1
Q
Malathion
A
- topical
- organophosphate cholinesterase inhibitor
- Tx for ectoparasites
2
Q
What is a sunshade?
A
opaque material that reflects light
3
Q
Give the classic example of a sunshade.
A
Titanium Dioxide
4
Q
What do humectants do?
A
draw water into the outer layer of the skin
5
Q
Give examples of humectants.
A
glycerin
lecithin
propylene glycol
6
Q
What organism requires you to wash your hands with soap and water, since hand sanitizer will not work to eliminate it?
A
C. diff
7
Q
What is minoxidil used for?
A
Tx of hair loss
8
Q
What is the mechanism of action for minoxidil?
A
vasodilation due to K+ channels opening
- promotes hair growth by increasing anagen (growth phase); decreasing telogen (rest phase)
- enlarges miniaturized follicles
9
Q
What is the mechanism of action of 5-fluorouracil?
A
inhibits thymidylate synthetase
-fast-growing dysplastic cells can’t synthesize DNA
10
Q
What are common drugs used to treat actinic keratosis?
A
5-fluorouracil imiquimod ingenol mebutate topical diclofenac retinoids
11
Q
What is the mechanism of action of imiquimod?
A
stimulates local cytokine induction, which activates TLR’s
12
Q
What are the two stages of actinic keratosis treatment by ingenol mebutate?
A
1) disruption of cell membrane and mitochondria, leading to cell necrosis (chemoablation)
2) Ab-dependent cell cytotoxicity mediated by neutrophils (eliminates any remaining tumor cells)
13
Q
What type of drug is ciclopirox?
A
topical antifungal (broad spectrum) -against dermatophytes, Candida and Malassezia
- disrupts macromolecular synthesis
- low incidence of adverse rxns or dermatitis
14
Q
What type of drug is terbinafine?
A
topical antifungal
-against dermatophytes, not active against yeasts
–can cause local irritation, avoid mucous membranes
15
Q
What is the mechanism of action of terbinafine?
A
-selective inhibition of squalene epoxidase (key enzyme in ergosterol synthesis)
16
Q
What kind of drug is tolnaftate?
A
topical antifungal
-distorts hyphae and stunts mycelial growth
–rarely causes irritation or contact dermatitis
17
Q
Against what organisms is tolnaftate active against?
A
- various dermatophytes
- Malassezia
-NOT candida
18
Q
What is the mechanism of action for permethrin?
A
- binds to insect Na+ channels and blocks membrane repolarization
- topical Tx of ectoparasites
19
Q
What is the mechanism of action of ivermectin?
A
- binds to glutamate-gated Cl- channels (in invertebrates) and hyperpolarizes nerve and muscle cells)
- oral Tx of ectoparasites
20
Q
What is the mechanism of action of lindane?
A
-disrupts GABA-ergic transmission in insects
- topical “last resort” Tx of ectoparasites
- -“last resort” due to its toxicity
21
Q
What are some common topical antimicrobials used to treat acne?
A
- benzoyl peroxide
- clindamycin
- erythromycin
- azelaic acid
22
Q
What are possible adverse effects of benzoyl peroxide?
A
- local skin irritation
- may bleach clothing/hair
23
Q
What is a possible side effect of clindamycin?
A
-pseudomembranous colitis (rare)
24
Q
In treating rosacea, what are some drugs that can be used to decrease the appearance of redness?
A
- brimonidine (topical gel)
- oxymetazoline (topical cream)
25
What is the mechanism of action behind brimonidine? Oxymetazoline?
Vasoconstriction
- brimonidine (alpha-2 agonist)
- oxymetazoline (alpha-1a and alpha-2 agonist)
26
In treating redness in the eyes, what are some drugs that can be used?
- naphazoline
- tetrahydrozoline
- phenylephrin
- oxymetazoline
27
What is the common mechanism of action behind the drugs used to treat eye redness? (naphazoline, phenylephrin, oxymetazoline, tetrahydrozoline)
adrenergic receptor agonists
28
What is the only approved agent for chronic diabetic food ulcers?
becaplermin
29
What is the mechanism of action of becaplermin?
PDGF that promotes cell proliferation and angiogenesis
30
What is a MAJOR risk of becaplermin?
-Black Box warning for malignancy
--use of >3 tubes increases risk of malignancy 4x
31
During the debridement stage of wound healing, what is the choice of wound dressing?
hydrogels
32
During the granulation stage of wound healing, what is the choice of wound dressing?
foam or low-adherence dressings
33
During the epithelialization stage of wound healing, what is the choice of wound dressing?
hydrocolloid or low-adherence dressings
34
True or False: wounds should be kept dry.
False
35
Why should wounds be kept covered and moist for healing?
- wounds are exposed to their own fluids, which is a mix of metalloproteases and cytokines
- occluded wounds heal 40% faster; less scarring
36
What three antibacterial agents are in a standard triple antibiotic ointment such as Neosporin?
- bacitracin
- neomycin
- polymixin B
37
Against what type of microbials is bacitracin active?
