pharm: derm Flashcards
most common causes of diaper rash? (1 & 2)
- yeast
2. bacteria – mostly staph and group A strep. pyogenes
protective barrier meds for diaper rash?
A&D ointment
petroleum
zinc oxide
Desitin (contains zinc oxide and emollient)
some contain protectant + drying agent + anti-microbial + vitamins
topical steroids for diaper rash?
do little to treat rash - they are beneficial for their anti-inflammatory effect
caution b/c they can cause adrenal suppression if too much gets absorbed
what does a diaper rash caused by yeast look like?
“red satellite lesions”
treatment of diaper rash caused by YEAST?
Topical antifungal:
- Nystatin
- Nystatin + triamcinolone
- Clotrimazole
- Clotrimazone + betamethasone
New combo product: zinc oxide, petrolatum, % 0.25% miconazole
what does a diaper rash caused by bacteria look like?
“yellowish, fluid filled pustules, honey-colored, crusty”
treatment of diaper rash caused by BACTERIA?
antibiotics
-mild infections = topical product
Bacitracin or Mupirocin
-severe infections = PO antibiotics
Beta-lactams = very effectivewhat is in “butt paste?”
is it for prevention or treatment?
zinc oxide
aquaphor, A&D oint, or petrolatum
Cholestyramine – binds uric acid, keeps pH at normal levels
zinc & A+D = provide protective barrier
treatment only!
what does cholestyramine do?
binds uric acid, keeps pH at normal levels
Rhus dermatitis?
name of delayed hypersensitivity rxn occurring 12-72 hours after exposure to poison ivy, oak, or sumac
Urushiol?
chemical secreted by bruised poison ivy, oak, or sumac plants
how is poison ivy, oak, and sumac transmitted?
primary or secondary exposure
NOT transmitted via fluid vesicles/blisters
can develop secondary infection from scratching (bacteria can enter broken skin)
what is Bentoquatum?
Ivy Block - barrier product to prevent poison ivy
what is Zanfel?
OTC wash - barrier product for poison ivy (NOT RECOMMENDED THOUGH)
Tx of mild & moderate cases of poison ivy, oak, and sumac?
- soaks, baths, mild dressings
- Colloidal oatmeal
- Aluminum acetate
- topical preparations to treat lesions
- Calamine
- Local anesthetics (ie. Caladryl = calamine + pramoxine)
- Antihistamines (generally not effective)
- Campor, menthol, phenol, EtOH
- Aluminum acetate solutions
- Steroids
what is colloidal oatmeal?
aveeno
oatmeal bath
what is aluminum acetate?
Burrow’s solution - moist/wet dressings, reduce itch, mild astringent for poison ivy, oak, and sumac
what is caladryl?
calamine + pramoxine (topical anesthetic)
why aren’t antihistamines effective to treat poison ivy?
diphenhydramine does not penetrate skin & may irritate further
what do camphor, menthol, phenol, and EtOH do for poison ivy?
promote drying of vesicles
camphor & menthol -> “cooling” effect
phenol & EtOH –> antibacterial
why shouldn’t you use ointments while vesicles are present and/or weeping in poison ivy pts?
b/c they can form a barrier and seal moisture in – the vesicles need to dry
Tx. of severe cases of poison ivy, oak, and sumac - widespread or eye involvement?
- oral antihistamines - anti-itch
Diphenhydramine - 20-50 mg PO qid prn - oral glucocorticosteroids
Prednisone - PO 7-21d, taper off - oral antibiotics - if infections occur
Treat for staph (most common skin infections) - cephalosporins and penicillins
what causes acne?
stimulated by testosterone and its metabolite – DIHYDROTESTOSTERONE
Pathogenesis is multifactorial
- Bacterial - P.acnes (propionibacterium)
- Irritants
- touching your face
- makeup
- foods
what is dihydrotestosterone?
metabolite of testosterone that’s involved in stimulating acne formation
what bacteria causes acne?
Propionibacterium
P. acne
general acne treatment guidelines?
