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clph 467
derms set 1 (scott)
171
Pharmacology
Graduate
09/23/2011

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Cards

Term
What can be used to treat Tinea infections?
Definition
gentian violet (used before modern topical antifungals)
hygeine
topical antifungals (clotrimazole, miconazole, terbenafine, tolnaftate)
Term
Brand: Lotrimin AF

generic/indication
Definition
clotrimazole
tinea infection
Term
brand: micatin

generic/indication
Definition
miconazole
tinea infection
Term
brand: lamisil

generic/indication
Definition
terbenafine
tinea infections
Term
brand: tinactin

generic/indication
Definition
tolnaftate
tinea infections
Term
how long/frequnecy should topical antifungals be used?
Definition
apply at least BID for 2-4 weeks
Term
What are tinea infections?
Definition
foot fungi/jock itch
(associated with moist footwear)
Term
What is seborrhic dermatitis?
Definition
-fungal like condition
-around the hairline, scalp, nose, neck, ears, back
-itching involved
-erythema with greasy yellow scaling
-scaly areas
-increased sebaceous gland activity
Term
How can babies get seborrhic dermatitis?
Definition
cradle cap in infants.
Term
How do you treat seborrhic dermatitis in infants from cradle cap?
Definition
Baby oil to soften
baby shampoo
no drug treatment usually required
can use a comb to get rid of the scales
Term
What are treatment options with seborrhic dermatitis?
Definition
medication shampoo
topical corticosteroids
Term
examples of medicated shampoos used for seborrhic dermatitis
Definition
coal tar, pyrithione zinc, sulfur, selenium, salicylic acid, ketoconazole
(keratolytics and cytostatic agents)
Term
Can you use medicated shampoos for seborrhic dermatitis on the face?
Definition
yes, but these will sting the eyes more than regular shampoos.
Term
How often/where should medicated shampoos for seborrhic dermatitis be used?
Definition
2-3 times per week
on scalp and hair line (also face if needed)

use OTC first then Rx if needed (Rx is 2xs stronger than OTC for ketoconzole/selenium)
Term
What is the purpose of the medicated shampoo for seborrhic dermatitis?
Definition
removes scales
reduces cell turnover
Term
What strength of topical corticosteroids should be used for seborrhic dermatitis and what is the purpose? How often should they be used?
Definition
low strength.
it will reduce inflammation and itching
ideal for lesions on face and ears
Use BID then PRN
not used for a chronic basis on the face
Term
Who is at risk for topical fungal infections?
Definition
infants
elderly
immunosuppressed
incontinent; increase frequency of BM
obese
warm and humid climates
Term
What are the treatment options for diaper rashes?
Definition
remove irritant (aka freq diaper changes)
air dry
keep clean (mild soap and water)
antifungal agents
apply protectants
Term
Examples of protectants for diaper rashes
Definition
zinc oxide
destin
aveeno
A&D ointment
butt paste (can be applied over anti-fungal if needed)
Term
How long should be the treatment for fungi?
Definition
treatment often 4 weeks or longer
(slow to grow, slow to go)
Term
What do pharmacist have to know when managing dermatologic patients?
Definition
knowledge of ...
vechiles and bases, commonly used terminology, drug-induced skin conditions

Be able to ID common dermatologic lesions and rashes

know advantages and disadvantages of dermatologic products

advise pts on the the proper use of dermatolgoic products
Term
When should refer to a MD?
Definition
multiple or extensive burns
human or animal bites
multiple or extensive cuts, bruises, or abrasions
rahs that is extensive, weeping, or infected
tumors or growths
yellow skin
deep infection (cellulitis)
large blisters of unknown origin
Term
What are the basic vehicles for derm products?
Definition
ointment
cream
lotion
gel
solution/spray
Term
What is an ointment?
Definition
semisolid preparations intended for external application to skin and mucous membranes

there are four classes
Term
Which vehicle is best for delivering a drug?
Definition
ointment
Term
What are the four classes of ointments?
Definition
hydrocarbon
absorption
water-removable
water-soluble
Term
What is a cream?
Definition
ointment bases of the water-removable class

