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Stage 3 Block 2 > Skin > Flashcards

Skin Flashcards

1
Q

What are the symptoms of eczema?

A

Pruritus
Blisters
Scaling plaques
Infection may result

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2
Q

Describe the pathophysiology of eczema

A

Dermal oedema and inflammatory cell infiltration
Spongiosis and fluid filled vesicles
Scales
Epidermal hyperplasia and hyperkeratosis

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3
Q

What are the different types of dermatitis?

A 
Primary irritant dermatitis 
Allergic contact dermatitis
Atopic dermatitis 
Drug-related eczematous dermatitis 
Photoeczematous dermatitis
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4
Q

Describe the mechanism of the sensitisation phase of contact dermatitis

A

Antigen gets recognised by Langerhans cells
These are antigen presenting cells which present the antigen to naive T cells
The T cells then differentiate to form memory and effector T cells which elicit an immune response

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5
Q

Describe the mechanism of the re-exposure phase of contact dermatitis

A

Antigen gets recognised by Langerhans cells and activated T memory cells
Cytokines are released and an immune response elicited

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6
Q

Describe the mechanism of action of tacrolimus and pimecrolimus

A

Forms a complex with FKBP12 to inhibit calcineurin
Prevents phosphorylation of NFAT
Inhibiting the translocation of NFAT and thus the production of interleukins

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7
Q

What are the indications of tacrolimus and pimecrolimus?

A

Pimecrolimus - mild-to-moderate eczema

Tacrolimus - moderate-to-severe eczema

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8
Q

What ADRs are associated with tacrolimus and pimecrolimus?

A

Burning

Pruritus

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9
Q

What cautions surround the use of tacrolimus and pimecrolimus?

A

Increased risk of skin infection
Increased risk of skin cancer
Avoid exposure to UV light

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10
Q

What are the contraindications for the use of tacrolimus and pimecrolimus?

A

Hypersensitivity (including other macrolides e.g. erythromycin, sirolimus)
Skin barrier defects
Immunodeficiency

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11
Q

What interactions are associated with tacrolimus and pimecrolimus?

A

Immunosuppressants

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12
Q

What class of drug is ciclosporin?

A

A calcineurin inhibitor

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13
Q

Describe the mechanism of action of ciclosporin

A

Forms a complex with cyclophilin, inhibiting calcineurin which inhibits the phosphorylation of NFAT, inhibiting the translocation of NFAT to the nucleus and inhibiting the production/release of interleukins

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14
Q

What ADRs are associated with ciclosporin?

A

Nephrotoxicity, HTN, neurotoxicity, hepatotoxicity, hyperlipidaemia, neoplasms, infection

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15
Q

What cautions surround the use of ciclosporin?

A

Avoid UV light
Monitor renal function
Existing infection

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16
Q

What are the contraindications for the use of ciclosporin?

A 
Hypersensitivity 
Poor renal function
HTN
Uncontrolled infection
Cancer
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17
Q

What interactions are associated with ciclosporin?

A

Immunosuppressants

CYP3A4

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18
Q

Describe the mechanism of action of methotrexate

A

Inhibits dihydrofolate reductase

  • decreased nucleotide synthesis
  • increased apoptosis of T cells
  • increase in adenosine is anti-inflammatory
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19
Q

What ADRs are associated with methotrexate?

A 
Bone marrow suppression and blood dyscrasia
Hepatotoxicity 
Nephrotoxicity 
GI ulceration 
Risk of infection
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20
Q

What cautions surround the use of methotrexate?

A

Impaired liver function
Blood disorder
GI ulceration
Impaired renal function

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21
Q

What are the contraindications for the use of methotrexate?

A

Severe renal or hepatic impairment

Pregnancy and lactation

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22
Q

What interactions are associated with methotrexate?

A

NSAIDs - inhibit tubular secretion, both compete for OAT3

Antifolate antibiotics - both inhibit folate synthesis

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23
Q

How is methotrexate secreted?

A

Tubular secretion by OAT3

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24
Q

Describe the mechanism of action of glucocorticoids

A

Bind with GR to promote translocation to nucleus, increasing production of anti-inflammatory cytokines and decreasing the production of pro-inflammatory cytokines

  • inhibition of inflammatory gene expression
  • induction of anti-inflammatory gene expression
  • inhibition of leukocyte migration and activity
  • inhibition of prostanoid/leukotriene synthesis
  • inhibition of T lymphocyte proliferation
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25
Q

What ADRs are associated with glucocorticoids?

A 
Inhibition of hypothalamic/pituitary/adrenal axis
Weight gain and DM
Redistribution of fat
Broad anti-inflammatory effects 
HTN
Euphoria
Buffalo hump
Moon face
Easy bruising
Poor wound healing
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26
Q

What cautions surround the use of glucocorticoids?

A

Short term use only

Avoid potent glucocorticoids in psoriasis

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27
Q

What are the contraindications for the use of glucocorticoids?

