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40 Cards in this Set
- Front
- Back
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if you alter the barrier of the patch disease can alter what? |
stratum corneum |
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what are the risks of topical meds in younger skin |
increased risk of systemic toxicity -especially in pre-mees bc decr. epidermal barrier function, incr. skin fragility, poor thermal regulation thru decr. sweating
increased surface area to body mass ratio |
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gels... |
release drugs faster little residue left behind |
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powders... |
absorb moisture decrease friction poor adherence to skin potential inhalation risk |
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MOA of corticosteroids |
anti-inflm immunosuppresive antiproliferative vasoconstriction |
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what are the 7 classes of topical corticosteroids |
class 1- super potent class 2- potent class 3- potent. upper midstrength class 4- midstrength class 5- lower midstrength class 6- mild strength class 7- least potent; hydrocortisone |
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use of corticosteroids in peds, geriatrics, pregnancy |
peds: risk in premies, good for atopic dermatitis prego: cat C |
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ADR of corticosteroids |
dermal atrophy acneiform rxn hypertrichosis pigmentary changes infx (exacerbate or mask) allergic rxn |
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dose for corticosteroids |
Hydrocortisone Ointment 1% 30g apply to affected areas BID |
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indications for retinoids |
acne cutaneous lesions in AIDS pt with Kaposi sarcoma cutaneous lesions in pts with T cell lymphoma |
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when do you want to apply retinoids and why? |
photoinactivated so apply in evening can enhance vit D activity in human skin |
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ADR of retinoids |
local irritation: erythema, peeling, dryness, tightness and burning sensation
potential teratogenicity |
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dose for retinoids |
Adapalene cream 0.1% 45g apply to face qd |
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what its the goal of acne tx |
reduction of oil production speed up skin cell turnover fight bacterial infx reduce inflm |
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what are options for acne |
retinoid acid and derivatives benzoyl peroxide axelaic acid sulfur/sulfacetamide/resorcinol salicylic acid topical abx |
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is benzoyl peroxide good for long term? |
yes! bacteria can't build resistance to it may even delay resistance to concurrent abx |
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ADR of benzoyl peroxide |
peeling, stinging, dryness, erythema, contact dermatitis |
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dose for benzoyl peroxide |
benzoyl peroxide lotion (4, 5, 6, 8, 10%) apply sparingly qd increasing to 2-3x a day if necessary |
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mupriocin inhibits bacterial synthesis gram + coverage only localized impetigo caused by s arues and strep pyongenes intranasal use is for eradication of nasal colonizaiton with MRSA |
bacitracin inhibits cell wall synthesis gram + coverage only superficial infx like impetigo, furunculosis, pyodermas combined with neomycin and polymixin B to yield "triple abx" ointment (don't really use combo now |
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polymixin B catiionic detergent that disrupts integrity of bacterial cell membrane gram neg coverare conbined with bacitracin |
aminoglycosides- neomycin activity against aerobic gram neg gram neg coverage only cause of cases of contact dermatitis |
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tx of burns |
mafenide and silver sulfadiazine |
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problems with mafenide |
large area coverage causes metabolic acidosis painful on application potential for candida superinfx |
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ADR of topical abx |
local effects systemic effects in larger areas, braided skin, change in stratum corneum adherence: applicatin issues, assurance of appropriate dose and application |
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dose for topical abx |
Neosporin Ointment 30g apply to affected site up to TID (may cover with sterile bandages) |
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dose for other topical abx |
bacitracin 5% TID |
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what are the topical antifungals |
nystatin miconazole terbinafine- prescription oral form toinaftate |
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ADR of topical antifungals |
imidazoles -disruption of fungal wall synthesis -some anti-inflm -limited antiabx -excellant pentration of stratum corneum
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ADR of topical antifungals |
imidazoles -irritant contact dermatitis -allergice contact dermatitis -urticarial rxn -OTC inappropriate tx -resistance |
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dose for topical antifungal powder |
Miconazole powder 2% 85g apply to affected area BID for 4wk |
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dose for topical anitfungal cream |
Terbinafine 1% cream 15g apply btw the toes to affected areas qd or BID for 1wk |
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MOA of the other topical antifungals |
Ciclopirox (Loprox, Peniac) -interrupts active membrance transport of essential cellular precursors -antiinflm -broad abx spectrum -great for tine pedis and seborrhea dermatitis |
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what are the calcineurin inhibitors |
pimecrolimus (Elidel) tacrolimus (protopic) |
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indication for calcineurin inhibitors |
second line therapy for atopic dermatitis |
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contraindications for calcineurin inhibitors |
IC netherton syndrome active bacterial or viral infx undergoing phototherapy |
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ADR of calcineurin inhibitors |
local: intense brungin/itching subside in few days worse in heat lower rate in children acneiform and resaceiform eruptions
disulfiram-like rxn: flushing with alcohol
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dose for calcineurin inhibitors |
Protopic Ointment 0.03% 30g apply to affected area in thin layer BID |
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timing and area for calcineurin inhibitors |
great in face and neck if doesn't help by 6wk then consider mis-dx |
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tx for plaque psoriasis |
topical: calciportriene, coal tar photo: PUVA, UV8 systemic: cyclosporine |
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vitamin D analogs |
-regulated skin cell production and proliferation -ADR: local irritation, systemic absorption if applied to large areas -Calcipotriene (Dovonex) |
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Coal Tar derivatives |
ADR: photosensitivity |
