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63 Cards in this Set

  • Front
  • Back
Oral Psoralens-Methoxaslen (PSORIASIS)
a)MOA (2)
b)dosing
c)ADR (3)
d)special considerations
a)anti-proliferative, anti-inflammatory, immunosuppressive
a)combined w/ phototherapy (UVA)

b)0.6mg/kg po q2h b4 UVA

c)phototoxic
c)n/v/d
c)cataracts

d)phototoxic rxns to UVA @ 48-72h
Methotrexate (PSORIASIS)
a)MOA
b)dosing
c)ADR (4)
d)special considerations (3)
a)inhibit DHFR to decr DNA/RNA/protein thereby decr epidermal prolif
b)2.5-5mg po q12h for 3doses/wk (max of 30mg/wk)

c)bone marrow depression
c)liver damage
c)pulmonary fibrosis
c)phototoxicity

d)CI in liver/kidney disease
d)NO in pregnancy
d)NO if immunosuppressed
Oral Retinoids-Acitretin (PSORIASIS)
b)dosing
c)ADR (3)
d)special considerations (2)
b)0.25-0.5mg/kg/d initial; 0.125-0.5mg/kg/d for 3-6mon

c)LFT changes
c)renal fxn changes
c)skin dry/peel

d)avoid in liver/kidney disease
d)avoid in pregnancy
Cyclosporine (PSORIASIS)
a)MOA
b)dosing
c)ADR (3)
d)special considerations (3 and 4 drug interaxns)
a)inhibits Tcells; anti-inflammatory
b)3mg/kg/d initially; 1-5mg/kg/d (up to 2years)

c)nephrotoxicity
c)tremor
c)HTN

d)CI in pregnancy/lactation
d)avoid in liver/kidney disease
d)interacts w/ dig/diltiazem/lovastatin/ketoconazole
Tacrolimus (PSORIASIS)
a)MOA
b)dosing
c)ADR (3)
d)special considerations
a)interferes w/ IL2/IL8 decr Tcells and decr neutrophil chemotaxis
b)0.05-0.15mg/kg qd to bid

c)HTN
c)LFT changes
c)nephrotoxicity

d)monitor LFT/renal
Hydroxyurea (PSORIASIS)
a)MOA
b)dosing
c)ADR (3)
d)special considerations (2)
a)interferes w/ DNA syn (immunosupp)
b)1g/d (up to 2g/d)

c)bone marrow tox
c)leg ulcers
c)anemia

d)monitor CBC/platelets
d)monitor liver/renal
Emollinets (PSORIASIS)
a)MOA
b)dosing
c)ADR (2)
d)special considerations
a)form occlusive film on skin allowing rehydration
b)apply liberally 3-4x daily

c)folliculitis
c)contact dermatitis

d)avoid eyes
Keratolytic agents-Salicylic acid (PSORIASIS)
a)MOA (2)
b)dosing
c)ADR (2)
d)special considerations
a)remove scales
a)reduce hyperkeratosis
b)apply 2-3x daily

c)skin irritation
c)salicylism (n/v/tinnitus)

d)avoid using on large areas
Coal Tar (PSORIASIS)
a)MOA
b)dosing
c)ADR (3)
d)special considerations
a)cytotoxic to psoriatic cells
b)apply hs and let remain to am

c)skin irritation
c)photosensitivity
c)bad odor/stain/messy

d)most effective w/ severe itching
Topical steroids (PSORIASIS)
a)MOA
b)dosing
c)ADR (3)
d)special consideration (2)
a)anti-inflam, anti-mitotic, immunosuppressive
b)apply bid-qid

c)folliculitis
c)skin atrophy
c)contact dermatitis

d)may cause flare-up******* (taper to prevent)
d)use occlusive dressings
Anthralin (PSORIASIS)
a)MOA (2)
b)dosing
c)ADR (2)
a)slow cellular division
a)decr inflammation
b)apply for 30-60min; remove (or apply hs and remove in am)

c)inflammation/irritation of skin
c)staining
Calcipotriene (PSORIASIS)
a)MOA (2)
b)dosing
c)ADR (3)
d)special considerations (3)
a)slow cell proliferation
a)incr cell differentiation
b)apply qd to bid

c)skin irritation
c)hypercalcemia
c)burn/sting

d)use in rotation w/ topical steroids
d)NO on face
d)NO for inflammation
Tazarotene (PSORIASIS)
a)MOA (2)
b)dosing
c)ADR (3)
d)special considerations (3)
a)binds RAR
a)causes normalization of cell differentiation, decr hyperprolif/inflam
b)apply hs

