Pharm- derm

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Pharm- derm
2013-05-25 17:52:42
pharm derm

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  1. The efficacy of any topical medication is related to:
    • The active ingredient (inherent strength)
    • Anatomic location
    • The vehicle (the mode in which it is transported)
    • The concentration of the medication
  2. lubricating, occlusive; greasy·        
    USE for smooth, non-hairy skin; dry, thick, or hyperkeratotic lesions·        
    AVOID on hairy and intertriginous (when skin is in contact with skin, e.g. armpits, groin, pannus) areas
  3. less greasy, drying effects; not occlusive, can sting, more likely to cause irritation (preservatives/fragrances)·        
    USE for acute exudative inflammation, intertriginous areas
  4. less greasy, less occlusive; may contain alcohol (drying effect on oozing lesion); penetrate easily, little residue·        
    USE for hairy areas
  5. less stinging than lotions or solutions·  
    USE for the scalp, especially for people with coarse or very curly hair
  6. may contain alcohol, greaseless, least occlusive; dry quickly·        
    USE for acne, exudative inflammation (e.g. acute contact dermatitis); on scalp/hairy areas without matting
  7. spread readily, easier to apply; more expensive·        
    USE for hairy areas; inflammation
  8. Aerosols(rarely used), pump sprays
  9. medication costs
    • Topical medications can be very expensive
    • They are not all covered by insurance
    • Over the counter (OTC) treatments are generally cheaper than prescriptions
    • Generics are less expensive than brand name prescriptions
    • It is helpful to know the costs of the medications you prescribe and be able to tell the patient in advance what they should expect to pay
  10. Topical corticosteroids
    • Produce an anti-inflammatory response in the skin
    • They are effective for conditions that are characterized by hyperproliferation, inflammation, and immunologic involvement 
    • They can also provide symptomatic relief for burning and pruritic lesions
  11. Mech of topical steroids
    • induction of phospholipase A2 inhibitory proteins, called lipocortins.
    • Control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid.
    • (Blocks phospholipase A2 and prevents the production of arachidonic acid.)
  12. How are topical steroids organized?
    • based on their strength (potency)
    • Each one in a class has = strength
  13. Potency of class I and ex agent
    • Super high
    • Clobetasol propionate 0.05%
  14. potency of class II and ex agent
    • High
    • Fluocinonide 0.05%
  15. potency of class III-V and ex agent
    • Medium
    • Triamcinolone acetonide in ointment cream & lotion 0.1%
  16. potency of class VI-VII and ex agent
    • Low
    • Flocinolone acetonide 0.01%
    • Desonide 0.005%
    • Hydrocortisone 1%
  17. Super high potency(Class I) are used for
    • severe dermatoses over nonfacial and nonintertriginous areas
    • Scalp, palms, soles, and thick plaques on extensor surfaces
  18. Medium to high potencysteroids (Classes II-V) are used for
    • mild to moderate nonfacial and  nonintertriginous areas
    • ok to use on flexural (joints) surfaces for limited periods
  19. Low potency steroids (Classes VI, VII) can be used for
    • Large areas and on thinner skin·        
    • Face, eyelid, genital and intertriginous areas
  20. Local SE
    • Skin atrophy
    • Telangiectasis (visible blood vessels)
    • Striae
    • Acne
    • Steroid Rosacea
    • Hypopigmentation
  21. How are SE more likely to occur?
    How can you reduce risk?
    • The higher the potency the more likely side effects are to occur. The longer you use it the more likely SE are to occur ·        
    • To reduce risk, the least potent steroid should be used for the shortest time, while still maintaining effectiveness
  22. Systemic SE
    • are rare due to low absorption
    • Glaucoma (when steroid applied to the eyelid)
    • Hypothalamic pituitary axis suppression 
    • Cushing’s syndrome (moon facies)
    • Hypertension
    • Hyperglycemia
  23. The higher the potency used...
    • more likely SE are to occur
    • To reduce risk, the least potent steroid should be used for the shortest time, while still maintaining effectiveness
  24. duration of tx for super high potency
    treat for <3 weeks
  25. Duration of tx for High and Medium potency
  26. Duration of tx for low potency
    side effects are rare. Treat facial, intertriginous, and genital dermatoses for 1-2week intervals to avoid skin atrophy, telangiectasia, and steroid-induced acne
  27. 1 palm =
    1% BSA
  28. 500 mg treats=
    2% BSA (2 palms)
  29. 2 palms 2 times a day=
    1 gram/day
  30. How many grams does it take to cover an avg adult body? for one application
    ~ 30 grams
  31. How many grams to cover the face?
    30-45 grams
  32. How many grams to cover extensor surfaces of both arms?
    120-150 grams
  33. How many grams to cover widespread on trunk, legs, and arms?
    1-2 pounds
  34. How many grams are in a pound?
    454 grams = 1 lb
  35. what is the best way to assure you are givin the right amount?
