Msi Week 4: Common Drugs Used In Dermatology

Front 1

What group of drugs are potent and effective local anti-inflammatory drugs that have a striking ability to inhibit cell division?

Back 1

Topical corticosteroids

Front 2

If a skin lesion does not respond to steroid treatment, then it is probably what type of infection?

Back 2

Fungal infection

Front 3

What is the therapy of choice in many inflammatory and pruritic eruptions (dermatitis)?

Back 3

Topical corticosteroids

Front 4

What treatment is effective in autoimmune hyper-proliferative disorders (psoriasis) and infiltrative disorders (sarcoidosis, granuloma annular)?

Back 4

Topical corticosteroids

Front 5

Topical corticosteroids have enhanced penetration in:

Thick skin or thin skin?

Ointments or creams?

Back 5

Enhanced penetration:

Thin skin (eyelids)

Ointments

Front 6

Topical corticosteroids have enhance penetration in:

Normal skin or eczematous inflamed skin?

Hydrated skin or dry skin?

Back 6

Enhanced penetration:

Eczematous inflamed skin > normal skin

Hydrated skin > dry skin

Front 7

What strength of topical coritcosteroid would you prescribe an adult patient for a localized area, RESISTANT thick lesions, palms, soles, and scalp?

Back 7

Very potent

Front 8

What strength of topical coritcosteroid would you prescribe an adult patient for a localized area, thick lesions, palms, soles, and scalp?

Back 8

Potent

Front 9

What strength of topical coritcosteroid would you prescribe an adult or child patient for an extensive area of skin?

Back 9

Moderately potent

(More potent creams are reserved for localized areas)

Front 10

What strength of topical coritcosteroid would you prescribe an adult, child, or infant patient to use on the face, folds, genitals, and for extensive areas of skin?

Back 10

Weak/ mildly potent

Front 11

What does systemic absorption of topical corticosteroids depend on?

Back 11

1. Integrity of the stratum corneum
2. Pharmacokinetic properties of the substance

Front 12

Occlusion and application of topical corticosteroids over large areas increase the risk of _______ suppresion.

Back 12

HPA axis suppression
(hypothalamic-pituitary-adrenal axis)

*Suppression of the HPA axis can occur with medium and high potency agents

Front 13

On what regions of the body should mild formulations of topical corticosteroids be used?

Back 13

1. Face
2. Groin
3. Axillae
4. Genital and perianal areas

Front 14

What formulation of topical corticosteroid are usually required on the palms and soles, and for lichenified or hypertrophic dermatoses?

Back 14

Potent or very potent

Front 15

How can the penetration of corticosteroids be improved on thick skin areas such as the palms and soles?

Back 15

Occlusion
(covering the treated area w/ plastic wrap, such as saran)

Front 16

Which type of therapy should be not be used on the face due to local side effects such as atrophy, striae (stretch marks), and purpura?

Back 16

Very potent-- moderately potent glucocorticoids
(only use mildly potent)

Front 17

If used around the eyes, what treatment can cause local side-effects such as glaucoma and cataracts?

Back 17

Topical corticosteroids

Front 18

What is tachyphylaxis?

Back 18

Diminishing response to a drug after repeated exposure

(This can happen with use of corticosteroids)

Front 19

What type of fungal infection can result from the use of topical corticosteroids?

Back 19

Tinea incognito

(As the skin fungal infection has lost some of the characteristic features due to suppression of inflammation, it may have a poorly defined border, skin atrophy, telangiectasia, and florid growth)

Front 20

Which type of treatment can have local side effects such as acne, perioral dermatitis, rosacea-like rash, increased hair growth, and hyperpigmentation?

Back 20

Topical corticosteroid

Front 21

List 2 systemic side effects of topical corticosteroids.

What individuals are more at risk for these side effects?

Back 21

1. Growth suppression
2. Adrenal suppression

*Infants are most at risk

*Increased risk when larger surfaces of skin area are treated

Front 22

What treatment can be used to achieve a high local concentration in the skin with no systemic side effects?

Back 22

Intralesional corticosteroids

Front 23

What treatment should you use for the following:

1. Acne cysts
2. Psoriatic plaques
3. Circumscribed dermatitis
4. Keloid scars
5. Alopecia
6. Areata
7. Granuloma

Back 23

Intralesional corticosteroid

Front 24

In addition to its anti-inflammatory properties, what side effect of intralesional corticosteroids can be used advantageously when treating hypertrophic types of lesions?

What are some examples of these lesions for which intralesional corticosteroids are used?

Back 24

Atrophogenic side effect

Can be used to treat:
1. Keloids
2. Lichen simplex chronicus
3. Hypertrophic lups
4. Psoriasis

Front 25

List 4 side effects of intralesional corticosteroids.

Back 25

1. Skin atrophy
2. Hypopigmentation
3. Infection
4. Ulceration

Front 26

Which group of treatments are synthetic derivatives of the natural steroid, cortisol, which is produced by the adrenal glands?

Back 26

Systemic corticosteroids

Front 27

List 3 diseases that systemic corticosteroids are used for.

