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Topical Medications Flashcards

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Dermatology Board Prep flashcards
1
Q

The success of dermatologic therapies is dependent upon several factors such as?

A
  1. Correct diagnosis
  2. Type of lesion being treated
  3. Medication being used
  4. Vehicle (the base in which the active medication is delivered)
  5. Method used to apply the medication
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2
Q

If the correct medication but the wrong vehicle is used, the response to therapy may be delayed, inadequate or even worsened
Examples:
1. Using a glucocorticoid gel on hand eczema and fissures will cause what?

  1. Treating a moist lesion with an ointment may cause what?
A
  1. increased pain and stinging due to the alcohol base of the gel
  2. folliculitis secondary to its occlusive properties
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3
Q
  1. What is a vehicle or base?
  2. What does the vehicle determine?
  3. Components of the base - may cause irritation or allergic response? 6
A
  1. Substance in which the active ingredient is dispersed
    • Vehicle (base) determines the rate at which the active ingredient is absorbed through the skin
    • Strength of the topical dependent
    • Solvents
    • Stabilizers
    • Emollients
    • Humectants
    • Thickening agents
    • Emulsifying agents
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4
Q

Both the vehicle and the active medication need to be appropriate for the skin disease:
“If it’s wet, dry it; if it’s dry, wet it”

  1. Acute contact dermatitis from poison ivy–moist deep lesions? How to treat?
  2. Chronic psoriasis—a dry lesion:
    How should we treat?
  3. In general, acute inflammation is treated with what?
  4. chronic inflammation is treated with what?
A
  1. Lotions will help “dry up” the dermatitis
    - Will also provide cool, soothing relief
  2. Chronic psoriasis—a dry lesion:
    - Creams or ointments help to retain native moisture
    - Provide relief to dry, itching skin
  3. aqueous drying preparations
  4. greasier, lubricating compounds
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5
Q
  1. Tachyphylaxis is what?
  2. When does it occur?
  3. Solution? 2
A
  1. A progressive decrease in clinical response due to repetitive application of a drug (i.e. glucocorticoids)
  2. Occurs when the body becomes tolerant to the pharmacotherapeutic effects of a particular medication
  3. Solution:
    - Allow for drug free intervals
    - Switch at various times to alternative agents
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6
Q

Vehicles consist of three basic ingredients:

3

A
  1. Powder
  2. Oils
  3. Liquids

Combinations of these three ingredients in varying proportions make up the most commonly used vehicles

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7
Q

Types of vehicles?

11

A
  1. Powders 2. Shampoos
  2. Solutions 4. Foam
  3. Tinctures
  4. Lotions
  5. Oils
  6. Ointments
  7. Creams
  8. Gels
  9. Aerosols & Sprays
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8
Q
  1. Powders help with what?
  2. Primarily used where? To do what? 3
  3. What are solutions?
  4. What are tinctures? What negative effects may these cause?
A

Powders:

