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139 Cards in this Set
- Front
- Back
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What is diascopy?
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blanch test
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Sx's of Erythema Multiforme?
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Target Lesions
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Triggers for Erythema Multiforme?
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Infections (herpes) and Drugs
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Cutaneous Signs of Hypersensitivity Vasculitis?
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Palpable Purpura (doesn't blanch)
Pain |
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Triggers for Hypersensitivity Vasculitis?
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Infections (strep)
Drugs (alpurinole, PCN) CT diseases (lupus) Neoplasms Henoch Schonlein (renal) C' def |
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Sx's of Erythema Nodosum
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Tender, Red Nodules appearing more on legs than arms
(panniculitis) |
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Cutaneous Signs of Lupus?
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Malar (butterfly) rash
Photodistributed red patches/plaques Nailfold Telangiectasia Nonscarring alopecia |
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4 of the 11 criteria for SLE are cutaneous, what are they?
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Malar Rash
Photosensitivity Oral Ulcers Discoid Rash |
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Discoid Rash kickers?
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well demarcated
scars-->hypo/hyperpigmentation localized: head and neck generalized: below neck Adherent scale follicular plugging |
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What is the most photosensitive type of Lupus?
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Subacute Cutaneous
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appearance of subacute cutaneous lupus?
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mimics psoriasis
nonscarring hypopigmentation can pass it on to kids |
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Dermatomyositis' cutaneous kickers?
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Heliotrope Rash (face)
Gottron's Papules (knuckles) Photosensitive Periungual Telangiectasia |
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Dx Behcet's?
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Recurrent Oral Ulcers plus 2 of:
Recurrent genital ulcers Uveitis Cutaneous Vasculitis Synovitis Meningoencephalitis |
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Cutaneous Sx's of Behcet's?
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Erythema Nodosum
Acneiform Eruptions Superficial Thrombophlebitis Pyoderma Gangrenosum Pathergy |
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what is pathergy?
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when minor trauma causes a rxn (i.e. a lesion after an injection)
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Aphthae vs Herpes
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Aphthae like soft foundations (soft palate)
Herpes like hard foundations (hard palate) |
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Skin manifestations of Scleroderma?
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Sclerodactyly
Mat-like and periungual telangiectasias Raynaud's Phenomenon (infarcts) Calcinosis Cutis |
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what is morphea?
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localized scleroderma
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Skin sx's of morphea?
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oval plaques
linear! En Coup de Sabre (forehead) NOTHING SYSTEMIC |
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who is "The Great Imitator?"
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Sarcoidosis
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Sx's of Sarcoidosis?
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Brownish Red Papules, Nodules
Around old scars Lupus Pernio (mid face) Erythema Nodosum |
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Who gets sarcoidosis mostly?
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the Southeast
Blacks |
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Kickers and Sx's for Hereditary Hemorrhagic Telangiectasia?
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Auto Dom
Telangiectasias Lips, Face, Mucosa, Digits, nose bleeds GI bleeding AV anastomoses (lung, liver, brain) |
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Who can't swallow steak?
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CREST?
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sx's of Livedo Reticularis?
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Skin has red-blue net-like pattern (blanches)
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causes of livedo reticularis?
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SLUDGING OF BLOOD
Cholesterol emboli Thrombi Hyperviscosity Vasculitis |
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Sx's of Acanthosis Nigricans
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Symmetric
Brown Velvety Axillae, neck, groin |
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Who gets acanthosis nigricans?
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blacks
insulin-resistant states (hyperinsulinemia) adenocarcinoma of stomach |
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Three types of hyperinsulinemia?
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Type A: hyper androgenic
Type B: Autoimmune FATTIES |
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Sx's of Necrobiosis Lipoidica?
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Oval, violaceous, shiny plaques
Pretibial and other places Red advancing border Yellow-brown atrophic centers Telangiectasias, ulcerations |
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causes of Necrobiosis Lipoidica?
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type 1 diabetes
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what are xanthomas?
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Papules, Plaques, Nodules
Yellowish, Erythema Lipid-laden Histiocytes |
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cause of xanthomas?
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hyperlipidemia
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4 types of xanthomas?
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Plane
Tuberous Tendinous Eruptive |
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Location of Plane xanthomas?
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eyelids (xanthelasma)
palms maybe? |
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location of tuberous xanthomas?
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elbows and knees
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location of tendinous xanthomas?
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achilles
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location of eruptive xanthomas?
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crops of em on ya butt
(w/ high high triglycerides) |
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Peutz-Jegher's kickers?
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Auto Dom
Hyperpigmented Macules Lips, oral mucosa Polyps in SI Intussception Risk of adenocarcinoma of GI |
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GARDNER'S SYNDROME
kickers |
Familial Adnomatous Polyposis
Epidermal Cysts Palpable Osteomas (skull,jaw) |
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Pyoderma Gangrenosum
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Pathergy
Tender macules/nodules Pustules, dusky red Enlarge and Ulcerate Cribiform, overhanging borders |
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When do we see pyoderma gangrenosum?
