Pharm derm exam 1 Flashcards
Medications that induced psoriasis?
NSAIDs
Antimalarials
ACE inhibitors
Inderal
Lithium
Salicylates or steroid withdrawal
Non-pharmacological tx for psoriasis?
Smoking cessation
UV radiation/phototherapy
Moisturizers
Treatment for mild-moderate psoriasis?
topical therapy and targeted phototherapy
Treatment for severe psoriasis?
Systemic may be needed
What should be considered when choosing a vehicle for topical therapy?
medication penetration; ointments increase delivery
What vehicle is best for hair bearing areas?
foam, shampoo, gel, spray
What vehicle is best for daytime wear?
creams
What vehicle is best for bedtime application?
ointment
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
What is used to determine the potency of topical corticosteroids?
vasoconstrictive ability
What type of topical corticosteroid should be avoided on the face?
high (2) and ultra-high (1) potency
What is the weekly limit for ultra-high potency topical steroids?
50g weekly (100 fingertips)
*can use up to 2-4 weeks
How often should topical steroids be applied?
once or twice daily
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
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
What agent is a commonly used Vit D analog?
Calcipotriene (Dovonex)
What is a safety concern with Vit D analogs?
Photosensitivity
What is a commonly used topical retinoid for psoriatic disease?
Tazarotene
What are two safety concerns with Tazarotene?
Pregnancy Cat X and photosensitivity
How effect is tazarotene for psoriatic disease?
greater than 50% improvement in symptoms at 12 weeks in about 50% of treated patients
What may be helpful when treating a patient with psoriatic disease with topical meds?
Use combination therapy
What medication should be reserved for patients with mod-severe or refractory psoriasis? Why?
Biologic response modifiers; Risk may be greater than disease risks
What is a biologic response modifier that can be used to treat psoriatic disease?
Methotrexate
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
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?
- Regular emollient use
- 1% topical hydrocortisone for face/intertriginous areas
- 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?
- 5-Flurouracil cream
- Imiquimod cream
- Methyl aminoevulinate photodynamic therapy
- 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?
- Stop offending drug
- 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
