DD- Topical Therapeutics in Dermatology

Question 1

To be effective, topical medications need to gain entry into the skin through the _______ and reach the site of action in desired concentrations

Answer 1

stratum corneum

Question 2

1- Meds move across the stratum corneum by passive diffusion.
2- the agents can be transported through channels or pores within a lacunar system in the stratum corneum.
3- Meds may be transported via _________ such as sweat glands or hair follicles.

Answer 2

appendageal structures

Question 3

Factors Influencing Absorption of Topical Medications

Answer 3

(a) drug factors and (b) patient factors.

Question 4

Drug factors affecting percutaneous absorption include

Answer 4

• Active drug concentration
• Composition of the vehicle
• Molecular size of the drug or prodrug
• Lipophilicity of the drug

Question 5

Molecular size of the drug affects its absorption at the site______

Answer 5

of action.

Question 6

1- Meds move across the stratum corneum by passive diffusion.
2- the agents can be transported through channels or pores within ______ system in the stratum corneum.
3- Meds may be transported via appendageal structures, such as sweat glands or hair follicles.

Answer 6

a lacunar

Question 7

Patient factors affecting percutaneous absorption of topical medications include:

Answer 7

• Presence of barrier disruption
• Anatomic location (including thickness of the stratum corneum)
• Skin hydration
• Occlusion

Question 8

________of the skin often leads to markedly increased skin hydration.

Why does this matter?

Answer 8

Occlusion

active ingredients delivered in the form of an ointment, tape, or to the skin folds, reach much higher [ ] because occlusion prevents loss of medication by evaporation, friction, or exfoliation.

Question 9

In general absorption is lower in anatomic regions where the_______ is thicker,

Answer 9

stratum corneum

Question 10

1- Meds move across the stratum corneum by ________
2- the agents can be transported through channels or pores within a lacunar system in the stratum corneum.
3- Meds may be transported via appendageal structures, such as sweat glands or hair follicles.

Answer 10

passive diffusion.

Question 11

Typically, the diffusion of a compound is

inversely proportional to the?

Answer 11

molecular size of the drug.

Question 12

• Ointments: Water in oil emulsion
• Creams: Oil in water emulsion
• Gels: Semisolid emulsion in alcohol base
• Lotions/Solutions: Powder in water (some oil in water)
• Foams: pressurized collections of gaseous bubbles in a matrix of liquid film

These are examples of?

Answer 12

Classification of Vehicles

Question 13

strong potency

hydrating, with very low sensitization risk or irritation risk

use are non-intertreginous sites

Answer 13

Ointments Vehicles

Question 14

moderate potency

some hydration

significant sensitization risk and a low irritation risk.

Answer 14

Creams Vehicles

Question 15

strong potency

drying

significant sensitization risk and a relatively high irritation risk

oral mucosal surfaces and the scalp

Answer 15

Gels Vehicles

Question 16

matrix is stable at room temperature but
readily melts at body temperature.

supersaturated active ingredients to interact with lipids of the stratum corneum.

Answer 16

Foams Vehicles

Question 17

When selecting an appropriate vehicle, three factors are of particular importance?

Answer 17

anatomic location, contact allergy/sensitization, and irritancy

Question 18

What is an FTU?

Answer 18

FTU=Fingertip Unit

Question 19

• 1 gram of cream covers approximately ______ area of skin

Answer 19

10 cm x 10cm

Question 20

• 1 gram of ointment spreads ____ further than the same amount of cream.

Answer 20

10%

Question 21

• Approximately _____ are necessary to treat the entire body of an adult man

Answer 21

20 g

Question 22

binding of glucocorticosteroids is associated with the following downstream molecular events:

Answer 22

Alteration of transcription rate–> inflammatory proteins

Inhibition of nuclear factor-κB pathway

interacts with other tx factors that play a role in the inflammatory response.

Question 23

Easy to apply/remove, non-toxic, non-irritating, stable, cosmetically acceptable, good at
delivering the drug, and inert

Answer 23

The ideal vehicle

Question 24

Water-based vehicles (__________) contain preservatives that may increase the risk of contact allergy and sensitization.

Answer 24

such as creams, lotions, and solutions

Question 25

_______ is associated with high concentrations of propylene glycol, other types of alcohols, and certain acidic vehicle ingredients.

Answer 25

Irritancy

Question 26

glucocorticoids inhibit…..

Answer 26

inflammatory cytokines.

Question 27

Seven classes have been proposed based on potency.

These classes were developed based on
vasoconstrictor assays.

Answer 27

superpotent topical glucocorticosteroids
belong to class 1

very low-potency topical glucocorticosteroids belong to class 7

Question 28

Class 7 (low-potency)

Efficacious for mild eczema in children and
adults

Treatment of inflammatory dermatoses
involving anatomic regions such as the face,
intertriginous areas, or groin.

Answer 28

Hydrocortisone 2.5%

Question 29

Class 4 (cream formulation, mid-potency)

Effective against most moderate spongiotic
dermatoses (including eczematous dermatitis, atopic dermatitis, allergic contact dermatitis, arthropod bite)

Use on trunk and extremities

Long-term use not recommended for facial,
intertriginous, and groin regions.

Answer 29

Triamcinolone Acetonide 0.1%

Question 30

Class 1 (high-potency)

Rx for acute eruptions that necessitate relatively rapid amelioration, such as contact dermatitis or acute drug eruptions.

Avoid use on the face, intertriginous
areas, or the groin.

Longer-term use of requires monitoring of development of adverse effects.

Answer 30

The Clobetasol Propionate 0.05%

Question 31

More potent topical steroids are associated with greater ______

Answer 31

adverse effects

Question 32

______ most commonly associated with long-term use of potent to super-potent topical steroids

Answer 32

Skin atrophy:

Question 33

The Clobetasol Propionate 0.05%

Answer 33

Class 1 (high-potency)

Rx for acute eruptions that necessitate relatively rapid amelioration, such as contact dermatitis or acute drug eruptions.

Avoid use on the face, intertriginous
areas, or the groin.

Longer-term use of requires monitoring of development of adverse effects.

Question 34

Extensive and long-term use of potent or super-potent topical steroids have been associated with _______

Answer 34

systemic side effects.

Potential systemic side effects include adrenal suppression, Cushing’s syndrome, and growth retardation in children

Question 35

Triamcinolone Acetonide 0.1%

Answer 35

Class 4 (cream formulation, mid-potency)

Effective against most moderate spongiotic
dermatoses (including eczematous dermatitis, atopic dermatitis, allergic contact dermatitis, arthropod bite)

Use on trunk and extremities

Long-term use not recommended for facial,
intertriginous, and groin regions.

Question 36

systemic side effects of GCs may include?

Answer 36

adrenal suppression, Cushing’s syndrome, and growth retardation in children

Question 37

Hydrocortisone 2.5%

Answer 37

Class 7 (low-potency)

Efficacious for mild eczema in children and
adults

Treatment of inflammatory dermatoses
involving anatomic regions such as the face,
intertriginous areas, or groin.