Back 27

(blistering diseases)

1. Pemphigus
2. Bullous pemphigoid
3. Severe forms of dermatitis

Front 28

Prednisone, prednisolone, and methylprednisolone are all examples of what type of drug?

Back 28

Systemic corticosteroid

Front 29

T or F.

The majority of undesirable side effects with steroids occur during long term therapy (> 3 months).

Back 29

TRUE.

Front 30

List 3 problems that may occur with systemic steroid use.

Back 30

1. Increased risk of infection
(bacterial--> cellulits; fungal --> tinea, candida)
2. Skin thinning (easy bruising, tearing, slow healing, stretch marks)
3. Steroid acne

Front 31

List 4 side effects that may occur with short term systemic steroid treatment

Back 31

1. Sleep disturbance
2. Increased appetite
3. Weight gain
4. Psychological effects, including increased or decreased energy

Front 32

List a few side effects that may occur with long term systemic steroid treatment.

Back 32

1. Osteoporosis
2. Diabetes
3. Hypertension
4. Glaucoma
5. Cushing's syndrome
6. HPA axis suppression
7. Headaches
8. Increased risk of infection

Front 33

What vaccination should be avoided during systemic corticosteroid therapy?

Back 33

Live polio vaccination

(However, it is safe and advisable to have other routine immunizations such
as annual influenza vaccination)

Front 34

What should you monitor in a patient taking systemic corticosteroids?

Back 34

1. Blood pressure
2. Blood sugar
3. Body weight

Front 35

What is the most important thing you can tell your patient when advising them on how to take their systemic steroid medication?

Back 35

Do not suddenly stop taking the systemic steroids!

Doses need to be tapered (unless the course of steroids has been for less than one week)

Front 36

How do histamines result in an "itchy" sensation?

Back 36

Histamine stimulates C-type fibers leading to the perception of itch in the CNS

Front 37

How do antihistamines work?

Back 37

They block the actions of histamine by occupying histamine receptor sites
(they have a close structural resemblance to histamine)

Front 38

Which generation of antihistamines bind not only to histamine receptors, but also to muscarinic, a-adrenergic, and serotonin receptors?

Back 38

First generation H-1

Front 39

Which generation of antihistamines have more sedation and anti-cholinergic effects?

Back 39

First generation H-1

Front 40

Which generation of antihistamines have a longer duration of action?

Back 40

Second generation

Front 41

Which generation of antihistamines have less central nervous system penetration?

Back 41

Second generation

Front 42

Which generation of antihistamines have minimal activity at non-histamine receptors and therefore less sedation and fewer side effects?

Back 42

Second generation

Front 43

What drug treatment is recommended for urticaria, contact dermatitis, insect bites, eczema, and sunburns?

Back 43

Antihistamines

Also suggested for:
1. Infections
2. Infestations
3. Bullous disorders
4. Photo-dermatoses
5. Atopic dermatitis (mostly for sedative effects)

Front 44

Which group of drugs often have side effects involving sleepiness, dullness of senses, giddiness, headache, or loss of appetite?

Back 44

Antihistamines

Front 45

Which group of drugs have pharmacological and biological properties similar to Vitamin A?

Back 45

Retinoids

Front 46

Which group of compounds play an important role in cellular morphogenesis, growth, and differentiation?

Back 46

Retinoids

(retinoid/receptor complex binds to specific genes and modify transcription of proteins)

Front 47

List 3 topical retinoids.

Back 47

1. Tretinoin
2. Adapalene
3. Tazarotene

Front 48

List 2 systemic retinoids.

Back 48

1. Isotretinoin
2. Acitretin

Front 49

Which group of drugs are indicated for acne, psoriasis, prevention of skin cancer, lichen planus, and actinic keratoses?

Back 49

Retinoids

Front 50

What is Tretinoin?

Back 50

Topical retinoid

Front 51

What is Adapalene?

Back 51

Topical retinoid

Front 52

What is Tazarotene?

Back 52

Topical retinoid

Front 53

What is Isotretinoin?

Back 53

Systemic retinoid

Front 54

What is Acitretin?

Back 54

Systemic retinoid

Front 55

Which retinoid is used for the topical treatment of acne and has anti-comedonic and anti-seborrheic effects?

Back 55

Tretinoin

Front 56

Which retinoid has a lower skin irritation potential due to its higher receptor affinity?

Back 56

Adapalene

Front 57

Which retinoid can be used to treat Psoriasis due to its ability to downregulate the effects of nuclear transcription factor AP-1, which is associated with inflammatory and cell proliferative changes?

Back 57

Tazarotene

Front 58

Which retinoid remains the most effective anti-acne drug?

Back 58

Isotretinoin
(Acts against all the major etiological factors of acne)

*Isomer of tretinoin

Front 59

List 6 side-effects of Isotretinoin.

Back 59

1. Highly teratogenic
2. Myalgias
3. Headaches and increased intracranial pressure
4. Hair loss
5. Dry skin, mouth, and eyes
6. Hypertriglyceridemia

Front 60

Which retinoid is useful in pustular, guttate, and erythrodermic psoriasis?

