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Dermatology > Pharmacology > Flashcards

Pharmacology 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
How do you apply emollients
Apply after bathing Apply in direction of hair growth Use clean spatula to remove from tub - prevents contamination
26
What are topical steroids commonly used for
Mainly eczema Psoriasis Other inflammatory dermatoses Keloid scars
27
What are the side effects of topical steroids
``` 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
What are calcineurin inhibitors
``` Non-steroid anti-inflammatory - e.g. Tacrolimus Suppress lymphocyte activation Use for atopic eczema Less side effects than steroids May cause burning sensation ```
29
What are the clinical uses of antiseptics
Recurrent infections Antibiotic resistance Wound irrigation One example is potassium permanganate bath
30
What skin conditions are antivirals used for
Herpes simplex (cold sore) - topical Eczema herpeticum - oral Herpes zoster - oral
31
Name some topical anti-fungals
Clotrimazole Nystatin Ketoconazole
32
Name some fungal skin conditions
Candida - thrush | Dermatophytes - ringworm
33
What conditions might you use keratolytics for
Viral warts Hyperkeratotic eczema and psoriasis Corns and callouses Removing keratin plaques from scalp
34
How would you treat a wart
``` Mechanical pairing - take off Keratinolytics Formaldehyde - soak for whole foot Silver nitrate - localised Cryotherapy - localised ```
35
What is the most common adverse drug reaction
Mainly cutaneous - show up with skin symptoms | around 30% are this
36
What types of reaction can drugs cause
Immunologically mediated reactions - all types Not dose dependant Non-immunological Can be dose-dependent
37
what are the typical presentations of cutaneous drug eruption
``` 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
what are the risk factors for drug eruptions
``` 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
how do drug reactions usually resolve
Often resolve when the drug treatment is stopped
40
how soon after taking the drugs does an eruption usually occur
onset is usually 4-21 after first taking the drug
41
what are some signs of a serious drug reaction
``` involvement of mucous membrane Facial redness and swelling Fever Pain Blisters, necrosis SOB, wheezing ```
42
How does an urticarial drug reaction occur
usually an immediate IgE reaction (type I)after 2nd drug exposure Can be a direct release of inflammatory mediators on first exposure
43
describe the appearance of an urticarial rash
Dermal oedema - raised wheal Blanches if pressure is applied Can come and go
44
Which drugs can cause a bullous or pustular reaction
``` Glucocorticoids Androgens Antibiotics CCB Antimalarial ```
45
which drugs are associated with fixed drug eruptions
Tetracycline, doxycycline Paracetamol NSAIDS Carbamazepine
46
Describe the presentation of a fixed drug eruptions
``` Well demarcated plaques Red and painful in the same place - can reoccur Often appear on hands, genitals, lips usually mild ```
47
Name some severe cutaneous drug reactions
SJS TEN - shedding of whole body superficial layer DRESS - huge number of circulating eosinophils
48
describe a phototoxic drug reaction
non-immunological reaction caused by the drug and light Makes skin more sensitive Can occur in a sunburn like reaction
49
How could a phototoxic reaction present
Immediate prickling with delayed erythema & pigmentation Exaggerated sunburn Exposed telangiectasia Increased skin fragility
50
what drugs are associated with phototoxicity
``` antibiotics thiazides NSAIDs immunosuppressants Amiodarone ```
51
What investigations can be used for drug reactions
Clear history Phototesting for phototoxic reactions Patch and photo patch test Skin prick tests for specific drugs
52
how do you manage a cutaneous drug reaction
discontinue the drug use alternative antihistamine may help with some symptoms

Dermatology (14 decks)

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