c)pruritis
c)burning
c)erythema

d)avoid vitA
d)may be teratogenic
d)psoriasis may worsen b4 improve*****
Topical Psoralens-Methoxsalen (PSORIASIS)
a)MOA (2)
b)dosing
c)ADR (2)
d)special considerations
a)combine w/ phototherapy
a)antiprolif, anti-inflam, immunosupp
b)apply 20min b4 UVA

c)photosensitivity
c)severe sunburn

d)soak in bath solution for 20min b4 phototherapy
Psoriasis Tx Algorithm
a)Stage1 (mild to moderate) (4)
b)Stage2 (mild to moderate NOT responding to Stage1) (3)
c)Stage3 (moderate to severe not responding to Stage1/2) (4)
a)emollients/keratolytics
a)tazarotene -> steroids
a)calcipotriene -> vit D3 analogs
a)coal tar -> anthralin

b)UVB
b)UVB & tar / anthralin
b)psoralen and UVA (topical -> oral)

c)oral retinoids-actretin
c)cyclosporine
c)MTX
c)biologics
Other regimens to tx Psoriasis
a)combo's (4)
b)rotational
c)sequential
a)acitretin + UVA/B
a)MTX + UVB
a)UVA + UVB
a)MTX + cyclosporine

b)biologic -> nonbiologic -> biologic

c)high dose agent to induce clearing followed by lower tox agent
Atopic Dermatitis
a)desc
b)etiology
a)itch that rashes*****
b)often associated w/ asthma, hay fever, chronic allergic rhinitis in pts****
Dry skin (xerosis)
a)presentation (3)
b)etiology
a)roughness
a)scaling
a)loss of flexibility

b)disruption of keratinzation and water binding to the skin
Non-pharma tx for Atopic Derma/Xerosis (7)
1)shower/bathe in warm water
2)use non-soap cleaners or mild soaps (cetaphil/dove)
3)pat skin dry (avoid rubbing)
4)apply lubricant to seal in moisture b4 skin is dry
5)keep fingernails short or use gloves to prevent scratching
6)avoid contact w/ allergens or irritants
7)cool water compress
Pharma tx's for Atopic Derma/Xerosis (10)
1)bath oils
2)colloidal oatmeal \
3)cleansers (cetaphil/glycerin)
4)emollient/moistures
5)keratin-softening agents
6)astringents
7)antipruritics (antihistamines, antidepressant, locals)
8)skin protectants
9)corticosteroids
10)immunomodulators
Keratin-softening agents for Atopic Derma/Xerosis (3 and desc of each 3,2,1)
Urea
a)helps w/ scale/crust removal
a)mildly keratolytic incr water uptake into skin
a)can cause burn/sting on broken skin

Alpha hydroxy acids
b)modulator of keratinzation
b)smooth the skins surface

Allantoin
c)disrupts the structure of keratin
Astringents for Atopic Derma/Xerosis
a)MOA (3)
b)use
c)2 products
a)coagulate proteins
a)vasoconstrict
a)cleanse skin of debris

b)for oozing/discharging/bleeding dermatitis

c)witch hazel
c)burrow's solution
Antihistamines and Atopic Derma/Xerosis
a)MOA (po/topical)
b)dosing (topical)
c)ADR (1 for topical, 1 for oral)
a)topical- depress cutaneous receptors which relieves itching/pain
a)oral- antagonize H1

b)topical- 3-4x daily for up to 7d

c)allergic contact dermatitis (if used too much) (topical)
c)anticholinergic effects (oral)
Antidepressants and Atopic Derma/Xerosis
a)drug
b)dosing
c)ADR (3)
a)doxepin cream

b)apply 4x/d for 8d (NO use if under 12yo)

c)burn/sting
c)drowsy
c)NO occlusive dressing
Local Anesthetics
a)drugs (3)
b)MOA
c)dosing
d)ADRs
a)caines
a)benzyl alcohol
a)phenol

b)reversible block of nerve impulses where applied

c)3-4x/d up to 7d

d)skin irritation/sensitization
Steroids and Atopic Derma/Xerosis
a)MOA (3)
b)admin (3)
c)ADR (3)
d)use
a)anti-inflam, antimitotic, antipruritic
a)vasoconstrictive
a)immunosupp

