SKIN.docx

[SKIN] **GLUCOCORTICOIDS** - Ointments = highest absorption - Creams = good for inflamed/dry skin - Gels = good for oily skin - AE: growth retardation in kids, adrenal suppression, systemic tox w/ long-term therapy **ACNE TREATMENT** - Benzoyl peroxide - First line mild-m...

[SKIN] **GLUCOCORTICOIDS** - Ointments = highest absorption - Creams = good for inflamed/dry skin - Gels = good for oily skin - AE: growth retardation in kids, adrenal suppression, systemic tox w/ long-term therapy **ACNE TREATMENT** - Benzoyl peroxide - First line mild-mod acne - Retinoids - Use every other day then daily redness, peeling, dry skin - Photosensitivity sunscreen! - Antibiotics - Agents of choice: Doxy, minocylcline - Alt: Tetra, erythromycin - Isotretinoin - Only for nodularcystic acne - Risk management - STRICT! Terotogenic Two preg test prior to starting, two forms of birth control, monthly preg. - Hormonal - OCs - Spironolactone - Blocks aldosterone and sex hormones **SUNSCREEN** Spf protects against UVB not UVA In order to get both UVA/UVB protection, the sunscreen has to contain abobenzene. Has to state on the bottle that the range of uv protection/water sweat resistance **PSORIASIS** - Glucocorticoids - Vit D analogs - Calcipotriene - Vit A derivative - tazarotene - Anthralin - dithrocreme - Tars - Coal tar Systemic: - Immunologic - Methotrexate, acitretin, glucocorticoids, cyclosporine - Biologic - Etanercept, mab's - Procedures - Photochemotherapy **ACTINIC KERATOSIS** Rough, scaly, red/brown papules by chronic exposure Drugs: fluorouracil, diclofenac, imiquimod, amino acid + blue light **ATOPIC DERMATITIS (or eczema)** - These kids normally have asthma - Glucocorticoids mainline tx - Topical immunosuppressants - Tacrolimus and pimecrolimus - AE: cancer, lymphoma reserve for those that have not responded to steroids - Crisaborole 2% ointment - When steroids cant be used - \>3mo - Monoclonal antibodies - Dupilumab injection (expensive) - \>6mo - Jak inhibitors - Topical Ruxolitinib 1.5% cream - Mild-mod - BBW: infections, malignancies - Oral - Upadacitinib - Severe - \>12 - Abrocitinib - Same as above **WARTS** - Common warts - Cause: HPV - Genital: HPV 6 and 11 - Cryo or topical for \@home: imiquimod, podofilox, kune **IMPETIGO** - Staph infection in kids 2-5 (honey colored crust) - Tx - Antibx: ceph, diclo, clinda, and amox/clavulanate - Topical: mupirocin, retapamulin - New drug: ozenoxacin **METABOLIC BONE DISEASE** - Osteoclast: break down - Osteoblast: deposit new bone - Blood: total serum calcium = 10mg - Elevated calcium check for hyperparathyroidism if not, then it's probably cancer! - Absorption occurs in the small intestine. Increased by parathyroid and Vit D. Glucocorticoids - decrease absorption. - Excreted by renal GFR - Excretion can be decreased by: PTH, Vit D, and thiazide - Excretion can be increased by: loop diuretics, calcitonin, and loading w/sodium. And can be lost in breast milk - Calcium regulates parathyroid! - Vit D: increases calcium resorption - Target level 30-60 - D3 is better absorbed - Calcitonin: lowers calcium levels by inhibits reabsorption of calcium from bone and increasing calcium excretion by the kidney **DISORDERS INVOLVING CALCIUM** - Rickets (usually in children) - Vit D deficiency soften bones deformity from bearing weight - Tx: supplement - Osteomalacia (adult counterpart) - Absence of Vit D - Bowing the legs, kyphosis, fractures - Tx: supplement HYPO/HYPER PARATHYROID - Hypo - Cause: inadvertent removal of parathyroid gland from sx - Lack of PTH: hypocalcemia - Tx: calcium supplement - Hyper - Cause: benign adenoma - Increase PTH: hypercalcemia and hypophosphatemia - Tx: sx resection of parathyroid glands, calcium-lowering drugs cinacalcet OSTEOPOROSIS - Goal: Prevent fracture! - Screening rec for \>65years - Prevention: weight bearing exercise, calcium (1200mg)/vit D supplement, smoking cessation, avoid excel alcohol, avoid glucocorticoids, thyroid regulation - Tx - Calcitonin- inhibits activity of osteoclasts, decreases bone resorption, inhibits tubular resorption, increases calcium excretion - **Bisphosphonates** - Main treatment. Inhibit bone resorption by decreasing osteoclast activity - AE: osteonecrosis of the jaw, femur frac, afib, hyperpara, esophageal cancer - **Alendronate** - Weekly. Taken on empty stomach, sit upright for 30min, prevents esophageal erosion - **Risedronate** - **Ibandronate** - Once a month or q3mo (PO or IV) - **Zoledronate** - Yearly IV - SERMS - raloxifene - **Teriparatide**- PTH analog - Increases bone formation - **Denosumab** - Controls osteoclast activity - transition from denosumab to a PTH analog results in high-turnover bone loss the PTH analog (Teriparatide) should be started first followed by denosumab - Sclerostin inhibitor - Romosozumab - For very high fracture risk TIPS FOR FINAL: Review summary chats Blueprint