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NRS 270: Pharmacology > Tx of Common Skin Disorders, Varicella, and Zoster IZs > Flashcards

Tx of Common Skin Disorders, Varicella, and Zoster IZs Flashcards

1
Q

Acne Vulgaris Pathogenic Factors

A
  • excess sebum production
  • keratinization→excess sloughin leads to blocked flow of sebum →black head (open comedo)
  • bacterial gorwth
  • inflammation
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2
Q

Development of Acne

A
  • bacteria proliferation (propionibacterium acnes [normal skin anaerobe]) + Sebum + keratinzation → inflammation → white head (closed comedo)
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3
Q

Keratolytic Agents

A
  • tx acne: apply BID
  • 1st line:
    • Benzoyl Perodixe: promotes shedding of epidermis for mild, non-inflammatory acne
      • SE: drying and peeling, hypersensitivty esp in asthmatics
  • 2nd line:
    • sulfure: less effective
      • has an odor
      • can cause brown scaling = Resorcinol
      • can cause salicylate intoxication with chronic use
    • Salicyclic Acid: readily abosrbed
      • 3% & 6% reak down horny layer of skin
      • 40% can be used to remove warts, calluses, and corns
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4
Q

Retinoids

A
  • treatment of acne, examples: Tretinoin, (adapalene (more expesnive b/c less side effects), tazarotene) [same side effects but not as sever as Tretinoin]
  • 1st line: for mild to moderate comedonal and inflammatory acne
    • stimulate the turnover of epithelial cells
    • unclog blocked pores
    • have anti-inflammatory properties
      • inhibit monocyte chemotaxis and neutrophils
    • Can be used with topical abx and benzoyl peroxide
  • SE: transient erythema, irritation, dryness, pealing photosensitivity
  • AVOID: children under 12 years old and pregnancy
  • Pt Education: symptoms may worsen in first few weeks, but should see improvement in 3-4 months
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5
Q

Topical Antibacterials for Acne

A
  • directly suppress P. acnes (anaerobic normal flora)
  • 1st line for mild to moderate inflammatory acne
    • examples:
      • Clindamycin 1%
      • erythromycin 2% QD-BID
    • SE: dryness, erythema, itching
  • can be added with benzoyl peroxide to decrease resistance and improve symptoms
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6
Q

Azelaic Acid

A
  • Mechanism of Action:
    • anti-bacterial
    • anti-inflammatory
    • stabilize keratinization
  • Indications:
    • for pts who cannot toleralte benzoyl or topical retinoids
    • mild to moderate acne
  • Side Effects:
    • erythema
    • skin irritation: should avoid occlusive dressings
    • may cause hypopigmentation
  • 20% cream apply BID, should see improvement in 1-2 months
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7
Q

Dapsone Gel

A
  • Mechanism of Action: (type of abx)
    • anti-microbial
    • anti-inflammatory
    • for mild-moderate acne
  • SE:
    • dryness, erythema, oiliness, peeling
  • Apply BID, if no improvement after 12 weeks (3 months) , re-evaluate treatment
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8
Q

Acne Treatment: Oral Abx

A
  • treatment for moderate to severe acne (especially after failed topicals)
  • prevent acne lesions from developing
  • using takes about 6-10 weeks to see improvement, maximal effects at 6 months
  • 1st line:
    • doxycyline, TCN, minocycline (Don’t Touch Me)
  • 2nd line:
    • erythromycin (inhibits 3A4), clindamycin,
    • isotretinoin (not an abx)
    • (Every Child’s Ill)
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9
Q

Oral Acne Treatment: Isotretinoin

A
  • only indicated for severe acne that is unresponsive to other POs and topicals
  • can cause remission of acne for several years
  • **requires online registery program iPledge**
    • category X drug
    • 2 negative pregnancy tests prior to start
      • 1 negative test each month during treatment
  • SE:
    • dry skin and mucus membranes
    • muscle and joint pain
    • elevated liver enzymes and triglycerides
    • depression
    • teratogenicity (inhibits fetal development)
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10
Q

teratogen

A

inhibits fetal development

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11
Q

Oral Acne Treatment: Oral concraceptives

A
  • 2nd line treatment for moderate to severe acne in females
  • yaz, estrostep, ortho tri-cyclen
  • oral contraceptives reduce the production of androgens in the ovaries →decreased production of sebum
  • SE:
    • nausea/vomiting
    • weight gain
    • breast tenderness
    • breakthrough bleeding
    • Venous thromboembolism (especially in heavy smokers)
      • caused by the estrogen in the pill
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12
Q

Contact Dermatitis: irritant vs allergic

A
  • irritant:
    • will have rxn with 1st time exposure
    • casuses damage to epidermis → erythema
    • examples:
      • soaps, detergents, cosmetics, solvents, acid, mild or strong
      • alkali, mild or strong
  • Allergic:
    • need to have an initial sensitivity
    • triggered by an immune response
    • examples:
      • plant resins, poison ivy, poison oaky, sumac
      • metals (nickel or gold in jewelry)
      • latex and rubber
      • cigarette smoke
      • local anesthetics (lidocain or benzocaine)
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13
Q

