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57 Cards in this Set
- Front
- Back
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What are the general features of topical corticosteroids?
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Local Anti-inflammatory
Inhibition of cell division Rapid action in small doses Easy to use |
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What conditions are frequently treated with topical corticosteroids?
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Inflammatory and pruritic eruptions (dermatitis)
Autoimmune hyperproliferative disorders (psoriasis) Infiltrative disorders (sarcoidosis, granuloma annulare) |
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What are some advantages of topical corticosteroids?
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Absence of pain and odor
Lack of sensitization Prolonged stability Compatible with other topical medications |
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Which factors determine the effectiveness of corticosteroids?
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Potency of drug
Percutaneous penetration |
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What is the mechanism of action for corticosteroids?
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Transcription of anti-inflammatory genes (annexin-1; secretory leukoprotease inhibitor; IL-10; inhibition of NFkB)
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Enhanced penetration of corticosteroids is associated with:
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Thin skin
Ointment (better absorbed than cream) Inflamed skin Hydrated skin |
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What strengths of corticosteroids are safe for children?
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Moderately potent
Weak/mildly potent |
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What strengths of corticosteroids are safe for infants?
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Weak/mildly potent
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What areas of the skin or types of lesions can be treated with very potent corticosteroids in adults?
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Localized area, resistant thick lesions
Palms, soles, scalp |
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What areas of skin should be treated only with weak/mild corticosteroids?
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face, folds, genitals
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What are the very potent corticosteroids?
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Betamethasone diproprionate (0.05%)
Clobetasol proprionate (0.05%) Halobetasol proprionate Halcinonide (0.1%) |
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What are the potent corticosteroids?
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Amcinonide
Betamethasone diproprionate Betamethasone valerate Desoximetasone Diflucortolone valerate Fluocinonlone acetonide Fluticasone proprionate Halcinonide Mometasone furoate |
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What are the medium potency corticosteroids?
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Betamethasone valerate
Hydrocortisone acetate Hydrocortisone valerate prednicarbate Triamcinolone acetonide |
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Names the mild corticosteroids
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Desonide
Hydrocortisone Hydrocortisone acetate |
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What factors determine the systemic effects of these drugs in a patient?
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Pharmacokinets of the drug used
Integrity of the stratum corneum |
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What hormonal loop can be disregulated by the use of corticosteroids?
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HPA axis (hypothalamic, pituitary, adrenal)
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What factors increase the risk of affecting the HPA axis?
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Occlusion
Application over large areas |
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What is the maximum amount of time (days) that a very strong corticosteroid should be used?
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14-20 days (or intermittently to reduce side effects)
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What anatomical locations generally require more potent drugs?
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Palms and soles
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When would you order a TEE (transesophageal echo) instead of a TTE (transthoracic echo)?
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1. To get higher resolution of posterior heart structures (LA, MV, aorta)
2. Aortic dissections and source of emboli |
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What types of skin (or skin conditions) preclude the application of corticosteroids?
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Ulcerated (open sores) skin
Atrophic skin |
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T/F: Briefly using potent corticosteroids controls eczema better and results in less steroid use and results in less steroid use than milder corticosteroid treatment?
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True
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When discontinuing use of corticosteroids, what should be done to avoid "rebound phenomena"?
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Tapered dosing (i.e. do not suddenly discontinue using the medication)
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What lab values should be checked in patients using steroids for long periods of time?
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Adrenal function
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What are the dermatological local side effects of corticosteroids?
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Atrophy, striae (stretch marks), purpura
Acne, perioral dermatitis, rosacea-like rash Hypopigmentation Contact dermatitis |
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What are the additional local side effects when used near the eyes?
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Glaucoma and cataracts
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What are the systemic side effects?
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Growth suppression
Adrenal suppression |
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What are the predictors of side effects?
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Used too long, too often and too much. Sensitive areas. Very young or very old patient.
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What are the advantages of intralesional corticosteroids?
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Achieve high local concentration
Prolonged depot effects No systemic side effects |
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What conditions can be treated by intralesional corticosteroids?
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keloids, lichen simplex chronicus, hypertrophic lupus, psoriasis
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What are the common side effects of intralesional corticosteroids?
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Skin atrophy
Hypopigmentation Infection Ulceration |
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Which skin conditions are treated with systemic steroids?
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Pemphigus, bullous pemphigoid, severe dermatitis
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Increased risk of adverse drug reactions is associated with long term treatment. What time frame is considered long term treatment?
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More than 3 months
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Systemic steroid side effects include:
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Sleep disturbance
Increased appetite Weight gain Psychological effects (increased or decreased energy) |
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Can systemic steroids be discontinued abruptly?
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No, doses must be tapered.
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What are the advantages of second generation antihistamines?
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Longer duration of action
Less CNS penetration Minimal activity at non-histamine receptors Less sedation, fewer side effects |
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What are the common indications for antihistamines?
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Urticaria, contact dermatitis, drug reactions, insect bites, infection, infestation, eczema, sunburn, bullous disorder, photo-dermatoses, atopic dermatitis
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What are the side effects of antihistamines?
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sleepiness, dulled senses, giddiness, headache, loss of appetite, blurry vision, dry mouth, difficulty urinating, nausea/vomiting, stomach upset
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Retinoid resemble what parent compound?
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Vitamin A
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What are the topical retinoids?
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Tretinoin, adapalene, tazarotene
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What are the systemic retinoids?
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Isotretinoin, acitretin
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What conditions do retinoids treat?
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Acne, Actinic keratoses, ichthyosis, melasma, psoriasis, lichen planus, photo-damage, prevention of skin cancer
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Tretinoin
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First retinoid
Anti-comedonic and anti-seborrheic Applied at night Retinoid dermatitis in first 2 weeks of treatment |
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Adapalene
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Distinct receptor profile (from tretinoin)
Used to treat lower skin irritation because of high affinity for RARB and inability to bind CRABP |
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Tazarotene
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Inactive prodrug;
active form = tazarotenic acid Enhances cell differentiation Effective in psoriasis - downregulates AP-1 which is involved with inflammatory and cell proliferation |
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Isotretinoin
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Treats acne
Most effective acne treatment |
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What are the side effects of isotretinoin?
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Teratogenic, dry skin/mouth/eyes, headache, myalgia, hair loss, hypertriglyceridemia
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Acitretin
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Useful in pustular, guttate and erythrodermic psoriasis
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What are the side effects of acitretin?
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High triglycerides, hepatitis, hair loss, thin nails, chelitis, xerosis, stickiness of skin
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How much UV-B light does SPF-15 sunscreen block? SPF-30?
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93% and 97% respectively
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What is the most serious potential side effect from sunscreen use?
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Decreased production of vitamin D
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What antibiotics are typically used in dermatology?
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tetracyclines
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What is the mechanism of action for Tetracyclines?
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Protein synthesis inhibitor binding to the 30s subunit of the bacterial ribosome.
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What clinical effects do tetracyclines have?
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Decreased function of:
Lymphocytes Antibody production Phagocytosis PMN chemotaxis Inhibition of complement, lipase, and collagenase |
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What are the indications for tetracycline use?
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Acne, Rosacea, pyoderma gangrenosum, telangiectasia, panniculitis, pustulosis, bullous pemphigoid, PLEVA
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What are the side effects of tetracyclines?
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stain teeth, inactivated by calcium, photosensativity, drug-induced lupus and hepatitis, tinnitus, negative effects on fetal growth
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What are the three main tetracyclines?
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Tetracycline, Doxycycline and Minocycline
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