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Topical Medications 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
Define Gels
Transparent semisolid emulsion that liquefies on contact with skin Dries as thin, greaseless, non-occlusive film
26
Uses for Gels
Seborrheic areas (face, chest) Considered drying Exudative inflammation (poison ivy) Acne (Retin-A)
27
Aerosols & Sprays
``` Alcohol based solutions Pressurized Considered drying Wasteful Scalp most frequently ```
28
Define Foams
Pressurized collections of gaseous bubbles in a matrix of liquid film
29
Shampoo uses
Seborrheic dermatitis of the scalp
30
Main Educational Point of Shampoos
Left on for 5-7 minutes
31
What is the strength of a topical medication dependent on?
Vehicle
32
Most Potent, Potent, & Least Potent Vehicle
Most: ointment/gel Middle: cream Least: lotion
33
MOA of Topical Glucocorticoids
Pass through stratum corneum Cause vasoconstriction Decrease inflammation Inhibit cellular proliferation
34
How are steroids ranked in potency?
Extensiveness of vasoconstriction
35
Indications for Topical Glucocorticoids
Therapy of choice for most inflammatory conditions Pruritic eruptions Hyperplastic disorders Infiltrative disorders
36
Desirable Qualities of Corticosteroids
``` Broad applicability Rapid action with small dose Ease of use Lack of sensitization Prolonged stability Combatible with most topical medications ```
37
Adverse Reactions with Topical Corticosteroids
Suppression of hypothalamic-pituitary system | Local reactions
38
Local Adverse Reactions to Topical Corticosteroids
``` Burning, itching, dryness (vehicle related) Atrophy & telangiectasias Irreversible stretch marks Skin fragility & easy bruising Steroid rosacea ```
39
Location of Greatest Penetration of Topical Corticosteroids
Genetalia
40
Location of Least Penetration of Topical Corticosteroids
Sole of foot
41
Factors that Affect Topical Corticosteroid Penetration
``` Thickness of area Skin hydration (increased = increased absorption) Inflamed skin (increased penetration) ```
42
4 Groups of Topical Steroids
Super potent Potent Intermediate Mild
43
Super Potent Topical Steroid Uses
``` Severe non-facial/non-intertriginous dermatoses Palms & soles Psoriasis Severe atopic dermatitis Severe contact dermatitis ```
44
Intermediated to Potent Topical Steroid Uses
Mild-moderate non-facial/non-intertriginous dermatoses
45
Mild-Intermediate Topical Steroid Uses
Large areas are treated (due to systemic absorption)
46
Mild Topical Steroid Uses
Eyelid dermatoses | Genital dermatoses
47
Frequency of SE of Mild Topical Steroid Use
Rarely | Intermittent therapy for long term use
48
Frequency of SE of Potent & Intermediate Topical Steroid Use
Rarely if
49
Length of Time for Super Potent Topical Steroid Use
50
What areas are most susceptible to atrophy, telangiectasia, & acneiform eruption?
Facial Intertriginous Genital
51
What increases systemic absorption in topical steroid use?
Application to highly permeable areas
52
Topical Steroid Use in Children
Low potency
53
What can help diagnose a fungus from an inflammatory dermatitis?
KOH scraping
54
Examples of Topical Antibacterials
Mupirocin (Bactroban) Neomycin Gentamycin Silver Sulfazine
55
Benefits of Topical Antibacterials
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
Bactroban (Mupirocin)
Ointment & cream Bugs: staph, strep, E. coli, H. flu, N. gonorrhea TREAT IMPETIGO
57
Neomycin
Ointment & cream Bugs: gram negatives (except Pseudomonas) 50 times more active against Staph Greater risk of allergic contact sensitivity
58
Gentamycin
Ointment or cream | Bugs: staph, group A beta-hemolytic strep, PSEUDOMONAS
59
Silvadene: Silver Sulfadiazine
1% cream Bugs: gram-positives, gram-negatives, candida albicans NOT WITH SULFA ALLERGY Leukopenia in burn patients
60
When to use silvadene: silver sulfadiazine?
