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190 Cards in this Set
- Front
- Back
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What are the 3 layers of the skin?
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Epidermis (Outer layer, divides to form keratinocytes, stratum corneum is the outer most layer), Dermis (has nerves, hair follicles and glands) and Subcutaneous tissue (deepest layer)
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What cells do acne meds work on?
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Keratinocytes
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T or F: Topical meds can penetrate the dermis?
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False, cannot penetrate the dermis
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Do topical Antivirals work?
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No, never Rx
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How do you tx think keloids?
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Intralesional steroids
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How does skin affect drug exposure?
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Absorption is higher where skin in thinner, absorption is higher where skin is broken and mucous membranes absorb more drugs
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T or F: The vehicle of the drug affects its absorption?
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True
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What is an ointment?
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Mixture of limited number of organic compounds consists of petroleum jelly with little or no water, it’s translucent and a greasy feeling persists on the skin
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What is an ointment good for?
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Drier lesions and atopic dermatitis because has higher potency
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What is an ointment bad for?
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Too occlusive for exudative eczema inflammation and interiginous areas
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What is a cream?
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Mixture of different organic oils and water, white, somewhat greasy. The most commonly rx’ed base and is used on nearly all body parts and cosmetically most accepted.
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What is a cream good on?
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Acute exfolliative dermatitis
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What is a cream not good on?
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Not best on atopic dermatitis and can be drying after a time
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What is a lotion?
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Alcohol, water and some chemicals that can be milky or clear. Good for covering large areas but can be drying or irritating
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What is a gel?
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Greaseless, mixtures of propylene glycol, water and alcohol that gives a unpleasant silky feel
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What are gels good for?
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Feels cool and is useful in acute exudative inflammation and scalp lesions
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What’s bad with gels?
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Not moisturizing, may be drying or irritating
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What is a solution?
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Alcohol, water and some chemicals
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What is a solution good at?
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Best at penetrating the scalp because it penetrates hair follicles
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Why is a solution bad?
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May be drying or irritating on interiginous areas
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What is aerosol?
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Drugs suspended in a base and delivered by a propellant
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What is aerosol good for?
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Useful on scalp and good for pts who lack mobility and have difficulty reaching lower legs
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Children absorb _________ times as much as adults.
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3
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Children under the age of 12 can’t receive which topical steroids?
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Group 1 and 2 because they absorb so much of the med and are likely to have suppression of the hypothalamic pituitary tract
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How much is Rx’d for the face?
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TID, 10 days 45gm
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How much Rx’d for the chest or back?
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TID, 10 days 180gm
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How much is Rx’d for the Arm?
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TID, 10 days 90gm
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How much is Rx’d for the hand or foot?
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TID, 10 days, 45gm
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How much is Rx’d for the upper thigh?
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9gm
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What are the instructions for using creams, ointments and pastes?
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Small amount on palm of hand, rub hands together, apply thin layer onto skin, apply in long downward strokes, may use a tongue blade if needed. Do not rub in back and forth motion
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What are the instructions for lotions?
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Shake container well, pour small amount in palm of hand, apply to skin with downward strokes, wash hands after application
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What’s the hallmark of strep on the skin?
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Crust
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What’s the hallmark of staph on the sking?
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Bollus
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What should a patient with a minor skin infection get?
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Mupirocin 2% (Bactroban)
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What should be done for a patient with a cutaneous abscess?
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Incision and drainage is primary treatment, role of ABX is undetermined
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What is Mupirocin active against?
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Gram positive
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What is Bacitracin active against?
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Gram positive but RMJ says this drug is a waste
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What is Erythromycin active against?
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Gram positive, good for ance and eyes
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What is Gentamycin active against?
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Gram negative, good for eye infections
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What is Neomycin active against?
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Gram negative
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What organisms is Mupirocin active against?
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S. aureus, b hemolytic strep, s pyogenes and maybe pseudomonas
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Can you put Mupirocin in the eye?
