Derm Test2 Set1

Front 1

Acute vs. Chronic wounds (4)

Back 1

Acute
1)result from direct injury or trauma
2)follow normal course of healing (most healed within 4wks)

Chronic
1)normal sequence of repair is lost (parts of wounds may be in different phases)
2)fail to show normal signs of healing in 4wks

Front 2

Ex of Chronic wounds (4), acute wounds (5)

Back 2

C)ischemic arterial ulcers
C)venous stasis ulcers
C)diabetic foot ulcers
C)decubitus or pressure ulcers

A)abrasions
A)incisions
A)lacerations
A)punctures
A)bites

Front 3

FIRST two phases of wound repair
a)coagulation (3)
b)inflammation (3)

Back 3

a)vasoconstriction
a)platelet aggregation
a)fibrin clot formation

b)vasodilation- allows PMNs and monocytes to infiltrate wound (chemotaxis)
b)macrophages replace PMN as primary inflammatory cell
b)then phagocytosis of bacteria and tissue debris and release of growth factors to signal initiaion of new tissue growth

Front 4

SECOND two phases of wound repair
a)proliferative/migration phase (4)
b)remodeling (3)

Back 4

a)begins 2-3d after injury
a)formation of granulation tissue (and new capillaries and blood vessels too)
a)re-epithelialization (migration of keratinocytes from edges of wound)
a)contraction of wound (myofibroblasts contract the edges of wound together)

b)last 3wks to 2years
b)continued deposition and reorganization of collagen
b)scar tissue will only be 80% as strong as original tissue

Front 5

Wound characteristics THAT AFFECT WOUND REPAIR (7)

Back 5

Type of Wound
a)wound w/ NO tissue loss can be apposed to facilitate more rapid healing (like laceration, NOT abrasion)

Anatomic site of wound
a)highly vascular areas heal quicker
b)lower extremities heal slower
c)areas difficult to keep disinfected heal slower (ex perianal)
d)areas prone to friction/mvmnt heal slower (knees/elbow)
e)cold temp decr healing

Front 6

Presence of Infexn (FACTOR THAT AFFECTS WOUND REPAIR)
a)terms relating to it (contamination, colonization, critical coloniztion, infexn)
b)impair wound healing by... (4)

Back 6

a)contamination- non-replicating bacteria in wound
a)colonization- bacteria replicate, but lack numbers/pathogenicity to inhibit normal wound healing
a)critical colonization- point @ which bacterial load begins to impair wound healing (10^5 bacteria per g of tissue)
a)infexn- bacterial load overwhelms host defenses and impairs healing

b)prevents re-epithelialization
b)prolong inflammatory phase
b)promoting excess tissue destruction
b)delaying collagen synthesis

Front 7

Wound environment (FACTORS AFFECTS WOUND REPAIR) (5)

Back 7

Dry wound site (crusty/scab)
a)delay wound healing
a)delay migration of keratinocytes

Excessively Wet Wound Site
b)delay wound healing
b)maceration of surrounding skin
b)infexn

Front 8

Tissue perfusion/environment (FACTORS AFFECTS WOUND REPAIR) (4)

Back 8

If poor perfusion
a)impaired leukocyte activity
a)decr production of collagen (O2 if cofactor in collagen syn)
a)can be caused by DM, COPD, CHF, PVD
a)decr epithelialization

Front 9

MEDS affecting wound repair
a)steroids (6)
b)anti-inflammatory agents (2)
c)immunosuppressant
d)chemo drugs (2)

Back 9

a)inhibits inflammatory phase
a)decr collagen syn
a)delays epithelialization
a)delays angiogenesis
a)inhibits contraction
a)incr susceptibility of infexn

b)inhibits inflammatory phase
b)impairs platelet aggregation

c)impairs immune response

d)inhibits proliferation of cells
d)inhibits DNA syn

Front 10

Pt related factors that affect wound healing (5)

Back 10

1)obesity
2)incr age
3)protein-calorie malnutrition
4)vitamins A/C/E, selenium, thiamine, pantothenic acid, Zn, Cu, Mn essential for healing
5)having DM, chronic renal failure, anemia/sickle cell

Front 11

Mneumonic for factors adversely affecting healing

Back 11

DIDN'T HEAL
D iabetes
I nfexn
D rugs
N utritional status
T issue necrosis
H ypoxia
E xcessive tension
A nother wound
L ow temperature

Front 12

Tx of Acute minor wounds (2)

Back 12

1)cleanse wound thoroughly to remove bacteria/debris
2)use topical antiseptics for application to INTACT skin on area AROUND wound

Front 13

Topical Antiseptics
a)Hydrogen Peroxide (2)
b)Alcohols (3)
c)Camphorated Phenol (2)
d)Iodine/Povidone-iodine (4)
e)Benzalkonium Chloride