  1. Aid in
    - absorbing moisture,
    - decrease friction and
    - help cover wide areas easily
  2. Primarily used in intertriginous areas to reduce
    - moisture,
    - maceration and
    - friction
  3. lotions with very minimal oil or solid content, but with active ingredients. (e.g. Visine)
  4. Alcoholic or hydroalcoholic solutions
    - may cause pain and irritation on erosions and abrasions
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9
Q
  1. What is the vehicle that consists of suspension of powder in water considered least potent topical therapies?
  2. Considered what kind of agents?
A
  1. lotion
  2. Considered drying (even emollient lotions)
    - As lotions evaporate they cool and dry
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10
Q
  1. What are shake lotions?
  2. What are emollient lotions?
  3. With emollients what happens as the water evaporates?
    - these are useful in what areas? 2
A
  1. solids are suspended within (e.g. Calamine lotion)
  2. Emollient lotions: oils are dispersed in the water usually with surfactant (to make them miscible)
  3. Emollients leave a slight residue as the water evaporates (e.g. Vaseline intensive care lotion)
    - Useful in
    - hairy areas and
    - conditions where large areas have to be treated
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11
Q
  1. What are Creams?
  2. Penetrates what part of the skin well?
  3. They can be washed off with what?
  4. Advantage?
  5. Disadvantage?
  6. Compare their potency to lotions and oitnments?
A
  1. Semisolid emulsions of oil in water about equal proportion
  2. Penetrates the stratum corneum of the skin well**
  3. They can be washed off with water
  4. Cosmetically appealing
  5. Can cause more adverse reactions because of preservatives
  6. For the same medication they are stronger than lotions but less potent than ointments
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12
Q
  1. What is an ointment?
  2. Desirable for what kind of lesions? Why?
  3. Facilitates what kind of retention?
  4. Potency?
  5. Generally the most potent vehicle due to what?
    - why dont pts like them?
  6. Used mostly in what?
  7. not useful in what areas?
A
  1. Ointments:
    - Consist of water droplets suspended in the continuous phase of oil (mineral oil) or of inert bases such as petrolatum (Vaseline)
  2. Most lubricating and moisturizing and thus desirable for dryer lesions
  3. Facilitates heat retention, they are semiocclusive
  4. Greater penetration of medicines than creams and therefore enhanced potency**
  5. their occlusive effect, but
    - patient acceptance may be low because they are greasy
  6. Useful for
    - dry dermatoses in non seborrheic, non intertriginous (mostly yeast) areas
  7. Not useful in hairy areas
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13
Q
  1. What are gels?
  2. Consists of what? 2
  3. Advantages?
  4. What kind of agent? Used for what areas?
  5. Useful for what where other vehicles mat the hair? 2
    - Useful for treating what else?
A
  1. Gels:
    Transparent semisolid emulsion that liquefies on contact with skin, drying as a thin, greaseless, non-occlusive film
  2. Consist of a hydrophilic base with water or acetone (avoid acetone on sensitive skin)
  3. Combines the best therapeutic advantages of ointments with the best cosmetic advantages of creams
  4. Considered drying and are used in seborrheic areas (face, chest)
    • exudative inflammation (poison ivy) and in
    • scalp and hair-bearing areas
    • Useful for treating acne (Retin-A)**
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14
Q
  1. Aerosols and sprays are what?
  2. Considered to be what kind of agent?
  3. Disadvantage?
  4. Most frequently used in the what?
A
  1. Sprays: alcohol based solutions, pressurized and delivered as an aerosol
  2. drying
  3. Wasteful (much of the active medication does not reach the skin)
  4. scalp
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15
Q
  1. Foams: are what?
  2. Advantages?
  3. Disadvantage?
A
  1. Pressurized collections of gaseous bubbles in a matrix of liquid film
  2. Easy to spread and apply especially to the scalp
  3. They are complex to make and can be more expensive
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16
Q
  1. Shampoos are used primarily for what?
  2. The main educational point is that the shampoo must usually be left on for _________ after application for the medication to be effective before being rinsed off
A
  1. Used primary for seborrheic dermatitis of the scalp

2. 5-7 minutes

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17
Q
  1. The strength of a topical medication is dependent on the what?

In general:

  1. What are more potent than creams of equal concentration?
  2. Creams are usually more potent than what?

Exception:
4._______ in gel form and solutions are more effective and more irritating than cream form

A
  1. vehicle**
  2. Ointment forms of topical corticosteroids
  3. lotions
  4. Retin-A
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18
Q
  1. – most potent?
  2. – potent?
  3. – least potent?
A
  1. Ointment/Gel
  2. Cream
  3. Lotion
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19
Q

Amount to dispense
1. One gram of cream will cover an area of skin approximately what area?

  1. The same amount of ointment will cover an area of what size?
  2. Total body application of different vehicles averages ______ grams for adults
A
  1. 10 cm x 10 cm
  2. 5 - 10% larger
  3. 30 - 60
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20
Q

Topical Glucocorticoids
MOA? 4
(pass through what, cause what things? 3)

The more potent the topical corticosteroid the more what?
-which causes less what? 2

A

Corticosteroids

  1. pass through the stratum corneum and
  2. cause vasoconstriction,
  3. decrease inflammation and
  4. inhibit cellular proliferation
  5. more vasoconstriction,
    - less inflammation, and
    - less proliferation
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21
Q

How can you rank potency of topical glucocorticoids?

