thera II test I topical garbage

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202311
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thera II test I topical garbage
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2013-02-22 12:30:13
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thera II test I topical garbage
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  1. rate limiting step for absorption
    Hydration of the skin and damage to the stratum corneum
  2. Preferred Characteristics of Topical
    Preparations
    • Low molecular mass (< 600 Da)
    • Adequate solubility in oil and water
    • High partition coefficient
    •    - hydrophobic we want
    •    - hydrophilic are more systemic
  3. two types of transdermal systems
    • membrane controlled reservoir - don't cut
    • monolithic matric patches
  4. transdermal systems place in therapy
    Useful for patients with compliance issues and those who are unable to take oral medications
  5. Transdermal Systems: Counseling
    Points
    • Apply to clean, dry, hairless skin 
    • Heat exposure increases absorption
    • Remove old patch before applying new patch
    • Disposal
  6. ointments place in therapy
    • Useful for thickened lesions or thicker areas of skin such as palms and soles of feet
    • Can also be used as emollients to form protective barriers

    greasy and difficult in hairy areas
  7. list potency of topical vehicles
    • ointment - most  O in W
    • gels - O in W alcohol base
    • cream - O in W
    • lotion -  P in W
  8. creams place in therapy
    Can be used in same areas as ointments with less penetration, also good for areas with skin folds
  9. lotion place in therapy
    • Useful for hairy areas and can be used over large portions of the body
    • Used to treat skin irritation and pruritus
  10. gels place in therapy
    Useful in treating acne and conditions in hairy areas

    dry in a non-greasy film
  11. Dispersion of finely divided solid particles of a drug in a liquid medium
    vasoconstrictive properties
    suspensions
  12. powders place in therapy
    Useful for treating mycoses of the skin, hair, and nails
  13. aerosols place in therapy
    • Useful in treating hairy areas
    • If intended for the face, spray on hands to apply

    no mechanical irritation of the skin from application
  14. foams place in therapy
    Useful in treating problems on the scalp and other hairy areas

    easy application increases patient acceptance
  15. vehicle for Smooth, nonhairy skin, thick
    hyperkaratotic lesions
    ointment
  16. vehicle for hairy area
    solution or foam
  17. vehicle for palms/soles
    ointment
  18. vehicle for infected areas
    solution
  19. Low-potency steroids
    Safest for long-term use; large surface area, face, genitals, skin-folds and for children
  20. Medium-potency steroids
    Used on the trunk, arms and legs
  21. High potency steroids
    reserved for thickest skin areas such as palms and soles 

    Can also be used for resistant conditions or in less severe cases for a shorter duration
  22. Approximate FTUs needed
    0.5 grams men & 0.4 grams women

    • Head and neck = 2.5
    • Trunk (front or back) = 7
    • One arm = 3, one hand = 1
    • One leg = 6, one foot = 2
  23. why must you determine if a person has a fungal infection if giving a topical steroid
    Immunosuppressant effects of topical steroids can prevent resolution of fungal infection, so they should be avoided


    Do not use combination of antifungal agent and steroid
  24. inflammatory, erythematous rash
    dermatitis
  25. Acute inflammatory dermatitis of buttocks, genitals, and perineum
    diaper dermatitis
  26. Erythematous patches, erosion of skin, vesicles, and ulcerations
    diaper dermatitis
  27. diaper dermatitis TX
    • Frequent diaper changes
    • Lukewarm water with mild soap
    • Occlusive agents as a barrier
    •    Zinc oxide, titanium dioxide, petrolatum
  28. Overproduction of skin cells and sebum 
    Also overgrowth of skin yeast
    seborrheic dermatitis
  29. Pruritus, erythematous papules, and vesicular lesions
    atopic dermititis
  30. Thickened plaques, accentuated skin markings (lichenification), and fibrotic papules
    atopic dermatitis
  31. Thicker, paler, scaly, erythematous, and
    excoriated plaques
    atopic dermatitis
  32. Atopic Dermatitis Treatment nonpharmacologic
    • Avoid potential allergens
    • Bathe in lukewarm water, 5 minutes daily or twice daily
    • Air dry or lightly towel dry
    • Avoid irritating soaps with dyes, fragrances, detergents
    • Apply emollient (ointment or cream) after bathing
    • Use other moisturizers at least twice daily
    • Keep fingernails short to avoid scratching
    • Wear clothing made of cotton
    • Avoid wool and synthetic fibers
    • Avoid pillows and bedding with feathers, down, or animal
    • fibers
  33. Atopic Dermatitis Treatment
    • Emollients and disease state
    • education

    • Acute control of pruritus and
    • inflammation

    • Topical corticosteroids or topical
    • calcineurin inhibitors (TCIs)

    • Maintenance therapy
    • At earliest sign of flare use TCI or
    • intermittent topical corticosteroids

