Pharm -Mata

Question 1

Which medication vehicles are best for hairy areas?

Answer 1

Lotions and solutions

Question 2

Where should you avoid using ointments? What type of medication vehicle should be used in these regions?

Answer 2

intertriginous (skin contacts skin–> armpit, groin, pannus)

Use creams instead

Question 3

What are the components of writing a topical prescription? (6)

Answer 3

• Generic name
• Vehicle
• Concentraion
• Sig (signa=”write on label” =BID, PRN, etc)
• Amount
• Refills

Example: Desonide cream 0.05% apply to affected area (face) BID PRN for scaling #15 grams RF 3

Question 4

How do corticosteroids work (3 mechanisms)?

Answer 4

• activate genes encoding beta2 adrenergic receptors and anti-inflammatory proteins
• inhibit transcription factors like NF-kB and AP-1
• Modulate signal transduction pathways through interaction between the T cell receptor and interference with the JNK signal

Question 5

What determines the efficacy of topical medications?

Answer 5

strength (potency), location, vehicle and concentrations

Question 6

What are some local side effects of topical steroid use? How are these affected by the potency?

Answer 6

• skin atrophy
• Telangiectasias
• Striae

-higher potency==> more likely SE

Question 7

What are some systemic SE of topical steroids?

Answer 7

• Glaucoma
• hypothalamic pituitary axis suppression
• Cushing’s syndrome
• HTN
• Hyperglycemia

Question 8

How long should you use super high potency corticosteroids to limit SE? High and medium potency?

Answer 8

super high = < 3 weeks

high and medium= <6-8 weeks

Question 9

What percentage BSA is the size of your palm?

Answer 9

1%

if measuring on a pt, use their hand, not yours

Question 10

What is 1 fingertip unit in mg? How much BSA can this cover?

Answer 10

1 Fingertip unit (FTU)= 500 mg = treats 2% BSA

Question 11

How many grams should be given to cover 2 palms of area (2% BSA), 2 times per day for 1 month?

Answer 11

30 grams

Question 12

Why do kids have a higher risk for systemic absorption of topically applied meds than adults?

Answer 12

they have a higher SA: body ratio

Question 13

What 4 processes have a role in the formation of acne lesions?

Answer 13

• inflammatory mediators released into skin (PLC/ PKC inducing IL-1 and other inflammatory reactions)
• alteration of keratinization –> comedones
• increased and altered sebum production (under androgen control) (PI3K/Akt and Shh/MC5R pathway inducing terminal sebocyte differentiation)
• follicular colonization by P. andes

Question 14

What are topical antibiotics be given with for the treatment of inflammatory papules and pustules? Why?

Answer 14

• Benzoyl peroxide

- prevent the development of antibiotic resistance

Question 15

How does Benzoyl peroxide work?

Answer 15

-antibacterial: form highly reactive ROS that oxidize bacterial cell membranes (and yeasts)

Question 16

What do topical retinoids target? What should they not be given with?

Answer 16

• comedones

- should not be given with benzoyl peroxide because benzoyl peroxide will oxidize it

Question 17

How long does it take topical acne treatment to take effect?

Answer 17

2-3 months

patient education is crucial

Question 18

What are the side effects of oral tetracyclines? How do these affect birth control pills?

Answer 18

GI upset and photosensitivity (except Minocycline)

Minocycline=vertigo and hyperpigmentation

• take with water to avoid esophageal erosions
• do NOT interfere with birth control

Question 19

What is oral Isotretinoin used to treat? What are some side effects?

Answer 19

• used to treat severe nodulocystic scarring acne or acne resistant to other therapies
• TERATOGENIC –> contraindicated in pregnant and MUST use 2 forms of contraception
• Xerosis (dry skin)
• Cheilitis (chapped lips)
• Elevated liver enzymes
• hyper triglyceridemia
• severe acne sufferers might suffer mood changes –> monitor for depression
• Pseudotumor cerebri (–> HA from inc ICP)

Question 20

Which class of antihistamines are better for anti-histaminic properties?

Answer 20

• 2nd generation (Cetirizine, Loratadine, fexofenadine)

- 1st generation work through sedative functions (Diphenhydramine, Hydroxyzine and Chlorpheniramine)

Question 21

Why are topical vitamin D analogs used for treatment of Psoriasis?

Answer 21

-Calcipotriene inhibits keratinocyte proliferation
(SE=skin irritation)

-Calcitriol also inhibits keratinocyte proliferation, inhibits T cell proliferation and stimulates keratinocyte differentiation (less skin irritation)

Question 22

What effect does Tar have on psoriasis? What can it be combined with?

Answer 22

anti proliferative effect

can combine with salicylic acid to penetrate thick plaques

Question 23

What is a SE of Tazarotene? What can be given with it to reduce this SE ?

Answer 23

• it is a topical retinoid used for acne, rosacea and psoriasis
• SE=skin irritation
• give with a class II corticosteroid to dec irritation

Question 24

How many grams does it take to cover an average adult body (1 application)?

Answer 24

30 grams*