Topical corticosteroids: Does the vasoconstrictor assay correspond well to clinical efficacy and is it an objective test
False is not an objective test
Topical corticosteroids: Potency of triamcinolone is moderate
Corticosteroids: Does hydrocortisone have cross reactivity with betamethasone
False nothing reacts with BM
Topical corticosteroids: Aclometasone - ?correlation with vasoconstriction assay
Diltiazem: Affects AV node
False it is verapamil that is a strong depressor of AV node
Diltiazem: Prolongs QT
Diltiazem: More peripheral oedema than verapamil
Verapamil: for keloids vs steroids verapamil is superior
False steroids superior, verapamil is an alternative
Nifedipine: alter erythrocyte deformation
20. Regarding Efudix:
Efudix: Do patients with DPD deficiency have increased reaction/toxicity
True (A key enzyme in the metabolic pathway is dihydropyrimidine dehydrogenase (DPD), which converts 5-FU to dihydrofluorouracil (DHFU).) (p518)
Efudix: The structure of 5-fluouracil is a uracil and a fluoride
Efudix: It is misincorporated into RNA
True (5-FU is an antimetabolite. As a structural analog of uracil, 5-FU and its metabolites are misincorporated into RNA and disrupt RNA synthesis. Its metabolites also block the function of thymidylate synthetase, thereby interfering with DNA synthesis as well.) (p518)
Efudix: Is duration to inflammation reaction 2 weeks
False 5-10 days
21. Regarding Imiquimod: pg476
Imiquimod: It is a non-nucleotide
False is a non-nucleoSIDE heterocyclic amine
Imiquimod: Its action is on Toll-Like Receptor 2
False. Toll-like receptor 7 (p476)
Imiquimod: Does it increase the secretions of IFN-alpha
True also TNF-a,IFN-y, IL-6, IL1-a, IL-IB, IL-8, IL-12, GM-CSF. G-CSF
Imiquimod: It increases secretion of IL1 and IL6
True (Imiquimod induces secretion of tumor necrosis factor (TNF)-α, interferon (IFN)-γ, IFN-α, interleukin (IL)-6, IL-1α, IL-1β, IL-8, IL-12, GM-CSF, and G-CSF. It's an activator of Toll-like receptor-7 (TLR-7)) (p476)
Imiquimod: Causes flu like symptoms (more than placebo?)
False. Similar to that of a placebo.
22. Regarding Bleomycin: pg 478
Bleomycin: It has direct antiviral effect
Regarding Bleomycin: It affects the S phase of cell cycle
False acts during the M and G2 phase
Bleomycin: The side effect of eschar uncommonly results in scarring
False blackened eschar forms. Scarring is uncommon
Regarding Bleomycin: Is Raynaud's phenomenon a possible side effect
True but is uncommon
Bleomycin: Is it systemically detectable in plasma with concentrations of 1unit/ml
True (Plasma concentrations of bleomycin after intralesional injection of 1 mg/mL (1 mg/mL = 1 U/mL) have shown detectable systemic levels,84 but to date there are no reports of systemic toxicity.) (p478)
23. Regarding Cantharidin: pg 479
Cantharidin: Application of Cantharidin is painless
True (Painless & no scarring) (p479)
Regarding Cantharidin: It forms blisters immediately
False usually forms within 6-24 hours and heals within 1 week
Cantharidin: Does it have a direct viral effect
False (It has no direct antiviral effect.) (p479)
Cantharidin: Causes mitochondrial apoptosis
True. Acts by interfering with mitochondria leading to epidermal cell death, acantholysis, and clinical blister formation.
Cantharidin: Is it available in 5% preparations topically
False available 0.7-1%
24. Regarding Ivermectin: pg 135
Regarding Ivermectin: Does it cross the blood brain barrier
False P-glycoprotein restricts entry of ivermectin across the blood-brain barrier by an ATP-driven efflux mechanism
Ivermectin: It can be used safely in lactation
False. Crosses into breast milk safety not established
Regarding Ivermectin: Is there increased resistance to this in the Northern Territory due to increased drug metabolism and efflux mechanisms
True pg 137
Ivermectin: Pharmacokinetics of ivermectin is binds to glutamate-gated chloride ion channels found in invertebrate nerve and muscle cells
True- binding results increased permeability of cell membranes to chloride, with hyperpolarisation and death of the parasite
25. Regarding dicloxacillin: pg 63
Dicloxacillin: Is absorption optimised by administration with food
False. Better taken 1 hour before or after a meal
Dicloxacillin: Does it have renal adverse effects
False this is not mentioned. Most are excreted renally
Penicillin V: safe in pregnancy/lactation
True. Category B and safe in lactation
Dicloxacillin: Aminopenicillins cause more allergies than diclox
True.The first B-lactams reported to cause hypersensitivity reactions was benzylpenicillin with amoxicillin noted to be the most common implicated agent more recently.
Clavulanate: Does clauvulanate improve the effectiveness against beta lactams
Clindamycin: Would you rely on sensitivity report panel for sensity to CA-MRSA
False. Treatment failure may still occur despite an indication of susceptibility on the sensitivity report.
