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Dermatology 1 > Pharm: Potpourri > Flashcards

Pharm: Potpourri Flashcards

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Dermatology Board Prep flashcards
1
Q

Lice - identify the drugs considered pediculicides

A
  • pyrethroids
  • malathion
  • benzyl alcohol
  • Spinosad
  • ivermectin
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2
Q

Lice - what is the choice for initial therapy in areas with low resistance?

A

Pyrethroids

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3
Q

Lice - tx timeline with pediculocides

A

a second treatment is required in 7-9 days to treat nits from eggs for all pediculocides except ivermectin

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4
Q

Lice - in which patients should pyrethroids be avoided?

A

in patients allergic to ragweed and chrysanthemums

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5
Q

Lice - MOA of malathion

A

It is a pediculicide and ovicide

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6
Q

Lice - age indication for pyrethrin and permethrin?

A
  • Pyrethrin: okay for patients ≥ 2 years old

* Permethrin: okay for patients ≥ 2 months old

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7
Q

Lice - age indication for malathion?

A
  • contraindicated in kids < 2 y/o

- studies on safety in kids < 6 are limited

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8
Q

Lice - age indication for benzyl alcohol, spinosad, and topical ivermectin?

A
  • Benzyl Alcohol: used for patients ≥ 6 months old
  • Spinosad: not recommended for kids < 6 months old
  • Topical Ivermectin: no established safety in infants < 6 months old
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9
Q

Lice - MOA of benzyl alcohol

A
  • asphyxiation of lice
  • benzyl alcohol paralyzes the louse respirator spiracles in an open state and mineral-oil-containing vehicle obstructs spiracles
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10
Q

Lice - MOA of Spinosad

A

Compromises CNS of lice by interfering with nicotinic acetylcholine receptor, resulting in neuronal excitation and paralysis

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11
Q

Lice - MOA of ivermectin

A

Induces paralysis and death of mice

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12
Q

Lice - what is the drug of choice for drug of choice for refractory lice infestations?

A

Oral ivermectin

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13
Q

Lice - dosing of ivermectin

A
  • based on weight (not recommended if < 15kg)

- dose every 7 days for 2 doses, so take a pill on day 1 and then day 8

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14
Q

Scabies - what is 1st line tx?

A

permethrin cream and oral ivermectin

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15
Q

Scabies - what is the first line agent for large outbreaks?

A

1st line = oral ivermectin (200mcg/kg/dose—2 doses)

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16
Q

Hidradenitis suppurativa - treatment goals

A
  • Prevent formation of new lesions and thus reduce extent/progression of disease
  • Treat new lesions quickly and effectively to prevent development of chronic sinuses
  • Eliminate existing nodules/sinus tracts to limit/prevent scar formation
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17
Q

Hidradenitis suppurativa - what abx are used to treat mild HS/AI

A

*1st line is topical clindamycin

Other treatment:

  • Topical resorcinol: topical 15% resorcinol cream
  • Intralesional corticosteroids (triamcinolone acetonide): useful adjunct therapy
  • Systemic antibiotics: doxycycline, minocycline
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18
Q

Hidradenitis suppurativa - MOA and clinical action of resorcinol

A
  • Topical chemical peeling agent with keratolytic and anti-inflammatory actions
  • Reduces pain and promotes healing of lesions
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19
Q

Hidradenitis suppurativa - what is the purpose of intralesional steroids and systemic antibiotics for mild HS/AI?

A
  • intralesional corticosteroid: useful adjunctive therapy for reducing symptoms
  • -intent of treatment: accelerate resolution of early, painful inflammatory lesions
  • systemic antibiotics: can quiet intermittent, acute flares in patients with mild disease
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20
Q

Hidradenitis suppurativa - what are the first line antibiotics for moderate (stage II) HS/AI?

A
  • Tetracyclines: tetracycline, doxycycline, minocycline

- Erythromycin/cephalosporin also used for long-term antibiotic treatment

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21
Q

Hidradenitis suppurativa - what are the second line antibiotics for moderate (stage II) HS/AI?