- cleanse skin BID w/ mild cleanser and pat dry
- use coarse cloth or other sponges to exfoliate skin
- astringent - closes pores helps prevent dirt from entering
- medication as necessary
pharmacological treatment of acne? (8 options)
- topical benzoyl peroxide
- topical salicylic acid
- topical retinoids (based off Vit. A - category X)
- miscellaneous topicals
- topical antibiotics
- oral antibiotics
- oral isotretinoin (Accutane) – category X
- oral contraceptives
Benzoyl peroxide (ACNE)
MOA? ADRs? category & percent used?
MOA: causes desquamation - increases turnover of epithelial cells, promotes healing, may be bacteriostatic or bacteriocidal
ADRs: drying, peeling, stinging
C
2.5-10%
Salicylic Acid (ACNE)
MOA? ADRs? percent used? other indications?
MOA: keratolytics – helps remove upper layer of dead cells
ADRs: drying, peeling
0.5 - 2%
other indications: higher conc (10-15%) used for wart removal
- 10% = warts on hand/body
- 15% = plantar warts (foot)
Topical retinoids - Vit A derivatives (ACNE)
MOA? Precautions? ADRs? Examples & their categories?
MOA: increases epithelial cell proliferation (growth/production), reduces comedo (blackhead) formation
Precautions: MUST AVOID SUN - can get 2nd degree burns
ADRs: erythema, dryness, peeling, scaling, itching, crusting, photosensitivity, pigment changes (bleaching)
Ex:
Trentinoin (retin-a)– D
Tazarotene (tazorac) – X
what are 2 examples of miscellaneous topical acne treatments?
Adapalene (Differin) – C
MOA: retinoid-like compound, binds to different retinoid type receptors
ADRs: similar to other retinoid, local skin irritation, not shown to be teratogenic in rodents (no human studies)
Azelic acid – C
MOA: not fully determined, but may have antimicrobial activity against P.acnes and blocks conversion of testosterone to dihydrotestosterone
ADRs: erythema, dryness
Topical antibiotics (ACNE)
MOAs? ADRs? Examples?
MOA: antimicrobial activity against causative organisms (underlying organisms causing acne)
Dosed 2-6x day – resistance rare due to minimal systemic absorption
ADRs: burning, stinging, drying, peeling, erythema
Ex:
Erythromycin (B)
Erythromycin + benzoyl peroxide (C)
Sodium Sulfacetamine (C)
Clindamycin (B)
when combined with benzoyl peroxide - Duac gel
Oral antibiotics (ACNE)
MOA? Precautions? ADRs? Examples?
MOA: antimicrobial activity against causative organisms
Precautions: chronic use may increase risk of resistance and/or can negatively affect residual bacteria levels
ADRs: nausea, vomiting, diarrhea, vertigo, and contraceptive failure of BC pills
Ex: Tetracyclines Doxycycline (D) Minocycline (D) Macrolides Erythromycin (B)
Oral retinoid (Isotretinoin) – Accutane (ACNE)
MOA? Dose? ADRs? Category and risks?
MOA: reduce sebaceous gland size, regulates cell proliferation and differentiation
Dose: 0.5-1 mg/kg/day divided BID for 15-20 wks. may repeat x1 after 2 months off (NEED BREAK)
ADRs: dryness, itching of skin & mucous membranes, headache, depression, hyperlipidemia, increase LFTs, alopecia, myalgia, hematologic ADRs, ocular ADRs, photosensitivity, increase suicide risk?
CATEGORY X – cant be or get pregnant
***USED ONLY FOR SEVERE CASES – BEST TREATMENT
Oral contraceptives (ACNE)
MOA? ADRs?
MOA: increased estrogen helps counterbalance high testosterone levels which cause acne
- estrogen alone or estrogen/progesterone
combo – want high estrogenic activity and low androgenic activity (tricycline brands are good)
ADRs: PMS like symptoms, bloating, weight gain
only women (>18 yo) not planning pregnancy
Drugs that CAUSE acne:
hormones
gonadotropins, anabolic steroids, corticosteroids
anti-epileptic drugs
TB drugs - INH, Rifampin
Miscellaneous - Lithium, Cyclopsorine, Iodine
Treatment of ACUTE psoriasis?
treat the severely erythematous lesions soothe irritation w/ non-medicated topicals: - aquaphor - cold cream - lac-hydrin - eucerin may also use topical steroids
Treatment of CHRONIC psoriasis?