A

The vasoconstriction of normal skin can be quantified and serves as a parameter by which topical steroids are ranked in potency

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22
Q

Topical Glucocorticoids

Indications? 4

A
  1. Therapy of choice for most inflammatory conditions
  2. Pruritic eruptions (dermatitis)
  3. Hyperplastic disorders (psoriasis)
  4. Infiltrative disorders (sarcoid)
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23
Q

Topical Corticosteroids
Desirable qualities of corticosteroids?
6

A
  1. Broad applicability in treatment of numerous diseases
  2. Rapid action with small dose
  3. Ease of use: no odor or pain
  4. Lack of sensitization
  5. Prolonged stability
  6. Compatible with most other topical medications
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24
Q

Topical Corticosteriods: Adverse reactions.
Suppression of the hypothalamic-pituitary system:
1. Particularly what agents?

  1. Happens in what kind of doses?
  2. Which will cause suppression with only 2 grams?
  3. Risk greatest with what? 3
  4. Except in _______, the mildest of steroids (hydrocortisone) is unlikely to result in systemic complications
A
  1. Particularly Class I agents
  2. Adults applying a potent steroid in excess of 50 - 100 grams weekly (10 - 20 grams in small children), for > 2 weeks may cause suppression
  3. (Clobetasol (the strongest) known to cause suppression with only 2 grams!)
  4. Risk greatest with
    - more potent steroids,
    - with damage to the stratum corneum or
    - in thin skin such as in children
  5. infants
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25
Q 
Topical Corticosteriods
Adverse Reactions (Local)? 4

Common in any steriod use of what duration?

Burning, itching or dryness usually due to what?

A
  1. Atrophy and telangiectasias are frequent in potent steroids or application to thin skin
  2. Irreversible stretch marks (striae distensae)
  3. Skin fragility and easy bruising may occur in chronic use
  4. Steroid rosacea

Common in any steroid use > 2 weeks duration

Burning, itching, or dryness are usually due to the vehicle

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26
Q

Regional differences in percutaneous absorption percentage wise:
7 from least to most absorption?

A
  1. Sole of foot - 0.14%
  2. Palm – 0.83%
  3. Forearm – 1%
  4. Scalp – 3.5%
  5. Forehead - 6.0%
  6. Cheek - 13.0%
  7. Genitalia - 42.0%
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27
Q

Topical Corticosteroids
1. Absorption is increased with increased what?

  1. Should be applied to what to achieve optimal penetration and efficacy?
  2. Inflamed skin has _________ penetration!!
  3. Ointments allow better what and are therefore more potent than creams and lotions?
  4. One exception is the super-potent topical, ___________________, which is packaged in a cream vehicle?
A
  1. skin hydration
  2. moist skin after bathing or soaking in water
  3. increased
  4. percutaneous drug absorption
  5. betamethasone dipropionate
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28
Q

Topical Corticosteroids

Seven Classes, Four groups: What are they?

A
  1. Super potent (Class I)
  2. Potent (Class II to III)
  3. Intermediate (Class IV to V)
  4. Mild (Classes VI to VII)
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29
Q
  1. Super potent topical steroids are used for what?
  2. Useful over what areas? 2
  3. Examples: 3
A
  1. severe dermatoses over non-facial/non-intertriginous areas
  2. palms and soles
    • Psoriasis
    • Severe atopic dermatitis
    • Severe contact dermatitis
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30
Q
  1. What are appropriate for mild to moderate non-facial/non-intertriginous dermatoses?
  2. What should be considered when large areas are treated because of the likelihood of systemic absorption?
  3. What should be used for treating eyelid and genital dermatoses?
A
  1. Intermediate to potent strength
  2. Mild to intermediate strength
  3. Mild strength
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31
Q
  1. Mild strength SE and time reccommendations?
  2. Potent and intermediate strength SE and time reccommendations?
  3. Super potent strength SE and time reccommendations?
A
  1. Rarely cause side effects, but intermittent therapy may be preferable to continuous therapy for the long-term treatment of large skin areas
  2. Rarely cause side effects if used for less than 6 to 8 weeks, except on the face and intertriginous areas
  3. Should not exceed three weeks if possible
    - Persistent lesions on small areas may be treated for a longer time
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32
Q