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IBD
RA lymphoreticular malignancies |
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what is NOT good Rx for pyoderma gangrenosum?
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surgical debridement...cause of pathergy
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PORPHYRIA CUTANEA TARDA
kickers |
Sun-exposed blistering, erosions, milia
Facial Hypertrichosis (hairy) Hypopigmented scarring |
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What is Milia?
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its little scar lesions left over after deep blistering
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Rx for PCT?
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Phlebotomy
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Primary Systemic Amyloidosis?
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Shiny, waxy papules
eyelids, nasolabial, lips Pinch Purpura Macroglossia Raccoon eyes from bleeding papules |
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Kickers of Paget's of the Boob?
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Unilateral Nipple Erythema
Serous Drainage, crust Indurated, sharp margin |
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What about Extramammary Paget's?
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Anogenital
White to red plaque Scaling or macerated Itching, Burning |
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Paget associations?
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cancer
GYN, rectal or ductal |
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what is the most common form of cutaneous t-cell lymphoma?
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mycosis fungoides
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MYCOSIS FUNGOIDES
skin sx's? |
Stages: Patch, Plaque, Tumor (nodular)
Erythrodermic (bad bad), sezary |
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Who are the eicosanoids?
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Prostaglandins
Thromboxanes Leukotrienes |
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How are they synthesized?
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Membrane phospholipid-->AA
1.COX -->PG's and TXA 2. Lipooxygenase-->LT |
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G=protein receptors and their effects on smooth muscle?
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Gq and Gi = contraction
Gs = relax |
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Who are examples of Smooth Muscle relaxing eicosanoids?
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PGI2 (prostacyclin)
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Who are examples of smooth muscle contracting eicosanoids?
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PGF2a
TXA2 |
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What does PGE2 do?
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Relaxes human uterus
Contracts pregnant uterus relaxes smooth muscle of weiner |
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Who do you use for abortion?
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Dinoprostone
Carboprost tromethamine Misoprostol |
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Who do you use for pulmonary HTN?
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Epoprostenol
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Who do you use for ED?
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Alprostadil
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Who do you use for patency of ductus arteriosus?
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Alprostadil
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Who do you use for Glaucoma?
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Latanoprost
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Who do you use for Gastric cytoprotection?
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Misoprostol
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When can you use the abortion drugs?
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Dino and Carbo are 2nd trimester
Miso is under 8 weeks |
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SE's of Carboprost tromethamine?
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CV collapse
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What is Epoprostenol?
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PGI2 = prostacyclin
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Epoprostenol SE?
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N&V
HA |
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What is Alprostadil?
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PGE1
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Alprostadil tx?
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Intracavernosal injection!!!!
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Alprostadil
SE? |
penile pain
priapism |
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Which eicosanoids keep the ductus arteriosus open?
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PGE2
PGI2 |
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SE's of Alprostadil in relation to ductus arteriosus?
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Apnea
Ductal rupture w/ prolonged rx |
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how do you administer Alprostadil?
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continuous IV
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Latanoprost kickers
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PGF2a
Eye drops Brown pigment of iris/eyelashes conjunctivitis dry eyes |
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Which eicosanoids decrease gastric acid?
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PGI2
PGE2 |
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Different effects of different doses of Misoprostol?
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low dose prevents ulcers
high dose heals ulcers |
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SE's of Misoprostol?
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Diarrhea
Abdominal Discomfort Bone Pain |
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Misoprostol contraindicated in?
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preggers
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4 things prostaglandins do?
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Inflammation
Pain Fever Platelet Aggregation |
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Aspirin vs NSAID inhibition of COX 1/2?
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Aspirin is irreversible
NSAIDs is reversible |
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pKa of aspirin?
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3.5
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ASPIRIN
anti=inflammatory effects? |
COX inhibition
Inhibit leukocyte migration |
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ASPIRIN
analgesic effects? |
local: inhibits PG's who usually lower threshold for nociceptor activation
Central: those same PG's can activate neurons in SC and brain |
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ASPIRIN
Antipyretic effects? |
Temp controlled by hypothalamus
IL and TNFa increase PG production in hypothalamus |
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ASPIRIN
Antiplatelet? |
Stops TXA2 which promotes platelet aggregation
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Uses for Aspirin?
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Antipyretic (need to rx cause)
Analgesic: HA, arthritis, myalgia, dysmennorhea Anti-Infl: RA CV stuff |
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Different doses of Aspirin?
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Low: prophylactic for CV (stop TXA, but not PGI2)
Moderate: antipyretic, analgesic High: anti-inflammatory |
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Adverse effects of Aspirin in the therapeutic range?
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GI effects
Bleeding |
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OD effects of Aspirin?
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Tinnitus
Hyperventilation Vasomotor collapse, renal & resp failure |
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Common NSAID Adverse Effects
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GI Effects (decreased protection, ulcers, bleeding)
Antiplatelet Prolonged gestation and premature DA closure Renal Failure in pts w/ renal disease Neuro Resp alkalosis/acidosis Metabolic acidosis |
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Rx of Aspirin OD?
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Gastric Lavage
Sodium Bicarb |
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Sx's of Aspirin Intolerance?
