Term
|
Definition
| an erythematous, scaly eruption secondary to exposure to a chemical irritant |
|
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Term
|
Definition
| an *allergic* dermatitis characterized as a pruritic, chronic inflammation |
|
|
Term
| What is another name for *eczema* and what is the prevalence of eczema? |
|
Definition
contact dermatitis
affects 5%-10% or population |
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Term
|
Definition
| restoration of normal epidermal layer, tx of inflammation, and control of itching |
|
|
Term
| usual drugs for dermatitis tx |
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Definition
|
|
Term
| Where are natural corticosteroids produced? |
|
Definition
|
|
Term
| 3 types of corticosteroids |
|
Definition
glucocorticoids
mineralcorticoids
adrenal androgens |
|
|
Term
| primary human gulcocorticoid |
|
Definition
|
|
Term
| What drugs control carb, protein, and fat metabolism? |
|
Definition
|
|
Term
| What drugs affect basal secretion necessary for organ function? |
|
Definition
|
|
Term
| In what drugs are extra secretion necessary for physical and mental stress? |
|
Definition
|
|
Term
| What drugs are used for suppressing inflammation and immune system? |
|
Definition
|
|
Term
| What drugs involve multiple systemic adverse effects as an extension of physiological effects? |
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Definition
|
|
Term
| Topical corticosteroids are more accurately known as what? |
|
Definition
|
|
Term
| Glucocorticoids are synthetic analogs of what endogenous hormone? |
|
Definition
| cortisol (hydrocortisone) |
|
|
Term
| What mode of corticosteroid tx is preferred to avoid systemic adverse effects? |
|
Definition
|
|
Term
| What drugs are used topically as anti-inflammatory agents? |
|
Definition
|
|
Term
| Systemic absorption and toxicity potential of topical corticosteroids increases with what 4 variables? |
|
Definition
1. Surface area covered
2. Vehicle (ointment > cream > lotion)
3. Potency of steroid
4. Duration of application |
|
|
Term
| On what is classification of topical corticosteroids based? |
|
Definition
| anti-inflammatory potency |
|
|
Term
| What is the potency of triamcinolone acetonide 0.5%? |
|
Definition
|
|
Term
| What is the potency of Betamethasone dipropionate 0.05%? (Diprolene) |
|
Definition
|
|
Term
| What is the potency of Triamcinolone acetonide 0.1%? |
|
Definition
|
|
Term
| What is the potency of hydrocortisone 1% (OTC) |
|
Definition
|
|
Term
| How does potency of drugs prescribed vary with acute flare-ups versus chronic phase of a disease? |
|
Definition
| May start with high potency product for acute flare-up, then switch to lower potency agent |
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|
Term
| What vehicle of corticosteroid delivery is more occlusive, causing greater absorption? |
|
Definition
| ointments are more potent than lotions of the same concentration of drug b/c of greater absorption |
|
|
Term
| Systemic corticosteroids are reserved for what conditions? |
|
Definition
| severe inflammatory conditions |
|
|
Term
| How should a systemic corticosteroids be administered for severe contact dermatitis such as poison ivy? |
|
Definition
| Give a high dose to start and taper over several days |
|
|
Term
| What side affect involving organs that secrete adrenal-related hormones should be avoided when administering systemic corticosteroids? |
|
Definition
| Supression of hypothalamic-pituitary-adrenal axis |
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|
Term
What pathology involves:
-increased sebum production
-follicular hyperkeratinization
-proliferation of proprionibacterium acnes
-androgen production
-inflammation |
|
Definition
|
|
Term
| What are 5 factors of affecting choice of drug tx for acne? |
|
Definition
1. Types of lesions
2. Clinical severity
3. Cost effectiveness
4. Psychological impact
5. Benefit v. Risk of drugs |
|
|
Term
| What vehicle is preferred for topical tx of acne, and why? |
|
Definition
| Gels and solutions preferred- cause more drying than cream or lotion. |
|
|
Term
| What vehicle should never be used in tx of acne? |
|
Definition
| Never use ointment for acne- occlusive |
|
|
Term
| What 5 drug types are used in tx of acne? |
|
Definition
1. Benzoyl peroxide
2. Azelaic Acid
3. Retinoids
4. Antibacterial agents
5. Salicylic acid and sulfur- in many OTC compounds |
|
|
Term
