Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacy Year 3 > Skin > Flashcards

Skin Flashcards

1
Q

What is the main function of the epidermis?

A

Replace damaged cells to maintain the skins protective features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does the epidermis protect the skin?

A

Produces keratinocytes and pushes them up through 4 layers of the epidermis until the cells are shed.
This takes 28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the epidermis consist of?

A

Keratinocytes, melanocytes and Langerhans cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many layers does the epidermis have? Name them

A 
4 layers:
Stratum basale
Stratum spinosum
Stratum granulosum
Stratum corneum (top part)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the stratum basale

A

Single layer of keratinocytes
Cells divide continually and push old cells up
Melanocytes produce melanin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the function of the stratum spinosum

A

Anchors cells together by interlocking cytoplasmic processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the processes in the stratum granulosum

What does it contain?

A

Cells undergo enzyme induced destruction, losing nuclei and cytoplasmic organelles
Keratin is laid down

Contains lipid rich secretions - skin water sealant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the stratum corneum

A

Layer contains dead cells flattened and filled with densely packed keratin
Cells are shed from skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the dermis

A

Located below the epidermis
Provides strength to skin, contains collagen and fibroblasts
Gives skin elasticity for strength
Has specialised structures e.g. sweat glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 7 skin functions

A 
Production of vitamin D
Sensory organ for touch, pain and temperature
Controls body temperature 
Weak insulator 
Barrier protection
Immune response
Healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the function of skin in the production of vitamin D

A

7 dehydroxycholesterol produces vitamin D3 in the presence of sunlight

D3 is converted to calcidol in the liver and the hydroxylated to calcitrol in the kidney to produce active D3

Vitamin D increases plasma calcium levels by stimulating the intestinal epithelium to produce carriers for transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does a lack of vitamin D lead to?

A

Inadequate calcium absorption and deposition in the bones.

Causes rickets in children and osteomalacia in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the function of skin as a sensory organ for touch, pain and temperature

A

Contains receptors which detect information from the skin surface and relay back to the CNS via sensory neurones

Mechanoreceptors can detect light touch and deep pressure on the skin surface

Thermoreceptors detect warmth and cold

Nocicereceptors respond to pain stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the function of skin in controlling body temperature

A

Capillaries in the skin control body temperature by altering blood circulation

Vasodilation causes capillaries to open and increase blood flow - causes heat loss at skin surface

Sweat glands in the skin secrete water and salt when internal body temp goes above normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the function of skin as a weak insulator

A

Mitochondria oxidise brown fat to produce more heat than ATP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the function of skin as barrier protection

A

Protects from bacteria, toxins, dehydration, UV radiation, mechanical damage and trauma

Outer epidermal layer has keratinocytes which push up old dying cells - gives a waterproof layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the function of skin in an immune response

A

Produces new skin to replace old and damaged skin

Epidermis is first line defence barrier

Langerhans cells in the epidermis ingest foreign particles to be presented to the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 4 stages of healing? And briefly describe what happens in each.

A
  1. Haemostasis - clot formation
  2. Inflammatory processes - cleans wound to prepare for healing
  3. Proliferative phase - dermal repair and epidermal regeneration
  4. Maturation phase - scar formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the process of haemostasis in skin healing

A

Platelets in the blood recognise exposed collagen, platelets become sticking, releasing thromboxane A2

Platelets aggregate with collagen, forming a temporary plug

Activated platelets release serotonin which decreases blood supply to the wound

Damaged tissue releases thromboplastin which with calcium produces fibrin

Fibrin combines with the aggregate - traps RBCs to produce a clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the inflammatory process in skin healing

A

Langerhans cells are activated and release inflammatory mediators

Bradykinin increases pain at the site

Leukotrienes increase blood flow and warm the skin

Increased vascular permeability allows WBCs to reach

Plasma movement makes wound look swollen

Neutrophils digest bacteria and particles

Monocytes move to the wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the proliferative phase in skin healing

A

Macrophages release angiogenic growth factors for new blood vessels - in wound with low oxygen, it bring oxygen and nutrients

Chemicals attract granulation tissue to produce new connective tissue

Platelet derived growth factors and macrophages activate fibroblasts which grow and divide to produce a collagen network to provide strength

Myofibroblasts contract edges of the wound to close it. Cells move until the meet and then contact inhibition stops them moving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the maturation phase in skin healing

A

Collagen is realigned to improve strength, the strands pull the wound inwards

Extra blood vessels close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens when a skin injury only affects the epidermis?