consisting of oil-in-water emulsions or aqueous microcrystalline dispersion of long fatty acids or alcohols
Term
Why is a cream better than an ointment?
Definition
water washable and more cosmetically and aesthetically acceptable than ointments
Term
What is a lotion?
Definition
A watered-down cream
they feel less greasy and easier to apply.
Term
What is a gel?
Definition
Used if want to dry out the area.
semisolid systems consisting of either suspensions made up of small inorganic particles or large organic molecules interpenetrated by a liquid.
Term
What is an emollient?
Definition
softens the skin
soothes irriation in skin or mucous membranes
Term
What is a protective? (give an example)
Definition
protects injured or exposed skin surfaces from harmful or annoying stimuli (zinc oxide, sunscreen, diaper ointment, A&D ointment)
Term
What is occlusive?
Definition
promotes retention of water in the skin and forms a hydrophobic barrier that prevents moisture in the skin from evaporating
Term
What is humectant
Definition
causes water to be retained bc of its hygroscopic properties. (when added to ointment it helps the water to be maintain)
Term
What are the properties of ointment?
Definition
emollient
protective
occulsive
humectant
Term
What are the uses of ointments?
Definition
protect skin or mucous membrane
permit rejuvenation of the tissue
provide hydration of the skin
provide a vehicle for applying medication
Term
examples of drugs for ointments
Definition
antibiotics
antifungals
corticosteroids
retinoids
nitroglycerin
analgesicsa
Term
The nature of the incorporated medication must have...
Definition
bioavialiabity
stability
compatibility
Term
What is the advantage of an ointment?
Definition
hydrates
removes scales
greatest bioavailibity
Term
what is the disadvantage of an ointment?
Definition
greasy (hard to have compliance when used with hair)
Term
What is the preferred area of use for an ointment?
Definition
smooth skin with short or sparse hair
Term
What is the advantage of using a cream?
Definition
good cosmetic appearance
high patient acceptance
Term
what is the disadvantage of using a cream?
Definition
not as hydrating as ointments
Term
What is the preferred area of use for creams?
Definition
smooth or hair-bearing skin
intertriginous areas (ie. groin, armpit)
Term
What is the advantage of using a gel?
Definition
non-greasy
easy to apply to hairy areas
high patient acceptance
Term
What is the disadvantages of using a gel?
Definition
drying
Term
What is the preferred area of use for a gel/lotion/solution/foam?
Definition
hair bearing skin
Term
How often should a lotion by applied?
Definition
3-4 hours (has a lower bioavailibility)
Term
What is the advantage of using a lotion/solution/spray?
Definition
easy to apply to hairy areas, scalp,
high patient acceptance
Term
What is the disadvantage of using a lotion/solution/spray?
Definition
drying
lower bioavailability (therapeutic event is compromised)
Term
What is the preferred area of use for lotion/solution/spray?
Definition
intertriginois and hair-bearing skin, face
Term
examples of oleaginous base
Definition
white petrolatum
vaseline
plastibase
Term
examples of absorption bases
Definition
aquaphor
aquabase
polysorb
Term
Characteristics of an oleaginous base
Definition
absorbs no water
not water washable (soap is required)
Term
characteristics of an absorption base
Definition
can absorb several times its weight of water
not water washable
Term
examples of water-in-oil emulsion bases
Definition
nivea
eucerin
hydrocerin
Term
characteristics of water-in-oil emulsion bases
Definition
absorbs less water than absorption bases
not water washable
Term
examples of oil-in-water emulsion bases
Definition
hydrophilic ointment
dermabase
hydrocerin
unibase
cetaphil lotion
vanicream
Term
characteristics of oil-in-water emulsion bases
Definition
water washable
add water = lotion
Term
examples of water soluble base
Definition
polyethylene glycol ointment
Term
characteristics of water soluble base
Definition
water washable
minimal therapeutic effect
used primary to deliver drugs
Term
examples of gels
Definition
methylcellulose gel
liqua-gel
carbomer gel
polxamer gel
Term
characteristics of gels
Definition
water washable
accepts water
has a polymer associated with it
Term
what are the two major types of skin lesions?
Definition
primary and secondary
Term
What are the primary lesions?
Definition
flat, nonpalpable changes in skin color
elevation formed from a fluid in a cavity
elevated, palpable solid masses
Term
What type of primary lesions are flat,nonpalpable changes in skin color
Definition
macule
patch
Term
what types of skin lesions are elevation formed by a fluid in a cavity
Definition
vesicle
bulla
pustule
Term
what type of skin lesions are elevated, palpable solid masses
Definition
papule
plaque
nodule
tumor
wheal
Term
What is the difference with a papule, vesicle, and pustule
Definition
papule is raised
vesicle is raised with fluid
pustule is raised with pus
Term
What are the types of secondary lesions?
Definition
material on skin surface
loss of skin surface
vascular lesions
Term
examples of drug induced disease
Definition
lupus
acne
Term
how do you treat drug rxns?
Definition
1) stop the drug (until have been evaluated)
2) systemic antihistames
3) systemic or topical corticosteroids
4) soothing baths or soaks (helps locally)
Term
types of drug-induced skin disorders
Definition
1) hypersensitivity/allergic rxn
2) photosensitivity (increase chance of development of a sunburn
3) toxic rxns
4) drug-induced disease
Term
examples of toxic rxns
Definition
erythema multiforme
stevens johnson syndrome (SJS)
toxic epidermal necrolysis
Term
how do you treat photosensitivity?
Definition
1) prevention with suncreens/clothing
2) systemic analgesics (for pain - best used is NSAIDS or aspirin)
3) systemic antihistamines for itching
4) prevent infection
5) moisturizers
6) cooling creams and gels (initially bc after 1st day probably will not help)
Term
what is toxic epidermal necrolysis?
Definition
drug rxns and attacks mucous membrane areas, this leads to infections (they die of the infection not TEN)
Term
What is the basic characteristics of Stevens Johnson syndrome?
Definition
severe breakdown of the skin
typically start with red large areas
Term
drugs that are associated with SJS/TEN
Definition
antibiotics: penicillins, fluoroquinolones, sulfonamides, cephalosporins

