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78 Cards in this Set
- Front
- Back
What is a vehicle? |
In order for a drug to get to the skin or through the skin, it must be dissolved in a substance known as Vehicle |
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What are the types of vehicles? |
1) Baths 2) Lotions 3) Gels 4) Powders 5) Pastes 6) Creams 7) Ointment |
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What are the factors that choice of vehicle depends on? |
1) Solubility of active drug 2) Ability to hydrate stratum corneum 3) Stability of drug in vehicle 4) Ability to retard evaporation from the skin --- Least with tinctures |
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What are the benefits of the baths? |
1) Baths are completely water soluble 2) They are colloidal 3) Baths are soothing |
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What are the indications for baths? |
1) Irritation 2) Inflamed tissue |
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What is the effects of baths? |
Attracts fluids out of the tissues = Swelling |
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What are the characteristics of lotions? |
1) Mostly water 2) Evaporation of the lotion is cooling --- Cooling action causes mild vasoconstriction 3) Vasoconstriction decrease inflammation |
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What are the characteristics of gels? |
1) Semi-solid colloidal solutions and suspensions 2) Contain Alcohol 3) Enhances absorption through skin |
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What are the characteristics of powders? |
1) Absorbent 2) Can cause crusting |
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What are problems with powders? |
1) Aspiration - especially for babies 2) Caution with corn starch (for diaper rash) |
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What are the characteristics of pastes? |
1) Thick ointment containing powder 2) Very adhesive --- Chemical dressing - sticks better to the wound |
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What are the characteristics of creams? |
1) Oil in water -- Mix with serous discharges -- Easily washable 2) Water in oil -- Vehicle for fat-soluble substances -- Do not mix with serous discharges -- Easily washable |
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What are the types & characteristics of Ointments? |
1) Water-soluble -- Improve penetration of drugs thru skin -- PEG - polyethylene glycol 2) Emulsifying -- Mix w/ water and exudate 3) Non-Emulsifying -- Occlusive dressing, enhance hydration |
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What are the causes of dermatitis/Eczema? |
1) Irritants & Allergens 2) Infections 3) Drugs 4) Environmental factors 5) Local factors (stasis) |
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What are the treatments for atopic dermatitis? |
1) Reduce contact with irritants 2) Reduce exposure to allergens 3) Emollients 4) Topical steroids 5) Antihistamines 6) Antibiotics 7) Steroids sparing |
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How to reduce contact with irritants? |
eg. Soap substitutes - Cetaphil 1) Far less drying and irritating than soap 2) Cleansing and moisturizing formulations -- All OTC 3) Lotions, bar, soap, cream, sunscreen 4) Cost is about $8-9 for 16oz. |
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How to reduce allergens? |
1) Dust 2) Pet dander 3) Food allergies |
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What are emollients? |
1) Soften the skin and reduce itching 2) Moisture trapping effectiveness -- Best: oils -- Moderate: Creams -- Least: lotions 3) Apply after bathing and when skin is unusually dry (winter months) 4) Urea creams |
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Creams are excellent for relieving dryness, but can sting and sometimes ________________ |
Aggravate eczema ** Creams are useful from maintenance not during inflammation ** |
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What is Alpha-Hydroxy acid? |
Emollients Preparations: 1) Glycolic acid - 8% 2) Lactic acid or lac-hydrin - 5-12% 3) Urea - 6% Use once a day |
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What are the benefits of using oils (emollients)? |
Using bath oil or mineral oil based lotions in lukewarm bath water Bath oil preparations: 1) Alpha-keri 2) Aveeno bath 3) Jeri-bath Colloidal oatmeal (Aveeno) reduces itching |
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What are the advantages of Corticosteroids? |
1) Topical steroids are very effective 2) Once under control, intermittent use of topical corticosteroids may prevent relapse 3) Once daily probably - cost effective |
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What are the disadvantages of Corticosteroids? |
Systemic steroids may bring under rapid control, but may precipitate rebound |
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What are specific indication for creams, lotions, & ointments? |
Ointments = dry or lichenified skin Cream = weeping skin or body folds Lotions = for areas w/ hair |