2nd/3rd degree burns Chronic ulcers Stasis ulcers
61
Examples of Topical Anti-fungal Agents
``` Polyene class Allayment class Others ```
62
MOA of Polyene Class of Anti-fungal Agents
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
Drugs in the Polyene Class of Anti-fungal Agents
``` Nystatin (Mycostatin) Amphotericin B (Fungizone) ```
64
Nystatin
Ointment, cream Treat Candida infections Oral preps poorly absorbed, no systemic or cutaneous infections
65
Amphotericin B (Fungizone)
``` RX only 3% cream, lotion, or ointment Topically treat Candida albicans Ineffective against dermatophytes (ring worm) & tinea versicolor May stain clothes ```
66
MOA of Allyamine Class
Inhibit squaline epoxidase | Enzyme necessary for ergosterol synthesis
67
Allyamine Class Medications
Terbinafine (Lamisil) | Naftitine (Naftin)
68
Terbinafine (Lamisil)
OTC 1% cream Dermatophytes (ring worm)
69
Naftifine (Naftin)
RX only 1% or 2% cream, gel, or powder Topical of tinea corporis, cruris, and versicolor
70
MOA of Imidazole Class
Inhibits lamosterol 14 alpha-demathylase | Leads to inhibition of fungal growth
71
Imadazole Class Medications
Clotrimazole (Lotrimin, Desenex) Miconazole (Micatin, Monostat) Ketoconazole (Nizoral)
72
Clotrimazole (Lotrimin, Mycelex)
OTC Cream, solution Treat tinea corporis, tinea pedis, tinea cruris, tinea versicolor
73
Miconazole (Monistat, Micatin)
OTC 2% cream, lotion, vaginal suppositories Treat vaginal infections due to candida albicans, tinea pedis, tinea cruris, tinea corporis, & tinea versicolor
74
Examples of Imidazole Anti-fungals
Ketoconazole (Nizoral) | Econazole (Spectazole)
75
Ketoconazole (Nizoral)
RX 2% cream: tinea infections & tinea versicolor 2% shampoo: seborrheic dermatitis
76
Econazole (Spectazole)
RX 1% cream Treat tinea corporis, tinea pedis, tinea cruris, tinea versicolor
77
Other Anti-fungals
``` Ciclopirox Oxamine (Loprox) Selenium sulfide (Selsun, Exsel) Tolnaftate (Tinactin, Cruex) ```
78
Ciclopirox Oxamine (Loprox)
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
Selenium Sulfide (Selsun, Exsel)
OTC MOA: anti-mitotic, anti-bacterial, anti-fungal 1% & 2.5% Treat: seborrheic dermatitis, dandruff, & tinea versicolor
80
Tolnaftate (Tinactin, Cruex)
OTC Believed to inhibit squalene epoxies 10% cream, powder, spray, ointment Treat: tinea versicolor, dermatophyte fungi
81
Examples of Acne Preparations
``` Azalea acid Benzoyl peroxidase Retinoids Topical antibiotics Dapsone ```
82
Azelaic Acid
MOA: reduces the populations of P. acnes Treat: mild to moderate inflammatory & non-inflammatory acne
83
SE of Azelaic Acid
Skin dryness | Lightening of the skin
84
Benzoyl Peroxide
OTC MOA: killing P. acne No anti-inflammatory abilities Vehicle: gel, lotion, cleanser, cream, & wash Increases effectiveness of erythromycin & clindamycin
85
SE of Benzoyl Peroxide
Skin irritation Bleach hair & fabrics Allergic reaction
86
Topical Retinoids
Treats mild to moderate severe acne Anti-inflammatory Unclog pores Diminish signs of aging
87
SE of Topical Retinoids
Irritate the skin | Increase sun sensitivity
88
Retinoid Acid (Retin-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
Adapalene (Differin)
Mild retinoid 0.1% gel Less irritating than Retin-A Mild to moderate acne vulgaris
90
Tazarotene (Tazorac)
0.1% gel & cream Mild to moderately severe facial acne & psoriasis >12 year old Pregnancy category X
91
SE of Acne Preparations
Erythema Dryness Sun sensitivity
92
Education with Retinoids
Don't put retinoid with benzoyl peroxidase | BP oxidizes the retinoid
93
Topical Antibacterials for Acne
Clindamycin Erythromycin Sodium sulfacetamide
94
Clindamycin
1% solution or gel Come in fixed dose with benzoyl peroxidase Formulations: water based gel & lotion
95
Erythromycin
1st line Use with benzyl peroxide Not as monotherapy
96
Sodium Sulfacetamide
Treats acne vulgaris & acne rosacea | NOT FOR SULFA ALLERGIES
97
Dapsone 5%
Anti-inflammatory Anti-bacterial Dapsone + benzyl peroxide = orange skin
98
Topical Medications for Parasitic Infections
Permethrin cream Lindane lotion Ivermectin
99
Permethrin Cream
``` 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
Permethrin Cream Rinse
Treat lice Reapplied after 14 days Fine tooth comb to remove nits
101
Lindane Lotion
Older children & adults | Second treatment required 2 weeks later
102
Ivermectin (Stomectol)
2 doses given a week apart | Helpful for severe infestations in immunocompromised system
103
Topical Immunosuppressive Medications
Tacrolimus (Protopic) | Pimecrolimus (Elidel)
104
2nd Line Treatment for Mild to Moderate Atopic Dermatitis
Topical Calcineurin Inhibitors
105
MOA of Topical Calcineurin Inhibitors
Inhibits effects of cytokine production but also may result in a decreased activity of T cells
106
Topical Calcineurin Inhibitors SE
Mild stinging Burning Pruritis
107
Medication class that increases the risk of developing lymphomas & skin cancer
Topical Calcineurin Inhibitors
108
Contraindications for Topical Calcineurin Inhibitors
109
Topical Meds for Skin CA & Actinic Keratosis
5-FU | Imiquimod
110
MOA of 5-FU (Efudex)
Interferes with DNA synthesis | Primarily in the fastest growing cells
111
5-FU Treats what Diseases
Actinic keratosis | Low grade BCC
112
Results of 5-FU on the Skin
Burning, peeling, blistering skin | Sun sensitive
113
MOA of Imoquimod
Immune modifies | Promotes apoptosis in skin cancer cells
114
Imoquimod Treats what Diseases
BCC Actinic keratosis Genital warts
115
Effects of Imoquimod on the Skin
Burning, peeling, blistering skin Sun sensitive Systemic fatigue Flu-like illness

Dermatology (13 decks)

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