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Rhinitis
Laryngeal Edema Brochoconstriction (asthma) Flushing and hypotension |
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Rx for Aspirin Intolerance?
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Montelukast
Zafirlukast |
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Prevention for Aspirin intolerance?
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Zileuton
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Contraindications of Aspirin
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hemophilia
preggers renal disease viral infection in kids (reye's) |
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IBUPROFEN
kickers |
Less GI irritation than Aspirin
Don't use it if taking aspirin for CV |
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INDOMETHACIN
Indications? |
Arthritis
Conjunctivitis, Gingivitis Suppress Contractions Patent Ductus Arteriosus Bartter's Syndrome |
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What the heck is Bartter's?
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Excess renal PG production
Hypokalemia Hyperaldosteronism Juxtaglomerular Hyperplasia |
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INDOMETHACIN
Adverse Effects? |
GI: anorexia, pain, ulcers, bleeding
CNS: frontal HA, dizzy, vertigo, confusion |
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who are the other NSAIDs and what's good about them?
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LONG HALF LIFE
Nabumetone Oxaprozin Piroxican Ketorolac |
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Locations of COX-1 and COX-2?
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COX-1 ubiquitous
COX-2: site of infl, kidney, brain |
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So what is the hoped for benefit of COX-2 inhibitors?
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decreased GI effects
decreased platelet activity |
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Who is the only COX-2 used currently and why?
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Celecoxib (celebrex)
RA and OA Intestinal polyps and acute pain |
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Why are COX-2 Inhibitors bad?
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They still hit on Endothelium and cause vasoconstriction
BUT, they don't have antithrombotic activity SO here come strokes |
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Acetaminophen indications?
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Mild to moderate analgesic
Antipyretic NOT anti-infl pts who can't take aspirin |
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Acetaminophen OD effects?
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N&V
Anorexia Abd Pain Hepatic Necrosis |
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Rx for Acetaminophen OD?
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Sulfhydryl compounds (methionine, N-acetylcysteine)
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Why isn't acetaminophen a good anti-infl agent?
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Inhibits COX in only low peroxide environment
Leukocytes living in inflammation generate peroxides |
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What is DMARD?
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Disease-modifying Antirheumatic Drug
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Target of DMARDs in RA?
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IL and TNFalpha b/c they mediate the immune rxn. Stop them. Stop tommy boy (or RA)
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Who are the DMARDs?
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Methotrexate
Cyclophosphamide Cyclosporine TNF-alpha BLOCKING AGENTS Adalimumab Infliximab Etanercept |
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who is the first line DMARD used for RA
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METHOTREXATE
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METHOTREXATE
other use? |
Chemo, but for RA its a lower dose
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SE's of METHOTREXATE
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Nausea
Mucosal ulcers Lymphoma... Skin Rxns |
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CYCLOPHOSPHAMIDE
moa |
crosslinks DNA-->suppressed lymphocyte fxn
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CYCLOPHOSPHAMIDE
SE's? |
Infertility
Bone Marrow Suppression Alopecia |
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CYCLOSPORINE
moa |
inhibits gene transcription
impairs T-cell's |
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CYCLOSPORINE
SE's |
Nephro and Hepato-toxicity
HTN |
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ADALIMUMAB
moa |
Recombinant Monoclonal Ab
Dec Fxn of macs and t's |
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ADALIMUMAB
SE's? |
Macrophage-dependent infection
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INFLIXIMAB
moa |
chimeric mAb
IV |
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INFLIXIMAB
indications? |
RA
Ulcerative Colitis PA |
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INFLIXIMAB
best way to give it? |
combo with methotrexate
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INFLIXIMAB
se's? |
Upper Resp Infections
Nausea HA Sinusitis Cough |
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ETANERCEPT
moa |
TNF receptor + Fc of human IgG
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ETANERCEPT
uses? |
RA
PA AS |
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ETANERCEPT
SE's? |
Injection site rxn
Opportunistic infections |
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Who do you use for Gout?
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Colchicine
Allopurinol URICOSURIC AGENTS Probenecid Sulfinpyrazone |
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COLCHICINE
moa |
binds tubulin and stops granulocyte motility
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COLCHICINE
uses? |
ONLY gouty arthritis
not analgesia prophylactic for recurrent gout |
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COLCHICINE
SE's |
N&V&D
Abd pain (from rapidly prolif GI cells) |
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ALLOPURINOL
moa |
competitive inhibitor of xanthine oxidase
(metabolite is non-competitive inhibitor) |
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ALLOPURINOL
uses? |
Chronic Gout
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ALLOPURINOL
SE's |
acute gouty attacks upon initiation, so give colchicine or indomethacin during initiation
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URICOSURIC AGENTS
moa? |
inhibit organic anion transporter in prox. tubule to cause net efflux of Uric acid.
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URICOSURIC AGENTS
uses? |
chronic gout
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PROBENECID
cautions? |
Maintain high urine output to prevent uric acid stones
Contraindicated in pts w/ kidney stones |
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SULFINPYRAZONE
activity? |
its action is additive to probenecid
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