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Pharm - Sam > pharm: derm > Flashcards

pharm: derm Flashcards

1
Q

most common causes of diaper rash? (1 & 2)

A
  1. yeast

2. bacteria – mostly staph and group A strep. pyogenes

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2
Q

protective barrier meds for diaper rash?

A

A&D ointment
petroleum
zinc oxide
Desitin (contains zinc oxide and emollient)
some contain protectant + drying agent + anti-microbial + vitamins

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3
Q

topical steroids for diaper rash?

A

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

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4
Q

what does a diaper rash caused by yeast look like?

A

“red satellite lesions”

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5
Q

treatment of diaper rash caused by YEAST?

A

Topical antifungal:

  • Nystatin
  • Nystatin + triamcinolone
  • Clotrimazole
  • Clotrimazone + betamethasone

New combo product: zinc oxide, petrolatum, % 0.25% miconazole

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6
Q

what does a diaper rash caused by bacteria look like?

A

“yellowish, fluid filled pustules, honey-colored, crusty”

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7
Q

treatment of diaper rash caused by BACTERIA?

A 
antibiotics 
-mild infections = topical product 
     Bacitracin or Mupirocin
-severe infections = PO antibiotics
     Beta-lactams = very effective
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8
Q

what is in “butt paste?”

is it for prevention or treatment?

A

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!

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9
Q

what does cholestyramine do?

A

binds uric acid, keeps pH at normal levels

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10
Q

Rhus dermatitis?

A

name of delayed hypersensitivity rxn occurring 12-72 hours after exposure to poison ivy, oak, or sumac

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11
Q

Urushiol?

A

chemical secreted by bruised poison ivy, oak, or sumac plants

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12
Q

how is poison ivy, oak, and sumac transmitted?

A

primary or secondary exposure
NOT transmitted via fluid vesicles/blisters

can develop secondary infection from scratching (bacteria can enter broken skin)

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13
Q

what is Bentoquatum?

A

Ivy Block - barrier product to prevent poison ivy

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14
Q

what is Zanfel?

A

OTC wash - barrier product for poison ivy (NOT RECOMMENDED THOUGH)

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15
Q

Tx of mild & moderate cases of poison ivy, oak, and sumac?

A
  1. soaks, baths, mild dressings
    • Colloidal oatmeal
    • Aluminum acetate
  2. topical preparations to treat lesions
    • Calamine
    • Local anesthetics (ie. Caladryl = calamine + pramoxine)
    • Antihistamines (generally not effective)
    • Campor, menthol, phenol, EtOH
    • Aluminum acetate solutions
    • Steroids
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16
Q

what is colloidal oatmeal?

A

aveeno

oatmeal bath

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17
Q

what is aluminum acetate?

A

Burrow’s solution - moist/wet dressings, reduce itch, mild astringent for poison ivy, oak, and sumac

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18
Q

what is caladryl?

A

calamine + pramoxine (topical anesthetic)

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19
Q

why aren’t antihistamines effective to treat poison ivy?

A

diphenhydramine does not penetrate skin & may irritate further

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20
Q

what do camphor, menthol, phenol, and EtOH do for poison ivy?

A

promote drying of vesicles
camphor & menthol -> “cooling” effect
phenol & EtOH –> antibacterial

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21
Q

why shouldn’t you use ointments while vesicles are present and/or weeping in poison ivy pts?

A

b/c they can form a barrier and seal moisture in – the vesicles need to dry

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22
Q

Tx. of severe cases of poison ivy, oak, and sumac - widespread or eye involvement?

A
  1. oral antihistamines - anti-itch
    Diphenhydramine - 20-50 mg PO qid prn
  2. oral glucocorticosteroids
    Prednisone - PO 7-21d, taper off
  3. oral antibiotics - if infections occur
    Treat for staph (most common skin infections) - cephalosporins and penicillins
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23
Q

what causes acne?

A

stimulated by testosterone and its metabolite – DIHYDROTESTOSTERONE

Pathogenesis is multifactorial

  • Bacterial - P.acnes (propionibacterium)
  • Irritants
    • touching your face
    • makeup
    • foods
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24
Q

what is dihydrotestosterone?

A

metabolite of testosterone that’s involved in stimulating acne formation

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25
Q

what bacteria causes acne?

A

Propionibacterium

P. acne

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26
Q

general acne treatment guidelines?