anticonvulsants
allopurinal
NSAIDS
can occur with any drug
Term
features of SJS/TEN
Definition
usually occurs within the first 1-4 weeks of treatment
prodromal NVD, myalgias, sore throat, arthralgias (flu-like symptoms plus rash)
involement of mucous membranes
widespread blisters and lesions
full thickness epidermal detachment (risk of infection occurs bc of this)
Term
Treatment of SJS/TEN
Definition
IV fluids/nutrition
pain control
eye care
nasal saline
oral hygiene and anesthetics
topical antiseptics
wound care
STOP OFFENDING AGENT
Term
common race associated with drug-induced lupus
Definition
butterfly rash (on the face)
Term
what drugs are associated with drug-induced lupus?
Definition
phenytoin
hydralazine
isoniazid
procainamide
Term
true or false: lupus will generally go away when remove drug
Definition
true
Term
what are some of the drugs associated with drug induced acne?
Definition
BC, testosterone, corticosteroids, (increased androgen in the system)
Term
example questions to ask a patient to evaluate them
Definition
anything new? ie food, soap
painful?
where is it?
how long?
have you had it before?
where do you work?
when did it start?
is it getting worse?
is it local/systemic?
Term
what can you treat acne with?
Definition
topical and systemic antibiotics
topical and systemic comedolytics
Term
true or false: pharmacist should recommend a dermatologist for all forms of acne
Definition
false: refer all but those with mild forms
Term
what is tinea pedis
Definition
athletes foot
Term
what do you treat for tinea pedis
Definition
topical antifungals and use for a while (slow to grow, slow to go)
Term
how is tinea pedis spread?
Definition
pools/showers
moist environments that promote growth
dermatophyte infections
Term
what is tinea corporis
Definition
body ring worm
Term
how can you get tinea corporis
Definition
commonly transmitted in day care
hot/humid environments promote growth
Term
characteristics of tinea corporis
Definition
located on body in areas where air flow is limited
worms are not involved
no itching
small, circular, red scaly areas
its a fungi
Term
true or false: can use the same treatment for tinea corporis, tinea pedis, and candida infections
Definition
true bc they are all fungal infections
Term
what can you use to treat tinea corporis
Definition
topical antifungals
Term
what is topical candida infection?
Definition
its fungal. common in moist areas in humid conditions. (where no air flow)
Term
what can you treat candida with?
Definition
topical antifungal
dry the affected area
Term
What is contact dermatitis?
Definition
delayed hypersentivity rxn
localized eruption in area exposed to irritant or allergen
pruritis (aka itch)
Term
How can you treat contact dermatitis?
Definition
remove allergen
topical corticosteroids
oral antihistamines
-use OTC if localized, Rx needed if systemic
Term
What is psoriasis
Definition
its immune related disorder with red and silver plaque lesions
Term
what can you use to treat psoriasis
Definition
emollients
topical corticosteroids and immunosupressants
systemic immunosuppressants
phototherapy
Term
what is rosacea?
Definition
redness of the skin; adult acne
Term
what can you use to treat rocacea
Definition
avoid triggers (sun is usually one)
topical and oral antibiotics
topical retinoids
laser treatment
Term
what is atopic dermatitis
Definition
eczema: common in pts with other allergies
dry skins with raised patches/lesions
Term
what can you use to treat atopic dermatitis?
Definition
topical emollients
topical corticosteroids
oral antihistamines for itching

