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Pathophys/Pharm > Skin and SSTI > Flashcards

Skin and SSTI Flashcards

1
Q

What are some functions of the skin?

A
  • Fluid homeostasis
  • Physical protection
  • Immune modulator
  • Vitamin D production
  • Structural/collagen
  • Hot/cold regulation
  • Radiation protection
  • Energy storage
  • Bilirubin metabolism
  • Neurosensory
  • AND MORE
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2
Q

How is a transcutaneous drug delivered?

A

Through the skin

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3
Q

Which layer of the skin is avascular, the epidermis or the dermis?

A

Epidermis

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4
Q

Does thin or thick skin have a loosely packed keratin in the stratum corneum?

A

Thin (face and genitals)

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5
Q

What are the five layers of the epidermis?

A
  1. Stratum corneum
  2. Stratum licidum
  3. Stratum granulosum
  4. Stratum spinosum
  5. Stratum basale
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6
Q

Where does cell division begin?

A

The lowest layer (stratum basale)

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7
Q

Which layer does keratin synthesis begin?

A

Stratum spinosum

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8
Q

What happens to cells as they move into higher layers?

A

They flatten, lose their nucleus and eventually die

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9
Q

What is the top layer of the epidermis composed of?

A

Stratum corneum, dead, flat skin cells

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10
Q

What is the function of epithelial cells of the skin?

A

Protective and secretory functions

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11
Q

What are some of the qualities of epithelial skin cells?

A
  • Tightly packed (limited intracellular space)
  • Avascular
  • Highly mitotic
  • Multiple layered
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12
Q

What are physical barriers of the skin?

A
  • Stratum corneum provides outer layer of defense

- Tightly packed cells create a physical barrier to invasion

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13
Q

What are chemical barriers of the skin?

A
  • Lysozyme (enzymatic protein in epithelial cells) degrades cell walls of bacteria (changes in this can affect skin conditions)
  • Lipids act as barriers on the skin are produced in the epidermal cells (S. granulosum) these can have antimicrobial properties
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14
Q

What is the function of Langerhan cells in the epidermis?

A

They function as macrophages

*Outermost guard of the cutaneous immune system

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15
Q

What layer of skin is the target for transcutaneous drugs?

A

Subcutaneous layer (hypodermis)

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16
Q

What is the function of the subcutaneous layer of skin?

A

Insulation and cushioning

*Vascular

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17
Q

What do sweat glands empty onto the skins surface and where are they located?

A

Water and electrolytes, located in the dermis

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18
Q

What do sebaceous glands empty onto into hair follicles and the skins surface and where are they located?

A

Sebum (lipids), located in the dermis

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19
Q

What type of response is sweating?

A

Sympathetic

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20
Q

What is sweating mediated by?

A

Acetylcholine at the glandular level

21
Q

What type of drug can help with hyperhydrosis?

A

An anticholinergic drug (blocks acetylcholine)

*Qbrexa (glycopyrronium tosylate)

22
Q

What type of glands are subject to infection?

A

Sebaceous glands (acne)

23
Q

What stimulates the secretion of sebum?

A

Testosterone

24
Q

What initiates the development of acne?

A

Hyper-secretion of sebum and blocked hair follicles

25
Q

What two things should be combined in treating acne?

A

Antimicrobials and topical retinoid (also with BP)

26
Q

Should you use a topical and oral antibiotic at the same time to treat acne?

A

NO

27
Q

What is the bacteria that causes acne?

A

Cutibacterium acnes

28
Q

What are the two most common antibiotics for treatment of acne?

A
  • Topical clindamycin (lincosamide)

- Oral minocycline (tetracycline)

29
Q

What is the treatment for mild (comedonal) acne?

A

Topical Benzyol peroxide and Topical antibiotic (clindamycin)

30
Q

What is the action of benzyol peroxide?

A

Breaks down sebum and keratin

31
Q

What is the treatment for moderate (inflammatory acne)?

A

Topical BP, Topical retinoid, Oral antibiotic (minocycline)

32
Q

What is the action of retinoic acid?

A

It is synthetic vitamin A which stops growth and differentiation of skin epithelial cells –> reduces sebum and keratin

33
Q

What is the treatment for severe acne?

A

Topical BP, oral/topical antibiotic OR Isotretinoin

34
Q

Why is oral isotretinoin systemic?

A

Because it kills epithelial cells everywhere, not just on the skin

35
Q

What else can you add as a treatment for severe acne for women?

A

Oral contraceptives because they can reduce testosterone levels which will help reduce sebum production

36
Q

What is the best drug class for C. acnes?

A

Oral tetracyclines

*But not for use beyond 3 months continuous

37
Q

What does stimulation of a retinoic acid receptor on an epithelial cell induce?

A

Cellular death pathway

aka when retinoic acid binds, it kills epithelial cells

38
Q

What are signs of acute inflammation?

A

Swollen, warm, red, painful, full of WBCs

39
Q

What are signs of systemic inflammation?

A

Fever, malaise, anorexia, chills, sweats

40
Q

Is all inflammation a infection?

A

NO

41
Q

What causes inflammation?

A

Inflammatory mediators inducing WBCs

macrophages, mast cells, B and T cells, PMNs, NK cells

42
Q

What do inflammatory mediators control?

A
  • Blood vessel dilation
  • Enhanced vessel wall permeability
  • WBC chemotaxis
  • Diapedesis
43
Q

How do you differentiate between inflammation and infection?

A

Infection - fever, pain, hard to the touch (cellulitis)

Inflammation - no fever, itchy, soft to touch (dermatitis)

44
Q

What leads inflammation due to cellulitis vs dermatitis?

A

Cellulitis - bacterial infection

Dermatitis - allergen, irritant or autoimmunity

45
Q

What are the most common bacteria that cause of cellulitis?

A
  1. Staph aureus
  2. Strep pyogenes (can cause necrotizing flesh eating)
    * But other organisms can also cause it
46
Q

What causes cellulitis (not the bacteria)?

A

Skin trauma or blood borne

47
Q

How do you treat cellulitis with an abscess?

A
  1. Must drain the abscess because it has no bioavailability so no drug will get to it (because it is dead cells)
  2. After abscess is drained, then you can treat cellulitis with a antibiotic
48
Q

What are some infections that Group A Strep can cause?

A
  • Furuncles/carbuncles
  • Imeptigo
  • Gangrene
49
Q

Which of these bites would be the worst?

  • Human
  • Dog
  • Cat
  • Reptile
A
  1. Human is worst
  2. Cat
  3. Dog
  4. Reptile

Pathophys/Pharm (9 decks)

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