    re-assess on follow-up
  36. What isa good, quick way of estimating the affected BSA?
    The "rule of nines"
  37. when is the rule of nine most often used?
    when assessing burns
  38. when is the rule of nines less accurate?
    in children
  39. Potentsteroids should be avoided in high risk areas such as the
    theface, folds, or occluded areas such as under the diaper
  40. Potency determines:
    • Efficacy
    • Safety
  41. Choosing a topical depends on:
    • Severity
    • Location
    • Application area
  42. Debris & bacteria collect in these clogged pores which then leads to:
    papules and pustules with erythema and edema
  43. Benzoyl peroxide
    • Is topical medication with both antibacterial and comedolytic (breaks up comedones)properties
    • used to treat acne vulgaris
  44. Common adverse effects of benzoyl peroxide:
    • Bleaching of hair, colored fabric, or carpet·        
    • redness & peeling, dry skin   
    • May irritate skin; discontinue if severe- or decrease amount
  45. Indication for Azelaic acid: Finacea (gel), Azelex (cream)
    • Acne
    • Rosacea
  46. Topical Retinoids are derivatives of what?
    vitamin A
  47. Indication for topical retinoids?
    • Photodamaged skin
    • Fine wrinkles
    • Hyperpigmentation
    • Acne
  48. Common adverse effects of topical retinoids?
    • Dryness
    • Pruritus
    • Erythema
    • Scaling
    • Photosensitivity
  49. How is it available?
    Cream or gel
  50. Can you apply it at the same time as benzoyl peroxide?
    No, benzoyl peroxide oxidizes tretinoin
  51. What are the retinoid drugs?
    • Adalapene
    • isotretinoin
    • Tazarotene
    • Acitretin
    • Bexarotene
    • Targretin gel
  52. MOA of retinoids
    • Bind and activate RARs and RXRs
    • (Retinoic acid receptors & Retinoid X receptors)
    • Results in increased growth factor release, epidermal hyperplasia and thickened skin.
    • Desquamation and peeling then occur
  53. Adverse effects of Tretinoin:
    • dryness
    • Redness
    • peeling
    • photosensitivity
  54. Which of the following is less irritating and why?
    • Adapalene
    • Its a water-based gel
    • It resembles tretinoin in structure, but tretinoid has alcohol
  55. What should you advise pts about adapalene?
    • it causes increased sensitivity to the sun (like tretinoin)
    • apply it at night and use SPF during the day
  56. Indications for Tazarotene
    • Acne
    • psoriasis
  57. CI for Tazarotene (Tazorac):
    • Preg! its cat X
    • get a preg test before starting tazorac
  58. Newest anti-wrinkle retinoid:
    • Avage (tazarotene)
    • it is the SAME as tazorac- just approved for a different indication
    • Avage= wrinkles
    • Tazorac= acne & psoriasis
    • all the retinoids help reduce fine wrinkles, rough skin, & brown spots.
    • wrinkles reappear when the retinoid is stopped
  59. How long can a topical agent take to see effect?
    2-3 mo
  60. topical acne SE
    • Irritating
    • dry skin
    • All topical meds can cause photosensitivity
  61. BBW for isotretinoin (Accutane)
    appropriate use
  62. CI for isotretinoid (Accutane)
    • Preg- cat X
    • breastfeeding
    • Tetracycline- combo may increase risk for pseuotumor cerebri
  63. What is a common SE seen in teens taking Accutane?
    • Muscle and joint pain
    • 1/3 develop back pain- imp to know if taking this med and playing sports
  64. SE of Accutane
    • Xerosis (dry skin)
    • Cheilitis (chapped lips)
    • Elevated liver enzymes
    • Hypertriglyceridemia
    • Mood changes, depression
    • HA- severe HA may be manifestation of pseudotumor cerebri
  65. Dosing of Accutane
    • 1x regime for 2x daily
    • give for 15-20 weeks
    • may repeat 1x after a period off of 2 mo
    • you are writing Rx monthly- have to take preg test every mo to get Rx