Back 13

a)enzymatic release of oxygen (effervescent cleansing axn)
a)recommend AGAINST USE; limited bactericidal effect and risk of tissue damage

b)good bacteriocidal activity
b)direct application to wound can cause tissue irritation/further damage
b)will cause drying of skin

c)should be applied to dry skin ONLY
c)do NOT use a bandage w/ this agent

d)active against bacteria, fungi, virus, spores, protozoa, yeast
d)can stain skin
d)both cause further damage to wound
d)do NOT recommend colorless or decolorized iodine (NOT effective as antiseptics)

e)for G+ only

Front 14

For Acute wound prevention of infexn use.. (4) and likely pathogens (2)

Back 14

1)topical abx
2)protect the wound
3)systemic abx
4)vaccination

1)staph/strep skin flora
2)G+

Front 15

Topical Abx and acute wounds
a)bacitracin (2)
b)polymyxin (2)
c)neomycin (3)
d)TCNs (3)

Back 15

a)G+
a)availilabe in single ingredient and combo w/ others

b)G-
b)availabile in combo ONLY

c)G- and some staph
c)available in single ingredient and combo
c)high rate of hypersensitivity (3-13%)

d)G+ and G-
d)limited availability
d)high incidence of resistance (OFTEN ineffective)

Front 16

Acute wounds
a)protecting it (4)
b)systemic abx (2)

Back 16

a)cover w/ sterile, breathable bandage
a)keep wound clean
a)avoid excessive moisture/dryness
a)change bandage q24-48h (clean wound b/w changes and allow exposure to air)

b)routine use NOT recommended
b)use ONLY if wound if dog/cat/human bite, intraoral laceration, periorbital trauma

Front 17

When to give TETANUS Vaccination w/ Acute Wounds******* (5)

Back 17

1)clean, minor wound w/ unknown vacc history or less than 3 doses
2)clean, minor wound whose had 3 or more doses BUT over 10y since last dose
3)all other wounds w/ unknown vacc hx or less than 3 doses
4)all other wounds w/ 3 or more doses, BUT over 5y since last dose
5)use TIG in all other wounds w/ unknown vacc hx or less than 3 doses

Front 18

Tx of chronic wounds (4)

Back 18

1)debridement
2)topical abx to reduce wound colonization (polymicrobial, mupriocin good for MRSA, gentamicin for pseudomonas)
3)systemic abx
4)PDGF

Front 19

Debridement of chronic wounds (5)

Back 19

1)remove slough, eschar, exudates, bacterial biofilms and callus from wound bed

2)converts chronic to acute wounds via
a)sharp debridement- most rapid and precise
b)wet-to-dry debridement
c)autolytic debridement (moisture donating dressings)
d)enzymatic debridement- has enzymes that target fibrin/collage

Front 20

Systemic abx and chronic wounds (3)

Back 20

1)used when signs of tissue invasion and/or systemic symptoms are present
2)typically polymicrobial infexn
3)duration of tx based on ulcer classification, response to tx, presence of osteomyelitis

Front 21

Honey and wound tx (4)

Back 21

1)promotes formation of granulation tissues and epithelial cell growth
2)anti-inflammatory effects (decr wound exudates/edema)
3)antibacterial and antifungal activity
4)called Medihoney dressings

Front 22

Granulated Sugar and wound tx (2 and 4 disadv)

Back 22

a1)high osmolarity and decr pH to 5 to prevent bacterial growth
a2)accelerates granulation tissue formation, decr odor/drainage/edema

d)may cause burning sensation
d)may be contamination
d)requires multiple dressing changes per day
d)reported case of hyperglycemia and renal insufficiency

Front 23

Sugar paste and wound tx (3)

Back 23

1)sugar + glycerin, PEG, povidone-iodine
2)does NOT burn
3)can be made in thick/thin consistency in an effect to reach all areas of wound

Front 24

Wound dressing (adv/disadv)
a)gauzes (2/2)
b)films (4/3)

Back 24

a)inexpensive
a)accessible
d)drying
d)poor barrier

a)moisure-retentive
a)transparent
a)semi-occlusive
a)protects from contamination
d)no absorption
d)fluid trapping
d)skin trapping

Front 25

Wound dressing (adv/disadv)
a)hydrogels (3/1)
b)alginates and hydrofibers (2/2)
c)foams (3/2)

Back 25

a)moisure-retentive
a)non-traumatic removal
a)pain relief
d)may over hydrate

a)highly absorbed
a)hemostatic
d)fibrous debris
d)lateral wicking

a)absorbent
a)thermal insulation
a)occlusive
d)opaque
d)malodorous discharge

Front 26

Principle of Wound care (4)

