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Dermatology > Topical Medications > Flashcards

Topical Medications Flashcards

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Dermatology Board Prep flashcards
1
Q

Dependent Factors of Success of Dermatologic Therapies

A 
Correct diagnosis
Type of lesion treated
Medication used
Vehicle (cream, ointment, etc.)
Method used to apply medication
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2
Q

What does the vehicle determine?

A

Rate at which the active ingredient is absorbed through the skin

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3
Q

Components of the Vehicle

A 
Solvents
Stabilizers
Emollients
Humectants
Thickening agents
Emulsifying agents
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4
Q

What is acute inflammation treated with?

A

Aqueous drying preparations

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5
Q

What is chronic inflammation treated with?

A

Greasy, lubricating compounds

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6
Q

Important Factors of Drug Penetration

A

Method of topical application
Site of application
Thickness of epidermal layer

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7
Q

Define Tachyphylaxis

A

Progressive decrease in clinical response due to repetitive application of drug
Similar to tolerance

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8
Q

Solution for Tachyphylaxi

A

Drug free intervals

Switch at various times to alternative agents (down a strain, different base)

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9
Q

3 Basic Ingredients of Vehicles

A

Powder
Oils
Liquids

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10
Q

Types of Vehicles

A 
Powders
Solutions
Tinctures
Lotions
Oils
Ointments
Creams
Gels 
Aerosols & Sprays
Shampoos
Foam
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11
Q

What vehicles should we be most concerned about?

A

Ointments
Lotions
Creams
Gels

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12
Q

What do powders aid in?

A

Absorbing moisture
Decrease friction
Help cover wide areas easily

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13
Q

Where is the best place to use powders?

A

Intertriginous areas

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14
Q

Define Solutions

A

Lotions with very minimal oil or solid content, but with active ingredients
Ex: Visine

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15
Q

Define Tinctures

A

Alcoholic or hydroalcohoic solutions

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16
Q

Define Lotions

A

Suspension of powder in water

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17
Q

Define Shake Lotions

A

Solids are suspended within

Ex: Calamine lotion

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18
Q

Define Emollient Lotions

A

Oils dispersed in the water usually with surfactant

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19
Q

Where are lotions useful?

A

Hairy areas

Conditions where large areas have to be treated

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20
Q

Least Potent Topical Therapy

A

Lotions

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21
Q

Define Creams

A

Semisolid emulsions of oil in water about equal proportion

Penetrates stratum corneum well

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22
Q

Define Ointment

A

Water droplets suspended in the continuous phase of oil or of inert bases
Ex oil: mineral oil
Ex inert bases: petrolatum (vaseline)

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23
Q

Use of Ointments

A

Most lubricating & moisturizing
Facilitates heat retention
Semi-occlusive
Non-seborrheic, non-intertriginous areas

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24
Q

Most Potent Vehicle

A

Ointment

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25
Q

Define Gels

A

Transparent semisolid emulsion that liquefies on contact with skin
Dries as thin, greaseless, non-occlusive film

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26
Q

Uses for Gels

A

Seborrheic areas (face, chest)
Considered drying
Exudative inflammation (poison ivy)
Acne (Retin-A)

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27
Q

Aerosols & Sprays

A 
Alcohol based solutions
Pressurized
Considered drying
Wasteful
Scalp most frequently
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28
Q

Define Foams

A

Pressurized collections of gaseous bubbles in a matrix of liquid film

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29
Q

Shampoo uses

A

Seborrheic dermatitis of the scalp

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30
Q

Main Educational Point of Shampoos

A

Left on for 5-7 minutes

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31
Q

What is the strength of a topical medication dependent on?

A

Vehicle

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32
Q

Most Potent, Potent, & Least Potent Vehicle

A

Most: ointment/gel
Middle: cream
Least: lotion

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33
Q

MOA of Topical Glucocorticoids

A

Pass through stratum corneum
Cause vasoconstriction
Decrease inflammation
Inhibit cellular proliferation

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34
Q

How are steroids ranked in potency?