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NO
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What is good for epistaxis?
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Mupirocin but it may cause burning and stinging
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You can only give Mupirocin if the infection is on less than _______ of the body?
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20%, if more than this you need to give PO med
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After giving Mupirocin, when should you reassess the pt?
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In 2-3 days, if still intensive really need to come back because cellulitis
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T or F: Children commonly get gram negative infections on the skin?
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False, very rare
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What is Bacitracin active against?
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Strep, clostridium and staph
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Why is Bacitracin not great?
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It’s poorly absorbed, allergy is rare but may develop, not very strong, has narrow spectrum of activity
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What are the side effects of Bacitracin?
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Pruritis and burning at application site
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What is Polymixin B?
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Peptide antibiotic, functions of detergent to disrupt the phospholipid bacterial cell membrane
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What is Polymixin B active against?
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Gram negative, proteus mirabils, pseudomonas and serratina marcessants
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What should you do with a pt with proteus on the skin and a UTI?
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Renal u/s
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What’s the MOA of Neomycin?
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Binds to bacterial 30S ribosome subunit and inhibits protein synthesis
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Who is Neomycin contraindicated for?
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Pts with renal disease
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Why is Neomycin bad?
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It’s highly sensitizing
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What’s the most common Rx for impetigo prophylaxis?
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Bacitracin
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What’s more effective than Neomycin?
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Gentamycin
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What are the adverse reactions of Gentamycin?
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Dryness, stinging, burning and contact allergy
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What is tinea?
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Dermatophyte fungus common in skin and nail infections, live in and infect dead keratin of the stratum corneum, affects mucosa as well and in immune suppressed pts can cause internal infection
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What is the mainstay Antifungal?
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Azoles
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What can you try if an azole does not tx a fungal infection?
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Allyamine/Benzylamine derivatives, hydroxypyridones or selenium sulfide
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What med is the most common to an azole?
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Terbinafine (Lamisil)
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What is used to tx Tinea Pedis?
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Lotrimin, Tinactin, Lamisil and Miconazole
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What’s the hallmark of tinea?
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A highly pruritic lesion
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T or F: All Azoles are equally effective for tinea pedis?
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True
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If azole doesn’t tx tinea pedis, what should you give?
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Allylamine, usually Terbinafine
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What is the MOA of Azoles?
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Inhibit fungal activity by preventing formation of ergosterol required for cell wall synthesis
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What are the side effects of Azoles?
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Erythema, burning, stinging, peeling, blistering, edema, pruritis, urticaria and allergic contact dermatitis
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Why is Naftifine not great to use against tinea?
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Because it doesn’t work against t. tonsurans and microsporum species
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T or F: Terbinafine is not very well tolerated?
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False, it’s well tolerated with no reported toxicity
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What is effective against seborrhea dermatitis?
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Terbinafine
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What are the adverse effects of Terbinafine?
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Stinging, pruritis and edema
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What is pityriasis versicolor?
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Superficial scaling of hypopigmented or hyperpigmented macules or flat papules on the upper trunk, arms, neck and face
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Where and when is pityriasis versicolor most common?
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High humidity, high temperature and more common in the spring and summer
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What is the tx of pityriasis versicolor?
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Selenium sulfide shampoo, ketoconazole shampoo or ketoconazole 200mg for 3 days PO
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What is the important pt education for pityriasis versicolor?
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It will recur, tx must be thorough, hypopigmentation will occur with sun exposure, tx recurrences early and may require monthly prophylaxis
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What is seborrheic dermatitis?
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Greasy scaly dermatitis characterized by diffuse red crusted with yellow scaling in infancy
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What organisms cause seborrheic dermatitis?
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Pitysporum ovale or malassezia yeast
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What are available antifungal topical shampoos?
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Nizoril shampoo, keratolytic shampoo, Selsun is better than ketoconazole and topical tacrolimus (not recommended)
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What’s the tx for lice?
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Malathion and permetherin (first line)
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What’s the tx for scabies?