A

If failure to respond to conventional antibiotic therapy: combination therapy with clindamycin and rifampin

22
Q

Hidradenitis suppurativa - what are the ADR for clindamycin and rifampin?

A
  • MC: diarrhea
  • C-dif specifically with clindamycin
  • Orange discoloration of bodily secretion with rifampin
23
Q

Hidradenitis suppurativa - what is the oral retinoid of choice for HS/AI?

A

acitretin (soriatane)

24
Q

Hidradenitis suppurativa -what are the antiandrogens used for stage II HS/AI?

A

Cyproterone, spironolactone, finasteride

25
Q

Hidradenitis suppurativa - what are the contraindications for using antiandrogens during pregnancy?

A

Risk of adverse effects on the fetus

26
Q

Hidradenitis suppurative - what is the contraindication with finasteride?

A

contraindicated in women of childbearing capacity

27
Q

Diaper dermatitis - select appropriate barrier products to prevent and treat

A
  • barrier preparations physically block chemical irritants/moisture from contacting skin and minimize friction
  • pastes/ointments generally better than creams/lotions
  • MC OTC barriers contain petrolatum, zinc oxide, or both. -Some contain lanolin, paraffin, dimethicone
28
Q

Diaper dermatitis - choose the appropriate use of topical corticosteroids for treatment

A

Low potency topical corticosteroid reduce inflammation

29
Q

Diaper dermatitis - which corticosteroids should you avoid??

A

Use of potent/fluorinated corticosteroids should be avoided because occlusion in area promotes systemic absorption and can cause adrenal suppression/iatrogenic Cushing disease

30
Q

Diaper dermatitis - select the appropriate use of topical antifungal agents

A

Topical antifungal agents good for diaper dermatitis caused secondarily from candida infection:

  • clotrimazole
  • miconazole
  • ketoconazole
  • sertaconazole
31
Q

Diaper dermatitis - list the harmful products or ingredients that should be avoided in the prevention or treatment

A
  • powders like cornstarch/talcum powder: significant respiratory risk if aspirated
  • baking soda/boric acid powders: risk of systemic toxicity with percutaneous absorption
  • topical barriers/meds that contain fragrance, preservatives, etc. have allergic potential
  • containing boric acid, camphor, phenol, benzocaine, salicylates avoided because potential for systemic toxicity or methemoglobinemia
32
Q

Diaper dermatitis - what are the preventative behaviors?

A

Minimize direct skin contact with urine/feces with frequent diaper change/gentle cleansing of diaper area

33
Q

Diaper dermatitis - what is the appropriate antibiotic to treat a bacterial superinfection?

A
  • Topical/oral antibiotics
  • Localized/mild: topical mupirocin (Bactroban)
  • Severe infection: oral antibiotics
34
Q

Seborrheic dermatitis - what are the treatments for dandruff?

A
  • OTC antidandruff shampoo containing selenium sulfide 2.5% or zinc pyrithione 1-2%, coal tar, salicylic acid
  • rotation of different shampoo improves/maintains efficacy of these formulations
35
Q

Seborrheic dermatitis - what is the best treatment regimen for the scalp?

A
  • Antifungal shampoo: selenium sulfide 2.5%, ketoconazole 2%, ciclopirox 1%
  • -Use medicated shampoo once weekly to prevent relapse
  • High-potency topical corticosteroid (Group 3 to 1): controls inflammation and itching
  • -Fluocinolone acetonide 0.01%
36
Q

Seborrheic dermatitis - what is the best treatment regimen for the face?

A
  • Low-potency (group 6-7) topical corticosteroid cream, topical antifungal agent, combination of both
  • For long-term control: topical antifungal cream to involved area 1x/wk
  • Long-term continuous use of even mild topical steroids- permanent telangiectasia and atrophy
  • In men: consider ketoconazole 2% shampooing of facial hair daily until remission (then drop to once/week)
  • Low-potency (group 7) topical corticosteroid can be added initially
37
Q

Seborrheic dermatitis - what is the best treatment regimen for the trunk/intertriginous areas?