-if very localized can use OTC
Term
What is cellulitis
Definition
infection in the skin (located near break in skin)
red, warm, swollen
Term
How do you treat cellulitis?
Definition
oral antibiotics
IV antibiotics in severe cases
must see PCP
Term
Which people are more likely to get cellulitis?
Definition
obese
diabetes
compromised circulation
Term
what is impetigo?
Definition
topical STAPH skin infection
most common in children
direct spread (from touching)
Term
How do you treat impetigo?
Definition
topical or oral antibiotics
refer to PCP
Term
how do you treat lice
Definition
permethrin 1%
malathion (ovide)
oral invermectin (strmectol)
see PCP
Term
characteristics of head lice
Definition
chidlren 3-12 yo
scalp redness and scaling
pruritus (itch)
Term
what is scabies?
Definition
sarcoptes scabiei infestation
raised lines caused by mites burrowing under skin
exterme pruritus (itch)
can be spread easily
primarily in children and adolescents (LTCF) (not good hygiene)
they have little lesions with itching
Term
how do you treat scabies
Definition
permethrin 5%
crotamiton (Eurax Cream)
oral ivermectin (stromectol)
-treatment like head lice
Term
What is herpes zoster?
Definition
shingles!!! viral infection among the nerve tract
Term
characteristics of herpes zoster
Definition
adults > 40 yo
triggered by stress, old age, immunosuprresion
extreme pain along dermatome
tender red papules - progress to scabs- usually one side of body
can spread to small infants or pts with immunosuppressant therapy
even after lesions the pain still among nerve tract
Term
treatment of herpes zoster
Definition
antivirals - oral valacyclovir and famciclovir
manage acute pain and posterpetic neuralgia
today there is a vaccine
can use lidoderm patches to protect and numb
Term
types of skin cancers
Definition
basal cell carcinoma (most common)
squamous cell carcinoma (sun-exposed)
melanoma (most deadly)- dark lesion
Term
treatment of skin cancer
Definition
removal of lesion
chemotherapy
radiation
Term
what is activic carontosis
Definition
precondition to cancer
Term
what is xerosis
Definition
dry skin - fissures, itching, cracking
Term
characteristics of xerosis
Definition
-fall and winter - dryer climates, tanning, bath excessively, older
-feet, lower legs
-hands, elbows, face
-rough, dry, scales, cracks
-itching is common
-wont bother until it starts flaking
Term
who is at risk for xerosis
Definition
elderly
frequent bathing
very warm, dry enviroments
-because of decreased sweat and sebaceous glands
Term
how do you treat xerosis
Definition
-emollients - first line for itching and restores barrier and skin function
-agents for itching
-alter bathing habits
Term
dr. martins rules of 3s
Definition
-tub bath or shower no more than 3 times per week
-tepid water (3-5 degrees above body temperature bc hot water water promotes dry skin)
-bathe for 3-5 minutes
-apply copious amounts of emollients within 3 minutes
-apply emollients at least 3 times a week