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Permetherin (first line)
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What’s the MOA of permetherin?
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Acts on parasitic cell membrane ATPases to disrupt sodium transport and lead to paralysis of the mite
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In scabies tx, how do you use permetherin?
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Apply from the neck down for 8 to 14 hours
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What are the side effects of permetherin?
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Irritation, tingling sensation and burning at site of application
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What is the second line tx for scabies?
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Malathion, has the fastest killing
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What is the MOA of Malathion?
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Cholinesterase inhibitor – will cause wetness and lice will die in their own secretions
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Why isn’t Malathion first line tx?
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Odor and alcohol, which burns
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How is Malathion used?
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Applied for 12 hours and then washed off
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Is Lindane recommended for use?
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No
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How are PO antihistamines used in the treatment of scabies/lice?
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To treat the itch
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Who should be treated when a pt has lice or scabies?
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The entire family (write for enough refills)
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When should a pt come back in for follow up to monitor scabies/lice?
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10 days
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What strength of steroid should be used to tx scabies/lice?
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Medium strength
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What is Crotamiton?
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A colorless oil in treatment of scabies but it’s very ineffective
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What are the adverse effects of Crotamiton?
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Skin irritation and allergic sensitivity
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What are the adverse effects of Malathion?
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Skin irritation, sm possibility of systemic toxicity, abd cramps, respiratory distress, muscle paralysis and seizure
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What are the adverse effects of Permetherin?
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Pruritis, mild transient burning, stinging, itching, numbness and rash (serious)
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What are the adverse effects of Lindane?
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Skin irritation and very sm chance of CNS effects
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What acne often lead to in adulthood?
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Rosacea
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Earlier treatment of acne leads to?
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Better results
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What should you never put on a teenagers face?
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Hydrocortisone cream
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What causes acne?
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Androgens are main factor, other hormones like estrogen, growth hormone, IGF-1, insulin, corticotropin releasing hormone, the excess sebum production is due to a difference in response of the pilosebaceous unit
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What is the pathophysiology of acne?
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Sebaceous hyperplasia with seborrhea, ductal hypercornification, propiobacterium acnes colonization of the duct, inflammation and immune response
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What are papules?
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1-5mm erythematous “bumps” that can be seen as well as felt, may or may not be tender, part of the continuum from pustule to nodule, resolves with post inflammatory red/brown pigmentation and there is a potential for scarring
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What must be done to a close comodome?
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Rx to open
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Why do scarring and nodules occur?
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Picking
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What is a pustule?
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Up to 5mm bumps with soft, white center, when the pustules rupture the papules remain, there’s a potential for scarring and there’s usually fewer pustules than papules
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What is the MOA of retinoids?
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Not all are known but acts on receptors that are bound by their ligand, altered gene transcription that affects the epidermal layer and keratinocyte growth and differentiation, promotes and increases cell turnover of the nrm follicle and comedomes (prevented)
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What’s best for inflammatory acne?
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Retinoids in combination with other topicals or oral abx
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What treats post inflammatory hyperpigmentation?
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Retinoids
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How do you use Retinoid cream?
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Not a spot tx, needs to be put on entire face, 3 dots on forehead and 3 on each cheek
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When should Retinoids be used?
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At night
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How long do you use Retinoids before seeing results?
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4-6 weeks to get better and it will get worse before it gets better
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What are the adverse effects of Retinoids?
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Erythema (most common), pruritis, burning, stinging, dryness, increased photosensitivity, irritation, highly susceptible to sun damage
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What things can interact with Retinoids?
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Cosmetics, astringents, alcohol and acne soaps
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How do you deal with the redness associated with Retinoids?
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For week 1 leave on 1 hour then wash off and increase weekly, after 3 weeks can use overnight
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What is Salicylic Acid?
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What’s in Proactive, well tolerated keratolytic agent, it’s very very very very drying so good on an oily face
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What is Benzoyl Perixide good for?
