Term
| What is the definition of acne vulgaris? |
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Definition
| self-limiting, multi-factorial disorder involving inflammation of the sebaceous follicles of the head and trunk |
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Term
| How many teenagers in US use OTC acne products? |
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Definition
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Term
| ***What are medications exacerbate acne? PIMPLES |
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Definition
Phenytoin
Isoniazid
Moisturizers
Phenobarbital
Lithium
Ethionamide
Steroids |
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Term
| What other factors exacerbate acne? |
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Definition
environmental and physical factors
cosmetics
emotional factors hormone factors |
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Term
| ***Is acne cured often? what are the tx goals? |
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Definition
-rarely
-Prevent formation of new lesions
Heal existing lesions
Prevent or minimize scarring
Relieve social discomfort |
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Term
| ***What type of acne tx is effective? |
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Definition
Cleanse with gentle, oil-free, non-drying agents
Topical pharmacotherapy
Systemic (oral) pharmacotherapy |
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Term
| ***What is an example of a topical retinoid to use for acne? |
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Definition
*Tretinoin gel/cream (Retin A®)
Topical vitamin A
Comedolytic, speeds cell turnover
May see initial acne flare with treatment
***is comedolytic, keratinolytic and antinflammatory |
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Term
| ***What oral antibiotic is inexpensive and most commonly used? |
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Definition
-a tetracycline agent:
**Doxycycline – inexpensive-most commonly used
Dose: 100 mg daily or twice daily, may reduce to 50 mg daily as maintenance
Doryx® ( doxycycline DR) cost: $780 / #60 capsules |
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Term
| ***Why is clindamycin limited to use for acne? |
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Definition
| *Limited use due to diarrhea and risk of pseudomembranous colitis |
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Term
| *** Which is the tx of choice for severe nodulocystic acne? |
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Definition
Acccutane (Isoretinoin, Amnesteem, Claravis)
MOA: decreases sebum production, inhibits p. acne, inhibits inflammeation |
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Term
| Why should you not give tetracyclines with oral isoretinoin? |
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Definition
| increases risk of intracranial HTN |
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Term
| For females, what can be used as an alternative or additional tx for moderate acne? |
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Definition
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Term
| ***What are the 4 first line topical txs for psoriasis |
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Definition
Keratolytics
-Salicylic acid gel or lotion applied 2-3 X daily
--Applied to large areas, may have adverse event: salicylism (nausea, vomiting, tinnitus)
Corticosteroids creams or ointments applied 2-4 X daily
Ointment is better due to oily occlusive property
Vitamin D Analogs
MOA: inhibits keratinocyte differentiation & proliferation, antiinflammatory
Calcipotriene (Dovonex®) synthetic vit D
Cream, ointment, or solution apply 1-2 X daily (do not exceed 100gm/week)
Tazarotene (Tazorac®) synthetic retinoid
Gel or cream apply once daily (usually in evening)
Do not apply to more than 20% of body surface (due to systemic absorption) |
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Term
| ***What are the 5 systemic treatments for the treatment of psoriasis? |
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Definition
Biologic therapies:
Infliximab (Remicade®) target: TNF-a
Indicated for psoriatic arthritis and chronic severe plaque psoriasis
Dose: 5 mg/kg IV infusion at weeks 0, 2, & 6; then every 8 weeks thereafter
Psoriatic arthritis: infliximab may be used with methotrexate
Etanercept (Enbrel®) target: TNF-a
Fusion protein that binds TNF-a
Fully humanized, so immunogenicity is minimized
Indicated for psoriatic arthritis and chronic mod-severe plaque psoriasis
May be used with methotrexate
Dosing: psoriatic arthritis 50mg SC inj. weekly; plaque psoriasis 50mg SC inj. twice weekly
Adalimumab (Humira®) target: TNF-a
Indicated for psoriatic arthritis and chronic mod-severe plaque psoriasis
Dosing: psoriatic arthritis 40mg SC every other week; plaque psoriasis 80mg initial dose, then 40mg SC every other week
Alefacept (Amevive®) target: CD2 on T cells
Inhibits cutaneous T-cell activation and proliferation
Indicated for psoriatic arthritis and mod-severe plaque psoriasis
Efalizumab (Raptiva®) target: CD11-a integrin
