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Dermatology 2 > Pharm - BP, Poison Ivy, Vitiligo > Flashcards

Pharm - BP, Poison Ivy, Vitiligo Flashcards

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Dermatology Board Prep flashcards
1
Q

Bullous Pemphigoid

- first line therapy

A

Topical or systemic steroids

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2
Q

Bullous Pemphigoid

- what is often added to first line therapy? why?

A
  • immunomodulatory therapy

- minimize ADR or augment response

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3
Q

Bullous Pemphigoid

- 3 goals of therapy for

A
  • Decrease blister formation and pruritis
  • Promote healing of blisters and erosions
  • Improve QOL
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4
Q

Bullous Pemphigoid

- What should be done with blisters?

A

rupture them daily - reduces lateral extension of blister edge

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5
Q

Bullous Pemphigoid

- risk factors for infection

A
  • # of skin lesions

- use of immunosuppressants

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6
Q

Bullous Pemphigoid

- 3 treatment phases

A
  1. Control: intense therapy to suppress disease activity until no new lesions appear. Duration is weeks.
  2. Consolidation: drugs and doses are maintained until complete clearance of lesions
  3. Maintenance: meds gradually tapered until reach lowest dose that prevents new lesions
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7
Q

Bullous Pemphigoid

- why are topical vs. systemic steroids preferred in extensive disease

A
  • Better clinical outcomes in extensive BP than with systemic steroid therapy
  • One-year survival rate, disease response, server complications lower versus tx with systemic steroids
  • There is apparently a third reason…
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8
Q

Bullous Pemphigoid

- what type of topical glucocorticoid is preferred

A

Super high potency

- clobetasol 0.05%

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9
Q

Bullous Pemphigoid

- How to dose topical corticosteroids

A
  • full therapeutic dose until active disease process halts: once active inflammation, new blister formation, pruritis cease for min 2 weeks and 80% of blisters are healed
  • prolonged taper needed: typically lasts 4 months or longer
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10
Q

Bullous Pemphigoid

- ADR of topical corticosteroids

A
  • Cutaneous atrophy
  • Striae
  • Folliculitis
  • Adrenal suppression
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11
Q

Bullous Pemphigoid

- what is second line when topical corticosteroids are not feasible

A

oral systemic corticosteroids

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12
Q

Bullous Pemphigoid

- The many ADR of systemic corticosteroids

A
  • HTN
  • Elevated blood glucose
  • Osteoporosis
  • Increased fx risk
  • Cataracts
  • Muscle wasting
  • Thinning skin
  • Increased bruising
  • Immunosuppression
  • Increased risk fo infection
  • Weight gain/ increased appetite
  • HPA axis suppression
  • Psychological effects- depressed or elevated mood
  • Changes in memory and behavior
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13
Q

Bullous Pemphigoid

- why are immunosuppressive and anti-inflammatory drugs used with glucocorticoids?

A

Minimize dependence on systemic glucocorticoid therapy

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14
Q

Bullous Pemphigoid

- how to dose glucocorticoid-sparing agents with glucocorticoids?

A
  • Glucocorticoid-sparing drugs clinical response is slower than systemic glucocorticoids
  • Begin treatment with glucocorticoid-sparing agent just prior to starting glucocorticoid taper
  • Then slowly taper glucocorticoid with goal to discontinue completely and continue therapy with immunosuppressant alone
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15
Q

Bullous Pemphigoid

- what are three immunosuppressive drugs

A
  1. azathioprine
  2. Mycophenolate mofetil
  3. Methotrexate
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16
Q

Bullous Pemphigoid

- Risk associated with immunosuppressants

A
  • cancer

- infection

17
Q

Bullous Pemphigoid

- What baseline labs are needed before starting immunosuppressants?

A
  • CBC
  • Renal fn
  • Liver fn
18
Q

Bullous Pemphigoid

- how to dose methotrexate

A

weekly

19
Q

Bullous Pemphigoid

- What must be added to methotrexate therapy

A

folic acid

- reduce hematologic and GI ADR

20
Q

Bullous Pemphigoid

- what is benefit to abx other than antimicrobial

A

anti-inflammatory

21
Q

Bullous Pemphigoid

- two abx used

A
  • tetracyclines
  • dapsone
  • Use when glucocorticoid-sparing agent is required for pts with mild BP (risk of immunosuppressants outweighs the benefit)
  • Also good option for pts who are not good candidates for immunosuppressants
22
Q

Bullous Pemphigoid

- what needs to be screened before using Dapsone

A

G6PD deficiency

23
Q

Bullous Pemphigoid

- what can be used to monitor response to therapy?

A
  • BP 180 antibodies

- Generally correlate with clinical activity of BP

24
Q

Vitiligo

- what is first line therapy for LIMITED dz

A
  • super high potency topical steroids

- modulate immune response

25
Q

Vitiligo

- Tx of choice for >10% BSA

A
  • Narrowband/ NB-UVB phototherapy

- used for both stabilization and re-pigmentation

26
Q

Vitiligo

- What treatment is used for depigmentation

A
  • monobenzone
27
Q

Poison Ivy

- role of decontamination after exposure

A
  • After known exposure, remove any contaminated clothing and gently wash skin with mild soap and water (not rough, likely make dermatitis worse)
  • After 10 minutes, 50% of urushiol can be removed
  • After 30 minutes, 10% of urushiol can be removed
  • Washing within 2 hours can sig reduce likelihood and severity of dermatitis
28
Q

Poison Ivy

- Decontamination products (3)

A
  • Tecnu
  • Goop
  • Dial ultra dishwashing soap
  • all sig reduce dermatitis when used within two hours of exposure
29
Q

Poison Ivy

- role of barrier cream in preventing exposure to poison ivy

A
  • Topical preparations that are applied prior to exposure to contact allergen, attempt to prevent reaction
  • Organoclay compounds more effective than other preparations
30
Q

Poison Ivy

- topical treatments to relieve pruritus

A
  • Oatmeal baths
  • Cool, wet compresses
  • Topicals containing menthol and phenol (calamine)
  • Topical astringents: aluminum acetate (Burow’s solution) or aluminum sulfate and calcium acetate (Domeboro) used under occlusion dressing
  • Soap mixture of ethoxylate and sodium lauroyl sarcosinate sufractants (Zanfel)
    • Avoid topical antihistamines, anesthetics with benzocaine, abx with neomycin and bacitracin dt allergic potential
31
Q

Poison Ivy

- role of oral corticosteroids to relieve dermatitis sx

A
  • Severe dermatitis (esp on face or genitals) may require

- If too short a course, risk rebound dermatitis (ex. 6-day medrol dose pack)

32
Q

Poison Ivy

- Oral corticosteroid example, dose, taper

A
  • Prednisone
  • 1 mg/kg/day
  • Taper 2-3 weeks

Dermatology 2 (10 decks)

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