Back 26

1)gentle soap/water can be used to clean wounds
2)avoid H2O2/alcohol b/c can worsen tissue damage (apply to intact skin only)
3)wounds heal optimally in a moist environment
4)observe for factors that may compromise a pt's ability to heal

Front 27

Burning vs Tanning (4)

Back 27

1)burning is NONadaptive mechanism
2)burning results in vasodilator mediators (histamines, PGs, cytokines)
3)burning causes incr blood flow, erythema, tissue exudates, edema and warmth
4)severe burns can results in 2nd degree burn w/ blisters, fever, chills, weakness, shock

Front 28

UVB (think b for burning) penetrates into dermis and causes and inflammatory response consisting of... (4)

Back 28

1)erythema 3-5h after exposure
2)peaks in 12-24h post exposure
3)begins to resolve in 72h
4)typically responsible for blistering, desquamation, tanning and skin cancer

Front 29

Incr risk of sunburn/photosensitization w/ these agents (10)

Back 29

1)sulfonylureas
2)diuretics
3)NSAIDs
4)antihistamines
5)amiodarone
6)phenothiazines
7)isotretinoin
8)FQs
9)TCNs
10)OCs

Front 30

Sun exposure protections (w/ chemical sunscreens) (4)

Back 30

1)products w/ SPF 30+ usually have greater amounts of chemical sunscreens (or atleast 3 different sunscreens)= incr risk of allergic rxns
2)efficacy depends on: skin type, environmental factors, amt of sunscreen applied
3)SPF 15 blocks 93% of UVB; SPF 30 blocks 97% of UVB (will NEVER get 100% no matter the SPF w/ chem sunscreen)
4)FDA says SPF of 30 gives enough protection for all skin types to prevent cancer and photoaging

Front 31

Sunscreens
a)aminobenzoic acid (PABA) (2)
b)anthranilates
c)benzophenones (2)
d)salicylates (2)
e)physical sunscreens (2)

e)cinnamates
f)dibenzoylmethane derivatives (just know these 2 exist)

Back 31

a)penetrates into skin for more long-lastin effects
a)can cause contact dermatitis, photosensitivity, sting/dry/yellowing

b)absorbs UVA (usually in combo w/ other agents)

c)absorb UVB mostly
c)oxybenzone found in cosmetics

d)weak sunscreen
d)must be used in high []s and in combo w/ other agents

e)scatter UVR rather than absorb it (so 100% protection)
e)white or colored substance + zinc oxide or titanium dioxide

Front 32

Sunscreen MOA (2)

How much to apply?

Back 32

a)incr UVR absorption by sunscreen rather than by skin
a)most penetrate and bind to the stratum corneum

b)apply liberally

Front 33

Practical issues to remember on sunscreen (5)

Back 33

1)prefer water resistant
a)SPF will be maintained after 2 twenty min dips in pool
b)very water resistant sunscreen SPF is maintain after 4 twenty min dips in pool
2)apply 30-45min prior to sun exposure

3)if NOT water proof reapply every 30min after sweating, swimming, toweling off

Front 34

Self-management Tx of 1st degree sunburns (5)

Back 34

1)NSAIDs or ASA
2)topical analgesics (camphor or menthol)
3)topical anti-inflammatory (hydrocortisone/aloe)
4)cooling compress
5)cool baths (colloidal oatmeal)

Front 35

Severe 1st/2nd degree sunburns tx (6 and last one has 4)

Back 35

1)should be eval by Dr.
2)may use tx in 1st degree burns as well
3)oral antihistamine
4)oral steroids
5)check for s/sx of infexn in burn site

6)topical anesthetics (benzocaine/lidocaine)
a)duration of axn 15-45min
b)admin 3-4x/d
c)use sparingly
d)not apply to raw, blistered or abraded skin

Front 36

If sunburn has ____ refer

Back 36

bubbles

Front 37

Exclusions to self tx of burns (5)

Back 37

1)burn to over 2% of BSA
2)burn involves eyes, ears, face, hands, feet
3)chemical, electrical, inhalation burns
4)incr age
5)immunocomp or multiple medical disorders

Front 38

Goals of care in severe burns (7)

Back 38

1)prevent deepening of wound
2)relieve pain
3)provide protective environment for wound to heal
4)prevent infexn of wound
5)provide appropriate resuscitation and preservation of organ system fxns
6)preserve physical fxn
7)tx complications aggressively

Front 39

Goals of care in severe burns
1)prevent deepening of wound
2)relieve pain
3)provide protective environment for wound to heal (2)
4)prevent infexn of wound (2)