A

Extensiveness of vasoconstriction

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35
Q

Indications for Topical Glucocorticoids

A

Therapy of choice for most inflammatory conditions
Pruritic eruptions
Hyperplastic disorders
Infiltrative disorders

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36
Q

Desirable Qualities of Corticosteroids

A 
Broad applicability
Rapid action with small dose
Ease of use
Lack of sensitization
Prolonged stability
Combatible with most topical medications
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37
Q

Adverse Reactions with Topical Corticosteroids

A

Suppression of hypothalamic-pituitary system

Local reactions

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38
Q

Local Adverse Reactions to Topical Corticosteroids

A 
Burning, itching, dryness (vehicle related)
Atrophy & telangiectasias
Irreversible stretch marks
Skin fragility & easy bruising
Steroid rosacea
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39
Q

Location of Greatest Penetration of Topical Corticosteroids

A

Genetalia

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40
Q

Location of Least Penetration of Topical Corticosteroids

A

Sole of foot

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41
Q

Factors that Affect Topical Corticosteroid Penetration

A 
Thickness of area
Skin hydration (increased = increased absorption)
Inflamed skin (increased penetration)
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42
Q

4 Groups of Topical Steroids

A

Super potent
Potent
Intermediate
Mild

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43
Q

Super Potent Topical Steroid Uses

A 
Severe non-facial/non-intertriginous dermatoses
Palms & soles
Psoriasis
Severe atopic dermatitis
Severe contact dermatitis
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44
Q

Intermediated to Potent Topical Steroid Uses

A

Mild-moderate non-facial/non-intertriginous dermatoses

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45
Q

Mild-Intermediate Topical Steroid Uses

A

Large areas are treated (due to systemic absorption)

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46
Q

Mild Topical Steroid Uses

A

Eyelid dermatoses

Genital dermatoses

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47
Q

Frequency of SE of Mild Topical Steroid Use

A

Rarely

Intermittent therapy for long term use

48
Q

Frequency of SE of Potent & Intermediate Topical Steroid Use

A

Rarely if

49
Q

Length of Time for Super Potent Topical Steroid Use

A
50
Q

What areas are most susceptible to atrophy, telangiectasia, & acneiform eruption?

A

Facial
Intertriginous
Genital

51
Q

What increases systemic absorption in topical steroid use?

A

Application to highly permeable areas

52
Q

Topical Steroid Use in Children

A

Low potency

53
Q

What can help diagnose a fungus from an inflammatory dermatitis?

A

KOH scraping

54
Q

Examples of Topical Antibacterials

A

Mupirocin (Bactroban)
Neomycin
Gentamycin
Silver Sulfazine

55
Q

Benefits of Topical Antibacterials

A

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

56
Q

Bactroban (Mupirocin)

A

Ointment & cream
Bugs: staph, strep, E. coli, H. flu, N. gonorrhea
TREAT IMPETIGO

57
Q

Neomycin

A

Ointment & cream
Bugs: gram negatives (except Pseudomonas)
50 times more active against Staph
Greater risk of allergic contact sensitivity

58
Q

Gentamycin

A

Ointment or cream

Bugs: staph, group A beta-hemolytic strep, PSEUDOMONAS

59
Q

Silvadene: Silver Sulfadiazine

A

1% cream
Bugs: gram-positives, gram-negatives, candida albicans
NOT WITH SULFA ALLERGY
Leukopenia in burn patients

60
Q

When to use silvadene: silver sulfadiazine?

