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Anatomy & Physiology > Pharm derm exam 1 > Flashcards

Pharm derm exam 1 Flashcards

1
Q

Medications that induced psoriasis?

A

NSAIDs
Antimalarials
ACE inhibitors
Inderal
Lithium
Salicylates or steroid withdrawal

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2
Q

Non-pharmacological tx for psoriasis?

A

Smoking cessation
UV radiation/phototherapy
Moisturizers

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3
Q

Treatment for mild-moderate psoriasis?

A

topical therapy and targeted phototherapy

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4
Q

Treatment for severe psoriasis?

A

Systemic may be needed

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5
Q

What should be considered when choosing a vehicle for topical therapy?

A

medication penetration; ointments increase delivery

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6
Q

What vehicle is best for hair bearing areas?

A

foam, shampoo, gel, spray

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7
Q

What vehicle is best for daytime wear?

A

creams

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8
Q

What vehicle is best for bedtime application?

A

ointment

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9
Q

How many fingertips = 1 gram of topical agent? % BSA?

A

2 fingertips = 1 gram
1 fingertip = 2% body surface area
1 gram would equal 4% BSA

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10
Q

What is used to determine the potency of topical corticosteroids?

A

vasoconstrictive ability

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11
Q

What type of topical corticosteroid should be avoided on the face?

A

high (2) and ultra-high (1) potency

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12
Q

What is the weekly limit for ultra-high potency topical steroids?

A

50g weekly (100 fingertips)
*can use up to 2-4 weeks

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13
Q

How often should topical steroids be applied?

A

once or twice daily

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14
Q

How effective are topical steroids for treating psoriatic disease?

A

treatment of choice for mild-mod disease; ultra-high potency or ointment based are the most effective

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15
Q

What is a down side of vitamin D analog treatment for psoriatic disease?

A

Does not modulate immune or inflammatory activity, so erythema will persist after scaling clears

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16
Q

What agent is a commonly used Vit D analog?

A

Calcipotriene (Dovonex)

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17
Q

What is a safety concern with Vit D analogs?

A

Photosensitivity

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18
Q

What is a commonly used topical retinoid for psoriatic disease?

A

Tazarotene

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19
Q

What are two safety concerns with Tazarotene?

A

Pregnancy Cat X and photosensitivity

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20
Q

How effect is tazarotene for psoriatic disease?

A

greater than 50% improvement in symptoms at 12 weeks in about 50% of treated patients

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21
Q

What may be helpful when treating a patient with psoriatic disease with topical meds?

A

Use combination therapy

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22
Q

What medication should be reserved for patients with mod-severe or refractory psoriasis? Why?

A

Biologic response modifiers; Risk may be greater than disease risks

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23
Q

What is a biologic response modifier that can be used to treat psoriatic disease?

A

Methotrexate

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24
Q

Why should methotrexate be used rather than cyclosporine doe psoriatic disease?

A

Even though it is less effective, it has fewer adverse side effects; may cause infection

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25
Q

How should biologic response modifiers be administered for psoriatic disease?

A

administered weekly with folic acid administered daily

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26
Q

What three topical treatment options should be employed for patients with atopic eczema or acute contact dermatitis?

A
  1. Regular emollient use
  2. 1% topical hydrocortisone for face/intertriginous areas
  3. 0.1% triamcinolone for other body sites
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27
Q

What medication has a questionable benefit for eczema treatment?

A

Antihistamines

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28
Q

Which antihistamines do not cross the BBB?

A

second generation; less drowsiness

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29
Q

Score eczema mild, moderate, and severe

A

Mild <25
Moderate 25-50
Severe >50

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30
Q

What are some non-pharm options to treat scabies?

A

Evaluate close contacts - all close contacts within the past 30 days should be treated
Decontaminate
Isolation facilities

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31
Q

First line scabies treatment?

A

Permethrin 5% topical

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32
Q

Second line treatment for scabies?

A

Oral Ivermectin 200mcg/kg x 2 doses

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33
Q

Third line treatment for scabies?

A

Lindane topical

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34
Q

Concerns for permethrin cream?

A

May worsen asthma
Photosensitivity
Burning/stinging

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35
Q

When should Ivermectin oral be used for scabies?

A

unable to cover body with topical treatments

36
Q

What is important to note about Ivermectin’s safety?

A

Endorsed by CDC for scabies, but not FDA approved;
May cause postural hypotension, life-threatening dyspnea

37
Q

How is Ivermectin oral taken?

A

Single oral dose repeated in 14 days

38
Q

Ivermectin efficay?

A

Less effective than permethrin, more effective than Lindane

39
Q

Lindane safety concerns?

A

BBW - neurologic toxicity that can cause seizures and death

Should not be used in pediatric patients

40
Q

First line treatment for lice?

A

Permethrin 1%
Can also be used as prophylaxisSe

41
Q

Second line treatment for lice?

A

Malathion

42
Q

Last line treatment for lice?

A

Ivermectin or add T/S to topical treatment

43
Q

What four options are there to treat actinic keratoses in order they should be used?

A
  1. 5-Flurouracil cream
  2. Imiquimod cream
  3. Methyl aminoevulinate photodynamic therapy
  4. Ingenol mebutate gel
44
Q

What is a benefit of 5-fluorouracil cream?