Back 39

a)cold water compress or cold water soaks

b)analgesics, cold water compress

c)sterile, non-adherent dressing to cover the wound (change q24-48h)
c)2nd layer of absorbent gauze to keep first layer place

d)cleanse wound w/ hypoallergenic soap
d)apply sterile dressing to cover wound and topical abx

Front 40

Goals of care in severe burns
5)provide appropriate resuscitation and preservation of organ system fxns
6)preserve physical fxn (3)
7)tx complications aggressively (2)

Back 40

a)fluids, O2

b)PT
b)skin grafts
b)minimize keloid scars and contractures

c)adequate nutrition/fluid replacement
c)abx of established infexns

Front 41

Fluids and tx of severe burns (4)

Back 41

1)give in first 24-48h to prevent shock, organ failure, death
2)have large amount of fluid and electrolytes in extravascular spce due to release of vasoactive mediators and capillary damage
3)incr amounts of fluids, proteins, lytes in open wound
4)#3= decr blood volume, decr CO, decr tissue/organ perf

Front 42

What fluids to give to replace fluids in severe burn pts, how to replace, what to monitor (5)

Back 42

1)cystalloid fluids (NS or lactated ringers; LR preferred)
2)colloidal (hetastarch, albumin, plasma)- not initially

Initial replacement (BASED ON % TOTAL OF BSA BURNED***)
a)use Parkland formula to figure amount for adults
b)use Graves formula to figure amount for kids

3)After replacement monitor goal BP, HR (want under 120), UO (want 0.5-1cc/kg/h)

Front 43

Oxygen and severe burns (3)

Pain management and burns (2)

Back 43

1)give if incr CO inhalation
2)admin 100% O2 by mask
3)intubate if necessary

1)may have incr pain med use based on amt of pain, incr metabolism, and tolerance development
2)opioids/MORPHINE best (IV, PCA, or po)

Front 44

Nutrition and burns
a)metabolic rate
b)result of rate (4)
c)what to give/how (3)

Back 44

a)incr by 2-3x normal

b)severe muscle wasting
b)decr muscle strength
b)fatty liver/hepatomegaly
b)incr risk for fracture

c)give early enteral feedings (more physiological, cost effective, avoids central line complications)
c)assure appropriate electrolyte replacement and maintenance
c)incr protein and caloric requirements by 2x

Front 45

Abx/wound management (which ones) (4 and 1 thing and which is best)

Back 45

1)Td (vaccine)- see wound management
2)silver sulfadiazine******
3)mafenide acetate
4)silver nitrate solution
5)BE SURE appropriate cleansing of the wound and protective bandages

Front 46

Silver Sulfadiazine and burn tx
a)spectrum
b)desc/application (3)
c)istructions
d)ADR's
e)CI (3)

Back 46

a)cover G+ and G-, Candida and pseudomonas

b)most effective if applied IMMEDIATELY POST THERMAL INJURY to prevent bacterial colonization
b)penetrates the eschar
b)easy/painless to apply

c)1/4in cream bid; remove qd

d)neutropenia in 1st wk (will resolve)

e)pregnancy/nursing
e)sulfa allergy
e)application to eyes/mouth

Front 47

Mafenide and burn tx
a)spectrum
b)desc (3)
c)instruction
d)ADRs (2)
e)CI

Back 47

a)G+ and G-

b)primary used post-skin graft as prophylaxis
b)penetrates the eshar
b)painful to apply (pain lasts 30min after application)

c)apply 1/4in cream bid, remove qd

d)burning/pain w/ application
d)inhibits carbonic anhydrase (decr bicarb = acidosis)

e)sulfa allergy

Front 48

Silver Nitrate Solution and burn tx
a)desc/application (2)
b)instructions
c)ADRs (2)

Back 48

a)best if applied immediately post thermal injury
a)will NOT WORK in an established infexn OR IF ESHAR is formed

b)apply soaks 2-3x/d, moistening q2h (soak in fabric and wrap)

c)incr risk of loss of K/Cl/Na/Ca
c)stain skin/clothing

Front 49

Risk factors for developing drug induced skin rxns (7)

Back 49

1)incr age
2)genetic predisposition (slow acetylator)
3)hx of allergic rxns
4)hepatic/renal dysfxn
5)ROA (topical > IV > oral)
6)incr dose/duration of use
7)altered immune status

Front 50

Immunologic skin rxns (8)

Back 50

1)maculopapular eruptions
2)urticaria/angioedema
3)fixed drug eruptions
4)vasculitis
5)AGEP
6)DIHS/DRESS
7)drug-induced lupus
8)SJS/TEN

Front 51

Non-immunologic skin rxns (4)

Back 51

1)photosensitivity eruptions (photoallergy or phototoxic)
2)dyspigmentation
3)warfarin-induced necrosis
4)warfarin-induced purple toe syndrome

