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Dermatology > Pharm 27 Objectives > Flashcards

Pharm 27 Objectives Flashcards

1
Q

What are some general principles of topical drug therapy?

A
  • Avoids systemic absorption of agents
  • Use an appropriate vehicle
  • Apply a WET dressing with evaporate to an oozing/weeping lesion to dry it
  • To moisturize a dry lesion, trap moisture with occlusive agents
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2
Q

What are some general principles of transdermal drug therapy?

A

Achievement of systemic concentrations due to controlled delivery of drug

Avoids “first pass” effect from the liver

Best for small, highly lipid-soluble molecules

Dose of drug is determined by surface are covered

Delay between start and stop of dosing

Types of patches differ

Patches can have 10-95% of drug left inside after removal

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3
Q

What vehicle do you select that are drying and will enhance evaporation from the skin?

A 
Solutions (wet dressing and suspensions)
Sprays (aerosols and aqueous sprays)
Lotions
Gels
Powders
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4
Q

What vehicle do you select that are moisturizing and will trap water in the stratum corneum

A

Creams
Ointments
Ointment bases

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5
Q

What is the rank of vehicles from most moisturizing to least moisturizing?

A 
Occlusive dressing
Ointment
Cream
Lotion
Gel
Spray
Solution
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6
Q

What will occur if you select the wrong vehicle (wetting vs non-wetting dressing)?

A

It can hamper wound healing

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7
Q

What is an example of low potency topical corticosteroid medication?

A

Hydrocortisone (1% or 2.5%)

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8
Q

What is an example of medium potency topical corticosteroid medication?

A

Triamcinolone (0.1%)

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9
Q

What is an example of high potency topical corticosteroid medication?

A

Flucinonide (0.05%)

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10
Q

What is an example of very high potency topical corticosteroid medication?

A

Clobetasol (0.05%)

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11
Q

Why can Tiamcinolone be in the medium and high potency class?

A

Different % of the drug (0.025%, 0.1% and 0.5%)

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12
Q

What are the therapeutic uses for topical corticosteroids?

A

Relieves inflammation and itching

  • Contact dermatitis
  • Eczema
  • Psoriasis
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13
Q

What are some ASEs of topical corticosteroids?

A

Atrophy/thinning of skin

Telangiectasias

Striae (striped skin)

HPA axis suppression from systemic absorption

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14
Q

What is Telangiectasia which are an ASEs to topical corticosteroids?

A

Dilated capillaries, red, elevated, wart-like spots

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15
Q

How does HPA axis suppression occur with the use of topical corticosteroids?

A

Applying high potency agents over time

Applying moderate-high potency agents over broken skin

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16
Q

What are contraindications of topical corticosteroids?

A

Skin infections

Applying to broken skin (causes systemic absorption)

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17
Q

What is the therapeutic use of Nystatin?

A

Yeast infections

- diaper dermatitis

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18
Q

What is the therapeutic use of Clotrimazole?

A

Tinea versicolor

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19
Q

What is the therapeutic use of Terbinafine?

A

Tinea Pedis

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20
Q

MOA of benzoyl peroxide?

A

Drying and may increase cell turnover

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21
Q

ASEs of benzoyl peroxide?

A

Local irritations and bleaches clothing/bed sheets

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22
Q

How do you reduce irritation caused by benzoyl peroxide?

A

Start by diluting it with water, then work up to full strength

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23
Q

Clinical use of benzoyl peroxide?

A

Acne

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24
Q

MOA of salicylic acid?

A

Desquamates stratum corneum by dissolving cement holding epithelial cells together
-Softens and discourages growth of calluses

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25
Q

Clinical uses of salicylic acid?

A 
Acne
Seborrheic derm
Psoriasis of body and scalp
Dandruff
Wart removal
Hyperkeratotic skin disorders
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26
Q

ASEs of salicylic acid?

A

Skin peeling

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27
Q

Contraindications of salicylic acid?

A

Avoid using on irritated, broken or infected skin, use appropriate product (use only as concentrated as necessary)

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28
Q

MOA of topical retinoids (adapalene, tretinoin, etc)?

A

Modulator of cellular differentiation, keratinization, and inflammatory processes

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29
Q

Clinical use of topical retinoids (adapalene, tretinoin, etc)?

A

Acne

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30
Q

ASEs of topical retinoids (adapalene, tretinoin, etc)?

A

Very irritating (adapalene is less irritating)

Photosensitivity

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31
Q

What are some special monitoring parameters of topical retinoids (adapalene, tretinoin, etc)?

A

Can be used with topical antibiotics, but need to watch for irritation

Use sunscreen when using retinoids

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32
Q

Clinical use of azelaic acid?

A

Inflammatory acne (BID up to 6 mos or longer)

Inflammatory lesions of rosacea

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33
Q

ASEs of azelaic acid?

A

Skin irritation

Lightening of skin

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34
Q

MOA of Isotretinoin (oral agent)

A

Reduce oil output to skin

35
Q

Clinical use of Isotretinoin (oral agent)?

A

Severe or cystic acne

36
Q

Contraindications of Isotretinoin (oral agent)?

A

Pregnancy- teratogenic

37
Q

Special monitoring parameters for Isotretinoin (oral agent)?

A

iPLEDGE program —> 2 forms of birth control at all times.

Depression screening

38
Q

What bugs do topical antibiotics target?

A

Staph and strep

39
Q

What topical agents are used for a pt with mild to moderate psoriasis?

A

Topical corticosteroids

Emollients

Salicylic acid

Calcipotriene ( Synthetic Vitamin D derivative)

Tazarotene

Coal tar

40
Q

What topical agents are used for a pt with moderate to severe psoriasis?