A

Prevents progression to SCC

45
Q

How is 5-fluorouracil offered?

A

Cream or solution

46
Q

Tolerability issues with MAPT?

A

erythema, burning, pain

47
Q

Ingenol mebulate FDA warning?

A

reports of severe allergic reaction and herpes zoster

48
Q

What is the main route of drug penetration

A

Epidermal layer

49
Q

Where is the skin most permeable?

A

Epigenital
Head and neck
Trunk
Arms
Legs

50
Q

Where is the best place for a transdermal patch to be applied?

A

Arm or trunk

51
Q

What is the most common type of adverse drug reaction?

A

Maculopapular drug eruptions

52
Q

How long does it typically take for a maculopapular rash to appear?

A

5-14 days after starting treatment

53
Q

What are the most common medications to cause maculopapular eruption?

A

Beta-lactams
Sulfonamides
Carbamazepine

54
Q

How should a mild maculopapular rash be treated

A

Stop the offending agent

55
Q

How should a more severe maculopapular rash be treated?

A

High potency corticosteroids (prednisone) and Antihistamines

56
Q

What are common medications that cause Urticaria/Angioedema?

A

IgE mediated:
Antibiotics (Penicillin, cephalosporins, sulfonamides)
Non IgE mediated:
Morphine, Codeine, NSAIDs, ACE Inhibitors

57
Q

How should Urticaria be treated?

A

H1 antihistamines - either first or second generation

58
Q

What are the benefits/drawbacks of second generation antihistamines?

A

1st gen: parenteral option and more rapid onset
2nd gen: minimal sedation, less anticholinergic effects, less frequent dosing

59
Q

How should angioedema be treated?

A

Glucocorticoids with antihistamines

60
Q

What are common medications that cause fixed drug eruptions?

A

S/T, Penicillin, NSAIDs, Barbiturates

61
Q

How to treat fixed drug eruptions?

A
  1. Stop offending drug
  2. Topical corticosteroids and systemic antihistamines
62
Q

What medication should be avoided with sunburn treatment?

A

Benzocaine

63
Q

How should severe sunburn be treated?

A

Fluid replacement, Parenteral analgesia, clean blistered areas, topical antimicrobials

64
Q

How should poison ivy be treated?

A

Calamine lotion, Hydrocortisone 1% cream, Prescription corticosteroids if severe (face and genital involvement)

65
Q

What should be AVOIDED with poison ivy treatment?

A

Antihistamines

66
Q

When should dermatology be referred to for poison ivy?

A

Fever > 100, pus, rash covering >1/4 of the skin, rash on eyes, mouth, genitals, Difficulty breathing

67
Q

What should you warn a patient of who just began acne treatment?

A

Acne may worsen in the first 4-8 weeks before it gets better

68
Q

How should mild-moderate acne be treated?

A

Topical retinoids, Topical antimicrobials, Oral contraceptives

69
Q

How should moderate to severe acne be treated?

A

Combination therapy

70
Q

What is the order that acne medications should be added as they increase in severity?

A

Topical retinoid - topical antimicrobial - oral antibiotic + BPO - oral isotretinoin

71
Q

What is the significance of topical retinoids (tretinoin)

A

First line agent that should be the foundation of all forms/severities of acne except nodular/conglobate acne

72
Q

How is tretinoin administered? What else should be used with it?

A

Once daily application in the evening; use sunscreen with outdoor activities

73
Q

Safety/tolerability with topical retinoids?

A

photosensitivity, sunburn risk, CI in pregnancy, skin irritation

74
Q

What are two topical antibiotics that can be used to treat ance?

A

Clindamycin and erythromycin

75
Q

Tolerability issues with topical antibiotics?

A

Dry skin
Erythema
Itching
Peeling

76
Q

Topical azelaic acid concern?

A

May cause skin lightening in patients with darker skin

77
Q

What is an added benefit to using BPO?

A

Frequent use inhibits the development of bacterial resistance

78
Q

What are some issues with BPO?

A

May irritate skin
May discolor/bleach fabric
Photosensitivity
Edema/crusting of skin
Skin bleaching

79
Q

When are oral contraceptive considered for acne treatment?

A

Mod/severe
Pregnancy prevention in patients using isotretinoin

80
Q

What is an important patient education piece with oral contraceptives?

A

Patient should stop smoking (VTE risk)
Also cancer risk

81
Q

What are some oral antibiotic options for acne treatment?

A

Tetracycline, doxycycline, minocycline
*Minocycline is most effective

82
Q

Safety/tolerability issues for oral antibiotics?

A

Tooth discoloration
Fetal/infant toxicitiy
Photosensitivity
N/V/D

83
Q

What are some important things to remember about oral isotretinoin?

A

iPledge program
All pregnancies must be referred to a reproductive toxicity specialist
Only order a 30 day supply
Sunscreen must be worn
Weight-based dosing
Will dry lips/mucous membranes

84
Q

How should mild/mod rosacea be treated?

A

Reduce triggers and topical metronidazole

85
Q

How can severe rosacea be treated?

A

Oral Isotretinoin

Anatomy & Physiology (6 decks)

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