Front 52

Maculopapular eruptions
a)pathogenesis (2)
b)presentation (5)

Back 52

a)cell-mediated (type 4) OR
a)humoral immune-complex mechanisms (type 3)

b)most common type of drug-induced skin rxn
b)erythematous macules/papules
b)begin on trunk or pressure areas
b)usually progress in symmetrical patterns
b)may be associated w/ severe pruritis/fever

Front 53

Maculopapular eruptions
a)onset/duration (2)
b)management (4)

Back 53

a)onset occurs within 1wk of initiation of tx
a)duration is under 2wks after dc of med

b)dc of suspected med
b)cool water baths/compresses
b)oral antihistamines for pruritis
b)topical steroids for inflammation/pruritis

Front 54

Urticaria/Angioedema
a)pathogenesis (2)
b)urticaria presentation (4)
c)angioedema presentation (2)

Back 54

a)acute urticaria is IgE mediated (type 1) OR drug-induced mast cell degranulation (non-immune)
a)serum sickness (immune-complexes -- Type 3)

b)raised, defined, pruritic wheals
b)pale in center and red on outside
b)variable size/# of lesions
b)may be 1st manifestation of anaphylaxis

c)urticarial swelling of deep dermal and SQ tissues and mucous membranes
c)typically involves mouth, lips, tongue

Front 55

Urticaria/Angioedema
a)onset/duration (4)
b)management (4)

Back 55

a)onset can be very rapid (min to hrs of drug exposure)
a)duration of INDIVIDUAL LESIONS is under 24h
a)urticarial rxn can last for wks, considered chronic if over 6wks
a)angioedema can resolve after 1-2h or persist for 2-5d

b)dc suspected med
b)oral antihistamine
b)if systemic involvement (hypotension)- short course of steroids
b)if anaphylaxis (epi/steroids)

Front 56

Fixed drug eruptions
a)presentation (5)

Back 56

a)erythematous or hyperpigmented lesion
a)round/oval
a)sometimes feature bullae/vesicles, desquamation follows
a)preferentially occurs in the oral mucosa or genitalia
a)lesions present in same site upon re-exposure (ie fixed)******

Front 57

Fixed drug eruptions
a)onset/duration (3)
b)management (3)

Back 57

a)onset within hours to few wks after initiation of med
a)duration is 7-10d after dc of suspected med
a)may have residual hyperpigmentation for yrs

b)dc of suspected med
b)topical steroids may help reduce intensity of rxn
b)re-challenge w/ lower dose of suspected med to confirm dx****

Front 58

Vasculitis
a)pathogenesis
b)presentation (3)

Back 58

a)type3 hypersensitivity rxn

b)purpuric lesions w/ irregular margins on legs, butt, trunk
b)range from pinpoint to several cm
b)other lesions: macules, hemorrhagic blisters, ulcers

Front 59

Vasculitis
a)onset/duration (2)
b)management (3)

Back 59

a)onset within 7-21d of initiation of med
a)may persist for up to 4wks

b)dc suspected med
b)supportive- bed rest, compression of lesions
b)systemic steroids/immunosuppressants in severe cases

Front 60

AGEP
a)pathogenesis
b)presentaion (4)

Back 60

a)T-cell mediated (type4)

b)small non-follicular pustules overlying edematous skin
b)may coalesce and lead to ulceration
b)accompanied by FEVER and ELEVATED NEUTROPHIL counts****
b)usually begins on face or intertingiousn area

Front 61

AGEP
a)onset/duration (3)
b)management (2)

Back 61

a)onset within few days of initiating med (abx)
a)later onset, 7-14d, w/ other meds (diltiazem, chloroquine)
a)resolve spontaneously in under 15d

b)dc suspected med
b)supportive care

Front 62

DIHS/DRESS
a)presentation (3)

Back 62

a)widespread erythematous eruption
a)w/ fever, FACIAL/PERIORBITAL EDEMA and EOSINPHILIA*******
a)morality up to 10%

Front 63

DIHS/DRESS
a)onset/duration (2)
b)management (3)

Back 63

a)cutaneous rxn begins 2-8wks after initiation of med
a)s/sx may persist for several wks

b)dc of suspected med
b)systemic steroids for severe cases
b)high potency topical steroids (augmented betamethasone)

Front 64

Drug induced lupus
a)pathogenesis
b)predisposing factors (4)
c)presentation (3)

Back 64

a)due to development of autoantibodies

b)50-70yo
b)females=males
b)white > blacks (in terms of risk)
b)slow acetylators

c)variant of autoimmune lupus (idiopathic lupus)
c)"butterfly rash"
c)presence of antinuclear antibodies

Front 65

Drug induced lupus
a)onset/duration (2)
b)management (3)

