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Dermatology > Pharmacology > Flashcards

Pharmacology Flashcards

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Dermatology Board Prep flashcards
1
Q

What dictates the choice of vehicle

A

Physio-chemical properties of the drug - how hydrophobic/Phillic it is
The condition of the skin

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2
Q

What are topical drugs used to treat

A 
Superficial skin disorders - eczema etc
Skin infections 
Itching 
Dry skin 
Warts
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3
Q

What factors of absorption are dependent on the vehicle

A

The concentration of drug in the vehicle

The partition coefficient

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4
Q

What are excipients

A

Substances added to the ointment etc that enhance solubilty and absorption
Pharmacologically inert in itself

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5
Q

What factors improve the partitioning of a drug

A

Hydration of the skin by occlusion - ointment or cling film
Stops water loss
Inclusion of excipients

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6
Q

How does the nature of the skin influence the topical drug chosen

A

Site of application - thickness of stratum corneum
Hydration of the skin
Intergrity of the epidermis

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7
Q

What are the 4 categories of steroid in the UK

A

Mild
Moderate
Potent
Very potent - can only be prescribed by the dermatologist

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8
Q

How do you choose a topical steroid

A

Depends on the severity of disease and the anatomical site

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9
Q

What are some long term effects of high potency steroids

A 
Steroid rebound - down regulation of receptor 
Skin atrophy 
Systemic effects
Spread of infection 
Rosacea 
Stretch marks
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10
Q

Describe the subcutaneous route of administration

A

Needle is inserted just beneath the surface of the skin

Drug reaches systemic circulation by diffusion into capillaries or lymphatic system

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11
Q

What are the advantages of the subcutaneous route

A

Slow absorption
Useful for protein drugs (insulin) and oil-based drugs
Can be used to create a depot of drug that is slowly released into system
Simple and painless

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12
Q

What are the disadvantages of the subcutaneous route

A

Injection is volume limited

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13
Q

why is the skin a good route for drug administration

A

Application is simple and non sterile (for topical drugs)
Allows for steady-state plasma conc to be achieved over a long period
Avoids first pass metabolism
Drug absorption can be terminated

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14
Q

What is a disadvantage of the skin as an administration route

A

Intact skin is a water tight barrier so only some drugs can cross the epidermis

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15
Q

What are the advantages of topical treatment

A

Direct application

Reduces systemic effects

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16
Q

What are the disadvantages of topical treatment

A

Time consuming
Correct dosage can be difficult
Messy - issue with greasy preparations

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17
Q

What are the advantages of creams

A

Cooling and moisturing
Non-greasy
Easy to apply
Cosmetically acceptable

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18
Q

What are ointments useful for

A

Occlusive - retains moisture

Good for thickened plaques in psoriasis

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19
Q

What are lotions used for

A

To treat the scalp and other hair bearing areas

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20
Q

What are gels used to treat

A

Scalp
Hair bearing areas
Face

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21
Q

Describe pastes

A

Semisolid
Often contain fine powders such as ZnO
They are protective, occlusive and hydrating
Used for cooling, bandages and around ulcers

22
Q

Describe foams and their use

A

2 or 3 phases - usually hydrophilic liquid in continuous phase with foam agent in gaseous phase
Gives increased penetrance of active agents
Can spread easily over large areas of skin
Non-greasy or oily

23
Q

What are keratolytics used for

A

Used for treating thickened skin

24
Q

Describe the use of emollients

A 
Help rehydration of the epidermis - used for dry skin 
Need to apply frequently an liberally 
Cosmetically acceptable 
Can be used as a soap substitute
Fire risk if contain paraffin
25
Q

How do you apply emollients

A

Apply after bathing
Apply in direction of hair growth
Use clean spatula to remove from tub - prevents contamination

26
Q

What are topical steroids commonly used for

A

Mainly eczema
Psoriasis
Other inflammatory dermatoses
Keloid scars

27
Q

What are the side effects of topical steroids

A 
Thinning of the skin 
Purpura - dark purple marks on skin
Stretch marks 
Rosacea
Fixed telangectasia 
Perioral dermatitis 
May worsen or mask infection
Systemic absorption 
Tachyphylaxis 
Rebound flare
28
Q

