Pharm derm exam 1 Flashcards by Bree Henry

Medications that induced psoriasis?

NSAIDs
Antimalarials
ACE inhibitors
Inderal
Lithium
Salicylates or steroid withdrawal

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Non-pharmacological tx for psoriasis?

Smoking cessation
UV radiation/phototherapy
Moisturizers

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Treatment for mild-moderate psoriasis?

topical therapy and targeted phototherapy

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Treatment for severe psoriasis?

Systemic may be needed

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

medication penetration; ointments increase delivery

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What vehicle is best for hair bearing areas?

foam, shampoo, gel, spray

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What vehicle is best for daytime wear?

creams

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What vehicle is best for bedtime application?

ointment

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

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

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What is used to determine the potency of topical corticosteroids?

vasoconstrictive ability

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

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

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

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

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How often should topical steroids be applied?

once or twice daily

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How effective are topical steroids for treating psoriatic disease?

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

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

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

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What agent is a commonly used Vit D analog?

Calcipotriene (Dovonex)

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What is a safety concern with Vit D analogs?

Photosensitivity

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What is a commonly used topical retinoid for psoriatic disease?

Tazarotene

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What are two safety concerns with Tazarotene?

Pregnancy Cat X and photosensitivity

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How effect is tazarotene for psoriatic disease?

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

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

Use combination therapy

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

Biologic response modifiers; Risk may be greater than disease risks

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

Methotrexate

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

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

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How should biologic response modifiers be administered for psoriatic disease?

administered weekly with folic acid administered daily

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

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

What medication has a questionable benefit for eczema treatment?

Antihistamines

Which antihistamines do not cross the BBB?

second generation; less drowsiness

Score eczema mild, moderate, and severe

Mild <25 Moderate 25-50 Severe >50

What are some non-pharm options to treat scabies?

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

First line scabies treatment?

Permethrin 5% topical

Second line treatment for scabies?

Oral Ivermectin 200mcg/kg x 2 doses

Third line treatment for scabies?

Lindane topical

Concerns for permethrin cream?

May worsen asthma Photosensitivity Burning/stinging

When should Ivermectin oral be used for scabies?

unable to cover body with topical treatments

What is important to note about Ivermectin's safety?

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

How is Ivermectin oral taken?

Single oral dose repeated in 14 days

Ivermectin efficay?

Less effective than permethrin, more effective than Lindane

Lindane safety concerns?

BBW - neurologic toxicity that can cause seizures and death Should not be used in pediatric patients

First line treatment for lice?

Permethrin 1% Can also be used as prophylaxisSe

Second line treatment for lice?

Malathion

Last line treatment for lice?

Ivermectin or add T/S to topical treatment

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

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

What is a benefit of 5-fluorouracil cream?

Prevents progression to SCC

How is 5-fluorouracil offered?

Cream or solution

Tolerability issues with MAPT?

erythema, burning, pain

Ingenol mebulate FDA warning?

reports of severe allergic reaction and herpes zoster

What is the main route of drug penetration

Epidermal layer

Where is the skin most permeable?

Epigenital Head and neck Trunk Arms Legs

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

Arm or trunk

What is the most common type of adverse drug reaction?

Maculopapular drug eruptions

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

5-14 days after starting treatment

What are the most common medications to cause maculopapular eruption?

Beta-lactams Sulfonamides Carbamazepine

How should a mild maculopapular rash be treated

Stop the offending agent

How should a more severe maculopapular rash be treated?

High potency corticosteroids (prednisone) and Antihistamines

What are common medications that cause Urticaria/Angioedema?

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

How should Urticaria be treated?

H1 antihistamines - either first or second generation

What are the benefits/drawbacks of second generation antihistamines?

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

How should angioedema be treated?

Glucocorticoids with antihistamines

What are common medications that cause fixed drug eruptions?

S/T, Penicillin, NSAIDs, Barbiturates

How to treat fixed drug eruptions?

1. Stop offending drug 2. Topical corticosteroids and systemic antihistamines

What medication should be avoided with sunburn treatment?

Benzocaine

How should severe sunburn be treated?

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

How should poison ivy be treated?

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

What should be AVOIDED with poison ivy treatment?

Antihistamines

When should dermatology be referred to for poison ivy?

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

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

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

How should mild-moderate acne be treated?

Topical retinoids, Topical antimicrobials, Oral contraceptives

How should moderate to severe acne be treated?

Combination therapy

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

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

What is the significance of topical retinoids (tretinoin)

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

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

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

Safety/tolerability with topical retinoids?

photosensitivity, sunburn risk, CI in pregnancy, skin irritation

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

Clindamycin and erythromycin

Tolerability issues with topical antibiotics?

Dry skin Erythema Itching Peeling

Topical azelaic acid concern?

May cause skin lightening in patients with darker skin

What is an added benefit to using BPO?

Frequent use inhibits the development of bacterial resistance

What are some issues with BPO?

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

When are oral contraceptive considered for acne treatment?

Mod/severe Pregnancy prevention in patients using isotretinoin

What is an important patient education piece with oral contraceptives?

Patient should stop smoking (VTE risk) Also cancer risk

What are some oral antibiotic options for acne treatment?

Tetracycline, doxycycline, minocycline *Minocycline is most effective

Safety/tolerability issues for oral antibiotics?

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

What are some important things to remember about oral isotretinoin?

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

How should mild/mod rosacea be treated?

Reduce triggers and topical metronidazole

How can severe rosacea be treated?

Oral Isotretinoin