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57 Cards in this Set

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