Prescribing safety Flashcards
What types of skin are creams, ointments and lotions/gels used on?
creams = weepy skin
ointments = dry skin
lotions/gels = hair-bearing areas
How should topical lotions be applied to hair-bearing areas?
with the direction of hair growth
(helps prevent product build up in hair follicles and therefore helping to prevent folliculitis)
What are the 4 potencies of topical steroids?
mild, moderate, potent, very potent
What steroid potency should be used on the palms and soles? [adults]
very potent
What steroid potency should be used on the trunk and limbs? [adults]
potent
What steroid potency should be used on the face and flexures? [adults]
moderate
What steroid potency should be used on the eyelids? [adults]
mild
Roughly how much does one fingertip unit (FTU) weigh and what area size would it cover?
1 FTU = 0.5g = covers area size of 2 hands (fingers together)
4 hands = 2 FTU = 1g
Topical steroids side effects
skin thinning
striae
telangiectasia
contact dermatitis
perioral dermatitis
worsening of untreated infection
acne or worsening of rosacea
depigmentation
hypertrichosis
Emollients functions
moisturise
soften
soothe
suitable as a barrier
soap substitute
What are the bases of ointments, creams and lotions/gels?
ointments = oil-based
creams = mixture of oil and water
lotions/gels = generally water-based
What ingredients should be avoided on broken skin?
avoid alcohol or salicylates - can sting
Side effects of emollients
folliculitis
irritant reactions/allergic contact dermatitis (reaction to excipients, active medicament and preservatives)
Can other topical treatments be applied immediately after application of emollient?
no
need to wait 30 mins between application of different topical products
What is a risk of using emollients as a soap substitute?
slippery skin - dropping babies
slipping in the bath/shower
What is an excipient?
other components other than active medicament
Do ointments contain preservatives?
ointments usually do not have any water therefore do not contain preservatives
Describe fire safety with emollients
paraffin-based products (eg. white soft paraffin) can be a fire hazard
on dressings/clothes can ignite with naked flame or cigarette
List some oral medications used in dermatology (4)
prednisolone
isotretinoin
methotrexate
ciclosporin
Prednisolone functions and indication
anti-inflammatory
immunosuppressive
anti-proliferative
vasoconstrictive
inflammatory skin conditions
Prednisolone side effects
diabetes
osteoporosis
muscle wasting
Cushing’s syndrome
psychiatric reactions
adrenal suppression
risk of infections
mineralocorticoid side effects = hypertension, water/Na retention
Usual dose of prednisolone
30-40mg (OD) - morning dose
withdraw gradually if treatment for more than 3 weeks
Effect of isotretinoin
reduces sebum production
Isotretinoin indications
severe acne or acne not responding to oral antibiotics/topical treatment
Isotretinoin side effects
dry skin/mucous membranes
nose bleeds
joint pains
liver toxicity
raised triglycerides
teratogenic
mood changes (including suicidal ideation)
Isotretinoin normal dose
0.5mg/kg then increase dose 1mg/kg, 4 month course
Isotretinoin monitoring
LFT
fasting lipids before treatment
Methotrexate MOA
dihydrofolate reductase enzyme inhibitor
Methotrexate indications (derm)
severe psoriasis
severe atopic eczema
How often should methotrexate be given?
once weekly dose (IM, SC, or oral)
fatal if given daily
What drug should be prescribed alongside methotrexate?
folic acid (on a different day) to prevent toxicity
Methotrexate side effects
nausea
bone marrow suppression
liver cirrhosis
opportunistic infections
interstitial pneumonitis
? carcinogenesis
Main interactions of methotrexate
trimethoprim
aspirin/NSAIDs
What symptoms should patients immediately report if on methotrexate?
features of blood disorders (eg. sore throat, bruising, mouth ulcers)
liver toxicity (eg. nausea, vomiting, abdominal discomfort, dark urine)
respiratory effects (eg. SOB)
Methotrexate dose
2.5-10mg once weekly, increased in steps of 2.5-5mg intervals at least once a week
usual dose 7.5-15mg once weekly
Cyclosporin MOA
calcineurin inhibitor
reduce T cells in epidermis
Ciclosporin indications
severe eczema
psoriasis
Main risk of ciclosporin
nephrotoxic
Ciclosporin side effects
hypertension
renal failure
carcinogenesis
opportunistic infections
hyperlipidaemia
Ciclosporin dose
2.5-5mg/kg daily in 2 divided doses
Why must you prescribe the same brand of ciclosporin?
switching may cause changes in serum ciclosporin concentration
What metabolic syndromes is psoriasis associated with?
hyperlipidaemia
diabetes
obesity
hypertension
cardiovascular disease