Topical Corticosteroids
The percentage of different active ingredients can be misleading:
1. 1% _________ is least potent?
2. 0.1% __________ is intermediate potency?
3. 0.05% __________ is most potent?

A
  1. Hydrocortisone
  2. Triamcinolone
  3. Betamethasone
33
Q

Topical Corticoidsteriods
1. What amount of a lotion or cream will cover an adult once?

  1. Prescribe what amount for dermatitis affecting 1/2 the body and expected to last weeks?
  2. For dermatitis of the finger prescribe ___ grams?
  3. In high potency steroids, a small tube will help how?
A
  1. 2 oz (60 grams)
  2. 240 - 480 grams
  3. 15
  4. remind the patient to use it sparingly!!
    Instructions to patient?
34
Q
  1. What dermatoses should be treated for short one to two week intervals? 3
  2. Why? 3
A
    • Facial,
    • intertriginous, and
    • genital
  2. most susceptible to
    - atrophy,
    - telangiectasia and
    - acneiform eruption
35
Q
  1. Topical steroid should be discontinued when what?

2. If continuous treatment is needed (chronic), patient should be monitored for the development of what?

A
  1. the skin condition has resolved!

2. adverse effects and/or tachyphylaxis

36
Q
  1. What kind of potency should we use in children?
  2. Children under age __ should not use potent or super potent topical steroids
  3. Exception for very severe dermatoses?
  4. Examples in which we would prescribe these? 2
  5. Bottom line? 2
A
  1. Use low potency (Class IV to VII)
  2. 12
  3. Short courses of more potent (Class I to III) for up to two weeks
    • Psoriasis,
    • severe atopic dermatitis
    • Use for short durations and
    • for appropriate inflammatory conditions
37
Q

Combination antifungal/glucocorticoids

  1. Often prescribed when?
  2. Usually a what can differentiate the two?
  3. Disadvantage?
  4. Steroid preparation in the combos are potent, increasing the risk of what?

DO NOT USE THEM!!!

A
  1. when provider is unsure if the diagnosis is fungal or inflammatory dermatitis
  2. Usually a simple KOH scraping
  3. These products are expensive compared to topical steroids and OTC antifungals
  4. cutaneous side effects

DO NOT USE THEM!!!

38
Q

TOPICAL ANTIBACTERIALS

4

A
  1. Mupirocin (Bactroban)
  2. Neomycin
  3. Gentamycin
  4. Silver Sulfazine
39
Q

Benefits of topical antibacterials:

6

A
  1. Treat a wide variety of potential pathogens
  2. No risk of ototoxicity or nephrotoxicity from the aminoglycoside topicals
  3. Drug concentration can be very high
  4. Drugs are in more direct contact with organisms
  5. Combinations of various antibacterials are synergistic
  6. Topical use helps to retard the emergence of resistant organisms
40
Q

Bactroban (Mupirocin):

  1. Comes in what forms of administration? 2
  2. Effective against what bugs? 2
  3. A few gram-negative organisms are susceptible such as? 2
  4. Only topical antibacterial that may be used to treat _______due to Staph aureus and or Strep pyogens
  5. No contact _________?
A
  1. Ointment and cream
  2. Effective against most
    - staphylococci (including Staph epidermidis and methicillin-resistant Staph)
    - streptococci
    • E. coli, H influenza,
    • N. Gonorrhea
  4. impetigo
  5. desensitization
41
Q