Atopic Dermatitis

A
  • aka eczema
    • signs:
      • crusting and oozing
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14
Q

Non-Pharmacologic Treatment of Contact Dermatitis

A
  • relieve pruritis
  • maintain the hydration of the skin
  • colloidal oatmeal baths
  • cool soapless showers
  • cool moist compressed TID
  • emollients: mineral oil or petrolatum
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15
Q

Pharmacological Treatment of Contact Dermatitis

A
  • astringents
  • topical steroids
  • PO steroids: widespread areas and sxs
  • antihistamines
  • topical immunosuppressants
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16
Q

Astringents

A
  • treatment for contact dermatitis
  • have drying effects → decreases oozing and relieves itching
  • causes vasoconstriction → anti-inflammatory
  • examples:
    • aluminum acetate
    • calamine lotion; zinc oxide
    • witch hazel
    • 15-30 min BID-QID
    • no longer than 7 days
  • SE:
    • drying, tightening of skin
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17
Q

Topical Steroids

A
  • relieve redness, inflammation, itching and pain
  • Vehicles:
    • ointment
    • creams
    • lotions
    • gels
    • foams/mousses/ shampoo
  • Want to provide optimal dosing: titrating amount to minimum that still gives relief
  • chronic application can lead to tolerance and tachyphylaxis
    • ultra-high potency: no longer than 3 weeks continuously
      • need to gradually taper to prevent rebound
    • 3 weeks on 1 week off dosing schedule
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18
Q

Oral Antihistamines for Pruritus

A
  • diphenhydramine
  • hydroxizine
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19
Q

Topical Immunosuppressants

A
  • pimecrolimus (Elidel) cream:
    • apply BID on anyone over 2 years
    • no longer than 6 weeks
    • avoid occlusive dressing
  • Tacrolimus ointment:
    • apply BID
    • can cause burning, erythema, pruritus
    • 3rd line
  • ​For SEVERE activation of immune symptoms
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20
Q

Tinea Infections

A
  • fungal infections where the fungus lives in keratinous layers of the nail or skins
  • types of lesions: rings, scales, single or multiple areas
    • circular ring lesions: ringworm
  • examples:
    • tinea pedis
    • tinea manuum
    • tinea cruris
    • tinea corporis
    • tinea versicolor
    • tinea barbae
    • tinea capitis
    • onychomycosis (tinea unguium)
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21
Q

tinea pedis

A
  • involves plantar surface and interdigital spaces of foot
22
Q

tinea manuum

A
  • infection of the interdigital and palmar surfaces
23
Q

tinea cruris

A
  • presents with follicular papules and pustules on the mdeial thigh and inguinal fold
  • ringed lesions may extend from the inguinal fold over to the adjacent inner thigh
24
Q

tinea corporis

A
  • presents with circular scaly patch with enlarged border
25
Q

tinea versicolor

A
  • characterized by skin depigmentation but can present as hyperpigmentation
    • especially dark-skinnned patients
26
Q

tinea barbae

A
  • infection of beard area
27
Q

tinea capitis

A
  • infection of the head and scalp
28
Q

Onychomycosis

A
  • aka tinea unguium
  • infection of nail plate and bed
29
Q

Steroid Ointments

A
  • more lubrication
  • occlusion which improves absorption
  • helpful for thick, dry hyperkeratotic lesions
  • not good for hairy areas
  • may cause maceration and folliculitis (in “skin rubbing areas” like the groin and the armpits)
  • they can be greasy which can cause an unpleasant sensation which may decrease compliance
30
Q

Steroid Creams

A
  • mix of water suspended in oil
  • good lubrication but less potant than same medications in ointments
  • often contain preservatives which may lead to allergic reactions, stinging, irritation
  • used for exudative inflammation (i.e. poison oak)→ has drying effects
  • does NOT provide occlusive effects
31
Q

Steroid Lotions

A
  • these are the LEAST greasy and occlusive
  • good for hairy areas
  • contains alcohol which has a drying effect → excellent for oozing lesions
32
Q

Steroid Gels

A
  • for exudative inflammation (i.e. poison oak)
  • dries quickly
    • good for use on hairy areas or scalp
33
Q

Steroid Foams/Mousse/Shampoo

A
  • spreads easily in hairy areas
  • good penetration
34
Q

Diaper Dermatitis Treatment

A
  • Protectants:
    • occlusive barrier
    • cream/ointment
    • promote healing
    • zinc oxide, petrolatum, witamins, A&D Lanolin, topical cornstarch
  • Topical Steroids
  • Anti-fungals
    • diaper rashes that last >48-72 hours at high risk of fungal infection
    • nystatin crea
    • clotrimazole
    • miconazole
      • BID-QID
  • Anti-bacterial
35
Q