Back 60

Acitretin

(major metabolite of etretinate)

Front 61

Which retinoid can have the following side effects?

1. Thinning of nails
2. Chelitis
3. Xerosis
4. Stickiness of skin
5. Hair loss

Back 61

Acitretin

Additional side effects:
1. Hepatitis
2. Stickiness of skin
3. Elevation of triglycerides

*Dose dependent

Front 62

What does SPF stand for?

Back 62

Sun protection factor

Front 63

How many minutes does a water-resistant sunscreen maintain its SPF level?

What about a "very" water-resistant product?

Back 63

40 minutes

"very" resistant = 80 minutes

Front 64

Suncreens are divided into two groups based on how they absorb UV radiation-- what are the two groups?

Back 64

1. Physical blockers
2. Chemical blockers

Front 65

What kind of UV protection does a broad-spectrum or full-spectrum sunscreen provide?

Back 65

Both UV-A and UV-B protection

Front 66

List two major contents found in sunscreens that are "physical blockers."

Back 66

1. Titanium dioxide
2. Zinc oxide

Front 67

What is the name for a small, rough spot occurring on skin that has been chronically exposed to the sun?

Back 67

Actinic keratosis

(occurrence can be reduced by sunscreen use)

Front 68

What is the name for the breakdown of elastic tissue due to sun exposure?

Back 68

Solar elastosis

(occurrence can be reduced by sunscreen use)

Front 69

Routine sunscreen use in humans has been shown to reduce what 3 skin conditions?

Back 69

1. Solar elastosis
2. Actinic keratoses
3. Squamous cell carcinomas

Front 70

What is the most common sensitivity complaint about sunscreens?

Back 70

Subjective irritation associated with burning or stinging without objective erythema

Front 71

T or F.

When using sunscreens, persistent objective irritant contact dermatitis is more common than allergic contact dermatitis.

Back 71

TRUE.

*However, these are difficult to distinguish from each other

Front 72

What components account for many of the allergic reactions that occur with sunscreens?

Back 72

Fragrances and preservatives

Front 73

T or F.

Regular sunscreen does not inhibit the UV-dependent cutaneous synthesis of Vitamin D.

Back 73

FALSE.

Sunscreens CAN diminish UV-dependent synthesis of Vitamin D

Front 74

What type of people are particularly susceptible to the consequences of Vitamin D deficiency?

Back 74

Elderly people
(osteopenia, bone fractures)

Front 75

What group of drugs are natural products derived from soil actinomycetes or their semi-synthetic derivatives?

Back 75

Tetracyclines

Front 76

Which group of drugs can bind to the 30S subunit of the bacterial ribosome?

Back 76

Tetracyclines

(halt protein synthesis)

Front 77

Which group of drugs drecrease antibody production, phagocytic function, and neutrophil chemotaxis?

Back 77

Tetracyclines

Front 78

Which group of drugs inhibit complement system, lipase, and collagenase, and lymphocytic function?

Back 78

Tetracyclines

Front 79

Which group of drugs are indicated for the following?

1. Acne
2. Rosacea
3. Pyoderma gangrenosum
4. Telangiectasia

Back 79

Tetracyclines

Front 80

Which group of drugs are indicated for the following?

1. Panniculitis
2. Pustulosis
3. Bullous pemphigoid
4. PLEVA

Back 80

Tetracyclines

(PLEVA = Pityriasis lichenoides et varioliformis acuta)

Front 81

Which group of drugs can result in drug-induced lupus and hepatitis?

Back 81

Tetracyclines

Front 82

Which group of drugs can stain developing teeth and cause tinnitus?

Back 82

Tetracyclines

Front 83

Which group of drugs can have the following side effects?

1. Photosensitivity
2. Abnormal bone growth of fetus
3. Microvesicular fatty liver

Back 83

Tetracyclines

Front 84

What types of foods should a patient avoid taking along with tetracyclines?

Back 84

Milk, yogurt, and other diary products
(Ca2+ inactivates tetracycline)

Front 85

List 3 tetracyclines.

Back 85

1. Tetracycline
2. Doxycycline
3. Minocycline

Front 86

Which tetracycline is more effective and expensive and causes more photosensitivity than some of the others?

Back 86

Doxycycline

Front 87

Which tetracyline has a longer action and less photosensitivity than the others?

Back 87

Minocycline

Front 88

The activity of topical corticosteroids is assessed by their ability to produce _______.

Back 88

Vasoconstriction

Front 89

Corticosteroids enter the cell, bind the the glucocorticoid receptor in the cytoplasm and translocate to the nucleus.

What do they do once in the nucleus?

Back 89

Enhance transcription of genes encoding ANTI-inflammatory mediators

Front 90

When should topical corticosteroids NOT be used?

Back 90

On ulcerated (open sores) or atrophic skin

Front 91

What are striae?

Back 91

Stretchmarks

Front 92

Which retinoid produces retinoid dermatitis during the first 2 weeks of treatment?

Back 92

Tretinoin