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Effective for mild and moderate acne
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Is Benzoyl Perixide systemically absorbed?
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Nope
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What’s the best formulation of Benzoyl Perixide?
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A wash, has best compliance
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What are the adverse effects of Benzoyl Perixide?
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Irritation, erythema, edema, photosensitivity
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How do you treat the adverse effects of Benzoyl Perixide?
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Cool compress and avoiding sunlight
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What are the most common topical abx used in acne tx?
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Clindamycin and Erythromycin
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How long can Clinda and Eryth be used in acne tx?
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No more than 12 weeks because bacterial resistance can occur – then try benzoyl perixide
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What’s the deal with combination of abx and benzoyl perixide?
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They work really well but they’re super sensitive
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How long can you use topical combination acne products?
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No more than 3 months
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What are warning signs in kids with acne?
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Growth abnormalities, blood pressure, early signs of puberty, acne that is resistant to treatment, testosterone excess and body odor
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What should be done with nodular acne?
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Sent to derm
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Who should Rx Accutane?
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Derm
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T or F: Neonatal acne is very common and will go away?
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True
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When is the time that a child who presents with acne is most likely to have an underlying endocrine disorder?
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Mid Childhood
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What are the endocrine disorders associated with acne?
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Polycystic ovarian syndrome, Cushings, Congenital Adrenal Hyperplasia, Androgen secreting tumors and Acromegaly
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What are the diseases associated with acne?
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Alpert Syndrome, Behcets, PAPA Syndrome and Acne
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What meds cause acne?
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Danazol, Testosterone, Progestins, Glucocorticoids, Lithium, Isonazid, Phenytoin, Vitamin B and Halogens
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What’s acne like in preteen times?
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Central facial with comedomal acne
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What’s acne like in teen years?
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Face and trunk with mixed appearance
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What’s acne like in adult?
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Perioral area, jaw and upper neck
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What’s the initial management for mild acne?
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Benzoyl Perixide or a topical retinoid or topical combination of benzoyl perixide and abx
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What’s management for mild acne if the initial management doesn’t work?
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Add benzoyl perixide or retinoid in not already using, change topical retinoid concentration
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What the initial tx for moderate acne?
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Topical combination of benzoyl perixide and retinoid, or retinoid and abx or abx, retinoid and benzoyl perixide or oral abx with a topical retinoid
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What is tx for moderate acne if the initial therapy doesn’t work?
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Change retinoid concentration, add or change abx, homone therapy in females or accutane
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What is adjunctive therapy for acne?
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Washes, rubs, masks, abrasives, astrinents, pore cleansers, cover ups, vibrating or heating devices
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What’s first line for comedonal acne?
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Topical retinoids
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What’s adjunctive therapy for comedonal acne?
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Salicylic acid, BPO and azeleic acid
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What’s first line therapy for mild popular/pustular acne?
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TR with or without BPO or topical abx
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What’s adjunctive therapy for mild popular/pustular acne?
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Sulfur/sodium sulfacetam and axeitic acid
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What’s first line therapy for moderate popular/pustular acne?
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TR with abx with BPO or TA/BPO
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What’s adjunctive therapy for moderate popular/pustular acne?
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Hormone therapy and TR with BPO or TA/BPO
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What’s the first line tx for moderate nodular acne?
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TR with OA with BPO or TA with BPO
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What’s adjunctive therapy for moderate nodular acne?
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Oral isotrethinion, hormonal therapy with TR, BPO, TA/BPO
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What’s first line tx for severe nodular acne?
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Oral isotrention
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What’s adjunctive therapy for severe nodular acne?
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OA with TR with BPO or TA/BP
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What’s the tx for contact dermatitis?
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Topical corticosteroids
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What’s the most common cause of allergic contact dermatitis?
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Nickel
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What’s the best formulation for treating weeping contact dermatitis?
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A foam but they’re really expensive
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What are Group 1 and 2 steroids reserved for?
