Therapeutics

Question 1

What is the mechanism of action of corticosteriods?

Answer 1

stabilize cell and lysosomal membranes, reduce vascular smooth muscle sensitivity to histamine, inhibit histamine release, decrease neutrophil migration and adherence, decrease production of IL-1

Question 2

Describe the bioavailability of corticosteriods in the body.

Answer 2

small amount binds to cortisol-binding globulin, while most is unbound and distributes to all body sites, is metabolized in the liver and excreted by the kidneys

Question 3

Which locations are most appropriate for application of a low potency steroid?

Answer 3

mucous membranes, scrotum, eyelids and face

Question 4

Which locations are most appropriate for application of a MP/HP steroid?

Answer 4

chest and back, arms and legs, dorsal hands and feet

Question 5

Which locations are most appropriate for application of UP steroids?

Answer 5

palms, soles and nails

Question 6

Name the 5 things to address when prescribing a topical steroid.

Answer 6

full name of medication
potency
vehicle
quantity
directions including frequency of application and body site
number of refills

Question 7

Name 4 key topical steroids and their potency.

Answer 7

UP clobetasol proprionate 0.05%
HP fluocinonide 0.05%
MP triamcinolone acetone 0.1%
LP hydrocortisone 1%

Question 8

What s lotrisone and what are its risks?

Answer 8

a combination of clobetasol 0.05% and clotrimazole 1% (anti fungal) which can cause rash in skin folds that is difficult to treat

Question 9

Name two vehicles that are used in the scalp and the advantages of either.

Answer 9

liquid is great for people with limited range of motion since it is easy to apply, but is messy and leaves a residue, foam does not leave any residue but is more difficult to apply and more expensive

Question 10

How many grams of cream/ointment does it take to cover the body once?

Answer 10

30-60g

Question 11

What are two things to avoid in prescribing UP steroids?

Answer 11

limit UP application to 2 weeks and avoid occlusion with UP, bonus! consider periodic drug holidays and provide written instructions

Question 12

What are things to consider when a disease does not respond to treatment?

Answer 12

inaccurate diagnosis
improper class, potency, vehicle, quantity, #refills
poor compliance
infection impeding healing

Question 13

What are concerning side effects of topical steroids?

Answer 13

rebound, atrophy, ocular side effects(cataracts, glaucoma, infection), pupura, lessened effectiveness, telangiectasias, acne, rosacea, perioral dermatitis, contact/irritant dermatitis (rare)

Question 14

Name a drug often used as a topical steroid substitute? Why is it particularly useful?

Answer 14

topical calcineurin inhibitors can be particularly useful when treating rebound, used as a second line therapy and does have a rare transient burning side effect; there is uncertainty about is carcinogenicity

Question 15

What medication would be used classically for a intralesional steroid injection?

Answer 15

triamcinolone 2.5-40 mg/mL

Question 16

When is intralesional steroid treatment indicated?

Answer 16

localized disease, lichenificaiton or deep inflammation, keloids– can be placed at the appropriate level but side affects include epidermal and dermal atrophy

Question 17

What are the advantages and risks of intramuscular corticosteroids?

Answer 17

creates a reservoir allowing slow release of steroids, but risk not being able to terminate effects once administered (do not recommend)

Question 18

Which dermatologic disease are systemic corticosteroids indicated?

Answer 18

pemphigus vulgarism, sever atopic dermatitis, poison ivy, acne fulminates NOT psoriasis, may risk pustular flare (years to manage)

Question 19

What is the particular concern in treating young children with corticosteroids?

Answer 19

risk of hypothalamic-pituitary axis suppression due to hi SA to mass ratio, growth retardation and osteoporosis

Question 20

Name risk factors for adverse affects of steroid use/

Answer 20

young age, liver disease, renal disease, occlusion, compromised skin barrier, amount and potency of topical med used

Question 21

What treatments are indicated due to allergic contact dermatitis due to poison ivy?

Answer 21

reaction occurs within 2 days, wash skin immediately with water, wash all clothing and tools, use topical corticosteroids or oral corticosteroids 1mg/kg/d up to 3 weeks (ensure long enough course for proper treatment