Neomycin
1. Comes in which forms of administration? 2

  1. Effective against what bacteria? 2
    - (But doesnt work against what?)
  2. Most dermatologist avoid Neomycin because it is responsible for a greater incidence of what than any other topical antibiotic
  3. this may be hidden because why?
A
  1. Ointment or cream
    • gram-negatives and is
    • 50 times more active against Staphylococci than Bacitracin
    • (except Pseudomonas)
  3. allergic contact sensitivity
  4. it frequently appears as though the original cutaneous disease were unaffected by treatment
42
Q

Gentamycin:
1. Forms? 2
2. Greater activity against what?
3

A
  1. Ointment or cream
2. 
Greater activity again 
-Pseudomonas
-staph
-group A beta-hemolytic strep
43
Q

Silvadene: silver sulfadiazine

  1. Forms?
  2. Works against what bugs? 3
  3. Do not use in pts with what?
  4. Complication?
  5. Uses?
A
  1. 1% cream
  2. Bacteriocidal against
    - gram-positives (including Staph aureus),
    - gram-negatives (including Pseudomonas)
    - Candida albicans
  3. Do NOT use in patients with sulfa allergies!
  4. May cause leukopenia in burn patients with large surface area burns
  5. Use : 2nd / 3rd degree burns and chronic ulcers
44
Q

TOPICAL ANTIFUNGAL AGENTS

3

A
  1. Polyene Class
  2. Allyamine Class
  3. Others
45
Q

Polyene class:
1. MOA? 2 steps

  1. What is the end result of the mechanism of action of the polyene class?
  2. Why are animal cells much less susceptible to damage from this drug class?
  3. Drugs in this class? 2
A
    • They bind with sterols in the fungal cell membrane—ergosterol
    • This changes the temperature of the cell membrane from a more fluid to a more crystalline state
  2. The result is leakage of ions and small organic molecules leading to cell death
  3. Animal cells contain cholesterol instead of ergosterol and so are much less susceptible to damage
  4. Drugs:
    - Nystatin (Mycostatin)
    - Amphotericin B (Fungizone)
46
Q

Commonly used antifungals (polyene class)

  1. Nystatin forms? 2
  2. Used to treat what?
  3. Should oral preparatons be used?
A
  1. Ointment, cream
  2. Used in the treatment of Candida infections of the skin and mucous membranes
  3. Oral preparations are poorly absorbed from the GI tract and will thus rid the oral and GI mucosa of Candida but have no effect on systemic or cutaneous infections
47
Q

Commonly used antifungals (polyene class)
Amphotericin B (Fungizone) RX only:
1. Forms? 3
2. Used topically to treat superficial what?

  1. Ineffective against what? 2
  2. Drug is yellow-orange and may do what?
A
    • 3% cream,
    • lotion or
    • ointment
  2. Candida albicans
    • dermatophytes (ringworm) and
    • tinea versicolor
  4. stain clothes and skin*
48
Q

Allyamine Class:
1. MOA?

  1. Drugs? 2
A
  1. Inhibit squaline epoxidase
    - An enzyme necessary for ergosterol synthesis
  2. Drugs:
    - Terbinafine (Lamisil)
    - Naftitine (Naftin)
49
Q

Commonly used Antifungals (allylamine class)

  1. Terbinafine (Lamisil) (OTC):
    - forms?
    - uses?
  2. Naftifine (Naftin) RX only:
    - forms? 3
    - Used in what? 3
A
    • 1% cream
    • Dermatophytes
  2. -1% or 2% cream, gel, powder
    -Used in topical treatment of Tinea corporis
    cruris
    versicolor
50
Q

Imadazole Class:
1. MOA?

  1. Drugs? 3
A
  1. Inhibits the enzyme—lamosterol 14 alpha-demethylase
    - Enzyme necessary for converting lanosterol to ergosterol
    • Clotrimazole (Lotrimin, Desenex)
    • Miconazole (Micatin, Monostat)
    • Ketoconazole (Nizoral)
51
Q

Imadazole Class:

What does the lack of ergosterol do?

