Mspa 2017 - Dermatology

Front 1

What is a vehicle?

Back 1

In order for a drug to get to the skin or through the skin, it must be dissolved in a substance known as Vehicle

Front 2

What are the types of vehicles?

Back 2

1) Baths

2) Lotions

3) Gels

4) Powders

5) Pastes

6) Creams

7) Ointment

Front 3

What are the factors that choice of vehicle depends on?

Back 3

1) Solubility of active drug

2) Ability to hydrate stratum corneum

3) Stability of drug in vehicle

4) Ability to retard evaporation from the skin

--- Least with tinctures

Front 4

What are the benefits of the baths?

Back 4

1) Baths are completely water soluble

2) They are colloidal

3) Baths are soothing

Front 5

What are the indications for baths?

Back 5

1) Irritation

2) Inflamed tissue

Front 6

What is the effects of baths?

Back 6

Attracts fluids out of the tissues

= Swelling

Front 7

What are the characteristics of lotions?

Back 7

1) Mostly water

2) Evaporation of the lotion is cooling

--- Cooling action causes mild vasoconstriction

3) Vasoconstriction decrease inflammation

Front 8

What are the characteristics of gels?

Back 8

1) Semi-solid colloidal solutions and suspensions

2) Contain Alcohol

3) Enhances absorption through skin

Front 9

What are the characteristics of powders?

Back 9

1) Absorbent

2) Can cause crusting

Front 10

What are problems with powders?

Back 10

1) Aspiration - especially for babies

2) Caution with corn starch (for diaper rash)

Front 11

What are the characteristics of pastes?

Back 11

1) Thick ointment containing powder

2) Very adhesive

--- Chemical dressing - sticks better to the wound

Front 12

What are the characteristics of creams?

Back 12

1) Oil in water

-- Mix with serous discharges

-- Easily washable

2) Water in oil

-- Vehicle for fat-soluble substances

-- Do not mix with serous discharges

-- Easily washable

Front 13

What are the types & characteristics of Ointments?

Back 13

1) Water-soluble

-- Improve penetration of drugs thru skin

-- PEG - polyethylene glycol

2) Emulsifying

-- Mix w/ water and exudate

3) Non-Emulsifying

-- Occlusive dressing, enhance hydration

Front 14

What are the causes of dermatitis/Eczema?

Back 14

1) Irritants & Allergens

2) Infections

3) Drugs

4) Environmental factors

5) Local factors (stasis)

Front 15

What are the treatments for atopic dermatitis?

Back 15

1) Reduce contact with irritants

2) Reduce exposure to allergens

3) Emollients

4) Topical steroids

5) Antihistamines

6) Antibiotics

7) Steroids sparing

Front 16

How to reduce contact with irritants?

Back 16

eg. Soap substitutes - Cetaphil

1) Far less drying and irritating than soap

2) Cleansing and moisturizing formulations

-- All OTC

3) Lotions, bar, soap, cream, sunscreen

4) Cost is about $8-9 for 16oz.

Front 17

How to reduce allergens?

Back 17

1) Dust

2) Pet dander

3) Food allergies

Front 18

What are emollients?

Back 18

1) Soften the skin and reduce itching

2) Moisture trapping effectiveness

-- Best: oils

-- Moderate: Creams

-- Least: lotions

3) Apply after bathing and when skin is unusually dry (winter months)

4) Urea creams

Front 19

Creams are excellent for relieving dryness, but can sting and sometimes ________________

Back 19

Aggravate eczema

** Creams are useful from maintenance not during inflammation **

Front 20

What is Alpha-Hydroxy acid?

Back 20

Emollients

Preparations:

1) Glycolic acid - 8%

2) Lactic acid or lac-hydrin - 5-12%

3) Urea - 6%

Use once a day

Front 21

What are the benefits of using oils (emollients)?

Back 21

Using bath oil or mineral oil based lotions in lukewarm bath water

Bath oil preparations:

1) Alpha-keri

2) Aveeno bath

3) Jeri-bath

Colloidal oatmeal (Aveeno) reduces itching

Front 22

What are the advantages of Corticosteroids?

Back 22

1) Topical steroids are very effective

2) Once under control, intermittent use of topical corticosteroids may prevent relapse

3) Once daily probably - cost effective

Front 23

What are the disadvantages of Corticosteroids?

Back 23

Systemic steroids may bring under rapid control, but may precipitate rebound

Front 24

What are specific indication for creams, lotions, & ointments?

Back 24

Ointments = dry or lichenified skin

Cream = weeping skin or body folds

Lotions = for areas w/ hair

Front 25

What is the indication of antibiotics for atopic eczema?