    • Severe, refractory cases
    • Phototherapy, potent steroids,
    • cyclosporine, methotrexate, oral steroids
  34. Pimecrolimus 1% (Elidel®)
    • BID
    • BBW
    • burning at site, respiratory infection, HA
    • approved for > 2yo
  35. Tacrolimus (Protopic®)
    • BID
    • BBW
    • cough, HA, fever, flu-like syndrome
  36. type 1 acne vulgaris
    comedones only,<10 on face only, no scarring
  37. type 2 acne vulgaris
    papules,10-25 on face and trunk mild scarring
  38. type 3 acne vulgaris
    pustules,>25 lesions, moderate scarring
  39. type 4 acne vulgaris
    nodules/cysts, extensive scarring
  40. Tx goals of acne vulgaris
    • Stop new lesions from forming
    • Heal existing lesions
    • Prevent/minimize scarring and
    • hyperpigmentation
  41. Non-pharmacologic Treatment for acne vulgaris
    • Use non-drying face cleanser and do not scrub
    • skin excessively
    • Use oil-free cosmetics
    • Use noncomedogenic cosmetic products
    • Avoid occlusive dressings
    • Refrain from rubbing face or picking skin
    • Control stress
    • Low-glycemic diet
  42. first-line for mild acne
    Salicylic acid (0.5-2%)—Clearasil Clearstick® Neutrogena®, Clean & Clear®
  43. Benzoyl Peroxide (BPO) adverse effects
    Dryness, discoloration of hair and clothing, photosensitivity
  44. Treats mild-to-moderate acne in patients who do not tolerate benzoyl peroxide
    azelic acid- BID
  45. azelic acid AE
    hypopigmentation
  46. First-line for mild to moderate inflammatory acne and comedonal (non-inflammatory) acne
    • topical retinoid
    •   tretinoin - retin A
    •   Adapalene - differin
    •   Tazarotene - tazorac
  47. when do you apply topical retinoids
    Apply once daily at night, due to photolability of products
  48. topical antibiotics
    • erythromycin
    • clindamycin
    • dapsone
  49. first-line option in mild to moderate rosacea
    • metronidazole - QD
    • azelaic acid - BID
  50. Presence of silvery scales with sharp,
    delineated surfaces
    psoriasis
  51. determing therapy for psoriasis
    • mild to moderate 5-10% topical therapy
    • severe > 10% oral therapy
  52. Cottony feeling in the mouth, loss of taste, and sometimes pain on eating and swallowing
    oral candidiasis
  53. Oral Candidiasis Treatment
    • Prevention is best
    • Topical treatment is first-line
    • Initial episodes should be treated for 7-14 days
    • Esophageal candidiasis should be treated for 14-21 days
  54. 2 topical Tx options for oral candidas
    • nystatin
    • clotrimazole
  55. glaucoma risk factors
    • elevated intraocular pressure
    •    normal 10-21mmHG
    • age and sex  
    •    >65, female
    • race
    •    african american
    • FH
    •    sibling or parent
  56. IOP > 40 mmHg, blurred or hazy vision with halos around lights, headache, cloudy, edematous cornea, ocular pain, nausea/vomiting, abdominal pain, and
    diaphoresis
    angle closure glaucoma
  57. Asymptomatic until substantial visual field loss
    General peripheral visual field constriction, isolated blind spots, nasal visual field depression or nasal step, enlargement of blind spot, large arc-like blind spots, reduced contrast sensitivity, reduced peripheral acuity, and altered color vision
    open-angle glaucoma
  58. glaucoma Tx goal
    • Decrease IOP to prevent long-term nerve damage and visual field loss
    •    20% - 35% decrease from baseline
  59. first line therapy for glaucoma
    • beta blockers
    • prostaglandin analogs
  60. prostaglandin analog dosing
    Instill 1 drop in affected eye(s) at night
  61. alternative first line agent for glaucoma
    • alpha2 agonist
    • brimonidine (alphagan) 1 gtt TID
    •   >2yo
  62. Used in patients with inadequate response or contraindications to first-line therapy for glaucoma
    • carbonic anhydrase inhibitors
    • dorzolamide - 1gtt TID, sulfa allergy
  63. Watery or mucoserous discharge; burning, sandy, or gritty feeling in one eye; second eye presents similarly in 24-48 hours
    viral conjunctivitis
  64. Purulent discharge throughout the day; thick yellow, white, or green
    bacterial conjuctivitis
  65. preferred agents for contact lens wearers due to increased likelihood of Pseudomonas infection who have conjuctivitis
    fluoroquinolones
  66. Photophobia, pruritus, tearing, burning, watery discharge
    allergic conjuctivitis
  67. Pruritus, discharge, hearing loss
    Pain with tragal pressure or when auricle is pulled
    Edematous ear canal with discolored debris
    otitis externa
  68. Sneezing, nasal itching, watery rhinorrhea, nasal congestion,
    and itching of throat, eyes, and ears
    allergic rhinitis
  69. Tx goals of allergic rhinitis
    • Minimize and prevent symptoms
    • None or minimal adverse medication effects
    • Reasonable medication expenses
  70. Considered first-line in patients with moderate-to-severe or chronic allergic rhinitis
    • intranasal corticosteroids
    • fluticasone - 2sprays each nostril daily
    • triamcinolone - 2 sprays each nostril daily

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