Back 65

a)can present months to yrs after exposure to med
a)resolves within days to months after dc of culprit med

b)dc suspected med
b)NSAIDs may help resolve symptoms faster
b)steroids for severe cases

Front 66

SJS
a)pathogenesis
b)presentation (5)

Back 66

a)cell-mediated (type4)

b)1-14d is prodromal period w/ n/v, conjunctiv/pharyngitis, my/arthralgia
b)purpuric lesions and extensive blistering
b)mortality is 5%
b)can have mucosal involvement
b)epidermal deatchment up to 10% of BSA******

Front 67

SJS
a)onset/duration (2)
b)managmenet (4)

Back 67

a)1-3wks after start of med
a)healing occurs in 3-4wks

b)dc suspected med IMMEDIATELY (decr mortality if dc'd quicker)
b)systemic steroids
b)fluid replacement/TPN
b)drug re-challenge is NEVER justified

Front 68

TEN
a)pathogenesis
b)presentation (6)

Back 68

a)cell mediated (type4)

b)same prodromal phase as SJS (1-14d)
b)acute phase has fever, burning, painful rash on face/trunk
b)then is widespread FULL-thickness epidermal necrosis and detachment*****
b)involves over 30% of BSA
b)common to involve mucous membranes
b)high morality rate (40%)--usually due to infexn

Front 69

TEN
a)onset/duration (2)
b)management (4)

Back 69

a)occurs 1-3wks after intiation of med
a)phenytoin-induced TEN occurs 2-8wks after initiation

b)dc suspected med
b)F/E/TPN
b)tx/prevent infexn
b)high doses of IVIG and use of immunosuppressive agents
b)steroid use controversial

Front 70

Meds involved w/
a)Maculopapular eruptions (5)
b)Urticaria (and 1 tx) (6)
c)Angioedema

Back 70

a)PCNs (highest rates)
a)cephalosporins
a)sulfonamides
a)phenytoin
a)tegretol

b)PCNs
b)cephalosporins
b)sulfonamides
b)TCN
b)opioids
b)vancomycin (redman; premed w/ diphen or slow infusion)

c)ACEI's

Front 71

Meds involved w/
a)fixed drug eruptioins (8)
b)vasculitis (5)

Back 71

a)barbituates
a)tegretol
a)lamotrigine
a)metronidazole
a)PCN
a)TCN
a)Bactrim
a)NSAIDs

b)allpurinol
b)MTX
b)minocycline
b)hydralazine
b)propylthiouracil

Front 72

Meds involved w/
a)AGEP (6)
b)DIHS/DRESS (10)

Back 72

a)cephalosporins
a)chloroquine/hydroxychloroquine
a)diltiazem
a)dexamethasone
a)amoxicillin/ampicillin
a)macrolides

b)abacavir
b)atenolol
b)captopril
b)tegretol
b)diltiazem
b)isoniazid
b)lamotrigine
b)NSAIDs
b)phenytoin
b)Bactrim

Front 73

Meds involved w/
a)drug induced lupus (6)
b)SJS/TEN (7)

Back 73

a)diltiazem
a)hydralazine
a)quinidine
a)isoniazid
a)minocycline
a)procainamide

b)B-lactams
b)tegretol
b)lamotrigine
b)NSAIDs
b)phenytoin
b)sulfomamides
b)Bactrim

Front 74

Photosensitivity rxns
a)pathogenesis (phototoxic) (2)
b)pathogenesis (phototallergic) (2)

c)presentation (phototoxic) (2)
d)presentation (photoallergic) (2)

Back 74

a)drug acts as chromophore and absorbs UV (generates free rads)
a)dose dependent response

b)UV causes drug to bind as hapten to protein on epidermal cells (IMMUNOLOGIC)
b)NOT dose dependent

c)severe sunburn (blistering)
c)confined to areas exposed to light

d)pruritis exzema eruption
d)can spread beyond areas exposed to light

Front 75

Phototoxic rxn
a)onset/duration of toxic/allergic (1each)
b)phototoxic management (3)
c)photoallergy management (3)
d)management for both
e)drugs

Back 75

a)phototoxic- rxns evident 5-20h after exposure to drug AND light
a)photoallergic- rxns occur 24-72h after exposure to drug AND light (slower b/c immune mediated; fyi)

b)NO need to stop med
b)routine burn care
b)provide protection from additional sunlight exposure

c)dc suspected med
c)oral antihistamine for s/sx relief
c)topical steroids

d)PROTECTION FROM SUN

e)see drugs in sunburn lecture

Front 76

Dyspigmentation
a)pathogenesis (2)
b)presentation (2)
c)management (2)