Lanosterol

A
  • stabilizes fungal membranes
  • precursor to Ergosterol
36
Q

Recurrent Vuvlovaginal Candidiasis

A
  • Fluconazole 150 mg PO Q3days x 2
  • Topical azoles x 14 days
  • consider non-albicans infections (C. Glabrata and C.tropicalis)
    • Resistant to fluconazole and itraconazole
    • tx:
      • 1st line: terconazole
      • 2nd line: vaginal borric acid capsules 2 weeks BID
  • Difficult to treat:
    • high levels of estrogen
    • don’t want to harm the fetus.
37
Q

Vulvocandidiasis during pregnancy

A
  • this is difficult to treat during pregnancy due to:
    • high levels of estrogen
    • potential harm to the fetus
      • fluconazole can cause congenital limb deformities if 400-800mg Q day are used during 1st trimester
  • Vaginal antifungals that can be used:
    • clotrimazole
      • 1-2 weeks is the preferred treatment
38
Q

Impetigo–superficial infection tx

A
  • scabby, crusty eruption usually caused by poor hygiene and crowding
  • **common bugs**:
    • beta-hemolytic streptococci
      • group A strep
    • ​Staph aureus
  • tx:
    • mild: Mupirocin (Bactroban) topical ointment
    • penicillinase-stable penicillins
    • 1st gen cephalosporins
    • Alternative:
      • clindamycin
      • macrolide
39
Q

Treatment of Scabies

A
  • Sarcoptes scabiei
  • Permethrin (Elimite) 5% cream
    • apply to whole body from neck down for 8-14 hours
  • Alternatives:
    • Crotamiton (Eurax) 10% cream or lotion
      • Q24hours x 2
    • Ivermectin (Stromectol)
40
Q

Shingrix: Ingredients, Indications, Administration

A
  • Ingredients:
    • lyophilized varicella zoster virus glycoprotein E (gE) antigen
  • Indications:
    • immunocompetent >50 years old
    • not indicated for prevention of primary varicella infection
  • Administration:
    • IM 2 doses (0.5mL each) at 0 and 2-6 months later
  • Contraindications:
    • severe allergic reaction
    • just received a dose
    • or just delay vaccine if:
      • pregnant or breastfeeding
      • currently have a shingles episode
41
Q

pneumonic to remember topical acne therapies

A
  • KRAAD:
    • Keratolytics
      • benzoyl peroxide 1st line
      • ASA 2nd line
      • Sulfur 2nd line
    • Retinoids
    • Antibacterials
    • Azelaic Acid
    • Dapsone gel →mostly severe cases
42
Q

Retinoid Examples and what they can be used with

A
  • Tretinoin (once daily before bed)
  • Adapalene
    • more expensive because less side effects
  • Tazarotene
    • last line agent
      • same SEs but MORE severe
  • Can be used with topical abx (clindamycine and erythromycin) and benzoyl peroxide
43
Q

Low Potency Steroids

A
  • Hey Fluorence, Design This Mask/Mouth
  • Hydrocortisone 1-2.5%
  • Fluocinolone 0.01%
  • Desonide 0.05%
  • Triamcinolone (0.1%-0.025%)
  • Mometasone 0.1%
44
Q

High Potency Steroids

A
  • Best DonuTs And CHips
  • Betamethasone
  • Desoximetasone
  • Triamcinolone (0.5% → medium to high)
  • Augmented Betamethasone
  • Clobetasole
  • Halobestasol
45
Q

Ultra-High Potency Topical Steroid Considerations

A
  • titrate to minimum frequency
  • no longer than 3 weeks
    • 3 weeks on 1 week off
    • otherwise results in tachyphylaxis (tolerance)
  • SEs:
    • steroid atrophy
    • secondary infections
    • delayed wound healing
    • hypopigmentation
    • rebound flare
    • cataracts (if too much in blood stream)
46
Q

Oral Antihistamines used for Pruritus

A
  • diphenhydramine
  • hydoxyzine (Atarax/ Visteril) → also used for anxiety
47
Q

Imidazoles

A
  • type of Azole (slightly different structure than triazoles)
  • I Make The Canadian Eat Ketoh
  • Imidazoles
  • Miconazoles
  • Tioconazoles
  • Clotrimazole
  • Econazole
  • Ketoconazole
48
Q

Triazoles

A
  • type of azole (interferes with ergosterol synthesis because blocks fungal P450 enzymes)
  • Try Flying Past That Insane Vortex
  • Triazoles
  • Fluconazole
  • Posaconazole
  • Terconazole
  • Itraconazole
  • Voriconazole
49
Q

Echinocandins

A
  • antifungal drug that blocks the cell wall synthesis
    • inhibit beta-glucan synthesis
  • Caspofungin – IV
50
Q

Allyamine

A
  • antifungal drug that inhibits the epoxidation of Squalene which leads to high squalene levels and results in cell death
    • Terbinafine
    • Butenafine
51
Q

Systemic Therapy for Tinea Infections

A
  • Fluconazole

NRS 270: Pharmacology (14 decks)

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