b)after bathing
b)use mild for face, interginous
b)use mid for trunk

c)skin atrophy/striae
c)telangiectasias
c)skin infexn

d)for severe tx-resistant cases
Topical Immunomodulators for Atopic Derma/Xerosis
a)drugs (2)
b)MOA
c)admin
d)ADR (3)
e)counsel
a)Tacrolimus
a)Pimecrolimus

b)inhibit Tcell release of cytokines

c)thin film and rub in bid and wash hands afterwards

d)burning
d)HA
d)flu-like s/sx

e)tell Dr if they do NOT get better within 6wks
Oral Immunomodulator for Atopic Derma/Xerosis
a)Cyclosporine (MOA/3ADR)
b)Azathioprine (MOA/3ADR)
a)inhibit Tcell activation
a)nephrotoxicity, HTN, tremor

b)immunosuppressive
b)bone marrow suppression, n/v/d, mouth ulcers
OTHER drugs for Atopic Derma/Xerosis (5)
1)LK inhibitors
2)interferon
3)phototherapy
4)IVIG
5)abx
Study tx algorith for Atopic Derma/Xerosis (p.1621 fig102-1 in dipiro)
.
Clinical Presentation of ACNE (5)
1)primarily on face (can be on back/chest)
2)primary lesions are comedones (5-10 are diagnostic)
3)blackheads (open comedones) caused by excess sedum and deposition of melanin
4)whiteheads (closed comedones) caused by plugged follice and inflammation
5)pustules form when follice ruptures or is damaged
Mild Acne Severity (3)

Moderate Acne Severity (3)

Severe Acne Severity (2)
1)non-inflammatory lesions
2)few papules/pustules
3)no nodules/scarring

1)multiple inflammatory lesions and non-inflammatory lesions
2)few nodules
3)no scarring

1)multiple inflammatory and non-inflammatory lesions
2)nodules, cysts, scarring
Basic pathophysiology of Acne (4)
1)incr androgens and incr sebum (due growth/incr in sebum glands due to incr androgen as from adrenal gland as person matures)
2)incr in adherent keratin cells causing obstruction of follicle (comedone) (may be due to defect in or inflam of follicle)
3)P.acnes; proliferates in environment of excess sebum/follicle cells
4)inflammation
Inflammation of Acne is due to (6)
1)free FAs and glycerol made by lipases of P.acnes
2)free FAs irritate follicle causing incr cell turnover and inflammation
3)P.acnes is antigenic causing incr IgG/IgM leading to local inflam
4)complement activation
5)hydrolytic enzymes damage follicle
6)neutrophil defects in chemotaxis/phagocytosis
TOPICAL Acne tx's (7)
1)benzoyl peroxide (topical)
2)keratolytic (sulfur, salicylic acid) (topical)
3)topical abx (TCN, clindamycin, erythromycin)
4)azelaic acid
5)Tretinoin or all-trans-retinoic acid
6)adapalene
7)tazorac
Benzoyl Peroxide
a)indication
b)MOA (3)
c)ADR (3)
a)mild to moderate acne

b)antibacterial and comedolytic
b)lipophilic so gets into skin and kills P.acnes
b)oxidizes bacterial proteins by being converted to free radicals by cysteine

c)bleaching of hair/clothing
c)dryness
c)burn/sting/irritation
Benzoyl Peroxide
a)formulations (3)
b)dosing regimen (2)
a)soaps, lotions, creams, gels
a)alcohol based
a)gels most potent

b)initially qod or qd; then bid
b)to limit ADRs initiate at lowest possible strength
Keratolytic Agents (sulfur, salicylic acid)
a)indication
b)MOA
c)ADR sulfur (2)
d)ADR salicylic acid
e)dosing
a)mild to moderate acne

b)dissolves intracellular cement of keratin cells in stratum corneum

c)yellow skin coloration
c)unpleasant odor

d)salicylism from repeated use

e)daily
Topical abx (TCN, clindamycin, erythromycin)
a)indicatoin
b)MOA (3)
c)ADR of each (5)
d)regimen
a)mild to moderate inflammatory acne

b)antibacterial/anti-inflammatory
b)suppresses P.acnes=decr free FAs
b)decr in inflam mediators made by P.acnes

c)TCN-yellowing of skin
c)Clindamycin-diarrhea, C.diff
c)erythromycin-skin irritation
c)all can cause skin irritation/dry skin