What are calcineurin inhibitors

A 
Non-steroid anti-inflammatory - e.g. Tacrolimus
Suppress lymphocyte activation 
Use for atopic eczema 
Less side effects than steroids 
May cause burning sensation
29
Q

What are the clinical uses of antiseptics

A

Recurrent infections
Antibiotic resistance
Wound irrigation
One example is potassium permanganate bath

30
Q

What skin conditions are antivirals used for

A

Herpes simplex (cold sore) - topical
Eczema herpeticum - oral
Herpes zoster - oral

31
Q

Name some topical anti-fungals

A

Clotrimazole
Nystatin
Ketoconazole

32
Q

Name some fungal skin conditions

A

Candida - thrush

Dermatophytes - ringworm

33
Q

What conditions might you use keratolytics for

A

Viral warts
Hyperkeratotic eczema and psoriasis
Corns and callouses
Removing keratin plaques from scalp

34
Q

How would you treat a wart

A 
Mechanical pairing - take off 
Keratinolytics 
Formaldehyde - soak for whole foot 
Silver nitrate - localised 
Cryotherapy - localised
35
Q

What is the most common adverse drug reaction

A

Mainly cutaneous - show up with skin symptoms

around 30% are this

36
Q

What types of reaction can drugs cause

A

Immunologically mediated reactions - all types
Not dose dependant

Non-immunological
Can be dose-dependent

37
Q

what are the typical presentations of cutaneous drug eruption

A 
exanthematous, maculopapular rash - 75-95% of the time 
Urticarial - 5-10% 
very rarely pustular etc 
itch is very common 
usually self-limiting 
mucous membranes usually spared
38
Q

what are the risk factors for drug eruptions

A 
Age - very young and elderly 
Gender - more in females 
Genetics - predisposition 
Concomitant disease - infection 
Immune status - previous sensitivity 
Chemistry of the drug
Route of administration 
Dose
Half-life
39
Q

how do drug reactions usually resolve

A

Often resolve when the drug treatment is stopped

40
Q

how soon after taking the drugs does an eruption usually occur

A

onset is usually 4-21 after first taking the drug

41
Q

what are some signs of a serious drug reaction

A 
involvement of mucous membrane 
Facial redness and swelling 
Fever 
Pain 
Blisters, necrosis 
SOB, wheezing
42
Q

How does an urticarial drug reaction occur

A

usually an immediate IgE reaction (type I)after 2nd drug exposure
Can be a direct release of inflammatory mediators on first exposure

43
Q

describe the appearance of an urticarial rash

A

Dermal oedema - raised wheal
Blanches if pressure is applied
Can come and go

44
Q

Which drugs can cause a bullous or pustular reaction

A 
Glucocorticoids 
Androgens 
Antibiotics 
CCB 
Antimalarial
45
Q

which drugs are associated with fixed drug eruptions

A

Tetracycline, doxycycline
Paracetamol
NSAIDS
Carbamazepine

46
Q

Describe the presentation of a fixed drug eruptions

A 
Well demarcated plaques 
Red and painful 
in the same place - can reoccur 
Often appear on hands, genitals, lips 
usually mild
47
Q

Name some severe cutaneous drug reactions

A

SJS
TEN - shedding of whole body superficial layer
DRESS - huge number of circulating eosinophils

48
Q

describe a phototoxic drug reaction

A

non-immunological reaction caused by the drug and light
Makes skin more sensitive
Can occur in a sunburn like reaction

49
Q

How could a phototoxic reaction present

A

Immediate prickling with delayed erythema & pigmentation
Exaggerated sunburn
Exposed telangiectasia
Increased skin fragility

50
Q

what drugs are associated with phototoxicity

A 
antibiotics
thiazides 
NSAIDs 
immunosuppressants 
Amiodarone
51
Q

What investigations can be used for drug reactions

A

Clear history
Phototesting for phototoxic reactions
Patch and photo patch test
Skin prick tests for specific drugs

52
Q

how do you manage a cutaneous drug reaction

A

discontinue the drug
use alternative
antihistamine may help with some symptoms

Dermatology (14 decks)

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