- -gram-positive
- -most anaerobic cocci
- -neisseria
- -tetanus bacilli
- -diptheria bacilli
38
Against what type of microbials is neomycin active?
gram-negative
39
Against what type of microbials is polymixin B active?
gram-negative
| including: P. aeruginosa, E. coli, Enterobacter, and Klebsiella
40
What is the mechanism of action of bacitracin?
inhibits bacterial wall synthesis
| a peptide antibiotic
41
What is the mechanism of action of neomycin?
binds to 30S ribosomal subunit and inhibits protein synthesis
(an aminoglycoside antibiotic)
42
What is the mechanism of action of polymixin B?
-damages bacterial cytoplasmic membrane by binding to phospholipids and altering membrane permeability
43
What is the method of application of salicylic acid and what condition(s) is it used to treat?
--topical Tx for pruritis
-acne, dandruff, and calluses
44
What is the mechanism of action of salicylic acid?
- COX inhibition
- causes epidermal cells to shed more readily (keratolytic effect) by dissolving the intercellular cement
-opens clogged pores
45
What do you need to be aware of for skin surfaces treated with salicylic acid?
-treated areas are photosensitized and need to be protected from the sun
46
What can be caused by prolonged used of salicylic acid?
-toxicity in children and those with reduced kidney or liver function
47
What is the method of application and condition treated by capsaicin?
- topical Tx for pruritus
| - particularly neuropathic pruritus
48
What is the mechanism of action of capsaicin?
- activates TRPV1 (transient release potential vanilloid-1)
- -ion channel in cutaneous nerve fibers
- stimulates neurons to release (and deplete) certain neuropeptides, including Substance P
- can induce lasting desensitization of neurons to stimuli
49
True or False: antiseptic wash solutions (iodine, chlorhexidine, hydrogen peroxide) promote wound healing
FALSE - they can potentially IMPEDE wound healing because of their toxic effects on normal tissue
50
Why is it important to debride wounds?
- removes dead tissue
- limits protease production
- conserves local resources needed for healing
51
What are common types of debridement?
- -low-pressure irrigation w/ normal saline
- -surgical for removing large areas of necrotic tissue
- -enzymatic
- -biologic (maggot therapy)
52
What is the effect of chlorhexidine on bacterial spores?
- prevents development of spores
| - does NOT prevent germination
53
What is the effect of chlorhexidine on mycobacteria?
- mycobacteriostatic
| - NOT mycobactericidal
54
What is the effect of chlorhexidine on non-spore-forming bacteria?
- protoplast and spheroplast lysis
| - high concentrations cause protein and nucleic acid precipitation
55
What is the effect of chlorhexidine on yeasts?
- protoplast lysis and intracellular leakage
| - high concentrations cause intracellular coagulation
56
What is the effect of chlorhexidine on viruses?
- -low activity against many viruses
| - -lipid-enveloped viruses are more sensitive
57
What is the effect of chlorhexidine on protozoa?
- activity against trophozoites
| - less activity toward cysts
58
What do topical calcineurin inhibitors treat?
-anogenital pruritis
59
What is the term for immune-mediated, chronic relapsing hair loss?
alopecia areata
60
What is the Tx for Alopecia Areata?
- corticosteroids (topical or intralesional)
- topical immunotherapy with a contact allergen (such as diphenylcyclopropenone - DPCP) causes contact dermatitis, which causes hair growth
61
What is isotretinoin and what is it used to treat?
- oral retinoid
| - acne
62
What is a MAJOR risk of isotretinoin?
- teratogenicity
| - -absolutely contraindicated in pregnancy
63
For how long should you wash your hands?
15-30 seconds
64
What is the most common mistake in handwashing?
not washing long enough
65
What is the categorical difference in use between antiseptics and disinfectants?
- antiseptics are for skin
| - disinfectants are for inanimate surfaces
66
What is the mechanism of action of glutaraldehyde?
--targets the cell envelope and cross-links proteins
67
What is the mechanism of action of quaternary amines?
-generalized membrane damage involving the phospholipid bilayers
68
What is the mechanism of action of halogens?
-oxidation of thiol groups to disulfides, sulfoxides, or disulfoxides
69
What is the mechanism of action of peroxygens?
-formation of free hydroxyl radicals, oxidizes thiol groups in enzymes
70
What is the Tx for Herpes Simplex and its method of application?
- topical acyclovir
| - ointment, cream, and buccal tablets available
71
What is the mechanism of action of acyclovir?
-guanine analog with inhibitory activity
72
From a metabolic standpoint, what is a major factor in wound healing?
glycemic control
73
What is the weird topical therapy for psoriasis?
tar
74
What are some oral antibiotics used in treating acne?
- -tetracycline
- -doxycycline
- -minocycline
- -erythromycin
- -azithromycin
- -trimethoprim-sulfamethoxazole
75
What are side effects of tetracycline?
- tooth discoloration
- GI distress
- photosensitivity
--contraindicated in pregnancy and children
76
What are the side effects of doxycycline?
- photosensitivity
- GI distress
--contraindicated in pregnancy and children
77
What are the side effects of minocycline?
- -dizziness
- -drug-induced lupus
- -skin discoloration
--contraindicated in pregnancy and children
78
What are the side effects of erythromycin and azithromycin? And what category of antibiotic are they?