d)bid
Azelaic acid
a)indication
b)MOA (2)*****
c)ADR (3)
d)dosing regimen
a)mild to mod acne

b)antibacterial by interfering w/ DNA syn of P.acnes (blocks thioredoxin)
b)comedolytic

c)mild,transient erythema
c)burning
c)pruritis

d)bid
Tretinoin/all-trans-retinoic acid (Retin-A, Avita)
a)indication
b)MOA (3)
c)ADR (4)
a)mild to mod acne

b)vitA derivative w/ comedolytic activity
b)decr # of cell layers in stratum corneum (14 to 5)
b)promotes drainage of preexisting comedones and inhibits formation of new ones

c)mod erythema
c)burn/sting
c)allergic contact dermatitis
c)incr sun sensitivity
Tretinoin/all-trans-retinoic acid (Retin-A, Avita)
a)regimens (3)
b)misc/application (3)
a)initially qod or qd; then up to bid
a)start w/ lowest strength qod then titrate up in strength/frequence
a)once acne controlled; lower dose to lowest effective

b)acne "flare" after starting tx and cleared in 8-12wks
b)apply 30min after washing skin
b)creams are least irritating
Adapalene
a)indication
b)MOA (2)
c)ADR (3)
d)regimen
e)big point*******
a)mild to mod acne

b)napthoic acid w/ retinoid-like activity
b)has comedolytic and anti-inflam activity

c)erythema
c)scaling/drying/burning
c)pruritis

d)qd

e)cause least amount of irritation of retinoid products (but is least effective of them)
Tazorac
a)indication
b)MOA (3)
c)ADR (3)
d)regimens
a)mild to mod acne

b)synthetic cmpd that readily penetrates skin
b)converted to tazarotenic acid and binds to retinoic acid receptors
b)alters genetic expression in cells involved in differentiation, proliferation, inflammation

c)erythema
c)pruritis
c)burn/sting

d)qd or bid (qod if not tolerated)
Other topical acne tx's (4)
1)topical steroids
2)dapsone (5% gel for over 12yo)
3)chemical peels made of salicylic acid and lactic acid (can be used for scarring)
4)phototherapy (UV/laser to zap bacteria)
Oral Acne tx's (4)
1)oral abx (TCNs/macrolides)
2)OCs/estrogens
3)isotretinoin (accutane)
4)hormonal tx (spironolactone/flutamide)
Oral Abx for acne
a)indication
b)MOA (4)
a)mod to severe inflammatory acne NOT responding to topical combinations

b)antibacterial/anti-inflammatory
b)suppress P.acnes to reduce free FAs and decr its release of inflammatory mediators
b)TCN reduces amount of keratin in sebeceous follices and inhibits immune processes
b)Doxy/minocycline are more lipophilic than erythromycin/TCN=gets into sebaceous gland better
Oral Abx for acne
a)ADR for TCN (5)
b)ADR for azithromycin/erythromycin (3)
c)ADR for clindamycin (2)
d)ADR for doxycycline (2)
e)ADR for minocycline (4)
a)photosensitive
a)Dairy/Fe/Ca interaxn
a)photo/hepatoxicity
a)vaginal candidasis
a)tooth discoloration in kids

b)GI upset
b)skin rxns
b)drug interaxns

c)diarrhea
c)pseudomembrane colitis

d)GI upset (esophagitis)
d)photosensitive

e)skin rxns
e)vestibular toxicity
e)discolor of skin/viscera/teeth
e)drug induced lupus
Oral Abx for Acne REGIMENS
a)TCN
b)doxycycline
c)minocycline
a)1g/d; can incr to 2-3g/d

b)50-100mg qd-bid

c)100mg bid (maint. 50-100mg qd)
Oral Abx for Acne REGIMENS
a)erythromycin
b)clindamycin
c)arithromycin
a)1g/d base (up to 2-3g/d); maintenance is 250-500mg qd

b)300-450mg qd

c)500mg po qd (3-4x/wk)
OCs/estrogens for acne
a)indication
b)MOA (2)
c)ADR (3)
d)regimen (3)
a)moderate acne in F's over 15yo

b)incr sex-hormone binding globulin causing decr unbound testosterone
b)suppresses sebum production

c)n/v
c)wt gain
c)breakthru menstrual bleeding

d)need 50mcg or more ethinyl estradiol (or equivalent dose of other estrogens)
d)low dose OCs w/ norgestimate or desogestrel can suppress sebum
d)2-4mon b4 improvement occurs
Isotretinoin (Accutane)
a)indication
b)MOA (3)
c)ADR (6)
d)regimens
a)severe recalcitrant nodular or inflammatory acne unresponsive to other tx's