Blocks T-cell activation, migration into skin, and cytotoxic function
Indicated for chronic mod-severe plaque psoriasis |
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Term
| ***When is PUVA used in psoriasis tx? |
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Definition
| For pts unresponsive to conventional topical and systemic therapies |
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Term
| *** What is the tx of eczema? |
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Definition
Patient or caregiver education
Decrease stress, if possible
Reduce exposure to triggers (wool, perfumes)
Fragrance-free detergent and a second rinse cycle
Cotton clothing
Proper Bathing
Lukewarm water, not hot
Avoid regular soap—use Cetaphil or Neutrogena |
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Term
| ***What are 7 factors that affect absorption of a topical drug? |
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Definition
1. status of the skin (absorption of drugs are increased when broken, inflamed or thinner)
2. characteristics of the drug and vehicle (if it hydrates the skin, thus preventing water loss the depth of absorption is enhanced)
3.topical is slower and incomplete compared to oral
4. optimal absorption is post bath or wet soaks.
5. children absorb about 3 times more than adults.
6. Children younger than 12 should not be treated with group 1 or 2 corticosteroids
7.pregnant and/or lactating women should be treated carefully |
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Term
| *** What topical agents should pregnant and/or lactating women avoid |
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Definition
| tretinoin, lindane, and podophyllum |
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Term
| ***What are three rules of thumb when using topical corticosteroids? |
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Definition
-lowest potancy for as short a time as possible
-lower potency for facial, eyelid or genital
-discontinue therapy ASAP, if chronic use, monitor adverse effects and/or tachyphylaxis (rapid development of decreased response) |
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Term
| ***Does the dose or % of drug correlate with potency of other creams, lotions or ointments? |
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Definition
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Term
| ***Immunosuppressives primecrolimus and tacrolimus are immunosuppressive topicals that can be used for what kind of atopic dermatitis? What is the black bow potential on these drugs? |
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Definition
-2md line agent for short term and intermittent long-term of mild to moderate atopic dermatitis
- risk of Cancer, also FDA –Approved medication guide MUST be given to patient (new or refill) |
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Term
| ***Which topical antibiotic is the ONLY drug in its class used exclusively for topical infection? |
|
Definition
Mupirocin (Bactroban, Centany)
-used for impetigo |
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Term
| ***What other topical antibiotic is effective for most topical infections? |
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Definition
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Term
| ***Why should you not use topical steroids for topical infections such as group A beta-hemolytic streptococci, Staphylococcus aureus and pyogenes? |
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Definition
can impair ability to fight infections
-keep area clean and covered. |
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Term
| ***How long must you use antifungals on topical fungal infections such as athlete's foot? |
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Definition
long enough for complete turnover of the skin to occur, may require maintenance therapy
-area must be kept clean and dry |
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Term
| What is the 1st line treatment of scabies? |
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Definition
| Permethrin 5% cream (Elmite, Acticin, Nix) applied from the nech down and washed off 8 to 14 hours later or Ivermectin (Stromectol) Oral (150-200mcg/kg) single does adults and children |
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Term
| ***What is the first line of treatment for pediculosis of the head? |
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Definition
| permethrin 1-5%-- apply and wash off body after 10 minutes |
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Term
| ***For acne vulgaris, you want to use a topical keratolytic and a topical antibiotic... what are some examples of the topical antibiotic to use? |
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Definition
benzoyl peroxide and azelaic acid
-kills bacteria and used to treat pustules. |
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Term
| ***What is the teratogenecity associated with oral Vitamin A (accutane, isotretinoin)? What is the black box warning? |
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Definition
-requires female to utilize TWO forms of contraception beginning 1 month before and up to 4 month after therapy ends. All females must participate in the iPLEDGE program
