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Pharmacology > Unit 2: Skin > Flashcards

Unit 2: Skin Flashcards

1
Q

Dermatitis

A

Alteration in skin reactivity caused by exposure to external agent
Usually appears as inflammatory process
Irritant or allergic

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2
Q

Allergic contact dermatitis

A

Exposure to antigen that causes immunologic response
During initial sensitization phase, host is immunized to allergen
On re-exposure, more rapid and potent secondary immune response occurs
T cells involved

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3
Q

Characteristics of dermatitis

A

linear streaks of papules, vesicles and blisters that are very pruritic

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4
Q

Ointments and gels for dermatitis

A

Offer best delivery and protection barrier

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5
Q

Topical corticosteroids for dermatitis

A

Effective for smaller outbreaks
Anti inflammatory and antimitotic
Should be avoided if infection present
Start with lowest potency

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6
Q

Prolonged use of topical corticosteroids can cause

A

Atrophy on face and acne like eruptions

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7
Q

Systemic corticosteroids for dermatitis

A

Use if widespread or resistant to topical

Prescribed in tapering dose for 2-3 weeks

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8
Q

Topical immunosuppressants for dermatitis

A

Pimecrolimus, tacrolimus
Acts on T cells by decreasing cytokine transcription
For moderate to severe dermatitis if can not tolerate steroids

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9
Q

Antihistamines for dermatitis

A

Used to relieve itching associated with contact dermatitis

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10
Q

First line agent for dermatitis

A

Low potency topical corticosteroid 2x a day with antihistamine for relief

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11
Q

2nd line agent for dermatitis

A

Increase potency of topical corticosteroid

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12
Q

Third line agent for dermatitis

A

Oral corticosteroid

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13
Q

Tinea

A

Fungi infection of skin

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14
Q

Tinea capitis

A

Head

Affects mostly 3-9 years old

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15
Q

Tinea corporis

A

Body

Ringworm when on face, limbs, trunk

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16
Q

Tinea Manus

A

Hands

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17
Q

Tinea Cruris

A

groin

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18
Q

Tina unguium

A

Nails

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19
Q

Predisposing factors for tinea

A

Warm, moist, occluded environments, compromised immune system

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20
Q

What can you use to diagnose fungal infection

A

10% KOH, Fungal culture, wood lamp

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21
Q

Topical azole antifungals

A

Impair synthesis of ergosterol; fungicidal
Effective for tinea corporis, tinea cruris, tinea pedis
2-4 weeks of tx; continue for 1 week after lesions disappear

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22
Q

Topical allylamine antifungals

A

Naftifine, terbinafine
Effective against dermatophyte infections but limited against yeast
Shorter treatment than azoles

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23
Q

Griseofulvin

A

Oral fungistatic agent that deposits in keratin precursor cells
May aggravate SLE and cause N/V, diarrhea, HA

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24
Q

Systemic allylamine antifungals

A

Terbinafine
Inhibits key enzyme in fungal biosynthesis
Treatment for nail fungus

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25
Q

Systemic azole antifungals

A

Itrazonazole, flucanazole
Inhibit P450 enzymes
Inhibit synthesis of ergosterol
Treatment for tinea capitis and tinea uriguium

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26
Q

First line agent for tinea capitis

A

Griseofulvin (8 weeks)

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27
Q

2nd line agent for tinea capitis

A

Terbinafine or itraconazole

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28
Q

First line agent for tinea corporis, cruris, and pedis

A

Topical azoles

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29
Q

First line agent for tinea uriguium

A

Itrazonazole or terbinafine (12 weeks)

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30
Q

Tinea versicolor

A

Opportunisitc superficial yeast infection
Chronic
Asymptomatic
Well-demarcated scaling patches of varied colors