b)vitA metabolite that decr sebum (and changes its composition)
b)inhibits P.acnes/inflammation
b)alters keratinization patterns of follicles

c)mucocutaneous effects
c)chelitis and skin desquam
c)photosensitivity
c)depression/psychosis/suicide
c)monitor LFT/lipids (can cause hyperTG)
c)CatX- must use 2 types of contraception for 1mon prior and 1mon after tx is dc

d)0.5-1mg/kg/d is 2 doses (for 4-5months
Hormonal tx (SPIRONOLACTONE, FLUTAMIDE) for acne
a)indication
b)MOA
c)ADR of spironolactone (2)
d)ADR of flutamide (3)
e)dosing (2)
f)imp. counsel
a)mod acne in females

b)block androgen receptors=decr sebum production

c)hyperkalemia
c)irregular menses

d)galactorrhea****
d)hot flashes
d)life-threatening hepatitis

e)spironolactone- 50-200mg bid
e)flutamide- 250-500mg bid x 6mon (limit 6mon due to hepatitis)

f)avoid flutamide in pregnancy (and use w/ Yasmin- combined OC)
Other oral tx's for acne (4)
a)gonadotropin-RH agonists (buserelin, nafarelin, lupron)
b)short burst-low dose steroids
c)dapsone for acne conglobata
d)nicotinamide in combo w/ Zn, Cu, folic acid
Tx algorithm for:
a)mild comedonal acne (4)
b)mild papular pustular acne (2)
a1)topical retinoid
a2)salicylic acid
a3)azeleic acid
a4)benzoyl peroxide

b1)topical retinoid + topical abx or benzoyl peroxide
b2)oral abx + topical retinoid or azaleic acid
Tx algorithm for:
a)moderate papular pustular acne (2)
b)moderate acne w/ cysts/nodes (3)
a)oral abx + topical retinoid + benzoyl peroxide
a)antiandrogen or OC + topical retinoid or azelic acid (if adding retinoid must add topical abx too)

b)oral abx + topical retinoid + benzoyl peroxide
b)oral isotretinoin
b)antiandrogen or OC
Tx algorithm for:
a)severe nodular/cystic acne (3)
b)special considerations
a)oral isotretinoin
a)oral abx + topical retinoid or benzoyl peroxide
a)antiandrogen or OC + topical retinoid

b)OCs and antiandrogens ARE FOR FEMALES ONLY
Clinical presentation of Rosacea (7)
Central face distribution of:
1)flushing
2)nontransient erythema
3)papules/pustules
4)lteangiectasia
5)burn/sting
6)elevated red plaques

7)ITCHING ALWAYS ABSENT
Rosacea
a)complications (3)

Stages
a)pre-rosacea (2)
b)vascular (2)
c)inflammatory
d)late
a)emotional/social stigma
a)ocular complications requiring corneal replacement
a)rhinophyma

a)flushing/blushing
b)erythmema/edema; ocular s/sx
c)papules/pustules
d)rhinophyma
Rosacea
a)aggravating factors (5)
b)aggravating meds (6 of many)
a)sun exposure
a)emotional stress
a)hot weather/baths/drinks/HEAT
a)alcohol/spicy foods
a)exercise

b)RETINOIDS
b)doxorubicin
b)nifedipine
b)niacin
b)capsaicin
b)steroids
Topical abx for Roseaca (4)

Oral abx for Roseaca (2)

Counsel on applying
a)metronidazole
a)clindamycin
a)azelaic acid
a)sulfacetamide/sulfur

b)Minocycline
b)doxycycline

APPLY TO WHOLE FACE RATHER THAN SPOTTED ON LESIONS
Doses for _____ in Roseaca:
a)medronidazole
b)azelaic acid
c)clindamycin
d)sulfacetamide/sulfur
e)minocyclin
f)doxycycline
a)bid
b)bid

c)bid (5min after washing skin)
d)1-3x per day (use w/ cleansing products 1-2x per day)

e)50-200mg qd
f)100-200mg/d initially; taper over 30-60d to dc
2nd Line tx for Roseaca (4)
1)isotretinoin (low dose, intermittent use)
2)occular steroids for eye s/sx
3)clonidine/BB for flushing
4)bactrim