-pat dry because irritate if rub
Term
examples of emollients
Definition
vaseline
nivea
keri
lubriderm
AmLactin
eucerin
Term
types of dermatitis
Definition
acute
subacute
chronic
Term
characteristics of acute dermatitis
Definition
red patches or plaques
pebbly surface or blisters (vesicles)
itching is common
Term
how do can tell if its acute contact dermatitis
Definition
look at pattern
look at part of body involved
main symptom is itching
irritant- non-immunological response to frequent contact with everyday substances
rxn in a few hrs
more common than allergic
-there are two types: allergic and irritant
-if systematic then its NOT acute contact dermatitis
Term
characteristics of subacute dermatitis
Definition
dry, less red, crusting, oozing, mild thickening. dry lesions
Term
characteristics of chronic dermatitis
Definition
-epidermal thickening
-exaggeration skin markings aka lichenification
-scaling
-less itching (some itching occurs)
-looks like leather bc of very prominent lines
Term
two ways to get poison ivy
Definition
-direct- broken exposure; resin 2 weeks active
-indirect - clothing, dog, smoke; does not spread from lesions
-most common Acute Contact Dermatitis
Term
how to prevent poison ivy
Definition
ivy-block: it will be a barrier (protectant) and must reapply every 4 hrs
-petrolatum can work as ivy-block
-eliminate all sources of exposure
-wash skin and nails within 10 mins (and clothing)
-topical therapy is fine if <10% of BSA
-1st want to dry the skin
-remove source, soaks, calamine lotion (dries), topical and oral antihistamines and corticosteroids
Term
characteristics of poison ivy
Definition
-dermatitis occurs 24 to 48 hrs after exposure
-pruritis is intense: as a result can get 2ndary infections. use cool water to help
Term
general treatment principles
Definition
if its wet, dry it
if its dry, wet it
Term
itch-scratch cycle
Definition
inflammatory/excitation of C-nerve fibers leads to scratching leads to itching and repeat
Term
how to stop scratch itch cycle
Definition
-keep finger nails short or wear gloves
-keep in mind the patients lifestyle, so each pt is diff
Term
treatment of acute dermatitis
Definition
soaks
topical corticosteroids
water
Term
types of soaks and how to use
Definition
domeboro (5% aluminum acetate) - packets in cool water
acetic acid: 60 mL vinegar in 1 qt warm water
saline: 1 tsp salt in 2 cups of water

apply linen or cheesecloth for 30 mins bid-qid remove when dry
Term
why are soaks used
Definition
for oozing, weeping, crusting lesions
wet dressings useful for drying acutely inflammed, wet areas
Term
choice of agent based upon...
Definition
location of lesion
type of lesion
severity of lesion/degree of inflammation
degree of skin penetration desired
Term
side effects of topical corticosteroids
Definition
-thinning of skin
-dilated blood vessels
-bruising
-skin color changes
-risk of HPA (hypo potency agents) suppression with long-term use of high-potency agents
=development of tolerance (tachyphylaxis) aka effects wear off
Term
how are topical corticosteroids classified
Definition
high mid low
now days using grades I (most potent) to VII (least potent)

potency relates to anti-inflammatory activity and vasocontrictive potency
Term
absorption of topical corticosteroids
how to improve
Definition
-only 1% is absorbed when applied to NORMAL INTACT skin
-if skin is BROKEN down then more is absorbed
-to improve use: plastic wrap + t-shirt/bandage because increases penetration
-leave on for 6 hrs (8 at most)
Term
freq and duration of topical corticosteroids
Definition
bid to qid for 3 to 14 days