A

Lack of ergosterol disrupts the fungal membrane leading to inhibition of fungal growth

52
Q

Imidazole antifungals

  1. Clotrimazole (Lotrimin, Mycelex) OTC:
    - forms? 2
    - Used to treat? 4
  2. Miconazole (Monistat, Micatin) OTC:
    - forms? 3
    - Spectrum of activity?
    - Used to treat what? 5
A
    • Cream, solution
    • Used to treat tinea corporis, tinea pedis, tinea cruris, tinea versicolor
    • 2% cream, lotion, vaginal suppositories
    • Same spectrum of activity as Clotrimazole.

Used to treat

  • vaginal infections due to Candida albicans,
  • tinea pedia,
  • tinea cruris,
  • tinea corporis and
  • tinea versicolor
53
Q

Imidazole antifungals:
Ketoconazole (Nizoral) RX only:
What are the forms of this and what is each one used in the treatment of?

A
  1. 2% Cream
    - Used in the treatment of
    - tinea infections and
    - tinea versicolor &
    - candida
  2. 2% Shampoo
    Used in the treatment of
    -seborrheic dermatitis

-There is an OTC shampoo that is not prescription strength

54
Q

Econazole (Spectazole) RX only:

  1. Cream?
  2. Spectrum of activity?
  3. Used to treat what? 4
A
  1. 1% cream
  2. Same spectrum of activity as Clotrimazole
  3. Used to treat
    - tinea corporis,
    - tinea pedis,
    - tinea cruris,
    - tinea versicolor
55
Q

Imidazole antifungals
1. Once or twice daily application to affected area will generally result in clearing of superficial dermatophyte infections when?

  1. Three or four applications to affected area will effectively treat what? 2
  2. Seborrheic dermatitis should be treated with twice daily applications of _______________ until clinical clearing is obtained
A
  1. 2-3 weeks
  2. paronychial and intertriginous candidiases
  3. ketoconazole
56
Q 
Ciclopirox Oxamine (Loprox) RX only:
1. Broad spectrum hydroxypyridine antifungal agent: MOA?
  1. Cream and lotion form used to treat what?
  2. Nail Lacquer used to treat what?

Selenium sulfide (Selsun, Exsel) OTC:

  1. Forms?
  2. Used to treat what? 2
  3. What kind of agent can this be categorized as? 3

Tolnaftate (Tinactin, Cruex) OTC:

  1. MOA?
  2. Forms? 4
  3. Used for what?
    - Ineffective against what?
A

Ciclopirox Oxamine (Loprox)

  1. Interferes with cell membrane transport and fungal respiratory process
  2. 1% cream and lotion:
    - Used for
    - dermatophytes,
    - C. albicans and
    - tinea versicolor
  3. 8% Penlac nail lacquer:
    Mild to moderate onychomycosis of fingernails and toes

Selenium sulfide (Selsun, Exsel)

  1. 1% and 2.5% solutions
  2. Used to treat
    - seborrheic dermatitis/dandruff
    - tinea versicolor
    • Antimitotic agent,
    • antibacterial and
    • antifungal**

Tolnaftate (Tinactin, Cruex)

  1. Believed to inhibit squalene epoxidase
  2. 10%
    - cream,
    - powder,
    - spray,
    - ointment
  3. Antifungal effective against
    - tinea versicolor and all dermatophyte fungi
    - Ineffective against C. albicans
57
Q

ACNE PREPARATIONS

5

A
  1. Azelaic Acid
  2. Benzoyl Peroxidase
  3. Retinoids
  4. Topical antibiotics
  5. Dapsone
58
Q

Azelaic acid

  1. Naturally found where?
  2. MOA? 3
  3. USed to treat what?
  4. Also proven effective in treating what?
  5. Drug safety and SE?
A
  1. Naturally occurring in the skin
  2. It is believed that azelaic acid clears acne by
    - reducing the populations of P. acnes,
    - decreasing the abnormal shedding of skin cells and
    - reducing inflammation
  3. Used to treat mild to moderate inflammatory and non-inflammatory acne
  4. Also proven effective in treating the dark spots that develop in some acne patients with skin of color
  5. Well tolerated by most people and can be safely used for years
    Side effects may include skin dryness and lightening of the skin where applied
59
Q

Azelaic acid Acne preparations

  1. What two drugs?
  2. These are found in what forms? 2
A

1.

