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Dermatology > 24: Dermatology Therapeutics - Frush > Flashcards

24: Dermatology Therapeutics - Frush Flashcards

1
Q

percutaneous absorption variables

A
  • concentration more important than volume
  • lipophilicity
  • molecular size (most effective topical meds have molecular weight of less than 1000)
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2
Q

strongest percutaneous absorption vehicle

A

ointment

  • solution is typically the weakest
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3
Q

will inflamed skin increase or decrease absorption?

A

increase

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4
Q

indications for open wet dressings

A

acute inflammatory conditions, erosions and ulcers

  • causes vasoconstriction and decreased inflammation
  • closed wet dressings can cause maceration
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5
Q
  1. used to reduce moisture, maceration, and friction
  2. suspension of powder in water
  3. semisolid emulsion of oil in water
  4. semisolid emulsion that liquefies on contact, leaving thin film
  5. water deroplets suspended in oil or petroleum
A
  1. powders
  2. lotions
  3. cream
  4. gel
  5. ointment
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6
Q

clinical comparisons of various vehicles

A
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7
Q

FTU

A

fingetip unit
- ointment expressed from tube from index finger MPJ to tip of finger

  • approx 0.5 g
  • 1 ftu should cover plantar aspects of 1 or both feet
  • need 2 ftu to cover one foot
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8
Q

antibiotic solutions used for soaking

A

dakin’s

  • sodium hypochlorite aka bleach

acetic acid

  • drying, good for wet tinea pedis, effective against sueprficial pseudomonas infections

burrow’s

  • aluminum acetate solutions, dry out wounds

epsom salt

  • magnesium sulfate, drying effect
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9
Q

Bacitracin

A

▪Good Gram (+) coverage

▪Minimal to no gram (-) coverage

▪Can cause sensitivity reaction, particularly with stasis dermatitis

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10
Q

Polysporin

A
  • Contains 2 abx – bacitracin and polymyxin B
  • PolymyXin B effective against gram (–)
  • Including pseudomonas
  • Contact allergy rare
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11
Q

Neosporin

A

Contains 3 abx – bacitracin, polymyxin B, and neomycin

Neomycin – covers gram (+) and (-)

▪Good S. aureus coverage

▪Does not cover Pseudomonas, or Bacteroides

▪Weak Strep activity

▪1% of population has contact allergic sensitivity, rate can increase to almost 10% in patients with prolonged use

▪Bacitracin causes coreaction with neomycin

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12
Q

Can be used in nasal passages for MRSA carriers

A

mupirocin (bactroban)

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13
Q

gentamicin

A

good gram - coverage, notably pseudomonas

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14
Q

silvadene

A
  • Effective against Gram (+) and (-)
  • Shouldn’t use in patients allergic to sulfonamides
  • If using in large area over long time period, can get significant absorption of silver
  • Can occasionally cause brown/gray hyperpigmentation of skin with use
  • Commonly used with burn patients
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15
Q

used for presurgical scrub for surgeon and/or patient

A

topical antiseptics

  • chlorhexidine
  • povidone-iodine
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16
Q

nystatin

A
  • polyene
  • effective against candida albicans
  • not used in podiatry much
17
Q

Miconazole

A
  • azole
  • Good activity against T. rubrum, T. mentagrophytes
  • Has mild effectiveness against some Gram (+)
  • BID x 4 weeks, OTC
18
Q

clotrimazole

A
  • Broad spectrum against, Trichophyton, Epidermophyton, and Microsporum
  • Also active against Gram (+) and Candida
  • BID x 2-4 weeks, OTC
19
Q

Econazole

A
  • Broad spectrum against Trichopyton, Microsporum, Epidermophyton, C. albicans, and M. furfur
  • Shows some gram (+) and (-) coverage
  • Apply QD
20
Q

Ketoconazole

A
  • Broad spectrum activity against dermatophytes
  • BID x 6 weeks
21
Q

Sertaconazole

A
  • Relatively lipophilic
  • Effective against T. rubrum, T. mentagrophytes, E. floccusum, Candida
  • Moderate activity against Gram (+) bacteria
    • Apply BID for 4 weeks
22
Q

oxiconazole (oxistat)

A
  • Apply QD-BID for 4 weeks
  • Good absorption into stratum corneum, will stay for several days after treatment
23
Q

efinaconazole topical

A

JUBLIA

  • 10% solution
  • Used for onychomycosis
  • Apply qd for 48 weeks
24
Q

naftifine (naftin)

A
  • allylamine/benzylamine
  • Highly lipophilic, allows good penetration and high concentration in stratum corneum
  • Expensive
  • Apply QD-BID
  • Earlier symptomatic relief than Lotramin
25
Q

terbinafine (lamasil)

A
  • allyamine/benzylamine
  • Broad spectrum against dermatophytes, molds, C. albicans
  • Effective against chronic tinea pedis
  • Apply BID 1-4 weeks
  • OTC
26
Q

butenafine (mentax)

A
  • allylamine and benzylamine
  • Broad spectrum against dermatophyes and dimorphic fungi
  • Apply BID x 7 days, or QD x 14 days
27
Q

what is propylene glycol?

A

Propylene glycol : Vehicle used in some antifungals to increase penetration. Can cause irritation is some patients.

28
Q

most potent anti-dermatophyte tx

A
  1. Butenafine (Mentax) = Terminafine (Lamasil)
  2. Ciclopirox (Loprox)
  3. Naftifine (Naftin)
  4. Azoles
29
Q

MOA topical corticosteroids

A
  • ¡Reduces number and function of inflammatory cells and chemical mediators
    • Reduced inflammation and immune response
  • Reduces keratinocyte proliferation, fibroblast activity, and dermal volume(due to decreased H2O content)
    • Thinning of the skin
    • Prolonged use causes skin atrophy
30
Q

indications for topical corticosteroids

A

inflamed, or irritated skin, non infectious in nature

Examples

  • Dermatitis, Eczema, Psoriasis, Lichen planus
31
Q

Absolute contraindication for topical corticosteroids

A

Hypersensitivity to the topical corticosteriod or vehicle

Relative: Bacterial, fugal, or viral infection and Ulceration

32
Q

Antihyperkeratotics

A
  • Used for patients with severe chronic hyperkaratosis
  • Helps to hydrate, soften and debride thickened skin

Lactic acid

  • Lac-Hydrin, Amlactin
  • 12% Cream or Lotion
  • May cause irritation in non-intact skin

Urea

  • Carmol 40
  • 40% urea cream, lotion, gel
33
Q

Neomycin + Polymyxin + Hydrocortisone

A

cotricosporin

  • used for Corticosteroid-responsive dermatoses with secondary infection
34
Q

clotrimazoel and betamethasone

A

lotrisone

  • used for inflamed tinea pedis

Dermatology (24 decks)

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