choice of vehicle depends on type of dermatitis
Term
purpose of corticosteroids
Definition
anti-inflammatory
anti-pruitic
suppress immune response
Term
low potency topical corticosteroids
examples, uses
Definition
-grade 5-7
-examples: hydrocortisone; hytone; cortaid; desonide; actovate
-use on face, groin, genitals, axilla
-mild anti-inflammatory effect
-safest for long-term use
-may not be strong enough to get rid of condition
Term
mid-potency topical corticosteroids
examples and uses
Definition
-grades 3-5
-examples: valisone, diprosone, kenalog, cordran
-used on most skin surfaces
-moderate anti-inflammatory effect
-safer for longer usage than high potency
Term
high/very high topical corticosteroids
examples and uses
Definition
-grades 1-2
-examples: lidex, ultravate, topicort, psorcon, temovate
-NEVER use on face or intratrigenous areas
-used for very severe lesions and on thicken skin when maximum penetration is needed (aka psoriasis)
avoid using super-potent agents for >2 weeks
-limit to no more than 50 grams a week
Term
What are topical calcineurin inhibitors?
Definition
MOA: blocks pro-inflammatory cytokine genes
can be used in any area
like a mid-potency
no risk of atrophy
few side effect
very costly
now considered a 2nd line treatment
intermittent use only
risk of problems when used for a long time
risk of resp infect in <2 yo
Term
True or False: dose pack should be avoided when administrating systemic corticosteroids
Definition
TRUE because the treatment is not long enough
Term
What is the dose/frequency/duration used for system corticosteroids
Definition
start at predinisone 40-60 mg per day; taper every 3 days. use for 10-14 days
Term
What can be used to treat systemically for acute dermatitis?
Definition
corticosteroids
non-sedating antihistamines
sedating antihistamines
Term
examples of non-sedating antihistamines
Definition
loratadine (Clartin)
desioratadine (clarinex)
fexofenadine (allergra)

*these will not help with severe itching*
Term
examples of sedating antihistamines
Definition
diphenydramine (benadryl)
certizine (zrytec)
hydroxyzine (atarax)
doxepin

*especially useful at night*
Term
what is the allergic traid
Definition
asthma, allergic rhinitis, eczema

people with eczema will 2/3 will have asthma or allergic rhinitis.
Term
examples of triggers of atopic dermatitis
Definition
allergens
chemicals
bathing
detergents
smoke
dust
infections
Term
common locations of atopic dermatitis (subacute)
Definition
folds of elbows and knees
face commonly involved in children
adults have more widespread involvement
Term
characteristics of subacute dermatitis
Definition
-red scaling, fissured, patches, or plaques
-slight to moderate pruritis, pain, stinging, or burning
Term
characteristics of atopic dermatitis
Definition
pruritis
red papules or plaques
scaling excoriations (when get worse)
overall dryness of skin
redness and inflammation
located on face and folds
Term
another name for atopic dermatitis
Definition
eczema
Term
how to treat atopic dermatitis
Definition
-emollients + education
-topical corticosteroid
-topical calcineruin inhibitor
-antihistamines at bedtime
-use systemic when topical fails
-avoid chronic treatment if possbile
-cont. to use emollients even after corticosteroid is gone
Term
want to avoid scratching with atopic dermatitis because...
Definition
-prone to infections
-usually staph aureus
-treatment with antibiotics
Term
treatment of stasis dermatitis
Definition
topical corticosteroids: for itching
emollients: for all pts
oral antihistamines
oral antibiotics for local infections
-use cephalexin 250 mg - 500 mg TID
-bandage any weeping lesions until healed
Term
to relieve edema
Definition
elevate feet and legs
support stockings
compression bandages
Term
treatment of chronic dermatitis
Definition
same as subacute
use emollients daily or more
avoid long-term corticosteroids
UV light
Term
characteristics of chronic dermatitis
Definition
well demarcated, lichenified, thickened plaques
excoriations, fissures, scaling
itching predominates (minor irritations or trauma worsens itching)
Term
characteristics of stasis dermatitis
Definition
patients > 50 yo
poor circulation
most common around ankles and uplegs
aching, swelling, discomfort
discoloration can occur
red, scaly, crusted plaques
swelling edema
2ndary infection and ulcers common
hyperpigmentation - retention of Fe++ in skin because circulation is compromised and capillaries leaks releasing iron deposit
Term
Types of 2ndary lesions that have a loss of skin surface
Definition
excoriation, fissure, ulcer, erosion
Term
type of 2ndary skin lesion that have material on skin surface
Definition
keloid, crust, scale
Term
type of 2ndary skin lesion that are vascular
Definition
petechias, ecctymiosis, cherry angioma, telangiectasia
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