A

2nd/3rd degree burns
Chronic ulcers
Stasis ulcers

61
Q

Examples of Topical Anti-fungal Agents

A 
Polyene class
Allayment class
Others
62
Q

MOA of Polyene Class of Anti-fungal Agents

A

Bind with sterols in fungal cell membrane
Changes temp of cell membrane from fluid to crystalline state
Leakage of ions & small organic molecules
Cell death

63
Q

Drugs in the Polyene Class of Anti-fungal Agents

A 
Nystatin (Mycostatin)
Amphotericin B (Fungizone)
64
Q

Nystatin

A

Ointment, cream
Treat Candida infections
Oral preps poorly absorbed, no systemic or cutaneous infections

65
Q

Amphotericin B (Fungizone)

A 
RX only
3% cream, lotion, or ointment
Topically treat Candida albicans
Ineffective against dermatophytes (ring worm) & tinea versicolor
May stain clothes
66
Q

MOA of Allyamine Class

A

Inhibit squaline epoxidase

Enzyme necessary for ergosterol synthesis

67
Q

Allyamine Class Medications

A

Terbinafine (Lamisil)

Naftitine (Naftin)

68
Q

Terbinafine (Lamisil)

A

OTC
1% cream
Dermatophytes (ring worm)

69
Q

Naftifine (Naftin)

A

RX only
1% or 2% cream, gel, or powder
Topical of tinea corporis, cruris, and versicolor

70
Q

MOA of Imidazole Class

A

Inhibits lamosterol 14 alpha-demathylase

Leads to inhibition of fungal growth

71
Q

Imadazole Class Medications

A

Clotrimazole (Lotrimin, Desenex)
Miconazole (Micatin, Monostat)
Ketoconazole (Nizoral)

72
Q

Clotrimazole (Lotrimin, Mycelex)

A

OTC
Cream, solution
Treat tinea corporis, tinea pedis, tinea cruris, tinea versicolor

73
Q

Miconazole (Monistat, Micatin)

A

OTC
2% cream, lotion, vaginal suppositories
Treat vaginal infections due to candida albicans, tinea pedis, tinea cruris, tinea corporis, & tinea versicolor

74
Q

Examples of Imidazole Anti-fungals

A

Ketoconazole (Nizoral)

Econazole (Spectazole)

75
Q

Ketoconazole (Nizoral)

A

RX
2% cream: tinea infections & tinea versicolor
2% shampoo: seborrheic dermatitis

76
Q

Econazole (Spectazole)

A

RX
1% cream
Treat tinea corporis, tinea pedis, tinea cruris, tinea versicolor

77
Q

Other Anti-fungals

A 
Ciclopirox Oxamine (Loprox)
Selenium sulfide (Selsun, Exsel)
Tolnaftate (Tinactin, Cruex)
78
Q

Ciclopirox Oxamine (Loprox)

A

RX
Broad spectrum anti-fungal agent
Interferes with cell membrane transport & fungal respiratory process
1% cream & lotion: dermatophytes, C. albicans & tinea versicolor
8% Penlac nail lacquer: mild to moderate onychomycosis

79
Q

Selenium Sulfide (Selsun, Exsel)

A

OTC
MOA: anti-mitotic, anti-bacterial, anti-fungal
1% & 2.5%
Treat: seborrheic dermatitis, dandruff, & tinea versicolor

80
Q

Tolnaftate (Tinactin, Cruex)

A

OTC
Believed to inhibit squalene epoxies
10% cream, powder, spray, ointment
Treat: tinea versicolor, dermatophyte fungi

81
Q

Examples of Acne Preparations

A 
Azalea acid
Benzoyl peroxidase
Retinoids
Topical antibiotics
Dapsone
82
Q

Azelaic Acid

A

MOA: reduces the populations of P. acnes
Treat: mild to moderate inflammatory & non-inflammatory acne

83
Q

SE of Azelaic Acid

A

Skin dryness

Lightening of the skin

84
Q

Benzoyl Peroxide

A

OTC
MOA: killing P. acne
No anti-inflammatory abilities
Vehicle: gel, lotion, cleanser, cream, & wash
Increases effectiveness of erythromycin & clindamycin