A

Keratinocytes in the stratum basale break from the basement membrane

Cells move till they meet each other, contact inhibitor stops cells moving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Give examples of intrinsic patient factors affecting wound healing

A 
Nutrition 
Skin perfusion
Age
Weight
Co-morbidity incl. medication
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does nutrition affect wound healing?

A

Protein is needed for antibodies, leukocytes, collagen and fibroblasts
Vitamin A, B, C, E, Zn and Fe are also needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does skin perfusion affect wound healing?

A

Wound need oxygen and nutrients, compromised blood supply can delay wound healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does age affect wound healing?

A

Younger people are more likely to have better perfusion, nutrition and less co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does weight affect wound healing?

A

In obesity, collagen structure may be altered and may decrease tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do co-morbidities (incl. medication) affect wound healing?

A

Hypoglycaemia affects leukocyte phagocytosis

Anaemia, ischaemia, jaundice and malignancy

Some cytotoxic drugs and PGEIs precept healing due to antagonism of growth factors

Vasoconstrictors e.g. nicotine and cocaine cause tissue hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does smoking affect wound healing?

A

Impairs wound contraction, decreases oxygen and causes platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Give examples of extrinsic wound factors affecting wound healing

A 
Moist wound
Temperature 
Oxygenation 
pH
Infection
Clean surface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does moisture affect wound healing?

A

Wounds ned to be moist to allow epithlialisation
Moisture allows growth factors and enzymes to diffuse

But too moist encourages bacterial and fungal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does temperature affect wound healing?

A

Wounds heal quicker at body temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How does oxygenation affect wound healing?

A

Less oxygen needed at granulation phase

More oxygen needed at epithelialisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does pH affect wound healing?

A

Decreased oxygen = increased lactic acid = decreased pH

Oxygen dissociated from Hb - this decreases tissue oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does infection affect wound healing?

A

Delays wound healing, chronic wounds are colonised with bacteria.

Infection shows when bacterial cells outweigh the body’s immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How does a clean surface affect wound healing?

A

Foreign matter increases inflammatory phase and delays healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the most common type of psoriasis?

A

Chronic plaque psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which parts of the body does psoriasis commonly affect?

A

Scalp

Outside surfaces of the limbs - skin & elbows and lower back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the biological abnormalities of psoriasis?

A

Abnormal differentiation of keratinocytes - they don’t mature in the same way as normal ones

Infiltration of dermis and epidermis with activated T cells and neutrophils

Stimulation of cutaneous vasculature, leading to new blood vessel formation in psoriatic plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What other parts of the body can chronic plaque psoriasis affect?

A 
Flexures
Intertriginous areas (axillae, groin, perineum and under the breasts)
42
Q

Describe the appearance of guttate psoriasis

A

Widespread small scaly lesions

43
Q

Describe the appearance of pustular psoriasis

A

Yellow-brown pustules on palms or soles of the feet

44
Q

What kind of psoriasis requires hospital administration?

A

Pustular

45
Q

Describe erythrodermic psoriasis

A

Psoriasis that becomes inflamed
Scaling of skin
Skin feels hot but patient feels cold
Usually use to systemic or potent topical steroids so stop them

46
Q

What kind of psoriasis appears on the nail?

A

Show as small pits, omycholysis and “oil spots” or “salmon patches”

47
Q

Give examples of precipitating/exacerbating factors for psoriasis

A 
Trauma 
Infection
Hormonal events
Sunlight
Drugs
Alcohol intake
Cigarette smoking 
Psychological stress
48
Q

What is classed as severe psoriasis?

A

Disease affecting >15-20% of body surface area (but this doesn’t factor in small areas or in sensitive or visible areas)

49
Q

What is used to treat mild psoriasis?

A

Topical treatments

50
Q

What is used to treat moderate to severe psoriasis?

A

Phototherapy, photochemotherapy or systemic drug treatment

51
Q

How do emollients treat psoriasis?