  • Azelex
  • Finacea
  1. Gel and cream
60
Q

Acne Preparations
1. Benzoyl peroxide (OTC)
MOA? Does not have what kind of properties?

  1. Available in a wide range of strengths and can be found in what forms? 6
  2. Many acne preparations include benzoyl peroxide because research shows that benzoyl peroxide increases the effectiveness of what? 2
  3. When used in combination with antibiotics, benzoyl peroxide also reduces the likelihood of what?
  4. The most common side effects are what? 3
A
  1. Benzoyl peroxide works by killing P. acnes
    - It does not have anti-inflammatory abilities

2.

  • gel,
  • lotion,
  • cleanser,
  • cream and
  • wash
  1. some medicines, such as erythromycin and clindamycin
  2. a patient developing resistance to the antibiotic
    • skin irritation,
    • the potential to bleach hair and fabrics as well as
    • possible allergic reaction
61
Q

Acne Preparations: Topical Retinoids
1. Prescribed to treat acne ranging from mild to moderately severe, topical retinoids are a derivative of ___________ and considered a cornerstone in acne treatment

  1. They are primarily what kind of agent?
  2. MOA?
  3. Can irritate the skin and increase sun sensitivity so it is important to use what?
  4. An added benefit in using topical retinoids is that they may help with what?
A
  1. vitamin A,
  2. anti-inflammatory
  3. Work to unclog pores and prevent whiteheads and blackheads from forming
  4. sun protection (even in winter!)
  5. diminish the signs of aging, such as fine lines and wrinkles!
62
Q 
Retinoic acid (Retin-A):
1. Acid form of what?
  1. Action decreases cohesion between what and what?
  2. This results in what?
  3. How does it promote dimished signs of aging?
A
  1. Acid form of Vitamin A
  2. epidermal cells and increased epidermal cell turnover
  3. Results in expulsion of open comedones and the transformation of closed comedones into open ones
  4. Promotes collagen synthesis, new blood vessel formation and thickening of the epidermis
63
Q

Acne Preparations
Adapalene (Differin) (mild retinoid):
1. Compare this to Retinoid?
2. Used for what?

Tazarotene (Tazorac) (retinoid):

  1. 1% gel and cream
  2. Used for what?
  3. In what ages?
  4. Who can this not be used in?
A

Adapalene (Differin) (mild retinoid):

  1. Less irritating than Retin-A
  2. Used for mild to moderate acne vulgaris.

Tazarotene (Tazorac) (retinoid):
1. mild to moderately severe facial acne and psoriasis
2. Use only in teens > 12 YO
3. Should be used by women of childbearing age when only after contraceptive counseling
Pregnancy category X

64
Q

MOst common side effects of acne preparations?

2

A

-Erythema and dryness
Occurs in the first few weeks of use, but can be expected to resolve with continued therapy

-Minimize sun exposure and use protective sunscreen!!!

65
Q

Use of Retinoids

  1. Instruct patient to NOT put on retinoid with what?
  2. Retinoid can be put on at night and a combination BP with a topical antibiotic when?
A
  1. benzoyl peroxidase as the BP oxidizes the retinoid

2. in the am

66
Q

Topical antibacterials used in acne: Clindamycin

  1. Forms? 2
  2. Good activity against what?
  3. Does come in a fixed dose with what?
A
  1. 1% solution or gel
  2. Good activity against Propionibacterium acnes
  3. Does come in a fixed dose with benzoyl peroxidase
67
Q

Erythromycin:

  1. First line what?
  2. Used with what do reduce resistance?
  3. Should not be used as what?
A
  1. First line topical antibiotic
  2. Used w/ benzyl peroxide to reduce resistance
  3. Should not be used as monotherapy as high bacterial resistance
68
Q 
Topical antibacterials used in acne
Sodium Sulfacetamide:
1. Used to treat what?
2. What forms? 2
3. Do not use in who?
A
  1. Used in the treatment of acne vulgaris and acne rosacea.
    • 10% lotion
    • 10% wash
  3. Do NOT use in patients with SULFA allergy
69
Q