SEE NOTES ABOUT EACH ONE
- Topical corticosteroids
- Coal tar (topical)
- Psoralens (PO)
- Retinoids (PO)
- Antimetabolites (PO)
- Immunosuppressants (PO)
- Immunomodulators (topical)
- Calciprotriene (topical)
- Anthralin (topical)
- Keratolytics (topical)
- phototherapy
Chronic psoriasis - topical steroid uses:
- anti-inflammatory
- antipruritic
3vasoconstrictor - immunosuppressive
psoriasis treatment with topical corticosteroids?
- start w super high potency (class 1 or 2) BID x 2-3 weeks
- after high potency treatment switch to Pulse treatment (2 days on 5 days off) OR change to lower potency steroid
- halogenated/ fluorinated steroids vs. non-fluorinated steroids
halogenated or fluorinated steroids?
improve absorption - DO NOT use on face, perineum, or mucus membranes
non-fluorinated steroids?
can be used on face, eyelids, perineum, and mucous membranes
ADRs of topical corticosteroids for psoriasis?
- thinning of skin
- tearing (due to thinning)
- bruising of skin
- acne
- hypopigmentation
- infection (immune system suppressed)
- contact dermatitis
problems with super potent corticosteroids?
- do not use on children/ elderly - increased systemic absorption (children: skin not keratinized, elderly: skin is thin)
- avoid use in flexural areas: groin, axilla, popliteal, and antecubital fossa (areas tend to be warm and moist - added absorption) – if used minimize to less than 2 wks, switch to lower potency
- may inhibit HPA axis (hypothalamic-pituitary-adrenal axis)
Coal Tar
tx for chronic psoriasis
ADRs of Coal Tar
folliculitis photosensitivity irritation scaling itching inflammation
Psoralen?
tx for chronic psoriasis
follow w/ UVA light for tx 2 hours post - PUVA
example of Psoralen?
Methoxsalen - PO, lotion
ADRs of Psoralen?
pruritis, dry skin, loss of pigmentation nausea blistering painful erythema drug-food interaction: avoid furocoumarin-containing foods
Examples of Retinoids (chronic psoriasis)?
Etretinate
Acitretin
Tazarotene
Etretinate? MOA?
retinoid used for chronic psoriasis tx
normalizes expression of keratin
suppresses chemotaxis
decreases stratum corneum cohesiveness
half life = 100 days
when combined with PUVA = RE-PUVA
Etretinate ADRs?
LFT abnormalities Alopecia exfoliation hyperlipidemia myalgia arthralgia
Acitretin?
retinoid used for chronic psoriasis tx
same precautions and ADRs as etretinate
half life = 49 hrs
Tazarotene?
retinoid used for chronic psoriasis tx
Examples of miscellaneous agents used to tx chronic psoriasis? (6)
- Antimetabolites
- Immunosuppressants
- Topical Immune modulators
- Calciprotriene
- Anthralin
- Keratolytics
Example of antimetabolite used to tx chronic psoriasis?
methotrexate (PO) - chemo drug
example of immunosuppressant used to tx chronic psoriasis?
cyclosporine A
2 examples of topical immune modulators used to tx chronic psoriasis?
Tacrolimus
Pimecrolimus
Calciprotriene? - MOA and SE
tx of chronic psoriasis
effects equal to class II or III steroids Vit D analog, therefore no steroid SE
SEs: local irritation, skin reactions
DO NOT USE on face, eyelids, perineum, or skin folds
Anthralin? - MOA and SE
tx of chronic psoriasis
use for short term treatment
apply for 1 hr or <, then wash off
SEs: staining, irritation of un-involved skin, permenant brown color staining of clothing and bathroom fixtures
Keratolytics?
tx of chronic psoriasis
soften keratin layer of skin
enhance absorption of other agents
phenol and salicylic acid used – mixed with aquaphor, cold cream, emollients, coal tar
Rosacea tx?
topicals - cream, lotions, oint, and gels
antibiotics
azelaic acid
sulfur lotions
benzoyl peroxide – limited data on effectiveness
rosacea topical antibiotic examples?
Metronidazole (Metrogel)– TREATMENT OF CHOICE!