Back 25

Atopic eczema frequently result in secondary bacterial infection

** Use oral antibiotics in recalcitrant or widespread cases **

Front 26

What are the indications for oral antihistamines?

Back 26

Urticaria w/ itch

-- Non-sedating = less effective but more expensive

eg. Benadryl

Front 27

What are some alternative medicine treatment options?

Back 27

1) Licorice

2) Calendula

3) Echinacea

4) Golden seal

5) Nettle

6) Oats

Front 28

What is diaper dermatitis?

Back 28

Irritant dermatitis

Front 29

What causes diaper dermatitis?

Back 29

Cutaneous Candidiasis infection

Front 30

What are the risk factors for diaper dermatitis?

Back 30

Area where warmth and moisture lead to maceration of skin or mucous membrane

Front 31

What is clinical presentation of Diaper dermatitis?

Back 31

1) Pruritus, pain

2) Erythematous papules/vesicles, edema

3) Satellite lesions to peri-genital, peri-anal, inner thigh & buttocks

Front 32

What is the treatment of diaper dermatitis?

Back 32

1) Topical antifungal agents such as nystatin, miconazole or clotrimatzole

2) Topical corticosteroids

Front 33

What are complications involved with diaper dermatitis?

Back 33

1) Secondary infection can occur

2) Generalized infections can be a serious problem

3) Educate the care givers

Front 34

What is the most common cause of diaper dermatitis?

Back 34

Neglect or not knowing how to care for it

Front 35

What is the mechanism of action of Pimecrolimus (Elidel) & Tacrolimus (Protopic)?

Back 35

1) Inhibits inflammatory cytokine release

2) Minimal systemic immunosuppression

Front 36

What are the indications for Pimecrolimus (Elidel) & Tacrolimus (Protopic)?

Back 36

Atopic dermatitis and contact dermatitis

** Alternative to corticosteroids **

Front 37

What is the mechanism of action of Imiquimod (Aldara)?

Back 37

Immunomodulator

1) Stimulates peripheral mononuclear cell to release interferon alpha

2) Stimulates macrophages to produce interleukins and TNF alpha

Front 38

What are the indications for Imiquimod (Aldara)?

Back 38

Treatment of external genital and perianal warts and actinic keratitis

Front 39

List the topical antivirals

Back 39

1) Acyclovir (Zovirax)

2) Pencyclovir (Denavir)

Front 40

What are the indications for topical antivirals?

Back 40

Treatment of herpes

Front 41

T/F: Topical antivirals should be used for active lesions

Back 41

FALSE

For active lesions, Oral antivirals should be used

Front 42

What are predisposing factors for parasitic skin infection?

Back 42

1) Poor Hygiene

2) Substandard living

Front 43

What are the types of pediculosis-lice (human lice)?

Back 43

1) Pediculosis capitis - Head

2) Pediculosis corporis - Body

3) Pediculosis pubis - Pubic or crab

Front 44

What are the treatment options for pediculosis capitis?

Back 44

1) Pediculicides

2) Hand pick or comb nits out

3) Launder bed linens & Vacuum

4) Seal items in plastic bags for 14 days

5) Repeat for 10-14 days

Front 45

What are the treatment options for pediculosis corporis & pubis?

Back 45

1) Chemical killing

2) Clean linens with hot water and soap

3) Dry clean

4) Fine-tooth comb

5) Treat social contacts

Front 46

What is the drug used to treat pediculocides?

Back 46

Lindane

1) Hepatotoxic and neurotoxic

2) Permethrin (Nix)

Front 47

What are the treatment options for scabies?

Back 47

1) Topical sulfur preparations

2) Crotamiton (Eurax)

3) Permethrin 5% (Elimite)

4) Launder personal items

5) No disinfectant

Front 48

What are the microorganisms responsible for Acne?

Back 48

1) Propionibacterium acnes

2) Staphlococcus spp

--- epidermidis or aureus

* Androgenic stimulation of sebaceous gland *

Front 49

What are OTC treatment options for Acne?

Back 49

Keratolytics

1) Benzoyl peroxide

-- Gel

-- Solution

-- Lotion

2) Selenium sulfide

Front 50

What are prescription treatment options for acne?

Back 50

Keratolytics -

Retinoid acid derivatives

1) Tretinoin (Retin-A) - Topical

2) Isotretinoin (Acdutane) - PO

Front 51

What is adverse effect of Isotretinoin (Accutane)?

Back 51

Liver dysfunction

Front 52

What is the contraindication of Isotretinoin?

Back 52

During pregnancy or patients planning pregnancy

** lead to teratogenic effects **

Front 53

What are the antibiotic options used in conjunction with keratolytics?

