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PM2 > Week 4 - Therapeutics 2 > Flashcards

Week 4 - Therapeutics 2 Flashcards

1
Q

Why Podiatrists use topical treatments

A

Applied directly to affected areas
lower doses required than systemically
reduces risk of interaction with other drugs
easily removed/stopped if reaction occurs
convenient for patients use

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2
Q

Topical treatment - DISADVANTAGES (2)

A
  • Rely on patient to apply treatment
  • patients wont use if they dont like the ‘feel’
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3
Q

Movement of topical medicaments through the skin (4)

A
  1. Absorption
  2. Penetration
  3. Permeation
  4. Reabsorption
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4
Q

ABSORPTION through the skin (2)

A

movement of topical medicament
- stratum corneaum = dead
- transport = diffusion

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5
Q

Factors affecting absorpton

A
  • diffusion gradient
  • no. of appendages
  • level of skin hydration
  • how often medicament is applied
  • thickness of stratum corneum
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6
Q

Topical agents contain: (4)

A
  1. active ingredient (drug)
  2. vehicle or base (substance that helps carry it into skin)
  3. preservative (antibacterial/antimicrobial agent)
  4. stabiliser
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7
Q

What vehicles can be used to deliver drugs

A
  • cream
  • ointments
  • lotions
  • foams
  • gels
  • power
  • sprays
  • lacquer
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8
Q

Comparison of lotions, creams and oils

A

Lotions: less oil more water than cream
Creams - more runny less water
Ointments - more oil less water

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9
Q

Main groups of topical agents (7)

A
  1. Antiseptic
  2. Moisturisers
  3. Keratolytics
  4. Antifungals
  5. Vit D
  6. Corticosteroids
  7. Caustics
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10
Q

Antiseptics

A

chemical that stops or inhibits the growth of bacteria - kill bacteria or stop bacteria dividing

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11
Q

NMF

A

Natural moisturising factors

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12
Q

Function of NMFs in the skin

A
  1. Humectant - decreases transepidermal water loss
  2. lower skin pH - acts as a buffer against extreme pH changes
  3. Reduces bacterial load
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13
Q

Emollients vs moisturisers

A

Emollients - creates a seal
- lipids that occlude the skins surface
- prevent water loss

Moisturisers
- lipid emulsions that actively hydrate the skin
- humectant - draw in and hold water

Some products can have both properties

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14
Q

Types of emollients and moisturisers (3)

A
  1. regular skin application
  2. soap substitues
  3. bath additives
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15
Q

How to use emollients correctly (6)

A
  1. urea based prodcuts
  2. apply regularly
  3. avoid all soaps and use emoolient wash products
  4. best applied to warm, moist skin
  5. pumps = better then pots
  6. around 4-8g per day for feet
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16
Q

Moisturisers in practice (5)

A
  • most dry skin conditions will benefit from a moisturiser
  • best = greasiest one your patient will use
  • avoid moisturisers with perfumes, colouring and sulphates (particularly for eczema)
  • ointment based = more effective
  • best way to relieve itch in dry skin conditions
17
Q

Keratolytic agents (4)

A
  1. agents that soften, seperate and cause desquamation of the cornified epithelium or horny layer of skin - expose mycelia of infecting fungi or to treat corns, warts + other skin diseases
  2. Used to soften keratin
  3. improve the skins moisture binding capacity = beneficial in treatment of dry skin
  4. agents include alkali, salicylic acid, urea, lactic acid, allantoin, glycolic acid and trichloroacetic acid
18
Q

Can Urea be used as a keratolytic

A

Yes

19
Q

Caustics

A

strong inorganic acid or alkali or organic acid applied to soft tissue
- different caustics exert different actions on tissues

20
Q

Imidazoles (Azoles)

A
  • larger group of drugs based on their chemical structure
  • work by inhibiting formation of cells walls
  • primarily = fungistatic
  • effective against dermatophytes, yeast and gram +vs bacteria
21
Q

Allylamines

A
  • Terbinafine
  • broad spectrum antifungal agent
  • fungicidal in action
22
Q

Topical terbinafine

A
  • most effective topical
  • single daily application
  • cure in around 1 wk
23
Q

Use of topical antifungals

A
  • used after washing skin first
  • use for a min of 2 weeks after symptoms have clered due to liklihood of recurrance
  • 1 finger tip unit per foot, per application
  • low risk of local irritation
24
Q

Corticosteriods

A
  • Manufactured from cholesterol
  • derived from 2 tissues in the human body
  • modified by halogenation or esterification to enhance therapeutic uses
25
Q

Action of corticosteriods (4)

A
  1. Anti-inflammatory - stabilises membranes
  2. Anti-proliferative - slow cell turnover
  3. immunosuppressive - reduces TNF-alpha, prostaglandins and leukotrienes producution and reduces immune cell activity
  4. vasocontrictive - reduces oedema
26
Q

Topical steriods

A

Available on most formats
used in treatment of inflammatory skin disorders
4 levels of topical potency: mild, moderate, potent, very potent

27
Q

Side effects of topical steriods (9)

A
  1. skin atrophy
  2. skin striae
  3. telangiectasia
  4. vellus hair growth
  5. increased hair growth
  6. hypo pigmentation
  7. allergy to steroid
  8. permanent facial erythema
  9. adrenal suppression
28
Q

Causes of side effects from topical steroids (7)

A
  1. too long
  2. too often
  3. too much
  4. under occlusion
  5. on face, folds, genitals or inner thighs
  6. too young or too old
  7. too extensive and area
29
Q

Applying topical steriods on the foot (3)

A
  1. plantar area requires a very potent steriod as the skin is thick
  2. 2 finger tip units on the foot per treatment
  3. step down the ‘steriod ladder’ as soon as possible
30
Q

Maximum effect and safety with topical steroids

A
  • use moderate, potent or very potent steroids only
  • only on thick lesions or plantar surface
  • only for 2-3 week s
  • apply once per day
  • best used in the early evening
  • if maintenance required - use on weekends only
  • step down to make steroid weaker when possible
  • use with an emollient
31
Q

Cheap and effective - topical steroids

A

Bleach baths
Vinegar - apple cider vinegar

PM2 (8 decks)

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