| Is Benzoyl peroxide available OTC or Rx? |
|
Definition
| Available in both OTC and prescription strenghts |
|
|
Term
| What is a bactericidal agent against P. acnes that can decrease acne by 90%? |
|
Definition
|
|
Term
| Benzoyl peroxide is metabolized in the skin to what compound? |
|
Definition
| benzoic acid, which is lipophilic, allowing it to penetrate better than other topical antibiotics |
|
|
Term
| Benzoyl peroxide is more effective when used how? |
|
Definition
| *More effective when used in combination with topical retinoids or antibiotics* |
|
|
Term
| What are 2 possible side effects of benzoyl peroxide? |
|
Definition
| possible skin irritation and dryness |
|
|
Term
| How can skin irritation with benzoyl peroxide be avoided? |
|
Definition
| begin with low concentration to minimize irritation |
|
|
Term
| What drug can bleach hair, linens, and clothes? |
|
Definition
|
|
Term
| For what conditions is benzoyl peroxide indicated? |
|
Definition
|
|
Term
| What drug is anti-keratinizing, anti-inflammatory, and reduces P. acnes proliferation? |
|
Definition
|
|
Term
| Is Azelaic Acid (Azelex) available OTC or Rx? |
|
Definition
|
|
Term
| Which drug is more irritating: Benzoyl Peroxide or Azelaic Acid (Azelex)? |
|
Definition
| Azelaic Acid (Azelex) is less irritating than benzoyl peroxide |
|
|
Term
| What is a side affect of Azelaic Acid (Azelex)? |
|
Definition
| can cause hypopigmentation |
|
|
Term
| With what other drugs is Azelaic Acid (Azelex) prescribed? |
|
Definition
| Used in combination with topical retinoids or oral antibiotics |
|
|
Term
| Topical retinoids are derivatives of what? |
|
Definition
| Natural and synthetic derivatives of retinol |
|
|
Term
| What drugs normalize or reverse keratinization that leads to plugging? |
|
Definition
|
|
Term
| What are 3 topical retinoids? |
|
Definition
1. Tretioin (Retin-A and others)
2. Adapalene (Differin)
3. Tazarotene (Tazorac) |
|
|
Term
| What is the oldest and most common retinoid? |
|
Definition
| Tretinoin (Retin-A and others) |
|
|
Term
| What are common side affects of Tretinoin (Retin-A and others)? |
|
Definition
| skin irritation and contact dermatitis common |
|
|
Term
| What concurrent effect may also occur with Adapalene (Differin) and Tazarotene (Tazorac)? |
|
Definition
| Also have some anti-inflammatory activity |
|
|
Term
| Which drugs are more expensive: Tretinoin (Retin-A and others), Adapalene (Differin), or Tazarotene (Tazorac)? |
|
Definition
| The newer retinoids Adapalene (Differin) and Tazarotene (Tazorac) are more expensive |
|
|
Term
| How is acne expected to progress when treated with topical retinoids? |
|
Definition
Dryness and minor irritation expected
Acne may temporarily worsen |
|
|
Term
| What is the minimum time frame for use of topical retinoids? |
|
Definition
| Need to try for a minimum of 6 weeks |
|
|
Term
| How should topical retinoids be applied? |
|
Definition
| Apply "pea-sized" amt to *dry* skin |
|
|
Term
| How frequently should topical retinoids be applied? |
|
Definition
| start every other evening or every 3rd evening for a few weeks to decrease adverse drug rxns |
|
|
Term
| What are 3 topical antibacterial agents? |
|
Definition
1. Erythromycin
2. Clindamycin (Cleocin T)
3. Metronidazole (Metrogel)- less commonlyl used |
|
|
Term
| What drug works via bacteriostatic action, decreasing bacterial colonization of P. acnes and reducing inflammation? |
|
Definition
| Topical antibacterial agents |
|
|
Term
| To generate maximum effect from topical antibacterial agents, how should they be prescribed? |
|
Definition
| More effective when combined with other topical agents |
|
|
Term
| How can development of bacterial resistance occuring with use of topical antibacterial agents be slowed? |
|
Definition
| combine antibacterial agents with other topical agents |
|
|
Term
| By what mechanism does salycilic acid 2% work? |
|
Definition
|
|
Term
| What are 3 drugs containing salicylic acid 2%? |
|
Definition
1. Clearasil
2. Neutrogena
3. PROPApH |
|
|
Term
| What are 2 sulfer containing compounds used in acne tx? |
|
Definition
|
|
Term
| Are drugs containing salycylic acid 2% or sulfur available OTC or Rx? |
|
Definition
|
|
Term
| What are 4 categories of oral therapy for acne? |
|
Definition
1. Antibiotics
2. Contraceptives
3. Sprionolactone (Aldactone)
4. Isotretinoin (Accutane) |
|
|
Term
| Which is more effective in acne tx: oral or topical antibiotics? |