A

Uncontrolled infections

28
Q

Describe the mechanism of action of retinoids

A

Form a complex with RAR and RXR to promote translocation to the nucleus and production of the genes regulating differentiation and proliferation, and genes that regulate apoptosis

29
Q

Give examples of retinoids and their indications

A

Alitretinoin - eczema
Tazoretene - psoriasis
Acitretin - severe psoriasis

30
Q

What ADRs are associated with the use of retinoids?

A

Burning, erythema

Teratogenic

31
Q

What are the contraindications for the use of retinoids?

A

Pregnancy
Hyperlipidaemia
Hepatic and renal impairment

32
Q

Give examples of vitamin D analogues

A

Calcipotriol, calcitriol, tacalcitol

33
Q

Describe the mechanism of action of vitamin D analogues

A

Inhibit epidermal cell proliferation
Induce keratinocyte differentiation
Anti-inflammatory (inhibit T cell proliferation and cytokine production)

34
Q

What ADRs are associated with vitamin D analogues?

A 
Burning
Erythema
Pruritus 
Paraesthesia
Hypercalcaemia
35
Q

What are the contraindications for the use of vitamin D analogues?

A

Calcium metabolism disorders

36
Q

Give examples of TNF-alpha inhibitors

A

Etanercept
Infliximab
Adalimumab

37
Q

What ADRs are associated with TNF-alpha inhibitors?

A

Increased risk of infection

38
Q

What cautions surround the use of TNF-alpha inhibitors?

A

Predisposition to infection

39
Q

What are the contraindications for the use of TNF-alpha inhibitors?

A

Uncontrolled infection

40
Q

What interactions are associated with TNF-alpha inhibitors?

A

Live vaccines

41
Q

What class of drug is ustekinumab?

A

IL12/IL23 inhibitor

42
Q

What ADRs are associated with the use of ustekinumab?

A

Increased risk of infection

43
Q

What cautions surround the use of ustekinumab?

A

Predisposition to infection

44
Q

What are the contraindications for the use of ustekinumab?

A

Uncontrolled infection

45
Q

What interactions are associated with ustekinumab?

A

Live vaccines

46
Q

What are the functions of the skin?

A 
Regulate body temperature 
Store blood 
Protect body from external environment 
Detect cutaneous sensations 
Excretion and absorption 
Synthesis of vitamin D
47
Q

What is the function of keratinocytes?

A

Produce keratin and lamellar granules to decrease water loss from skin and protect skin from heat, microbes and chemicals

48
Q

Name the 5 layers of the epidermis

A 
Stratum basale
Stratum spinousum
Stratum granulosum
Stratum lucidum 
Stratum corneum
49
Q

Outline the process of keratinisation

A

Keratinocytes accumulate keratin, and are pushed up from the stratum basale, and undergo apoptosis at the stratum granulosum and are sloughed off when they reach the stratum corneum.

50
Q

Describe atopic dermatitis

A

Most commonly affects flexures
Type IgE mediated
FH of atopy

51
Q

What type of dermatitis is type IgE mediated?

A

Atopic dermatitis

52
Q

What patient groups get gravitational dermatitis?

A

Those with varicose veins

53
Q

What type of dermatitis is type IV mediated?

A

Allergic contact dermatitis

54
Q

What are the 4 Ps of lichen planus?

A

Pruritic
Purple
Polygonal
Papules

55
Q

Describe the process of healing by primary intention

A 
Acute inflammation
Platelets 
Thromboplastin 
Vasodilation
Neutrophils and macrophages 
Fibroblasts 
Scab
Epithelial cells
Healed 2-3w
56
Q

Outline the process of healing by secondary intention

A

Necrosis
- debridement

Granulation

  • inflammation
  • infiltration with erythrocytes, leukocytes and platelets
  • endothelial cells
  • growth factors

Epithelialisation

57
Q

Which part of a hydrocolloid dressing is hydrophilic?

A

Granules

58
Q

Which part of a hydrocolloid dressing is hydrophobic?

A

Adhesive matrix

59
Q

How do hydrocolloid dressings work?

A

Slowly absorb fluid from wound, forming cohesive or hydrophilic gel

60
Q

What are the components of foams?

A

Absorbent polyurethane with other components:

  • hydrocellular foams
  • hydropolymer foams
  • soft silicone foams
  • foam and silver
  • foam and charcoal
61
Q

What component of an alginate dressing forms a soft flexible gel?

A

Mannuronic acid

62
Q

What component of alginate dressings form a firm gel?

A

Guluronic acid

63
Q

What types of dressing can be used in a low granulating wound?

A

Foams

hydrogels

64
Q

What types of dressings can be used in a wound with light to medium exudate?

A

Foams
Alginates
Thin hydrocolloids
Hydrogels

65
Q

What types of dressings can be used in a wound with medium to heavy exudate?

A

Alginates
Hydrocolloids
Foams

66
Q

What types of dressings can be used in a wound with heavy exudate?

A

Alginates
Hydrocolloids
Foams

Stage 3 Block 2 (8 decks)

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