– also an antiprotozoal agent
Sulfur products (Novacet, Sulfacet-R) Clindamycin & erythromycin -- not as effective as other topical antibiotics or azelaic acid
what is the treatment of choice for rosacea?
Metronidazole (Metrogel) (topical antibiotic)
– also an antiprotozoal agent
topical azelaic acid?
tx for rosacea (also acne)
antibacterial, comedolytic, anti-inflammatory
one small study – as effective as Metronidazole (Metrogel)
ADRs- local skin irritation
azelaic acid products?
Finacea Gel 15% - for rosacea
Azelex or Finevin Cream 20% - for acne
oral antibiotic examples for rosacea?
Tetracyclines --> most commonly used! Erythromycin Clarithromycin Sulfamethoxazole/ Trimethoprim (Bactrim, Septra) Metronidazole
which oral antibiotic is most commonly used to tx rosacea?
Tetracyclines
Miscellaneous tx for rosacea?
glycolic acid peels q2-4 weeks washes and creams topical tretinoin isotretinoin
tx for eye problems associated with rosacea?
Doxycycline
Minocycline
Tetracycline
tx for redness and flushing associated with rosacea?
anti-inflammatory meds - steroid creams
electrosurgery
intense light therapy
vascular lasers
tx for rhinophyma (large, bulbous, ruddy nose) associated with rosacea?
dermabrasion
electrosurgery
laser surgery
tx of eczema?
prevent scratching
creams and lotions to moisturize
cold compresses
topical corticosteroids
topical and PO antibiotics
oral antihistamines
coal tar
phototherapy
cyclosporine A -- only for resistant eczema (immunosuppressant)
topical immune modulators
- tacrolimus
- pimecrolimuswhat is actinic keratoses?
early beginning stage of skin cancer
common lesions of epidermis
caused by long sun exposure (most common)
appear approx 40-50 yo (teens - 20s in sunny places)
definition- cutaneous dysplasia (abnormal development) of epidermis
tx of actinic keratoses?
cryosurgery (application of extreme cold)
surgical incision and biopsy
suspect squamous cell carcinoma
retinoids - topical and PO
topical chemotherapy
5-fluoruracil (X)
chemical peels - dermabrasion, laser skin resurfacing, and electrosurgical skin resurfacing
melanoma - higher stages tx
interferon injection
interleukin injection
combination chemotherapy
treatment of choice of ectoparasites?
Permethrin
Pernethrin?
treatment of choice for lice/scabies
MOA- pediculicide, scabicide
derived from Chrysanthemum plant
Malathion?
tx for lice/scabies
MOA - pediculicide, scabicide
**ORGANOPHOSPHATE cholinesterase inhibitor – 2nd line agent
Lindane?
tx for lice/scabies
MOA- pediculicide, scabicide
can be absorbed and concentrate in fatty tissues, especially brain
2nd or 3rd line – CNS hematological toxicity
DO NOT use in premature infants or pts with known seizure disorders
Crotamiton?
tx for lice/scabies
MOA - not fully understood, may also have some antiprutitic properties
2nd or 3rd line
Ivermectin PO?
tx for lice/scabies
MOA: antihelminthic agent – drugs that expel parasitic worms (helminthes) from the body, by either stunning or killing them
2nd or 3rd line
precautions: Mazzoti rxn in pts with onchocercisis (allergic and inflammatory response due to death of the microfilariae - often affects eyes)
topical antibiotic preparations for lice/scabies?
bacitracin gramicidin mupirocin polymyxin B neomycin/ gentamycin
miscellaneous topical agents for lice/scabies?
topical antibiotics
doxepin hydrochloride - antipruritic
pramoxine - topical anesthetic
what drugs cause drug-induced photosensitivity?
benzocaine coal tar hexachlorophene isotretinoin methoxsalen tacrolimus tazarotene retinoin sunscreen agents: PABA, cinnamates, benzyphenones
2 types of photosensitivity?
- photoallergy
2. phototoxicity
what is a photoallergy?
rare, immunological response
light causes the drug to act as a hapten - triggering a hypersensitivity response
leads to pruritis, eczematous rxn
what is phototoxicity?
more common
chemically-induced rxns when drug absorbs UVA light and causes cellular damage