Back 76

a)incr melanin synthesis
a)cutaneous deposition of drug related material

b)pigmentation may be widespread or local
b)deposits can occasionally occur in internal organs

c)dc med (especially w/ antimalarials)
c)avoid sun exposure

Front 77

Dyspigmentation
a)onset/duration/meds (3)

Back 77

Antimalarials- after 4mon of tx; return to normal several mon after dc of med (blue-grey)

Minocycline- after long term use or high cumulative dose; gradually fades upon dc (blue-grey/brown)

Amiodarone- after long term use or dose over 400mg/d; resovles over months to yrs following dc (slate gray)

Front 78

Warfarin induced necrosis
a)pathogenesis (3)
b)presentation (3)
c)onset/duration
d)management (3)

Back 78

a)associated w/ protein C deficiency (natural anticoag and is vitK dependent)
a)results in hypercoagulation and thrombosis in microvasculature
a)may be dose related (LD)

b)demarcated, erythematous, pupuric lesions
b)can progress to hemorrhagic bullae w/ eventual necrosis
b)females > males

c)occurs b/w 3-10d of tx w/ warfarin

d)dc warfarin
d)admin vitK and heparin
d)most do NOT develop necrosis upon re-initiation

Front 79

Warfarin-induced purple toe syndrome
a)pathogenesis (2)
b)presentation (3)
c)onset/duration (2)
d)management (2)

Back 79

a)related to cholesterol emboli from plaques
a)NOT related to warfarin dose

b)characterized by sudden discolorization of toes/sides of feet
b)affected area is cold/tender to touch w/ burning sensation
b)males > females

c)develops after 3-8wks of tx
c)toe pain resolves after dc, but purple color persists

d)dc warfarin
d)try to reinitiate circulation

Front 80

Dandruff
a)clinical presentation (3)
b)etiology/pathophys (3)

Back 80

a)ACCELERATED EPIDERMAL GROWTH
a)diffuse patchy white/gray scales on scalp
a)scales do NOT itch

b)hyperproliferative skin disorder
b)incr skin turnover w/ abnormal skin
b)dandruff cell turnover is 13-15d (normal is 25-30d)

Front 81

Seborrheic dermatitis
a)clinical presentation (4)
b)etiology/pathophys (4)

Back 81

a)chronic, inflammatory condition associated w/ pruritis or burning
a)affects areas of head and trunk w/ most sebasceous gland activity
a)has oily, yellowish scales
a)mostly happens in older ppl; can see cradle cap in young kids

b)cell turnover is 9-10d (incr epidermal production)
b)enhanced sebaceous gland activity
b)genetic predisposition
b)may involve fungus P.ovale

Front 82

Agents to use w/ seborrheic dermatitis AND dandruff (8)

Back 82

a)pyrithione zine (cytostatic)
b)selenium sulfide (cytostatic)
c)coal tar (cytostatic)
d)salicylic acid (keratolytic)
e)sulfur (keratolytic)
f)ketoconazole/miconazole/clotrmazle (antifungal)
g)terbinafine
h)hydrocortisone (NOT IN DANDRUFF)

Front 83

Pyrithione zinc (DANDRUFF/SEBORRHEIC)
a)administration
b)desc (3)

Back 83

a)apply to scalp and leave on 5-10min; rinse

b)use qd initially then twice weekly as needed
b)absorption incr w/ contact, time, freq of application
b)can use on scalp, face, body

Front 84

Selenium Sulfide (DANDRUFF/SEBORRHEIC)
a)admin
b)desc (4)
c)ADR (3)

Back 84

a)apply to scalp leave on 5-10min; rinse

b)use qd initially then twice weekly as needed
b)absorption incr w/ time
b)apply to intact skin only (systemic toxicity)
b)can use on scalp, face, body

c)discoloration of white/blonde hair
c)irritating to eyes/scalp
c)hair loss

Front 85

Coal Tar (DANDRUFF/SEBORRHEIC)
a)admin
b)desc (4)
c)ADR (3)

Back 85

a)apply and leave 5-10min; some applied hs and left overnight

b)use daily as needed then as needed
b)do NOT use for over 6mon w/o monitoring
b)Goeckerman method (used in combo w/ UV)
b)can use in scalp, face, body

c)messy/stains skin
c)strong odor
c)folliculitis/rash/irritaion

Front 86

MOA of ____ dandruff/seborrheic agents:
a)cytostatic agents
b)keratolytic agents (2)
c)antifungal
d)topical steroids (3)

