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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
What ADRs are associated with glucocorticoids?
``` 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 ```
26
What cautions surround the use of glucocorticoids?
Short term use only | Avoid potent glucocorticoids in psoriasis
27
What are the contraindications for the use of glucocorticoids?
Uncontrolled infections
28
Describe the mechanism of action of retinoids
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
Give examples of retinoids and their indications
Alitretinoin - eczema Tazoretene - psoriasis Acitretin - severe psoriasis
30
What ADRs are associated with the use of retinoids?
Burning, erythema | Teratogenic
31
What are the contraindications for the use of retinoids?
Pregnancy Hyperlipidaemia Hepatic and renal impairment
32
Give examples of vitamin D analogues
Calcipotriol, calcitriol, tacalcitol
33
Describe the mechanism of action of vitamin D analogues
Inhibit epidermal cell proliferation Induce keratinocyte differentiation Anti-inflammatory (inhibit T cell proliferation and cytokine production)
34
What ADRs are associated with vitamin D analogues?
``` Burning Erythema Pruritus Paraesthesia Hypercalcaemia ```
35
What are the contraindications for the use of vitamin D analogues?
Calcium metabolism disorders
36
Give examples of TNF-alpha inhibitors
Etanercept Infliximab Adalimumab
37
What ADRs are associated with TNF-alpha inhibitors?
Increased risk of infection
38
What cautions surround the use of TNF-alpha inhibitors?
Predisposition to infection
39
What are the contraindications for the use of TNF-alpha inhibitors?
Uncontrolled infection
40
What interactions are associated with TNF-alpha inhibitors?
Live vaccines
41
What class of drug is ustekinumab?
IL12/IL23 inhibitor
42
What ADRs are associated with the use of ustekinumab?
Increased risk of infection
43
What cautions surround the use of ustekinumab?
Predisposition to infection
44
What are the contraindications for the use of ustekinumab?
Uncontrolled infection
45
What interactions are associated with ustekinumab?
Live vaccines
46
What are the functions of the skin?
``` Regulate body temperature Store blood Protect body from external environment Detect cutaneous sensations Excretion and absorption Synthesis of vitamin D ```
47
What is the function of keratinocytes?
Produce keratin and lamellar granules to decrease water loss from skin and protect skin from heat, microbes and chemicals
48
Name the 5 layers of the epidermis
``` Stratum basale Stratum spinousum Stratum granulosum Stratum lucidum Stratum corneum ```
49
Outline the process of keratinisation
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
Describe atopic dermatitis
Most commonly affects flexures Type IgE mediated FH of atopy
51
What type of dermatitis is type IgE mediated?
Atopic dermatitis
52
What patient groups get gravitational dermatitis?
Those with varicose veins
53
What type of dermatitis is type IV mediated?
Allergic contact dermatitis
54
What are the 4 Ps of lichen planus?
Pruritic Purple Polygonal Papules
55
Describe the process of healing by primary intention
``` Acute inflammation Platelets Thromboplastin Vasodilation Neutrophils and macrophages Fibroblasts Scab Epithelial cells Healed 2-3w ```
56
Outline the process of healing by secondary intention
Necrosis - debridement Granulation - inflammation - infiltration with erythrocytes, leukocytes and platelets - endothelial cells - growth factors Epithelialisation
57
Which part of a hydrocolloid dressing is hydrophilic?
Granules
58
Which part of a hydrocolloid dressing is hydrophobic?
Adhesive matrix
59
How do hydrocolloid dressings work?
Slowly absorb fluid from wound, forming cohesive or hydrophilic gel
60
What are the components of foams?
Absorbent polyurethane with other components: - hydrocellular foams - hydropolymer foams - soft silicone foams - foam and silver - foam and charcoal
61
What component of an alginate dressing forms a soft flexible gel?
Mannuronic acid
62
What component of alginate dressings form a firm gel?
Guluronic acid
63
What types of dressing can be used in a low granulating wound?
Foams | hydrogels
64
What types of dressings can be used in a wound with light to medium exudate?
Foams Alginates Thin hydrocolloids Hydrogels
65
What types of dressings can be used in a wound with medium to heavy exudate?
Alginates Hydrocolloids Foams
66
What types of dressings can be used in a wound with heavy exudate?
Alginates Hydrocolloids Foams

Stage 3 Block 2 (8 decks)

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