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What is the indication of antibiotics for atopic eczema? |
Atopic eczema frequently result in secondary bacterial infection ** Use oral antibiotics in recalcitrant or widespread cases ** |
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What are the indications for oral antihistamines? |
Urticaria w/ itch -- Non-sedating = less effective but more expensive eg. Benadryl |
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What are some alternative medicine treatment options? |
1) Licorice 2) Calendula 3) Echinacea 4) Golden seal 5) Nettle 6) Oats |
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What is diaper dermatitis? |
Irritant dermatitis |
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What causes diaper dermatitis? |
Cutaneous Candidiasis infection |
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What are the risk factors for diaper dermatitis? |
Area where warmth and moisture lead to maceration of skin or mucous membrane |
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What is clinical presentation of Diaper dermatitis? |
1) Pruritus, pain 2) Erythematous papules/vesicles, edema 3) Satellite lesions to peri-genital, peri-anal, inner thigh & buttocks |
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What is the treatment of diaper dermatitis? |
1) Topical antifungal agents such as nystatin, miconazole or clotrimatzole 2) Topical corticosteroids |
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What are complications involved with diaper dermatitis? |
1) Secondary infection can occur 2) Generalized infections can be a serious problem 3) Educate the care givers |
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What is the most common cause of diaper dermatitis? |
Neglect or not knowing how to care for it |
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What is the mechanism of action of Pimecrolimus (Elidel) & Tacrolimus (Protopic)? |
1) Inhibits inflammatory cytokine release 2) Minimal systemic immunosuppression |
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What are the indications for Pimecrolimus (Elidel) & Tacrolimus (Protopic)? |
Atopic dermatitis and contact dermatitis ** Alternative to corticosteroids ** |
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What is the mechanism of action of Imiquimod (Aldara)? |
Immunomodulator 1) Stimulates peripheral mononuclear cell to release interferon alpha 2) Stimulates macrophages to produce interleukins and TNF alpha |
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What are the indications for Imiquimod (Aldara)? |
Treatment of external genital and perianal warts and actinic keratitis |
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List the topical antivirals |
1) Acyclovir (Zovirax) 2) Pencyclovir (Denavir) |
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What are the indications for topical antivirals? |
Treatment of herpes |
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T/F: Topical antivirals should be used for active lesions |
FALSE For active lesions, Oral antivirals should be used |
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What are predisposing factors for parasitic skin infection? |
1) Poor Hygiene 2) Substandard living |
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What are the types of pediculosis-lice (human lice)? |
1) Pediculosis capitis - Head 2) Pediculosis corporis - Body 3) Pediculosis pubis - Pubic or crab |
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What are the treatment options for pediculosis capitis? |
1) Pediculicides 2) Hand pick or comb nits out 3) Launder bed linens & Vacuum 4) Seal items in plastic bags for 14 days 5) Repeat for 10-14 days |
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What are the treatment options for pediculosis corporis & pubis? |
1) Chemical killing 2) Clean linens with hot water and soap 3) Dry clean 4) Fine-tooth comb 5) Treat social contacts |
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What is the drug used to treat pediculocides? |
Lindane 1) Hepatotoxic and neurotoxic 2) Permethrin (Nix) |
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What are the treatment options for scabies? |
1) Topical sulfur preparations 2) Crotamiton (Eurax) 3) Permethrin 5% (Elimite) 4) Launder personal items 5) No disinfectant |
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What are the microorganisms responsible for Acne? |
1) Propionibacterium acnes 2) Staphlococcus spp --- epidermidis or aureus * Androgenic stimulation of sebaceous gland * |
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What are OTC treatment options for Acne? |
Keratolytics 1) Benzoyl peroxide -- Gel -- Solution -- Lotion 2) Selenium sulfide |
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What are prescription treatment options for acne? |
Keratolytics - Retinoid acid derivatives 1) Tretinoin (Retin-A) - Topical 2) Isotretinoin (Acdutane) - PO |
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What is adverse effect of Isotretinoin (Accutane)? |
Liver dysfunction |
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What is the contraindication of Isotretinoin? |
