols best for?

A

Exudative lesions on hairy areas

Scalp and hair areas w/out need for contact (Miconazole)

102
Q

What are tinctures best for?

What are foams best for?

A

Scalp/hair areas (Benzoin, Podophyllum, Minocazole)

Spread easily through scalp/hairy areas (Rogaine)

103
Q

What are pastes best for?

What are powders best for?

What are wet preparations best for?

A

Chronic inflammation w/ xerosis, scaling/ not for weeping/hairy areas (Anthralin Paste)

Wet skin Dzs and reduce friction (Tinactin)

Acute inflammation w/ oozing and vesiculation lesions (NS, Acetic Acid, Domeboro)

104
Q

What is the most common derm condition in clinic?

What are the 3 phases?

A

Contact dermatitis
Irritant: acid/soap
Allergic: poison ivy

Acute- blisters/weeping skin
Sub-acute- crust/scab
Chronic- dried and thickened lesions

105
Q

What meds are avoided in contact dermatitis Tx?

What 3 can be used for mild cases?

A

Ointment, anesthetics, anti-histamines, calamine

Wet dressing
Astringents- Aluminum Acetate
Colloidal oatmeal bath

106
Q

How is moderate contact dermatitis treated?

How are severe cases Tx?

A

Counterirritant- Camphor/Methanol
Topical anti-histamine- Diphenhydramine
Topical steroid

Systemic corticosteroids- Prednisone 40mg 4-6days

107
Q

How is Seborrheic dermatitis treated

A

Shampoos w/ any of these ingredients:
Antigungal- ketoconazole
Antiproliferative- Coal tar, Selenium sulfide, Zinc pyrithione

108
Q

What is the IgE mediated skin response and how is it treated

A 
Atopic Dermatitis
Inc skin hydration
Corticosteroids
TIMS
Systemic therapy- PO antihistamines
109
Q

TIMs MOA and names

What are they used for

A

Inhibit T cell activation
Pimecrolimus
Tacrolimus

Atopic dermatitis and chronic inflammatory skin dz
Alternative to topical steroids

110
Q

What is the FIRST line choice for atopic dermatitis and psoriasis of the face, flexural or genital areas?

What caution needs to be taken with these drugs?

A

TIMS

UV exposure
Lymphoma and skin CA

111
Q

How is impetigo treated

A

Mupirocin

Systemic ABX- Dicloxacillin/Cephalexin

112
Q

Stopped on Slide

A

24 Derm

IPAP (212 decks)

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