A

Restore pliability of the skin and reduce shedding of skin scales. They reduce itching (pruritus) and help to prevent painful cracking and bleeding

52
Q

Give examples of vitamin D analogues

A

Calcipotriol
Tacalcitol
Calcitriol

53
Q

How do vitamin D analogues treat psoriasis?

A

Inhibit keratinocytes and differentiation

Anti-inflammatory activity

54
Q

What makes calcitriol suitable for use on sensitive skin?

A

It is less irritating

55
Q

Which areas of skin are mild topical steroids suitable for in psoriasis?

A

Face, flexures or genitalia

56
Q

On which kind of psoriatic skin would potent steroids used for?

A

Recalcitrant lesions on trunk/limbs

57
Q

How much skin can be covered by one FTU of a topical steroid?

A

2 palms worth of skin

58
Q

Which topical corticosteroid should not be used in psoriasis?

A

Clobetasone butyrate 0.05%

59
Q

What is Tazarotene?

A

Topically active retinoid

60
Q

How does tazarotene treat psoriasis? How can its side effect be avoided?

A

Normalises keratinocyte differentiation and has anti-proliferative and anti-inflammatory effects

Use with a topical corticosteroid to minimise irritation

61
Q

How does coal tar treat psoriasis?

A

Keratolytic with anti-inflammatory effects

62
Q

What is dithranol?

A

Yellow irritating powder that causes inflammation, blistering and stains

63
Q

What are the counselling points for psoriasis treatment?

A

Psoriasis can’t be cured but it can be controlled

Psoriasis is not infectious

Doesn’t develop into skin cancer

Can’t spread to new areas through topical treatment

64
Q

What is involved in the management of atopic eczema in primary care?

A

Identify and avoid triggers

Care plan tailored to disease severity

Referral when conventional measures are ineffective

65
Q

Give examples of tigger factors for eczema

A

Irritation
Psychological stress
Food hypersensitivity
Allergens

66
Q

How do emollients treat eczema?

A

Restore/maintain or restore suppleness and pliability of the skin, they reduce corticosteroid requirements and improve cosmetic appearance

Form an oily layer over the skin that prevents water evaporation. Water trapped causes swelling of corneocytes which closes intercellular gaps

67
Q

When should an emollient be applied with using with a steroid?

A

At least half an hour before any topical corticosteroid to avoid dilution or spread of the steroid

68
Q

What is the purpose of humectants in emollients? Give examples of commonly used ones

A

They rehydrate dry and flaky skin

Urea, glycerin, PEG and lactic acid

69
Q

What are the properties that colloidal oatmeal adds to an emollient?

Give an example of a product with colloidal oatmeal

A

Soothing and anti-pruritic properties

Aveeno cream

70
Q

What property do lauromacrogols add to emollients?

Give examples of products with lauromacrogols

A

Balneum plus and E45 Itch

71
Q

How do topical corticosteroids treat asthma?

A

Inhibit the production and action of inflammatory mediators, this reduced inflammation and itch

72
Q

Give an example of a mild corticosteroid.

What kind of skin would it be used for?

A

Hydrocortisone

Thin skin

73
Q

Give an example of a moderate corticosteroid

What is it used for and for how long?

A

Clobetasone butyrate

Used for mild-moderate eczema for 1-2 weeks

74
Q

Give an example of a potent corticosteroid

What is it used for?

A

Mometasone furoate

Moderate-severe eczema and for areas where there is thicker skin

75
Q

What should infants <1 y/o with eczema be treated with

A

Mild potency preparations e.g. hydrocortisone ointment 1%

76
Q

What can be given OTC in community pharmacies for eczema?

A

Hydrocortisone 1% for mild-moderate atopic eczema but shouldn’t be used for >1 week without medical advice

Clobetasone butyrate 0.05% for short term use and for >12 y/o

77
Q

What are the counselling points for eczema patients using corticosteroids?

A

Don’t use as an emollient
Make sure they know the difference between potency and concentration
One FTU for 2 palms worth of skin

78
Q

When would antibiotics be needed in the treatment of eczema?
Give examples of the antibiotics used

A

Moderate-severe bacterial infection with S.aureus

Treat with oral antibiotics - flucloxacillin and erythromycin for a short period of time

79
Q

How can sedating antihistamines be used in ecemza treatment?