-depression and suicide |
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Term
| ***Does colonization cause disease? |
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Definition
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Term
| How do antibiotics really work? |
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Definition
| -break down bacterial cell wall and get into the DNA. |
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Term
| Anytime you put someone on an antibiotic, what do you want to let them know they might get? |
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Definition
|
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Term
| ***Why are antibiotics becoming less and less effective? |
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Definition
-over-prescription
-inappropriate use |
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Term
| ***What is an example of a natural penicillin? An extened spectrum penicillin? Extended spectrum with Beta-lactamse inhibitors? |
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Definition
-penicillin V
-amoxicillin
-amoxicillin/clauvulanate (Augmentin) |
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Term
| ***What is a penicillinase-resistant penicillin? |
|
Definition
Dicloxacillin
-can be used on impetigo
-target penicillinase-resistant staphylococcus |
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Term
| ***What do aminopenicillins target and what are 2 examples? |
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Definition
-gram-negtive organisms
-amoxicillin for more sever infections and augmentin (amoxicillin and clavulanate) |
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Term
| ***What is an example of an antipseudomonal penicillin and what does it do? |
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Definition
| calvulonic acid- inhibits beta-lactamase but has no intrinsic anti-microbial activity (combo with Amoxicillin) |
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Term
| ***Name one cephalosporin from each class? This is the most commonly used antibiotic class (safe and effective with minimial side effects) |
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Definition
First Gen: Cephalexin (Keflex); every 12 hrs
--also cefadroxil (duricef)
Second Gen: better at gram negative: Cefuroxime (Ceftin (oral) or Kefurox (parenteral))
Third Gen: crosses BBB: Ceftriaxone (Rocephin) and Cefdinir (Omnicef)
Fourth Gen: good for: extended spectrum of activity and very little anaerobic
--approved for intra-abd infections, febrile neutropenia, same indics as 3rd gen. |
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Term
| What IV antibiotic is active against almost all gram negative organisms including pseudomonas? |
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Definition
Monobactams (class)
Aztreonam (Azactam) |
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Term
| What are 4 examples of a fluoroquinolone? |
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Definition
-ciprofloxacin
-levofloxacin
moxifloxacin |
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Term
| Where macrolides work, they work very well...what are 3 examples? |
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Definition
-azithromycin
-clarithromycin
-telithromycin
Adverse effects: N/Vdiarrhea and dyspepsia (most common with erythromycin), cholestatic hepatitis, thrombophlebitis |
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Term
| What are 3 tetracycline drugs in use? what are they? |
|
Definition
*Tetracycline (Sumycin®, Achromycin®)
*Doxycycline (Vibramycin®)
*Minocycline (Minocin®)
-bacteriostatic |
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Term
|
Definition
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Term
| What are some risk factors for sepsis? |
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Definition
Age (older patients)
Cancer
Immunodeficiency
Chronic organ failure
Genetic factors (male, nonwhite ethnic origin in North America)
Bacteremic patients
Genetic polymorphisms of immune system |
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Term
|
Definition
Gram + bacteria 30-50% of cases
Gram – bacteria 25% of cases
Viruses are 4% of the cases |
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Term
| After the initial infection, what then occurs? |
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Definition
increased inflamm
increased coagulation
decreased fibrinolysis |
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Term
| What is the clinical presentation of early sepsis? |
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Definition
Fever, chills, change in mental status
Tachycardia
Tachypnea
N/V
Hyperglycemia
Myalgias
Lethargy & malaise
Proteinuria
Leukocytosis
Hypoxia
Hyperbilirubinemia |
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Term
| What is the clinical presentation of late sepsis? |
|
Definition
Lactic acidosis
Oliguria
Leukopenia
Thrombocytopenia
Myocardial depression
Pulmonary edema
Hypotension
Hypoglycemia
GI hemorrhage |
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