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Severe contact or palms of hands/soles of feet
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What’s a medium strength steroid?
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Triamcinalone
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What’s an example of a Group 1 steroid?
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Very high, betamethasone propionate ointment
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What’s an example of a Group 2 steroid?
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Betamethasone valerate ointment
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What’s an example of a Group 3 steroid?
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Betamethasone dipropionate lotion
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What’s an example of a Group 4 steroid?
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Hydrocortisone ointment
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What groups of steroids are OTC?
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5-7
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What are the adverse effects of topical steroids?
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Supression of the hypothalamus pituitary axis, thinning of skin and vascular lesions
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How often can you use topical steroids?
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2 weeks out of the month
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What is the MOA of Calcineurin Inhibitors?
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Immunosuppressive drugs. Blocks the production of proinflammatory cytokines by T lymphocytes and prevents release of inflammatory mediators from cutaneous mast cells and basophils
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What are examples of Calcineurin Inhibitors?
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Elidel and Protopic
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What is the Black Box Warning associated with Calcineurin Inhibitors?
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Rare lymphoma in mice
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What are Calcineurin Inhibitors good for?
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Highly effective and very good at treating atopy around the eyes
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What are the adverse effects of Calcineurin Inhibitors?
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Transient local reactions, mild to moderate burning, warmth, itching and erythema
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What does Vaseline cause in African Americans?
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Keratosis
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What is Psoriasis?
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Chronic inflammatory disease of the skin, characterized by silvery white plaques that are scaly, is usually symmetrical and causes characteristic nail changes like nail pitting, oncholysis and sub-ungal debris
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Where is Psoriasis usually found?
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Front of knees and back of elbows
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What is the first episode of strep usually triggered by?
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Strep
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What precipitates a flare up Psoriasis?
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Trauma, infection, endocrine imbalance, drugs and emotional stress
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What is the first line tx of Psoriasis?
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Latest is Anthralin Cream
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What are the other tx of Psoriasis?
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Topical steroids, Tar, Topical Calcineurin Inhibitors, Phototherapy and systemic agents (cyclosporine, oral abx, methotrexate and retinoids)
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What is the most common tx of Psoriasis?
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I guess it’s steroids, RMJ says most of them are approved for use
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What is the tx for Pityriasis Rosea?
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Sunlight, Erythromycin and Acyclovir (doesn’t usually work)
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What are the pros of using Bacitracin on a burn?
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Inexpensive and OTC also provides a moist environment for reepithelialization
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What are the cons of using Bacitracin on a burn?
|
Prolonged use leads to yeasts, does not cover pseudomonas (most common) so it’s not really recommended
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What are the pros of using Silver Sulfadiazine cream on a burn?
|
Inexpensive, nonpainful, soothing, broad spectrum (VRE, MRSA, pseudomonas) and provides a moist environment.
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What’s the best med for extensive burns with possible pseudomonas infection?
|
Silver sulfadiazine
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Is Provodone Iodine Solution used to tx burns?
|
No because highly allergenic, pruritic, may delay wound healing and has systemic absorption with many side effects
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What is a Hydrocolloid?
|
Dressing with gel that covers wound, prevents dessication, requires fewer dressing changes, stimulates wound healing, hypoallergenic and relatively low cost
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What is a Hydrogel?
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Nonadherent gel, ideal for all partial thickness burns, reduces pain, not for third degree burns but is a little expensive
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What is Hydrofiber?
|
Soft gel dressing that requires very few dressing changes, better scar formation, is really good for peds pts but like $100
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What is Biobane?
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Biosynthetic dressing with very low infection rate
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What is Transcyte?
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Extracellular matrix dressing, decreases pain, decreased healing time, low scarring, highly effective, super expensive
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What is EZ Derm?
|
Xenogenic skin substitute that can be used prior to a skin graft, low risk of disease transmission
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What is Dermagraft?
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Substitute skin, secretes collagen, lack of rejection or disease transmission but super crazy expensive
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