Back 53

Topicals combination w/ keratolytics

1) Erythromycin

2) Clindamycin (Cleocin)

3) Azelaic acid (Azelex, Finacea)

Oral for cystic acne or scaring acne

1) Tetracyclines

2) Erythromycin

Front 54

What are the topical medications indicated for Rosacea?

Back 54

1) Azelaic acid

2) Metronidazole

Front 55

What are the topical medications for Psoriasis?

Back 55

1) Keratolytics

-- Coal tar

-- Salicylic acid

2) Corticosteroids (potent)

Front 56

What are the systemic medications for Psoriasis?

Back 56

1) Corticosteroids (may lead to dependence)

2) Methotrexate

3) Hydroxeurea (Hydrea)

4) Cyclosporin (decreases infiltration of inflammatory cells

5) Infliximab (Remicade)

Front 57

What is the treatment for mild psoriasis?

Back 57

1) Topical

-- Keratolytics

-- Corticosteroids

2) Phototherapy (UV light shown to be helpful)

Front 58

What is the treatment for mild psoriasis arthritis?

Back 58

1) NSAIDs

2) Intra-articular injections of corticosteroids

-- If isolated to one or two joints

Front 59

T/F: Psoriasis is a form of Rheumatoid Arthritis (RA)

Back 59

TRUE

Front 60

What is the treatment for moderate psoriasis or psoriatic arthritis?

Back 60

1) Disease modified anti-rheumatic drugs (DMARDs)

2) Systemic Corticosteroids = Prednisone

3) Rheumatoid Arthritis drugs

4) Biologics

Front 61

What are the drugs used to treat moderate to severe psoriatic arthritis (form of RA)?

Back 61

1) Methotrexate

2) Cyclosporin

3) Gold (major renal side effects)

4) Antimalarial

Front 62

What are biologics?

Back 62

Drugs with lots of side effects (however they do help treat psoriasis

Front 63

What is the contraindication for biologics?

Back 63

Cannot be used with active infection or with liver dysfunction

Front 64

What is the criteria for using Biologics?

Back 64

1) 18 y/o or older

2) Moderate to severe psoriatic arthritis with at least one comorbidity

-- Inadequate control with DMARD alone

-- Other therapies have failed

3) Normal liver function

4) No active infection

Front 65

List the drugs that are biologics

Back 65

T-cell Inhibitors

1) Alefacet (Amevive)

2) Efalizumab (Raptiva)

TNF inhibitors

1) Etanercept (Enbrel)

2 )Adalimumab (Humira)

3) Infliximab (Remicade)

Front 66

What are the types of glucocorticoids available?

Back 66

1) Mild

2) Moderate

3) Potent

4) Very potent

** Limited absorption **

Front 67

Which type of glucocorticoid can be used on the face?

Back 67

Only Mild glucocorticoid

** Stronger can cause coarsening of features and hirsutism **

Front 68

List the glucocorticoids

Back 68

1) Hydrocortisone

2) Triamcinolone

3) Desonide (potent)

4) Mometasone (ultra potent)

Front 69

Where is hydrocortisone safe to apply?

Back 69

For the face

** Less than 1% strength **

Front 70

Where is triamcinolone safe to apply?

Back 70

Can use it for the body except face

Front 71

What is the indication for mometasone?

Back 71

Treatment for psoriasis

Front 72

What is the difference between sunscreen and sunblock?

Back 72

Sunscreen filters the UVA and UVB rays

vs.

Sunblock will completely block the UV rays

Front 73

What are the types of sunscreens available?

Back 73

1) Mild <10 spf

2) Moderate 10-15 spf

3) Strong > 15 spf

Front 74

What are the treatment options for hair loss?

Back 74

1) Minoxidil (Rogaine)

2) Finasteride (Propecia)

Front 75

What is the mechanism of action of Minoxidil?

Back 75

1) Vasodilation

2) Effect not predictable or permanent

3) Quality of hair is not the same

4) Some systemic absorption if using in large quantity

Front 76

What is Finasteride?

Back 76

Similar to Testosterone agonist

Front 77

What are the topical treatment options for fungal skin infections?

Back 77

1) Clotrimazole (Mycelex)

2) Miconazole (Monistat)

3) Terbinafine (Lamisil)

4) Ketoconazole (Nizoral)

5) Tolnaftate (Tinactin)

6) Nystatin (Mycostatin)

Front 78

What are the systemic treatment options for fungal skin infections?

Back 78

1) Ketoconazole (Nizoral)

2) Itraconazole (Sporanox)

3) Terbinafine (Lamisl)

4) Grisefulvin (Grisactin)