Give examples

A

If taken at night they may help to reduce itching

Promethazine and alimethazine

80
Q

When would topical immunomodulators be used in the treatment of eczema?

A

When there is a risk of serious side effects with topical corticosteroids or when eczema isn’t controlled with corticosteroids

81
Q

Give examples of topical immunomodulators and the types of eczema they treat.

How do they work?

A

Pimecrolimus for mild - moderate eczema
Tacrolimus for moderate - severe eczema

They are both inhibitors of calcineurin phosphatase, an enzyme involved in the activation of T cells

82
Q

Give examples of immunosuppressants used to treat severe atopic eczema

A

Ciclosporin
Axathioprine
Methotrezate

83
Q

What needs to be measured before a patient is started on azathioprine?

A

Thiopurine methyltransferase enzyme activity

84
Q

What is phototherapy and how does it work?

A

Controlled exposure to UV light, UVA or UVB

Involves immunosuppression

85
Q

What kind of eczema is wet wrapping used for?

Describe the process

A

Extensive and severe eczema in young children

A layer of emollient or mild corticosteroid is applied and covered with a wet cotton tubular bandage, then a dry one. Can go to bed with it on.

86
Q

What kind of counselling points should eczema patients be given?

A

Recognition of flares
Management of flares according to care plan
Importance of starting treatment for flares as soon as signs and symptoms appear and continue for ~48 hours after they subside

87
Q

What is isotretinoin used for?

A

Severe acne unresponsive to topical treatments and oral antibiotics

88
Q

How does isotretinoin work?

A

Reduces skin sebum excretion by ~90% after 6 weeks
Decreases hyperkeratinisation - interferes with comedogensis
Anti-inflammatory

89
Q

What are the risks associated with isotretinoin use?

A 
Teratogenic
Depression, anxiety, suicidal ideation 
Impaired night vision 
Dry skin and mucous membranes 
Joint pains
Makes skin sensitive (need UV protection)
90
Q

What is psoralens used for?
When should it be taken?
How does psoralens work?

A

Psoriasis

Take 2 hours before UVA exposure, 3 times a week for 5-6 weeks

Disrupts DNA synthesis inhibiting basal cell proliferation
Slows basal cell growth to normal

91
Q

What are the ADRs associated with psoralens use?

A

Teratogenic
Premature skin ageing
Skin pigmentation
Cataract formation

92
Q

How does acitretin work?

Why would it be considered to be better than isotretinoin?

A

Decreases hyperkeratinisation - normalises skin cell proliferation and differentiation

Longer half life than isotretinoin

93
Q

What are the risks associated with acitretin use?

A

Hyperlipidaemia

Hepatoxicity

94
Q

How does methotrexate work?

A

Folic acid antagonist
Blocks DNA synthesis - slows down basal cell proliferation in psoriasis
Enzyme inhibition leads to increased adenosine which inhibits neutrophil chemotaxis and cytokine secretion

95
Q

What are the risks associated with methotrexate use?

A 
Liver cirrhosis (LFTs monthly)
Blood disorders (FBC weekly then monthly)
GI symptoms (5mg folic acid)
Alopecia 
Infection risk
96
Q

How does ciclosporin work?

A

Blocks calcineurin dependent factor
Interleukin 2 (IL2) is blocked
Blocks proliferation of T cells and cytosines
Blocks proliferation of keratinocytes

97
Q

What are the risks associated with ciclosporin use?

A

Nephrotoxicity
Hypertension
Teratogenic
Infections

98
Q

Give examples of biologics used in complex dermatology therapy

A 
Etanercept
Infliximab
Adalimumab
Usterkinumab
Secukinumab
99
Q

What are the risks associated with biologics?

A

Increased risk of infections
CVD risk
Worsening of neurological disease
Lymphoma

100
Q

Which biologic are given as an IV infusion?

How often is it given?

A

Infliximab

0, 2, 6 then 8 weekly

101
Q

Which biologics are given as a sub cut injection?

How often are they given?

A

Ethanercept - twice weekly injection

Adalimumab - every 2 weeks

Ustekinumab - 0, 4 then every 12 weeks

Secukinumab - weekly for 4 weeks, then every 4 weeks

Pharmacy Year 3 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions