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Pharm Exam 3 > Treatment of Dermatological dz > Flashcards

Treatment of Dermatological dz Flashcards

1
Q

Classification of acne: Mild

A

Few-several papules and pustules. No nodules

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2
Q

Classification of acne: Moderate

A

Several papillose or pusutules. Few Nodules

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3
Q

Classification of acne: Severe

A

Many papules and pustules. Several Nodules

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4
Q

Tx: for Mild Acne 1st line

A

Topical retinoid. consider adding antimicrobial (benzoyl peroxide-Keratolytic)

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5
Q

Tx: for Mild Ance Alternative to 1st line

A

Salicylic acid (topical keratolytic)

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6
Q

Tx: for Mild Acne Maintenance

A

Topical retinoid

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7
Q

Tx; for moderate acne 1st line

A

Topical retinoid PLUS oral abx w/ or w/o benzoyl peroxide. (keratolytic)

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8
Q

Tx: for Moderate Acne Alternative

A

Topical ABX instead of PO

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9
Q

Tx for Moderate Acne Maintenance

A

Topical retinoid w/ or w/o benzoyl peroxide

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10
Q

Tx: for Severe Acne 1st line

A

Oral isotrenoin

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11
Q

Tx: for Severe Acne Alternative

A

Topical retinoid + po ABX + benzoyl peroxide (keratolytic)

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12
Q

Tx: for Severe Acne Maintenance

A

Topical retinoid w/or w/o benzoyl peroxide (keratolytic)

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13
Q

How are retinoids different from keratolytics?

A

Retinoids prevent formation of comedones, Keratolytics prevent the formation of comedones as well but also contribute to the rapid shedding of skin.

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14
Q

What medication form is preferred in the tx of urticaria?

A

PO is usually preferred

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15
Q

What is the difference between second generation and 1st generation antihistamines?

A

2nd gen is effective with no/minimal drowsiness (don’t enter CNS). 1st gen typically results in drowsiness (does enter CNS)

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16
Q

What are the pathogens of impetigo?

A

S. aureus, and S. pyogenes (appearance=honey crusted lesions)

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17
Q

Where might HSV 1 and 2 occur?

A

Face, mouth, genital, eyes, brain etc.

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18
Q

What are the characteristics of HSV 1/2

A

Painful pruritic vasicular lesions with periods of remission.

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19
Q

What dosage form is used for mild HSV lesions?

A

Topical

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20
Q

What dosage form is used for Genital, oral, sever or suppression HSV?

A

Oral with prophylaxis of breakouts

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21
Q

What is another name for viral Herpes Zoster?

A

Shingles

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22
Q

What virus causes Herpes zoster?

A

Recurrence of varicella zoster

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23
Q

What characterizes Herpes zozter?

A

Painful, vesicular lesions, localized along dermatome

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24
Q

What are the 5 main layers of skin?

A
  1. Cornified (stratum corneum)
  2. Clear/translucent (lucidem)
  3. Granular cell layer(granulosum)
  4. sinus (spinosum)
  5. Basal Layer (basale)
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25
How many days does it take for a cell to fully keratinize to outer layer?
30
26
What is the most moisturizing dosage form?
Ointments
27
What is the most drying dosage form?
tinctures (second most drying is wet dressings)
28
If the problem is dry (lchenifications, scaling) use _____?
Wet--ointments
29
If the problem is wet (weeping, oozing, vesicular) use______
Dry--Tinctures and wet dressings
30
On hairy areas (including scalp) use _____?
tinctures, Aerosoles, lotions gels
31
If there is a cosmetic consideration for an area use____?
creams
32
What is the mainstay of tx for acute/chronic dermatitis?
Corticosteroids
33
What strength dose would be used for eczema, irritant dermatitis, seborrhea, or atopic term?
Low/medium
34
What strength dose is used in psoriasis, lichen planus, allergic contact term?
High dose
35
What is the MOA of corticosteroids?
Non specific anti-inflammatory. Decreases migration of PMN's and fibroblasts. Reverses capillary permeability, controls rate of protein synth, and stabilizes lysosomes.
36
Ultra High potency steroids should not be used for >____ weeks?
>3 weeks.
37
Low-High potency steroids should not be used for >_____?
>3 mos.
38
P'Kinetics for Corticosteroids: ADMEH
``` A-minimal systemic (depends on dose, area, form) D: Highly protein boudn M: Hepatic E: Urine Half life: 6.5hrs ```
39
Common ADE for Corticosteroids?
Cutaneous atrophy. Telangiectasia and purpura. Resolves (after months). Also-striae, acne, refractory rosacea, Adrenal suppression with increased dose/duration and in children.
40
DI for Corticosteroids?
none if topical
41
CI for corticosteroids?
systemic fungal infection, hypersensitivyt
42
Caution for corticosteroids?
Pregnancy (Cat. C), Children < 12yo, ?fungal if sx worsen.
43
Fingertip method?
Half fingertip=area of whole hand | Whole fingertip = 0.5g
44
What is the etiology of Psoriasis?
Psoriatic plaques via hyper proliferation of keratinocytes, and inflammation (neutrophils and T-cells)
45
What is considered mild-moderate psoriasis?
5%BSA
46
What is considered Moderate-severe psoriasis?
>5% or hand, feet, face or genitals
47
When are corticosteroids used?
Mainly used in mild disease as first line. Cacipotriene + corticosteroid is more effective than mono therapy.
48
What follow up is necessary for non-biologics?
Baseline and follow up CBC, BUN pregnancy tests etc.
49
What drugs used for psoriasis are most concerning for drug interactions?
Methotrexate and cyclosporine.
50
What is the back box warning for biologics used in psoriasis?
Concern for serious infections: obtain negative PPD before initiating, Malignancies have been reported.
51
What form of UV is approved for use in psoriasis?
UVB
52
What is the case of acne?
- Seabeous gland hyperplasia-excessive sebum production. - Hyperkeratinization of hair follicle. - colonization of Propionbacterium acnes (elicits inflammatory response). - Formation of comedones
53
MOA for topical retinoids
- Prevents formation of comedones and inflammatory lesions. - doesn't contribute to bacterial resistance - no concernes for long term use - negligible systemic absorption.
54
ADE for topical retinoids?
peeling, redness, dryness, burning, pruritus - Avoid use in pregnancy, - use daily moisturizer w/ built in sunscreen
55
MOA for topical Keratinolytics
Rapid Shedding of epidermis - prevents "clogging" and formation of comedones -Benzoyl peroxide oxicizes bacteria, effective topical antimicrobial. not associated with resistance.
56
ADE of Keratinolytics
Akin irritation, contact derm, dryness, erythema, peeling, stinging
57
MOA for antimicrobial tx. for acne
Decerases bacterial load, reduces inflammation, PO reserved for severe. Combined with benzoyl peroxide (clindamycin can be compounded)
58
Safety considerations for general antimicrobials?
Resistance: ideal length for PO=3 mos. Avoid combining topical w/ oral, and avoid switching without justification.
59
contraindications for tetracycline?
P. acnes is resistant to tetracycline. T-cycline is also absolutely contraindicated in pregnant women and children. Do not use t-cycline after exp. date (potency increases).
60
safety considerations for Clindamycin?
increased risk of C. Diff
61
Safety considerations for E-mycin?
resistance may be increasing
62
Safety considerations for Dapsone?
severe hemolytic anemia (not yet related to topical). Test for G6PD deficiency.
63
MOA for oral isotretinoin?
Vitamin A deriviative, Reduces 4 pathogenic factors of acne: - sebum production - comedone formation (keratinization) - P. acnes coloniziation - inflammation
64
ADE isotretinoin?
Excessive drying burning and inflammation of skin, inflammation of lips (90%), Dyslipidemia, Arthralgias/msk pain.
65
Absolute CI for isotretinoin
Pregnancy (
66
What are REMS requirements?
iPLEDGE program. 2 forms of BC, monthly pregnancy test, prescriber, pt and pharm must all be registered.
67
What is etiology of urticaria
Release of histamine
68
What meds can be used in tx. of Impetigo?
Topical usually sufficient: single ointment (effective against MRSA), Double and triple, Neomycin is missing in double. Oral (if needed): dicloxcilin, cephalexin, e-mycin, augmentin
69
Tinea pedis
athlete's foot
70
Yeast infection / thrush
Vulvovaginal candidiasis/ oral candidiasis
71
Tinea cruris
jock itch
72
tinea corporis / tinea capitis
Ringworm
73
Onychomycosis
Nails
74
MOA Imidazole, triazole:
Inhibit conversion of lanosterol to ergosterol via CYP 450 system-required in fungal cell wall, Also human steroid synth (careful with long term use)
75
MOA allylamines
Inhibit squalene epoxidase-ergosterol synth Less effective on human steroid synthesis.
76
MOA Griseofulvin
Binds to fungal microtubules and inhibits mitosis
77
MOA Ciclopirox
not well understood, blocks cell membrane transport, depletes cell of substrates (AA) and ions (potassium)
78
Safety with Azoles (imidazole triazole)
CYP P450 DI. Mainly local ADE, PT education to reduce risk of transmission.
79
What is oral dosing dependent upon in tx of HSV
- first episode of genital herpes - recurrence of g.h. - suppressive tx. of g.h. - tx of herpes zoster
80
ADE for topical antivirals
Urticaria
81
ADE for oral antivirals?
GI irritation, elevated LFT's, Disorientation, hallucinations, DI-nephrotoxic drugs.

Pharm Exam 3 (4 decks)

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