Prescribing safety

Question 1

What types of skin are creams, ointments and lotions/gels used on?

Answer 1

creams = weepy skin
ointments = dry skin
lotions/gels = hair-bearing areas

Question 2

How should topical lotions be applied to hair-bearing areas?

Answer 2

with the direction of hair growth
(helps prevent product build up in hair follicles and therefore helping to prevent folliculitis)

Question 3

What are the 4 potencies of topical steroids?

Answer 3

mild, moderate, potent, very potent

Question 4

What steroid potency should be used on the palms and soles? [adults]

Answer 4

very potent

Question 5

What steroid potency should be used on the trunk and limbs? [adults]

Answer 5

potent

Question 6

What steroid potency should be used on the face and flexures? [adults]

Answer 6

moderate

Question 7

What steroid potency should be used on the eyelids? [adults]

Answer 7

mild

Question 8

Roughly how much does one fingertip unit (FTU) weigh and what area size would it cover?

Answer 8

1 FTU = 0.5g = covers area size of 2 hands (fingers together)

4 hands = 2 FTU = 1g

Question 9

Topical steroids side effects

Answer 9

skin thinning
striae
telangiectasia
contact dermatitis
perioral dermatitis
worsening of untreated infection
acne or worsening of rosacea
depigmentation
hypertrichosis

Question 10

Emollients functions

Answer 10

moisturise
soften
soothe
suitable as a barrier
soap substitute

Question 11

What are the bases of ointments, creams and lotions/gels?

Answer 11

ointments = oil-based
creams = mixture of oil and water
lotions/gels = generally water-based

Question 12

What ingredients should be avoided on broken skin?

Answer 12

avoid alcohol or salicylates - can sting

Question 13

Side effects of emollients

Answer 13

folliculitis
irritant reactions/allergic contact dermatitis (reaction to excipients, active medicament and preservatives)

Question 14

Can other topical treatments be applied immediately after application of emollient?

Answer 14

no
need to wait 30 mins between application of different topical products

Question 15

What is a risk of using emollients as a soap substitute?

Answer 15

slippery skin - dropping babies
slipping in the bath/shower

Question 16

What is an excipient?

Answer 16

other components other than active medicament

Question 17

Do ointments contain preservatives?

Answer 17

ointments usually do not have any water therefore do not contain preservatives

Question 18

Describe fire safety with emollients

Answer 18

paraffin-based products (eg. white soft paraffin) can be a fire hazard

on dressings/clothes can ignite with naked flame or cigarette

Question 19

List some oral medications used in dermatology (4)

Answer 19

prednisolone
isotretinoin
methotrexate
ciclosporin

Question 20

Prednisolone functions and indication

Answer 20

anti-inflammatory
immunosuppressive
anti-proliferative
vasoconstrictive

inflammatory skin conditions

Question 21

Prednisolone side effects

Answer 21

diabetes
osteoporosis
muscle wasting
Cushing’s syndrome
psychiatric reactions
adrenal suppression
risk of infections
mineralocorticoid side effects = hypertension, water/Na retention

Question 22

Usual dose of prednisolone

Answer 22

30-40mg (OD) - morning dose

withdraw gradually if treatment for more than 3 weeks

Question 23

Effect of isotretinoin

Answer 23

reduces sebum production

Question 24

Isotretinoin indications

Answer 24

severe acne or acne not responding to oral antibiotics/topical treatment

Question 25

Isotretinoin side effects

Answer 25

dry skin/mucous membranes nose bleeds joint pains liver toxicity raised triglycerides teratogenic mood changes (including suicidal ideation)

Question 26

Isotretinoin normal dose

Answer 26

0.5mg/kg then increase dose 1mg/kg, 4 month course

Question 27

Isotretinoin monitoring

Answer 27

LFT fasting lipids before treatment

Question 28

Methotrexate MOA

Answer 28

dihydrofolate reductase enzyme inhibitor

Question 29

Methotrexate indications (derm)

Answer 29

severe psoriasis severe atopic eczema

Question 30

How often should methotrexate be given?

Answer 30

once weekly dose (IM, SC, or oral) fatal if given daily

Question 31

What drug should be prescribed alongside methotrexate?

Answer 31

folic acid (on a different day) to prevent toxicity

Question 32

Methotrexate side effects

Answer 32

nausea bone marrow suppression liver cirrhosis opportunistic infections interstitial pneumonitis ? carcinogenesis

Question 33

Main interactions of methotrexate

Answer 33

trimethoprim aspirin/NSAIDs

Question 34

What symptoms should patients immediately report if on methotrexate?

Answer 34

features of blood disorders (eg. sore throat, bruising, mouth ulcers) liver toxicity (eg. nausea, vomiting, abdominal discomfort, dark urine) respiratory effects (eg. SOB)

Question 35

Methotrexate dose

Answer 35

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

Question 36

Cyclosporin MOA

Answer 36

calcineurin inhibitor reduce T cells in epidermis

Question 37

Ciclosporin indications

Answer 37

severe eczema psoriasis

Question 38

Main risk of ciclosporin

Answer 38

nephrotoxic

Question 39

Ciclosporin side effects

Answer 39

hypertension renal failure carcinogenesis opportunistic infections hyperlipidaemia

Question 40

Ciclosporin dose

Answer 40

2.5-5mg/kg daily in 2 divided doses

Question 41

Why must you prescribe the same brand of ciclosporin?

Answer 41

switching may cause changes in serum ciclosporin concentration

Question 42

What metabolic syndromes is psoriasis associated with?

Answer 42

hyperlipidaemia diabetes obesity hypertension cardiovascular disease