|
Definition
| *Oral antibiotics are more effective than topical tx* |
|
|
Term
| What is the most common tx for acne vulgaris? |
|
Definition
|
|
Term
| When are oral antibiotics indicated for tx of acne? |
|
Definition
| moderate to severe inflammatory acne |
|
|
Term
| What oral antibiotics are most commonly used for tx of acne? |
|
Definition
1. The tetracyclines (tetracycline, minocycline, and doxycycline)
2. Also can use erythromycin and clindamycin |
|
|
Term
| What are 2 side affects of tetracyclines (tetracycline, minocycline, and doxycycline) for acne tx? |
|
Definition
1. Photosensitivity rxns- avoid prolonged sunlight/tanning
2. Pregnancy category D- known teratogen |
|
|
Term
| What is one side effect of erythromycin and clindamycin in acne tx? |
|
Definition
| GI problems more frequent |
|
|
Term
| How long do oral antibiotics take to tx acne? |
|
Definition
|
|
Term
| What drugs are oral antibiotics used in tx of acne? |
|
Definition
| Use with topical retinoids +/- benzoyl peroxide |
|
|
Term
| Resistance may occur in what percentage of acne pts receiving oral antibiotic tx? |
|
Definition
| resistance may occur in up to 25% of pts |
|
|
Term
| What are 2 categories of anti-androgenic tx of acne? |
|
Definition
1. oral contraceptives
2. spironolactone (Aldactone) |
|
|
Term
| When are oral contraceptives indicated for tx of acne? |
|
Definition
| For women with persistent inflammatory acne, occurring around menses |
|
|
Term
| What is the action of oral contraceptives in tx of acne? |
|
Definition
| Suppresses production of free testosterone |
|
|
Term
| Why are newer progestins in oral contraceptives preferred for tx of acne? |
|
Definition
| Newer progestins in OC's have less androgenic activity and are preferred |
|
|
Term
| What is the action of spironolactone (Aldactone) |
|
Definition
| an aldosterone antagonist |
|
|
Term
| When is spironolactone (Aldactone) indicated for use in tx of acne? |
|
Definition
|
|
Term
| What is a side effect of spironolactone (Aldactone) |
|
Definition
| Category D pregnancy risk |
|
|
Term
| What is a drug for tx of acne that is derived from vitamin A |
|
Definition
| Oral Isotretinoin (Accutane) |
|
|
Term
| *What is the most effective tx option for acne?* |
|
Definition
| Oral isotretinoin (Accutane) |
|
|
Term
| *What drug for tx of acne has the most potential for toxicity?* |
|
Definition
| Oral Isotretinoin (Accutane) |
|
|
Term
| What drug for tx of acne acts by suppressing abnormal keratinization, increased sebum production, proliferation of P. acnes, and inflammation? |
|
Definition
| Oral Isotretinoin (Accutane) |
|
|
Term
| What are 4 adverse affects of Oral Isotretinoin (Accutane)? |
|
Definition
1. Dry skin and mucous membranes most common
2. Elevated lipids in 25%
3. Back pain and arthralgias reported in 20-30% of children
4. Black Box Warning: Possible aggressive and violent behavior |
|
|
Term
| When is Oral Isotretinoin (Accutane) indicated for tx of acne? |
|
Definition
| Only use for severe acne unresponsive to other therapies |
|
|
Term
| What is the program in which pt, physician, and pharmacy must all meet the requirements and register in program before the drug can be prescribed and dispensed? |
|
Definition
| iPLEDGE program, for Oral Isotretinoin (Accutane) tx of acne |
|
|
Term
| What acne medication is a known teratogen- Pregnancy category X? |
|
Definition
| Oral Isotretinoin (Accutane) |
|
|
Term
| What FDA category is applied when controlled trials fail to demonstrate risk to human fetus? |
|
Definition
|
|
Term
| What FDA category is applied when animal studies do not indicate risk, or animal studies indicate risk but controlled trials in pregnant women do not? |
|
Definition
|
|
Term
| What FDA category is used when no studies are available or animal studies indicate risk but no controlled trials on women have been published? |
|
Definition
|
|
Term
| What is the most common FDA category for drug use in pregnancy? |
|
Definition
|
|
Term
| What FDA category is applied when positive evidence of fetal risk has been demonstrated but situations may exist where benefit outweighs the risk? |
|
Definition
|
|
Term
| What FDA category is applied when definite fetal risk exists and risk clearly outweighs benefit? |
|
Definition
|
|
Term
| What is the first line of tx for acne? |
|
Definition
| topical therapy (min of 6 weeks) |
|
|
Term
| What is the second line of tx for acne? |
|
Definition
