Pharm: Potpourri Flashcards
Lice - identify the drugs considered pediculicides
- pyrethroids
- malathion
- benzyl alcohol
- Spinosad
- ivermectin
Lice - what is the choice for initial therapy in areas with low resistance?
Pyrethroids
Lice - tx timeline with pediculocides
a second treatment is required in 7-9 days to treat nits from eggs for all pediculocides except ivermectin
Lice - in which patients should pyrethroids be avoided?
in patients allergic to ragweed and chrysanthemums
Lice - MOA of malathion
It is a pediculicide and ovicide
Lice - age indication for pyrethrin and permethrin?
- Pyrethrin: okay for patients ≥ 2 years old
* Permethrin: okay for patients ≥ 2 months old
Lice - age indication for malathion?
- contraindicated in kids < 2 y/o
- studies on safety in kids < 6 are limited
Lice - age indication for benzyl alcohol, spinosad, and topical ivermectin?
- 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
Lice - MOA of benzyl alcohol
- asphyxiation of lice
- benzyl alcohol paralyzes the louse respirator spiracles in an open state and mineral-oil-containing vehicle obstructs spiracles
Lice - MOA of Spinosad
Compromises CNS of lice by interfering with nicotinic acetylcholine receptor, resulting in neuronal excitation and paralysis
Lice - MOA of ivermectin
Induces paralysis and death of mice
Lice - what is the drug of choice for drug of choice for refractory lice infestations?
Oral ivermectin
Lice - dosing of ivermectin
- 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
Scabies - what is 1st line tx?
permethrin cream and oral ivermectin
Scabies - what is the first line agent for large outbreaks?
1st line = oral ivermectin (200mcg/kg/dose—2 doses)
Hidradenitis suppurativa - treatment goals
- 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
Hidradenitis suppurativa - what abx are used to treat mild HS/AI
*1st line is topical clindamycin
Other treatment:
- Topical resorcinol: topical 15% resorcinol cream
- Intralesional corticosteroids (triamcinolone acetonide): useful adjunct therapy
- Systemic antibiotics: doxycycline, minocycline
Hidradenitis suppurativa - MOA and clinical action of resorcinol
- Topical chemical peeling agent with keratolytic and anti-inflammatory actions
- Reduces pain and promotes healing of lesions
Hidradenitis suppurativa - what is the purpose of intralesional steroids and systemic antibiotics for mild HS/AI?
- 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
Hidradenitis suppurativa - what are the first line antibiotics for moderate (stage II) HS/AI?
- Tetracyclines: tetracycline, doxycycline, minocycline
- Erythromycin/cephalosporin also used for long-term antibiotic treatment
Hidradenitis suppurativa - what are the second line antibiotics for moderate (stage II) HS/AI?
If failure to respond to conventional antibiotic therapy: combination therapy with clindamycin and rifampin
Hidradenitis suppurativa - what are the ADR for clindamycin and rifampin?
- MC: diarrhea
- C-dif specifically with clindamycin
- Orange discoloration of bodily secretion with rifampin
Hidradenitis suppurativa - what is the oral retinoid of choice for HS/AI?
acitretin (soriatane)
Hidradenitis suppurativa -what are the antiandrogens used for stage II HS/AI?
Cyproterone, spironolactone, finasteride
Hidradenitis suppurativa - what are the contraindications for using antiandrogens during pregnancy?
Risk of adverse effects on the fetus
Hidradenitis suppurative - what is the contraindication with finasteride?
contraindicated in women of childbearing capacity
Diaper dermatitis - select appropriate barrier products to prevent and treat
- 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
Diaper dermatitis - choose the appropriate use of topical corticosteroids for treatment
Low potency topical corticosteroid reduce inflammation
Diaper dermatitis - which corticosteroids should you avoid??
Use of potent/fluorinated corticosteroids should be avoided because occlusion in area promotes systemic absorption and can cause adrenal suppression/iatrogenic Cushing disease
Diaper dermatitis - select the appropriate use of topical antifungal agents
Topical antifungal agents good for diaper dermatitis caused secondarily from candida infection:
- clotrimazole
- miconazole
- ketoconazole
- sertaconazole
Diaper dermatitis - list the harmful products or ingredients that should be avoided in the prevention or treatment
- 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
Diaper dermatitis - what are the preventative behaviors?
Minimize direct skin contact with urine/feces with frequent diaper change/gentle cleansing of diaper area
Diaper dermatitis - what is the appropriate antibiotic to treat a bacterial superinfection?
- Topical/oral antibiotics
- Localized/mild: topical mupirocin (Bactroban)
- Severe infection: oral antibiotics
Seborrheic dermatitis - what are the treatments for dandruff?
- 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
Seborrheic dermatitis - what is the best treatment regimen for the scalp?
- 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%
Seborrheic dermatitis - what is the best treatment regimen for the face?
- 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
Seborrheic dermatitis - what is the best treatment regimen for the trunk/intertriginous areas?
- 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
Tinea capitis - what is first line therapy?
- Griseofulvin: 1st line based on drug efficacy
- Terbinafine: alternative 1st line because of evidence that need shorter treatment
Tinea capitis - what is second line therapy?
Fluconazole and itraconazole - effective, less frequently used
Tinea capitis - which antifungal should not be used??
Ketoconazole
Tinea capitis - what is the adjunctive therapy?
shampoo with antifungal properties (selenium sulfide, ciclopirox, ketoconazole) at least 2x/week to decrease shedding of fungal spores
Tinea capitis - what are the duration of therapy and administration instructions for griseofulvin?
- 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
Tinea capitis - what are the duration of therapy and administration instructions for terbinafine?
-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
Tinea capitis - how do you manage household contacts?
- 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
Atopic dermatitis - what are the nonpharm treatments that can help control pruritus?
- 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
Atopic dermatitis - what is the therapy for mild to moderate atopic derm?
- 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)
Chronic hand eczema - what methods decrease irritation?
- 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
Chronic hand eczema - what methods protect skin?
- personal protective equipment (gloves used to cook, garden, clean)
- vinyl/non-latex gloves suitable for routine exposures
- moisturizers/skin barrier repair creams
Chronic hand eczema - what is the best treatment regimen for mild-moderate disease?
- 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
Chronic hand eczema - what is alternative treatment regimen?
topical calcineurin inhibitor (tacrolimus 01% oint) if don’t respond to topical corticosteroids of have contact allergy to topical corticosteroids
Chronic hand eczema - how do you treat severe-recalcitrant disease?
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)