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31
Q

DOC for tinea versicolor

A

Selenium sulfide

CI in pregnancy and breastfeeding

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32
Q

Candidiasis

A

Superficial fungal infection of skin and mucus membranes

Commonly found in diaper area, oral cavity, nails, vagina, penis

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33
Q

Intertrigo

A

Armpits, under breasts, groin

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34
Q

Balanitis

A

Glans penis

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35
Q

Candidal folliculitis

A

Follicular pustules

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36
Q

Candidal paronychia

A

Nail folds

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37
Q

Nystatin

A

Fungicide that binds to sterols in cell membrane of fungus

Used for thrush–placed inside of mouth 3x . day for 10-14 days

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38
Q

First line agents for candidiasis

A

Cool soaks with Burow solution
Topical azole for skin
Oral nystatin for mouth

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39
Q

Second line agents for candidiasis

A

Itracanazole or fluconazole

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40
Q

HSV-1

A

Involves face and skin above waist

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41
Q

HSV-2

A

genitals

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42
Q

Herpes Zoster

A

Shingles and varicella

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43
Q

EBV

A

Causes mono

44
Q

HHV-6

A

Causes roseola

45
Q

HHV-8

A

Causes kaposi sarcoma

46
Q

Topical antiviral agents for HSV-1

A

Acyclovir and Penciclovir

47
Q

Systemic antiviral agents for HSV-1

A

Acyclovir, Famciclovir, Valacycolvir

Recommended for adolescents, adults + high risk patients

48
Q

First line tx for HSV-1

A

Topical therapy with acyclovir or penciclovir

49
Q

Second line tx for HSV-1

A

Systemic acyclovir, famciclovir, valacyclovir

50
Q

First line treatment for herpes zoster

A

Systemic antiviral if outbreak <72 hours in duration, patient is >50 or patient is immunocompromised

51
Q

Warts

A

Caused by HPV

52
Q

Salicyclic acid

A

Can treat warts
Keratolytic peeling agent
Available in liquid, gel and patches

53
Q

2nd line therapy for warts

A

Cryosurgery, electrotherapy, CO2 laser surgery

54
Q

Most common causes of bacterial skin infections

A

Staph aureus and group A strep

55
Q

Impetigo

A

Superficial skin infections

Due primarily to staph aureus

56
Q

Ecthyma

A

Chronic form of impetigo
G- organisms such as pseudonomas
More common in children
Spread between people in schools and daycare center and due to crowded living spaces

57
Q

Cellulitis

A

Infection involving skin and subcutaneous layers, can spread systemically

58
Q

Common precipitants to cellulitis

A

Break in skin, stasis dermatitis, stasis ulcers, edema of lower extremities, venous insufficiency, obesity, iV site of drug user

59
Q

Cellulitis usually due to

A

Staph aureus or Group A strep

60
Q

Primary cause of infection due to animal bites

A

Pasteurella multocida

61
Q

Erysipelas

A

Superficial form of cellulitis in children

Due to group A strep

62
Q

Folliculitis

A

Superficial infection of hair follicle

Primarily due to staph aureus

63
Q

Predisposing factors to folliculitis

A

Shaving, waxing, plucking, humidity, tight clothing, DM, sunscreen or make up, poor hygiene

64
Q

Necrotizing fasciitis

A

Serious infection of subcutaneous tissues that can be life threatening
Polymicrobial: group A strep, staph aureus, anaerobic bacteria

65
Q

Broad spectrum penicillins for bacterial skin infections

A

Choose agent that is penicillinase resistant

Amoxicillin-clavulanate

66
Q

1st generation cephalosporin for bacterial skin infections

A

Cephalexin oral or cefazolin IV

Active against GAS and Staph aureus mostly

67
Q

2nd generation cephalosporin for bacterial skin infections

A

Cefaclor, cefuroxime, cefprozil

Additional coverage against H. Influenzae, E Coli, Klebsiella, Proteus

68
Q

3rd generation cephalosporin for bacterial skin infection

A

Cefpodoxime, ceftriaxone, ceftazidine
Reserved for more serious infection
Less effective against staph aureus

69
Q

Clindamycin for bacterial skin infection

A

Alternative for patients allergic to penicillin or cephalosporin
Can be active against community acquired MRSA

70
Q

Fluoroquinolones for bacterial skin infection

A

Levofloxacin, moxifloxacin, ciprofloxacin
Useful for patients with penicillin allergy or infection with G- bacteria
Levo and Cipro active against pseudomonas

71
Q

Vancomycin for bacterial skin infection

A

Active against MRSA

72
Q

Mupirocin ointment

A

Active against staph aureus and some strep
Metabolized by skin
Adjunct therapy to antibiotics

73
Q

First line therapy for impetigo

A 
Topical mupirocin for 7-10 days for minor
Oral antibiotic (penicillin or 1st gen cephalosporin) for 7-10 days
74
Q

First line therapy for ecthyma

A

Dicloxacillin or cephalexin for 2-3 weeks

75
Q

First line therapy for cellulitis

A

Mild-moderate without systemic symptoms or purulence: penicillin, augmentin, dicloxacillin
Purulent infection: bactrim, minocycline, clindamycin, linezolid