| oral antibiotics plus topical therapy |
|
|
Term
| What is the third line of tx for acne? |
|
Definition
| referral to dermatologist +/- oral isotretinoin |
|
|
Term
| What dz involve facial eruption of unknown etiology? |
|
Definition
|
|
Term
| What is the first line of therapy for rosacea? |
|
Definition
|
|
Term
| What are the most common topical antibiotics used to tx rosacea |
|
Definition
| metronidazole (Metrogel) and azelaic acid (Azelex) most common |
|
|
Term
| What is the second line of therapy for tx of rosacea? |
|
Definition
| topical agents and oral antibiotics used for acne |
|
|
Term
| What is the last resort for tx of rosacea? |
|
Definition
|
|
Term
| What is a chronic, relapsing dz of the skin with raised erythematous plaques with distinct borders, silvery scales, glossy erythema, and punctate bleeding if scale removed, involving 2% of the population? |
|
Definition
|
|
Term
| When is topical therapy indicated for psoriasis? |
|
Definition
| Lmt to pts with mild to moderate disease and lesions that cover *less than 20%* of body surface area |
|
|
Term
| What is the drug of choice for psoriasis? |
|
Definition
| topical corticosteroids: *ointments* most effective |
|
|
Term
| What is a vitamin D3 analog used with steroid that inhibits keratinocyte proliferation and is used in tx of psoriasis? |
|
Definition
|
|
Term
| What is a retinoid that is similar in effect to high potency steroids that is used in tx of psoriasis? |
|
Definition
|
|
Term
| What are 3 common side effects of Tazarotene (Tazorac)? |
|
Definition
| Erythema, burning, and pruritis common |
|
|
Term
| When is phototherapy indicated in tx of psoriasis? |
|
Definition
| when unresponsive to topical therapy |
|
|
Term
| What is the 1st line of phototherapy used in tx of psoriasis? |
|
Definition
|
|
Term
| What is the second line of phototherapy used in tx of psoriasis? |
|
Definition
| Photochemotherapy with Psoralen and UV-A (PUVA) |
|
|
Term
| Oral 8 methoxypsoralen followed by exposure to UV-A light after 2 hrs is used for what dz? |
|
Definition
|
|
Term
|
Definition
| Psoralen combines with DNA to increase sensitivity to UVA and improve hyperproliferative phase of psoriasis |
|
|
Term
| when is systemic therapy for psoriasis indicated? |
|
Definition
| for moderate to severe disease |
|
|
Term
| What are 3 forms of systemic therapy for psoriasis? |
|
Definition
| methotrexate, cyclosporine, and acitretin (Soriatane) |
|
|
Term
| What is a folic acid antagonist that inhibits DNA synthesis and is used in tx of psoriasis (chemotherapy agent in higher doses)? |
|
Definition
|
|
Term
| Is methotrexate prescribed weekly or daily in tx of psoriasis? |
|
Definition
|
|
Term
| What are 2 common ADE's and 3 severe ADE's of methotrexate? |
|
Definition
common ADE's: nausea, phototoxicity
severe ADE's: hepatotoxicity, bone marrow suppression
Pregnancy category X: teratogenic |
|
|
Term
| What is the action of cyclosporine in tx of psoriasis? |
|
Definition
| immunosuppressant (also used after organ transplants)- low doses for psoriasis |
|
|
Term
| What are 3 ADR's in cyclosporine used in tx of psoriasis? |
|
Definition
| nephrotoxicity, htn, drug interactions (both substrate and inhibitor of CYP 3A4 enzymes) |
|
|
Term
| What is an oral retinoid, synergistic with phototherapy that is used in tx of psoriasis? |
|
Definition
|
|
Term
| What are 4 ADE's of Acitretin (Soriatane)? |
|
Definition
excessive drying, hair loss, vision loss
pregnancy category X: teratogenic |
|
|
Term
| What are 2 types of recombinant technologies producing unique biologic agents specifically targeting the immune system, used in tx of psoriasis? |
|
Definition
T-Cell inhibitors
TNF (Tumor necrosis factor) inhibitors |
|
|
Term
| Alefecept (Amevie) given IV and Efalizumab (Raptiva) given SC are used in tx of what dz? |
|
Definition
| T-Cell inhibitors- biological therapy for psoriasis |
|
|
Term
| What are 4 ADE's of T-Cell inhibitors used in tx of psoriasis? |
|
Definition
headache
chills
fever
serious infections |
|
|
Term
| Etanercept (Enbrel) given SC, Infliximab (Remicade) given IV, and Adalimumab (Humira) given SC are used to treat what dz? |
|
Definition
| TNF inhibitors used in biological therapy for psoriasis |
|
|
Term
| What are 3 ADE's of TNE inhibitors used in biologic therapy of psoriasis? |
|
Definition
Bacterial sepsis
reactivation of TB
malignancy |
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