Back 86

a)decr epithelial cell turnover rate

b)decr epithelial turnover
b)loose/lyse keratin aggragates causing removal from scalp in smaller particles

c)active against P.ovale

d)anti-inflam/anti-mitotic/anti-pruritic
d)vasoconstrictive
d)immunosuppressive

Front 87

Salicylic acid (DANDRUFF/SEBORRHEIC)
a)admin
b)desc (3)
c)ADR

Back 87

a)apply and leave in 5-10min; rinse

b)keratolytic effect can take 2-10d
b)can use on scalp, face, body
b)risk of toxicity if applied over large areas

c)irritation of skin/mucous membranes

Front 88

Sulfur (DANDRUFF/SEBORRHEIC)
a)admin
b)desc (2)
c)ADR

Back 88

a)apply for 5-10min; remove

b)often combined w/ salicylic acid
b)can use on scalp, face, body

c)irritation of skin/mucous membranes

Front 89

Ketoconazole (DANDRUFF/SEBORRHEIC)
a)admin (shampoo/cream) (2)
b)ADR (2)
c)use of shampoo/cream (2)

Back 89

a)shampoo for 1-3min and rinse for 2x/wk w/ 3d b/w tx for 4wks
a)cream apply qqd or bid to affected areas for 4wks

b)skin irritation/stinging/pruritis
b)hair loss

c)can use on scalp, face, body
c)can only use on face, body

Front 90

Miconazole/clotrimazole/terbinafine (DANDRUFF/SEBORRHEIC)
a)admin
b)ADR
d)use

Hydrocortisone
a)admin

Back 90

a)apply qd or bid
b)skin irritation/pruritis
c)face and body only

a)apply bid to qid; do NOT use for over 7d w/o MD monitoring

Front 91

Psoriasis
a)presentation (6)

Back 91

1)chronic inflammatory condition
2)males=females
3)rapid turnover and hyperkeratinization of epithelial cells
4)exacerbations/remissions common
5)plaques are sharply demarcated, dry, thick skin
6)have silvery/white scale and are red

Front 92

Psoriasis
a)etiology/pathophys (4)
b)triggers (4)

Back 92

a)malfxn in T-cell immunity
a)cell turnover is 3-4d
a)abnormal pattern of keratinzation
a)genetics

b)skin trauma
b)infexn
b)climate may exacerbate/alleviate
b)meds like antimalarials, BB, steroid withdrawal

Front 93

Topical Agents used in Psoriasis (8)

Back 93

1)emollients (glycerin)
2)keratolytic agents (salicylic acid)
3)Coal tar
4)topical steroids
5)anthralin
6)Calcipotriene (vit D3)
7)Tazarotene
8)Topical psoralens (methoxsalen)

Front 94

Systemic Agents used in Psoriasis (6)

Back 94

1)oral psoralens (methoxsalen)
2)MTX (first line)
3)oral retinoids (acitretin)
4)cyclosporine (first line too)
5)tacrolimus
6)hydroxyurea

Front 95

Biologic Agents used in Psoriasis (5) and risk w/ all of them

Back 95

1)infliximab
2)etanercept
3)alefacept
4)efalizumab
5)adalimumab

RISK OF INFEXN W/ ALL

Front 96

Infliximab (PSORIASIS)
a)MOA
b)dosing
c)ADR (4)
d)special considerations (3)

Back 96

a)inhibits TNF alpha
b)5mg/kg IV over 2h

c)infusion rxns
c)URI
c)nausea/ab pain
c)fever

d)TB skin testing
d)CI in severe CHF****
d)avoid live vaccines

Front 97

Etanercept (PSORIASIS)
a)MOA
b)dosing
c)ADR (4)
d)special considerations (2)

Back 97

a)inhibit TNF alpha
b)25mg SQ twice weekly

c)injexn site rxns
c)HA
c)rhinitis
c)URI

d)CI in pts w/ sepsis*****
d)rotate injexn sites

Front 98

Adalimumab (PSORIASIS)
a)MOA
b)dosing
c)ADR (4)
d)special considerations

Back 98

a)inhibits TNF alpha
b)40mg SQ weekly or every other week

c)injexn site rxns
c)rhinitis
c)HA
c)flu-like s/sx

d)TB skin testing

Front 99

Alefacept (PSORIASIS)
a)MOA
b)dosing
c)ADR (4)
d)special considerations

Back 99

a)decr T-cell counts (immunosuppress)
b)7.5mg IV weekly; 15mg IM x12wks

c)injexn site rxns
c)pharyngitis
c)myalgia
c)CV events

d)NOT in gutt, pust or erythrodermic psoriasis

Front 100

Efalizumab (PSORIASIS)
a)MOA
b)dosing
c)ADR (3)
d)special considerations (2)

Back 100

a)inhibits Tcells by CD11 inhibitor
b)1mg/kg SQ weekly x12wks

c)HA
c)flu-like s/sx
c)myalgia

d)NOT in gutt, pust or erythrodermic psoriasis
d)NO in pts w/ allergies/asthma