85
Q

SE of Benzoyl Peroxide

A

Skin irritation
Bleach hair & fabrics
Allergic reaction

86
Q

Topical Retinoids

A

Treats mild to moderate severe acne
Anti-inflammatory
Unclog pores
Diminish signs of aging

87
Q

SE of Topical Retinoids

A

Irritate the skin

Increase sun sensitivity

88
Q

Retinoid Acid (Retin-A)

A

Acid form of Vitamin A
Decreases cohesion between epidermal cells
Increased epidermal cell turnover
Expulsion of open comedones
Transform closed comedones to open ones
Promotes collagen synthesis, new blood vessel formation & thickening of the epidermis

89
Q

Adapalene (Differin)

A

Mild retinoid
0.1% gel
Less irritating than Retin-A
Mild to moderate acne vulgaris

90
Q

Tazarotene (Tazorac)

A

0.1% gel & cream
Mild to moderately severe facial acne & psoriasis
>12 year old
Pregnancy category X

91
Q

SE of Acne Preparations

A

Erythema
Dryness
Sun sensitivity

92
Q

Education with Retinoids

A

Don’t put retinoid with benzoyl peroxidase

BP oxidizes the retinoid

93
Q

Topical Antibacterials for Acne

A

Clindamycin
Erythromycin
Sodium sulfacetamide

94
Q

Clindamycin

A

1% solution or gel
Come in fixed dose with benzoyl peroxidase
Formulations: water based gel & lotion

95
Q

Erythromycin

A

1st line
Use with benzyl peroxide
Not as monotherapy

96
Q

Sodium Sulfacetamide

A

Treats acne vulgaris & acne rosacea

NOT FOR SULFA ALLERGIES

97
Q

Dapsone 5%

A

Anti-inflammatory
Anti-bacterial
Dapsone + benzyl peroxide = orange skin

98
Q

Topical Medications for Parasitic Infections

A

Permethrin cream
Lindane lotion
Ivermectin

99
Q

Permethrin Cream

A 
OTC
RX for lice & scabies
Med of choice for children
Pruritus may continue
Apply to entire body
Kills mite
Family should be treated
Clothing & bedding washed
100
Q

Permethrin Cream Rinse

A

Treat lice
Reapplied after 14 days
Fine tooth comb to remove nits

101
Q

Lindane Lotion

A

Older children & adults

Second treatment required 2 weeks later

102
Q

Ivermectin (Stomectol)

A

2 doses given a week apart

Helpful for severe infestations in immunocompromised system

103
Q

Topical Immunosuppressive Medications

A

Tacrolimus (Protopic)

Pimecrolimus (Elidel)

104
Q

2nd Line Treatment for Mild to Moderate Atopic Dermatitis

A

Topical Calcineurin Inhibitors

105
Q

MOA of Topical Calcineurin Inhibitors

A

Inhibits effects of cytokine production but also may result in a decreased activity of T cells

106
Q

Topical Calcineurin Inhibitors SE

A

Mild stinging
Burning
Pruritis

107
Q

Medication class that increases the risk of developing lymphomas & skin cancer

A

Topical Calcineurin Inhibitors

108
Q

Contraindications for Topical Calcineurin Inhibitors

A
109
Q

Topical Meds for Skin CA & Actinic Keratosis

A

5-FU

Imiquimod

110
Q

MOA of 5-FU (Efudex)

A

Interferes with DNA synthesis

Primarily in the fastest growing cells

111
Q

5-FU Treats what Diseases

A

Actinic keratosis

Low grade BCC

112
Q

Results of 5-FU on the Skin

A

Burning, peeling, blistering skin

Sun sensitive

113
Q

MOA of Imoquimod

A

Immune modifies

Promotes apoptosis in skin cancer cells

114
Q

Imoquimod Treats what Diseases

A

BCC
Actinic keratosis
Genital warts

115
Q

Effects of Imoquimod on the Skin

A

Burning, peeling, blistering skin
Sun sensitive
Systemic fatigue
Flu-like illness

Dermatology (13 decks)

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