A
  1. cleanse skin BID w/ mild cleanser and pat dry
  2. use coarse cloth or other sponges to exfoliate skin
  3. astringent - closes pores helps prevent dirt from entering
  4. medication as necessary
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27
Q

pharmacological treatment of acne? (8 options)

A
  1. topical benzoyl peroxide
  2. topical salicylic acid
  3. topical retinoids (based off Vit. A - category X)
  4. miscellaneous topicals
  5. topical antibiotics
  6. oral antibiotics
  7. oral isotretinoin (Accutane) – category X
  8. oral contraceptives
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28
Q

Benzoyl peroxide (ACNE)

MOA? ADRs? category & percent used?

A

MOA: causes desquamation - increases turnover of epithelial cells, promotes healing, may be bacteriostatic or bacteriocidal

ADRs: drying, peeling, stinging

C

2.5-10%

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29
Q

Salicylic Acid (ACNE)

MOA? ADRs? percent used? other indications?

A

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)
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30
Q

Topical retinoids - Vit A derivatives (ACNE)

MOA? Precautions? ADRs? Examples & their categories?

A

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

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31
Q

what are 2 examples of miscellaneous topical acne treatments?

A

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

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32
Q

Topical antibiotics (ACNE)

MOAs? ADRs? Examples?

A

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
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33
Q

Oral antibiotics (ACNE)

MOA? Precautions? ADRs? Examples?

A

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)
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34
Q

Oral retinoid (Isotretinoin) – Accutane (ACNE)

MOA? Dose? ADRs? Category and risks?

A

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

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35
Q

Oral contraceptives (ACNE)

MOA? ADRs?

A

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

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36
Q

Drugs that CAUSE acne:

A

hormones
gonadotropins, anabolic steroids, corticosteroids
anti-epileptic drugs
TB drugs - INH, Rifampin
Miscellaneous - Lithium, Cyclopsorine, Iodine

37
Q

Treatment of ACUTE psoriasis?

A 
treat the severely erythematous lesions
soothe irritation w/ non-medicated topicals:
- aquaphor
- cold cream
- lac-hydrin
- eucerin
may also use topical steroids
38
Q

Treatment of CHRONIC psoriasis?

SEE NOTES ABOUT EACH ONE

A
  1. Topical corticosteroids
  2. Coal tar (topical)
  3. Psoralens (PO)
  4. Retinoids (PO)
  5. Antimetabolites (PO)
  6. Immunosuppressants (PO)
  7. Immunomodulators (topical)
  8. Calciprotriene (topical)
  9. Anthralin (topical)
  10. Keratolytics (topical)
  11. phototherapy
39
Q

Chronic psoriasis - topical steroid uses:

A
  1. anti-inflammatory
  2. antipruritic
    3vasoconstrictor
  3. immunosuppressive
40
Q

psoriasis treatment with topical corticosteroids?

A
  • 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
41
Q

halogenated or fluorinated steroids?

A

improve absorption - DO NOT use on face, perineum, or mucus membranes

42
Q

non-fluorinated steroids?

A

can be used on face, eyelids, perineum, and mucous membranes

43
Q

ADRs of topical corticosteroids for psoriasis?

A
  • thinning of skin
  • tearing (due to thinning)
  • bruising of skin
  • acne
  • hypopigmentation
  • infection (immune system suppressed)
  • contact dermatitis
44
Q

problems with super potent corticosteroids?

A
  • 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)
45
Q

Coal Tar

A

tx for chronic psoriasis

46
Q

ADRs of Coal Tar

A 
folliculitis
photosensitivity 
irritation
scaling
itching
inflammation
47
Q

Psoralen?

A

tx for chronic psoriasis

follow w/ UVA light for tx 2 hours post - PUVA

48
Q

example of Psoralen?

A

Methoxsalen - PO, lotion

49
Q

ADRs of Psoralen?

A 
pruritis, dry skin, loss of pigmentation
nausea
blistering
painful erythema
drug-food interaction: avoid furocoumarin-containing foods
50
Q

Examples of Retinoids (chronic psoriasis)?

A

Etretinate
Acitretin
Tazarotene

51
Q

Etretinate? MOA?

A

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

52
Q

Etretinate ADRs?

A 
LFT abnormalities
Alopecia
exfoliation
hyperlipidemia
myalgia 
arthralgia
53
Q

Acitretin?

A

retinoid used for chronic psoriasis tx

same precautions and ADRs as etretinate
half life = 49 hrs

54
Q

Tazarotene?