A
  • Mild-potency (group 4-5) topical corticosteroid cream, topical antifungal, combination of both
  • Apply to affected area 1-2x/day until symptoms subside
  • Long-term control: topical antifungal cream to area 1x/week
38
Q

Tinea capitis - what is first line therapy?

A
  • Griseofulvin: 1st line based on drug efficacy

- Terbinafine: alternative 1st line because of evidence that need shorter treatment

39
Q

Tinea capitis - what is second line therapy?

A

Fluconazole and itraconazole - effective, less frequently used

40
Q

Tinea capitis - which antifungal should not be used??

A

Ketoconazole

41
Q

Tinea capitis - what is the adjunctive therapy?

A

shampoo with antifungal properties (selenium sulfide, ciclopirox, ketoconazole) at least 2x/week to decrease shedding of fungal spores

42
Q

Tinea capitis - what are the duration of therapy and administration instructions for griseofulvin?

A
  • it is available in microsize formulation as tablets or suspension and in ultramicrosize formulations in tablets
  • treatment regimen based on weight: 10mg/kg (5-15mg/kg for ultramicrosize)
  • treatment duration: up to 12 weeks
43
Q

Tinea capitis - what are the duration of therapy and administration instructions for terbinafine?

A

-oral is commercially available as granules or tablets
-Granule: swallowed with food, can be sprinkled onto non-acidic food
-Tablet: can be taken without regard to meals
-Timeframe: 6 weeks
< 25 kg: 125 mg 1x/day
25-35kg: 187.5 mg 1x/day
> 35kg: 250 mg 1x/day

44
Q

Tinea capitis - how do you manage household contacts?

A
  • Household members should be physically examined for signs and should be treated simultaneously if tinea capitis is detected
  • Asymptomatic carriers of dermatophytes serve as reservoirs for recurrent infections
  • Household members begin antifungal shampoo when infected individual begins
  • Avoid sharing hair care tools, pillowcases, head-to-head contact sports, bedding/towels
  • Pets/animals are reservoirs for infection. Evaluate by vet if show and signs of infection
45
Q

Atopic dermatitis - what are the nonpharm treatments that can help control pruritus?

A
  • tepid baths, wed dressings/wraps, emollients applied to skin
  • meds: sedating/non-sedating antihistamines, topical calcineurin inhibitors
  • skin hydration: lotions with low/zero water content better protect (patient may complain it’s greasy); emollients applied 2+x/day after bathing/hand-washing
46
Q

Atopic dermatitis - what is the therapy for mild to moderate atopic derm?

A
  • Initial: topical corticosteroids and emollients (liberally used before/after steroids)
  • Corticosteroid potency choice based on age, body area involved, degree of inflammation
  • Mild: group 5-6
  • Others: topical calcineurin inhibitors as alternative (esp. for face)
47
Q

Chronic hand eczema - what methods decrease irritation?

A
  • Harsh soaps should be avoided, wash with lukewarm water and mild unscented, fragrance-free soap, dry with pat dry
  • Hand washing/drying followed by application of heavy hand cream/ointment
48
Q

Chronic hand eczema - what methods protect skin?

A
  • personal protective equipment (gloves used to cook, garden, clean)
  • vinyl/non-latex gloves suitable for routine exposures
  • moisturizers/skin barrier repair creams
49
Q

Chronic hand eczema - what is the best treatment regimen for mild-moderate disease?

A
  • high-potency or super high-potency (group 1-3) topical corticosteroids as 1st line; apply 1-2x/day for 2-4 weeks
  • emollients applied liberally many times/day
  • maintenance: high/super high topical corticosteroids 2-3x/week to prevent relapse
  • long-term use may cause skin atrophy
50
Q

Chronic hand eczema - what is alternative treatment regimen?

A

topical calcineurin inhibitor (tacrolimus 01% oint) if don’t respond to topical corticosteroids of have contact allergy to topical corticosteroids

51
Q

Chronic hand eczema - how do you treat severe-recalcitrant disease?

A

if don’t respond to super-potent topical corticosteroids - systemic therapies (ex: oral corticosteroids, immunosuppressants, retinoids, phototherapy with narrow-band UVB or psoralen plus ultraviolet A-PUVA)

Dermatology 1 (19 decks)

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