A

Acitretin

Calcitriol

Entanercept

41
Q

What is the concentration dependent therapeutic use of salicylic acid?

A

Low concentrations can correct abnormal keratinization

1% concentrations cause skin peeling

20% concentration has caustic effects on the skin

42
Q

What 2 drugs are used to stimulate hair growth?

A

Finasteride

Topical minoxidil

43
Q

What is the MOA of Finasteride?

A

Inhibits conversion of testosterone to dihydrotestosterone (DHT)

44
Q

What are advantages of Finasteride?

A

First line for hair growth, may be slightly more effective than topical minoxidil

45
Q

What are disadvantages of Finasteride?

A

Length of time to wait to see response, potential for chronic sexual dysfunction, pregnant women should avoid skin exposure

46
Q

What is the MOA of Topical minoxidil (Rogaine®)?

A

Stimulates follicles and follicle cycling, induces vascular endothelial growth factor (VEGF)

47
Q

What is an advantage of Topical minoxidil (Rogaine®)?

A

No prescription needed

48
Q

What is a disadvantage of Topical minoxidil (Rogaine®)?

A

5% more effective but more irritating

49
Q

What medication is used for unwanted hair growth?

A

Eflornithine

50
Q

What is the MOA of Eflornithine?

A

Inhibits enzyme which blocks cell division of hair cells, slowing growth

51
Q

What is an advantage of Eflornithine?

A

Can use with other methods of hair removal

52
Q

What is a disadvantage of Eflornithine?

A

Prescription required and $$$

53
Q

What are the medications used as the first line treatments for head lice?

A

Permethrin

Pyrethrins + piperonyl butoxid

54
Q

Does Permethrin kill both live lice and eggs?

A

Only kills live lice, has no effect on eggs

55
Q

What are some dosing guidelines for Permethrin?

A

May require repeat dose in 7-9 days

Stays on the hair for 14 days

Saturate hair and scalp; wash out after 10 minutes

56
Q

Pyrethrins + piperonyl butoxide is both a shampoo and?

A

Spray for furniture and toys

57
Q

What is a dosing guideline for Pyrethrins + piperonyl butoxide?

A

Apply shampoo to hair and scalp; wash out in 10 min; reapply in 5-10 days prn

58
Q

What are the 2nd line medications for head lice?

A

Ivermectin lotion ( >6 mo)

Malathion lotion ( >6 yrs)

Spinosad 0.9% ( >6 mo)

Lindane lotion and shampoo (>2 yrs)

Ivermectin (oral)

59
Q

What head lice medication is no longer recommended in pediatric pts and why?

A

Lindane lotion and shampoo

Due to CNS toxicity

60
Q

What are the medications use tx scabies?

A

Topical permethrin 5% (1st choice)

Crotamiton

Lindan lotion (avoid in preg and peds)

61
Q

What are the medications used to tx genital warts (condyloma accuminatum)?

A

Podophyllum Resin (25% of podophyllotoxin)

Podoflox (0.5% of podophyllotoxin)

Imiquimod (Aldara® cream)

62
Q

How is Podophyllum Resin applied?

A

Only applied by clinician due to toxicity

63
Q

What are ASEs of Podophyllum Resin?

A

Can lead to cell death (nectoris)

64
Q

What are contraindications of Podophyllum Resin?

A

NEVER apply Podophyllum Resin to cervix or vaginal epithelium!!!
- Chemical burns

Teratogenic- avoid in pregnancy

Not for mucosal use (external use only)
- cause skin irritation up to ulceration

65
Q

What are some ASEs of Imiquimod?

A

Mild to moderate local redness

66
Q

How does changes in skin structure in older pts result in drug toxicity?

A

Older pts are more prone to dry skin, itching, and cracking which means using topical drugs on damaged skin may lead to potential for systemic absorption leading to toxicity.

67
Q

What is the dose of topical cream/ointment for face and neck, one arm, and hands and feet BID x 1 week?

A

15 gm

68
Q

What is the dose of topical cream/ointment for face and neck, one arm, and hands and feet TID x 2 week?

A

45 gm

69
Q

What is the dose of topical cream/ointment for face and neck, one arm, and hands and feet BID x 4 week?

A

60 gm

70
Q

What is the dose of topical cream/ointment for trunk BID x 1 week?

A

60 gm

71
Q

What is the dose of topical cream/ointment for trunk TID x 2 week?

A

180 gm

72
Q

What is the dose of topical cream/ointment for trunk BID x 4 week ?

A

240 gm

73
Q

What is the dose of topical cream/ointment for one leg BID x 1 week?

A

30 gm

74
Q

What is the dose of topical cream/ointment for one leg TID x 2 week?

A

90 gm

75
Q

What is the dose of topical cream/ointment for one leg BID x 4 week?

A

120 gm

76
Q

What is the dose of topical cream/ointment for the body BID x 1 week?

A

180 gm

77
Q

What is the dose of topical cream/ointment for the body TID x 2 week?

A

454 gm

78
Q

What is the dose of topical cream/ointment for the body BID x 4 week?

A

454 gm

79
Q

Clinical use of Entanercept?

A

Psoriasis and psoriatic arthritis

80
Q

MOA of Entanercept?

A

TNF-alpha blocking agent

81
Q

MOA of misc. anti-pruritic topical drug: Pramoxine?

A

Antagonizes histamine-triggered itching

82
Q

Topical antibiotic: Bacitracin is used for gram - or +?

A

Gram +

83
Q

Topical antibiotic: Gentamicin, neomycin, polymixin is used for gram - or +?

A

Gram -

84
Q

Topical antibiotic: Silver sulfadizazine is used for gram - or +?

A

Gram + and Gram -

Dermatology (6 decks)

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