Another Topical Med for Acne
1. Dapsone 5% has what kind of properties? 2

  1. Applying dapsone w/ benzyl peroxide can do what?
A
  1. Both anti-inflammatory & anti-bacterial

2. turn the skin orange

70
Q

TOPICAL MEDS FOR PARASITIC INFECTIONS

3

A
  1. Permethrin cream
  2. Lindane lotion
  3. Ivermectin
71
Q

Paracisitic Infections

  1. Permethrin cream (OTC) Rx? 2
  2. DOC for who?
  3. Applied to the __________(excluding face of older children) {for scabies}
  4. Leave on for _____ hours
  5. Kills mite and eliminates the risk of contagion within ___ hours
  6. Pruritus may continue for several days to___weeks after treatment
  7. Who should be treated if a child has this?
A
  1. lice & scabies
  2. Children
  3. entire body
  4. 8-12
  5. 24
  6. 2
  7. Entire family should be treated
    - All clothing and bedding washed
72
Q

Permethrin cream rinse:
1. Used to treat what? 2

  1. Has to be reapplied after ___ days for the most successful treatment
  2. Fine tooth comb to remove ___?
A
  1. head lice and pubic lice
  2. 14
  3. nits
73
Q

Parasitic infections
1. For older children and adults, ______________ is an alternative

  1. With either drug, a second treatment is required a ___ weeks later
  2. What other drug is taken by mouth in two doses given a week apart also is effective and is especially helpful for severe infestations in people with a weakened immune system?
A
  1. Lindane lotion
  2. 2
  3. Ivermectin (STROMECTOL)
74
Q

TOPICAL IMMUNOSSUPPRESSIVES

2

A
  1. Tacrolimus (Protopic)

2. Pimecrolimus (Elidel)

75
Q

Topical Calcineurin Inhibitors
1. What are they? Benefit?

  1. They are second-line treatment for what?
  2. MOA—?
  3. Main adverse effects? 2
  4. Because of the decreased activity ot T cells there is evidence that they may increase the risk of developing what?
  5. Therefore, They should NOT be used on children younger than __YO
  6. They should be used how long? and in what area?
  7. They should NOT be used in patients with a what?
A
  1. Nonsteroidal immunomodulating agents that do not have the skin side effects that topical steroids do
  2. mild to moderate atopic dermatitis involving the face, including the eyelids, neck and skin folds
  3. inhibits effects of cytokine production but also may result in a decreased activity of T cells
    • mild stinging, burning and
    • pruruitis
  5. lymphomas and skin cancer therefore***:
  6. 2
  7. extended periods of time and over a minimum area
  8. compromised immune system
76
Q

TOPICAL MEDS FOR SKIN CANCER & ACTINIC KERATOSIS

2

A
  1. 5-FU

2. Imiquimod

77
Q

5-FU (Efudex)

  1. MOA?
  2. Used to treat what? 2
  3. Use for how long?
  4. Result? 2
A
  1. MOA:
    - Interferes with DNA synthesis
    - Primarily in the fastest growing cells
  2. Used to treat
    - actinic keratosis** &
    - low grade basal cell skin cancers
  3. Use: apply to affected area using an applicator for 2-6 weeks
  4. Result:
    - Burning, peeling, blistering skin
    - More sun sensitive—need to protect!
78
Q

Imoquimod

  1. MOA:
  2. Treatment for what? 3
  3. USE: apply when and for how long?
  4. Side Effects? 2
  5. If a patient has what they should not use imoquimod?
A
  1. Immune modifies—acting at several levels of the immune system
    - Promotes apoptosis in skin cancer cells
    • basal cell CA,
    • actinic keratosis and
    • genital warts
  3. apply at night either for two weeks or longer only 2 times a week then
  4. same as with 5-FU + systemic fatigue & flu-like illness
  5. another cancer

Dermatology (12 decks)

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