- GI distress
| - macrolides
79
What are the side effects of trimethoprim-sulfamethoxazole?
- SJS (Stevens-Johnson Syndrome)
| - TEN (toxic epidermal necrolysis)
80
What are some common systemic causes of pruritis?
- chronic renal failure
- biliary obstruction
- diabetes, hyperthyroidism, hypercalcemia
- Hodgkin Lymphoma, polycythemia, IDA
81
What type of medication is nystatin and what does it treat?
- topical antifungal
- limited to cutaneous and mucosal candida
-may cause diarrhea if swallowed
82
What is the mechanism of action of nystatin and amphotericin B?
-alters membrane permeability by binding to fungal sterols
83
What type of medication is amphotericin B and what does it treat?
- topical antifungal
- limited to cutaneous candida
-may cause temporary yellow staining of the skin
84
What are some factors that affect cutaneous absorption?
- regional (axilla is more permeable than forearm)
- concentration gradient
- dosing schedule
- vehicles/occlusion
85
What is the term for female pattern hair loss?
androgenic alopecia in women
86
In female pattern hair loss (androgenic alopecia), if minoxidil (first-line Tx) fails, what category of drugs are used next and which drugs are in that category?
- -anti-androgens
- spironolactone (androgen partial agonist)
- finasteride (blocks DHT synthesis)
- flutamide (androgen antagonist)
87
Topical imidazoles are what kind of drug, and what is their mechanism of action?
- topical antifungals
| - block ergosterol synthesis
88
What are examples of imidazoles?
- miconazole
- clotrimazole
- efinaconazole (onychomycosis)
- ketaconazole (CYP inhibitor)
89
What are examples of systemic drugs for treatment of psoriasis?
- methotrexate
- apremilast (oral)
- retinoids
- calcineurin inhibitors
- biologic agents
90
What is the mechanism of action of apremilast?
PDE4 inhibitor
- -increases cAMP levels
- -decreases NO synthase, TNF-alpha, and IL-23
- -increases IL-10
91
What is the mechanism of action of ustekinumab?
- -human monoclonal Ab that targets IL-12 and IL-23
- -decreases activation of NK cells
- -decreases CD4+ T-cell differentiation
92
What are side effects of ustekinumab and secukinumab?
increased risk of infection
93
What is the mechanism of action of secukinumab?
- -human monoclonal Ab that targets IL-17A
| - -decreases IL-6, IL-8, and prostaglandins
94
What enzyme does finasteride inhibit?
5-alpha reductase
95
What is the usual reason for a wound to lack adequate oxygenation during healing?
-sympathetic overactivity, causing local vasoconstriction
--caused by low blood volume, pain, hypothermia
96
What do emollients do?
-form an oily layer on top of the skin, trapping water
97
What are examples of emollients?
-petroleum, lanolin, mineral oil, dimethicone
98
What do horny substance (keratin) softeners do?
- loosen bonds between the top layer of cells
| - help dead skin cells fall off
99
What are examples of horny substance (keratin) softeners?
- urea
- alpha hydroxy acids (lactic, citric, glycolic)
- allantoin (end of purine metabolism in mammals)
100
Name some characteristics of biofilm.
- antibiotics have limited penetration
| - microbes develop a phenotype that replicates slowly
101
What are some hormonal agents that are used to treat acne?
- combo oral contraceptives (estrogen and progestin)
| - spironolactone (K+ sparing diuretic)
102
What is the mechanism of action of spironolactone?
-K+ sparing diuretic that is a partial agonist at androgen receptors
103
In what population of patient is spironolactone useful to treat acne?
adult women with breakouts related to their menstrual cycle
104
What is the general principle when starting glucocorticoid therapy?
- start with the highest potency to gain control and titrate down for maintenance
- use low potency on face, genitals, and skin folds
105
Why do synthetic detergents irritate skin less than soaps?
- a lower pH, closer to that of skin (5.5-7.0)
| - soap has a pH of 9.0-10.0
106
What is the most important component of infection control?
-hand hygiene
107
What is azaleic acid?
-dicarboxylic acid (white powder found in wheat, rye, barley; involved in plant defense to infection)
- -Tx for acne, bactericidal, decreases keratin production
- -Tx for post-inflammatory hyperpigmentation
108
Name characteristics of creams.
- half water, half oil with emulsifier
- spread easily, well absorbed, wash off with water
- better for "wet" skin
109
Name characteristics of ointments.
- 80/20, oil/water
- feel greasy, stays on surface
- more complete absorption of active ingredient
- best on "dry" skin
- less likely to cause allergic reaction
110
What are gels?
-made from polyionic colloids expanded with water
111
What are pastes?
-mixtures of oil, water, and powder
112
What are some topical medications for basal cell carcinoma?
--imiquimod (immunse response modifier that stimulates local cytokines and activates TLR's)
--5-fluorouracil (inhibits thymidylate synthetase)
113
What are medications for advanced basal cell carcinoma?
- vismodegib
- sonidegib
--oral "hedgehog" signaling pathway inhibitors
114
True or False: epidermal growth factor improves epithelialization
False
SBL
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