A

retinoid used for chronic psoriasis tx

55
Q

Examples of miscellaneous agents used to tx chronic psoriasis? (6)

A
  1. Antimetabolites
  2. Immunosuppressants
  3. Topical Immune modulators
  4. Calciprotriene
  5. Anthralin
  6. Keratolytics
56
Q

Example of antimetabolite used to tx chronic psoriasis?

A

methotrexate (PO) - chemo drug

57
Q

example of immunosuppressant used to tx chronic psoriasis?

A

cyclosporine A

58
Q

2 examples of topical immune modulators used to tx chronic psoriasis?

A

Tacrolimus

Pimecrolimus

59
Q

Calciprotriene? - MOA and SE

A

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

60
Q

Anthralin? - MOA and SE

A

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

61
Q

Keratolytics?

A

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

62
Q

Rosacea tx?

A

topicals - cream, lotions, oint, and gels
antibiotics
azelaic acid
sulfur lotions
benzoyl peroxide – limited data on effectiveness

63
Q

rosacea topical antibiotic examples?

A

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
64
Q

what is the treatment of choice for rosacea?

A

Metronidazole (Metrogel) (topical antibiotic)

– also an antiprotozoal agent

65
Q

topical azelaic acid?

A

tx for rosacea (also acne)

antibacterial, comedolytic, anti-inflammatory
one small study – as effective as Metronidazole (Metrogel)
ADRs- local skin irritation

66
Q

azelaic acid products?

A

Finacea Gel 15% - for rosacea

Azelex or Finevin Cream 20% - for acne

67
Q

oral antibiotic examples for rosacea?

A 
Tetracyclines --> most commonly used!
Erythromycin
Clarithromycin
Sulfamethoxazole/ Trimethoprim (Bactrim, Septra)
Metronidazole
68
Q

which oral antibiotic is most commonly used to tx rosacea?

A

Tetracyclines

69
Q

Miscellaneous tx for rosacea?

A 
glycolic acid
peels q2-4 weeks
washes and creams
topical tretinoin
isotretinoin
70
Q

tx for eye problems associated with rosacea?

A

Doxycycline
Minocycline
Tetracycline

71
Q

tx for redness and flushing associated with rosacea?

A

anti-inflammatory meds - steroid creams
electrosurgery
intense light therapy
vascular lasers

72
Q

tx for rhinophyma (large, bulbous, ruddy nose) associated with rosacea?

A

dermabrasion
electrosurgery
laser surgery

73
Q

tx of eczema?

A 
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
    - pimecrolimus
74
Q

what is actinic keratoses?

A

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

75
Q

tx of actinic keratoses?

A

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

76
Q

melanoma - higher stages tx

A

interferon injection
interleukin injection
combination chemotherapy

77
Q

treatment of choice of ectoparasites?

A

Permethrin

78
Q

Pernethrin?

A

treatment of choice for lice/scabies

MOA- pediculicide, scabicide
derived from Chrysanthemum plant

79
Q

Malathion?

A

tx for lice/scabies

MOA - pediculicide, scabicide
**ORGANOPHOSPHATE cholinesterase inhibitor – 2nd line agent

80
Q

Lindane?

A

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

81
Q

Crotamiton?

A

tx for lice/scabies

MOA - not fully understood, may also have some antiprutitic properties
2nd or 3rd line

82
Q

Ivermectin PO?

A

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)

83
Q

topical antibiotic preparations for lice/scabies?

A 
bacitracin
gramicidin
mupirocin
polymyxin B
neomycin/ gentamycin
84
Q

miscellaneous topical agents for lice/scabies?

A

topical antibiotics
doxepin hydrochloride - antipruritic
pramoxine - topical anesthetic

85
Q

what drugs cause drug-induced photosensitivity?

A 
benzocaine
coal tar
hexachlorophene
isotretinoin
methoxsalen
tacrolimus
tazarotene
retinoin
sunscreen agents: PABA, cinnamates, benzyphenones
86
Q

2 types of photosensitivity?

A
  1. photoallergy

2. phototoxicity

87
Q

what is a photoallergy?

A

rare, immunological response
light causes the drug to act as a hapten - triggering a hypersensitivity response
leads to pruritis, eczematous rxn

88
Q

what is phototoxicity?

A

more common

chemically-induced rxns when drug absorbs UVA light and causes cellular damage

Pharm - Sam (3 decks)

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