76
Q

First line therapy for pustular infections

A

If deep infection, dicloxacillin, cephalexin, clindamycin

77
Q

first line therapy for necrotizing fasciitis

A

Combo antibiotics

Surgery

78
Q

Drugs known to exacerbate psoriasis

A

Systemic steroids, lithium carbonate, antimalarials, beta blockers, interferon, alcohol

79
Q

Psoriasis

A

Autoimmune-mediated process driven by abnormally activated helper T cells

80
Q

Characteristics of psoriasis

A

Well-demarcated, erythematous papules/plaques surrounded by silvery or whitish scales
Symmetric lesions usually found on face, extensor joints, anogenital area, palms and soles, trunk, scalp, ears, nails

81
Q

3 treatment modalities for psoriasis

A

topical agents, phototherapy, systemic agents

82
Q

Emolients for psoriasis

A

Useful as adjunct therapy

Hydrate the stratum corneum, decrease water evaporation and soften scales or plaques

83
Q

Examples of emolients for psoriasis

A

Eucerin, lubriderm, moisturel, cetaphil

84
Q

Topical corticosteroids for psoriasis

A

Decrease redness, itching and scaling, promote vasoconstriction
Most effective tx is medium to high dose agent for limited time followed by less potent for maintenance

85
Q

Coal tars for psoriasis

A

Decrease DNA synthesis and has anti inflammatory and anti pruritic properties
Used as adjunct to steroids
Unpleasant odor, staining, photosensitivity

86
Q

Anthralin for psoriasis

A

Topical coal tar derivative
Time consuming and slow onset of action
Decreases DNA synthesis and epidermal proliferation

87
Q

Vitamin D analogs for psoriasis

A

Calcipotriene + Calcipotriol
For mild to moderate
Decreases proliferation and anti inflammatory
Topical format
Similar efficacy as high potency corticosteroids

88
Q

Topical retinoid

A 
Vitamin D derivative 
Tazarotene
for mild to moderate
Normalizes epidermal differentiation, decreased hypoproliferation, diminishes inflammation
Promotes longer remission
89
Q

Systemic retinoids

A

Acitretin

Long term therapy for psoriasis

90
Q

Methotrexate

A

Treatment of generalized psoriasis

Inhibits folic acid reductase which inhibits cellular replication

91
Q

Cyclosporine for psoriasis

A

Decreases cell mediated immune reactions and humoral immunity; decreased production of IL2
Promotes rapid remission of severe psoriasis
Used short term for severe exacerbations

92
Q

Phosphodiesterase 4 inhibitors for psoriasis

A

Apremilast, etanercept, infliximab

93
Q

First line therapy for psoriasis

A

Moisturizers and topical steroids

2 weeks of high potency topical steroid 2x a day and cover with occlusive dressing

94
Q

Second line therapy for psoriasis

A

Taper high potency topical steroid to 1-2x a week and add vitamin D analog 2x a day

95
Q

Comedolytics for acne

A

Retinoic acid
Adapalene gel
Tazarotene gel

96
Q

Comedolytic bactericidals for acne

A

Benzoyl Peroxide + Azelaic acid
Specific to p.acnes
Decreases inflammation

97
Q

Topical antibiotics for acne

A

Inhibit growth of p. acnes + decreases number of comedones

Clindamycin 2% or erythromycin 2-3%

98
Q

Oral antibiotics for acne

A

When improvement does not occur with topical
Indicated for inflammatory acne
Tetracycline or erythromycin

99
Q

Tetracycline for acne

A

Improvement can take 3-4 weeks

Can stain teeth and decrease effectiveness of OC

100
Q

Isotretinoin

A

Reserved for severe nodulocystic acne when other treatment fails
Decreases sebum production, follicular obstruction and number of skin bacteria
Requires 2 forms of birth control due to teratogenicity

101
Q

Hormonal therapy for acne

A

Oral contraceptive containing ethinyl estradiol, levonorgestrel, norgestimate

102
Q

First line tx for acne

A

Topical antibiotics or comedolytics

103
Q

Second line tx for acne

A

oral antibiotics + topical medications

Oral contraceptives

104
Q

Third line tx for acne

A

Isotretinoin

105
Q

Rosacea

A

Acneiform disorder that begins in midlife; symmetric rash on central part of face

106
Q

First line tx or rosacea

A

Topical metronidazole

107
Q

Second line tx for rosacea

A

If no improvement after 6 weeks
Oral tetracycline DOC
doxycycline, erythromycin, bactrim and isotretinoin can be tried

Pharmacology (56 decks)

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