During pregnancy or patients planning pregnancy ** lead to teratogenic effects ** |
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What are the antibiotic options used in conjunction with keratolytics? |
Topicals combination w/ keratolytics
1) Erythromycin 2) Clindamycin (Cleocin) 3) Azelaic acid (Azelex, Finacea) Oral for cystic acne or scaring acne 1) Tetracyclines 2) Erythromycin |
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What are the topical medications indicated for Rosacea? |
1) Azelaic acid 2) Metronidazole |
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What are the topical medications for Psoriasis? |
1) Keratolytics -- Coal tar -- Salicylic acid
2) Corticosteroids (potent) |
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What are the systemic medications for Psoriasis? |
1) Corticosteroids (may lead to dependence) 2) Methotrexate 3) Hydroxeurea (Hydrea) 4) Cyclosporin (decreases infiltration of inflammatory cells 5) Infliximab (Remicade) |
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What is the treatment for mild psoriasis? |
1) Topical -- Keratolytics -- Corticosteroids 2) Phototherapy (UV light shown to be helpful) |
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What is the treatment for mild psoriasis arthritis? |
1) NSAIDs 2) Intra-articular injections of corticosteroids -- If isolated to one or two joints |
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T/F: Psoriasis is a form of Rheumatoid Arthritis (RA) |
TRUE |
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What is the treatment for moderate psoriasis or psoriatic arthritis? |
1) Disease modified anti-rheumatic drugs (DMARDs) 2) Systemic Corticosteroids = Prednisone 3) Rheumatoid Arthritis drugs 4) Biologics |
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What are the drugs used to treat moderate to severe psoriatic arthritis (form of RA)? |
1) Methotrexate 2) Cyclosporin 3) Gold (major renal side effects) 4) Antimalarial |
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What are biologics? |
Drugs with lots of side effects (however they do help treat psoriasis |
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What is the contraindication for biologics? |
Cannot be used with active infection or with liver dysfunction |
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What is the criteria for using Biologics? |
1) 18 y/o or older 2) Moderate to severe psoriatic arthritis with at least one comorbidity -- Inadequate control with DMARD alone -- Other therapies have failed 3) Normal liver function 4) No active infection |
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List the drugs that are biologics |
T-cell Inhibitors 1) Alefacet (Amevive) 2) Efalizumab (Raptiva) TNF inhibitors 1) Etanercept (Enbrel) 2 )Adalimumab (Humira) 3) Infliximab (Remicade) |
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What are the types of glucocorticoids available? |
1) Mild
2) Moderate 3) Potent 4) Very potent ** Limited absorption **
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Which type of glucocorticoid can be used on the face? |
Only Mild glucocorticoid ** Stronger can cause coarsening of features and hirsutism ** |
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List the glucocorticoids |
1) Hydrocortisone 2) Triamcinolone 3) Desonide (potent) 4) Mometasone (ultra potent) |
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Where is hydrocortisone safe to apply? |
For the face ** Less than 1% strength ** |
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Where is triamcinolone safe to apply? |
Can use it for the body except face |
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What is the indication for mometasone? |
Treatment for psoriasis
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What is the difference between sunscreen and sunblock? |
Sunscreen filters the UVA and UVB rays vs. Sunblock will completely block the UV rays |
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What are the types of sunscreens available? |
1) Mild <10 spf 2) Moderate 10-15 spf 3) Strong > 15 spf |
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What are the treatment options for hair loss? |
1) Minoxidil (Rogaine) 2) Finasteride (Propecia) |
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What is the mechanism of action of Minoxidil? |
1) Vasodilation 2) Effect not predictable or permanent 3) Quality of hair is not the same 4) Some systemic absorption if using in large quantity |
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What is Finasteride? |
Similar to Testosterone agonist |
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What are the topical treatment options for fungal skin infections? |
1) Clotrimazole (Mycelex) 2) Miconazole (Monistat) 3) Terbinafine (Lamisil) 4) Ketoconazole (Nizoral) 5) Tolnaftate (Tinactin) 6) Nystatin (Mycostatin) |
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What are the systemic treatment options for fungal skin infections?
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1) Ketoconazole (Nizoral) 2) Itraconazole (Sporanox) 3) Terbinafine (Lamisl) 4) Grisefulvin (Grisactin) |