Clindamycin: Provide strong anaerobic cover
True. Has some cover to P.acnes and Propionibacterium spp. and in the text as covering “a wide variety of anerobes”
Clindamycin: It is bactericidal
False (Is bacteriostatic to gram +ve cocci, some staph & some strep) (p93)
Clindamycin: Does it have a direct effect on cell walls
False. It binds to the 50s subunit of bacterial ribosomal RNA inhibiting ribosomal translocation, resulting in decreased RNA synthesis
Clindamycin: Does it cover most streptococcus species
True. Covers Strep and Staph but not enterococci
27. Clotrimazole:pg 463
Clotrimazole: Does it cover gram positive bacteria
True. Covers gram +ve bacteria
28. Topical metronidazole: pg 456
Topical metronidazole: Does it cover m. furfur
False not mentioned
Topical metronidazole: Does it cover p. acne
False not active against P.acnes
Topical metronidazole: Does it cover demodex mites
False not active against Demodex. Role in rosacea must not be realted to direct killing of the mite.
29. Terbinafine: pg 100
Terbinafine: Is terbinafine metabolised by CYP3A4 isoform
True. Also metabolised by CYP2C9, 1A2, 3A4, 2C8, 2C19
Terbinafine: Is it renally excreted
True 70% renally cleared.
Terbinafine: It is fungicidal
True. Both static and cidal, all the others are only static (i.e. TER-binafine TER-minates)
Terbinafine: Does it penetrate hair shaft
False? Early detection in the hair by delivery of the drug via the sebum. Later the drug may become incorporated into the hair by hair matrix cells. Pg 102
30. Azelaic acid: pg 457
Azelaic acid: Does it bleach normal skin
False. Has no depigmenting activity on normal skin.
Azelaic acid: Does it reduce sebum
False. It does not reduce the rate of sebum production but patients often report gradual reduction in skin greasiness after 1-2 months of treatment.
31. Topical Benzyl peroxide: pg 452
Topical Benzyl peroxide: Does it bleach hair and fabric
True. Can bleach fabric, hair, and other coloured material.
Topical Benzyl peroxide: Is p. acne resistant to this
False. Is bactericidal for P.acnes. In vitro resistance of P.acnes to BP HAS NOT BEEN ENCOUNTERED.
Topical Benzyl peroxide: Is it more likely to cause contact allergy than irritant allergy
False. Main adverse effect is irritant dermatitis. True contact allergy 0.2-1%.
Topical Benzyl peroxide: The combination of benzyl peroxide and adapalene is more irritating than benzyl peroxide alone
True (pg 454). Transient dryness and irritation is more frequent with adapalene/BP than with monotherapy with either agent.
Topical Benzyl peroxide: Is it an oxidiser
True. Broad spectrum bacteriocidal agent that functions through its powerful oxidising activity.
32. Topical adapalene/retinoids: pg 509
Topical adapalene/retinoids: Is adapalene lipophilic
True. More lipophilic which enables it to penetrate follicles quickly.
Topical adapalene/retinoids: Is adapalene less photo-labile compared to other topical retinoids
True. It is less photolabile than other all-trans retinoic acid.
Topical adapalene/retinoids: Does Tretinoin occur naturally
True. Tretinoin is an all-trans retinoic acid and is naturally derived.
Topical adapalene/retinoids: Binding of retinoids to nuclear receptors – uses RAR and RXR which binds to RARE
True. Transported to nucleus by CARBP. RAR and RXR (heterodimerizes and homodimerizes) which then bind to RAREs in DNA to influence gene transcription. (Fig 20-1, p254).
Topical adapalene/retinoids: Is topical Tretinoin safe in pregnancy
False . Excessive oral vitamin A is teratogenic . No data available on topical all-trans retinol.
33. Systemic retinoids: pg 253
Systemic retinoids: Bioavailability of acitretin is improved with a fatty meal
True. Oral bioavailability is enhanced with food intake. The effects of a fatty meal is especially great with acitretin and bexarotene.
Systemic retinoids: Acitretin has a possible side effect of elevating serum cholesterol and triglyceride levels
True both hypercholesterolaemia and hypertriglyceridemia are common. TG in 50% of patients and 30% patient increased cholesterol.
Systemic retinoids: Elevated transaminases can occur with both acitretin and isotretinoin use
True (Have been reported in acitretin and isotretinoin. There was no correlation between hepatic transaminase abnormalities and liver biopsy findings.) (p264)
Systemic retinoids: Acitretin is more likely than isotretinoin to cause telogen effluvium
True more common with acitretin than from etretinate therapy and is much less common with isotretinoin and bexarotene.
Systemic retinoids: The recommended dose of isotretinoin for acne is 0.1mg/kg
False. Standard dosage range is 0.5-2mg/day see table 20-1 pg 253 or 0.1-1mg/Day in text pg 257 **interesting contradiction!!
Systemic retinoids: Total cumulative dose of isotretinoin for acne vulgaris is 120-150mg/kg
True. Pg 257.
34. Topical corticosteroids: pg 487
Topical corticosteroids: Rebound syndrome may be characterised by a burning sensation
True. Pg 497
Topical corticosteroids: Striae are irreversible
True. Striae are permanent pg 497 under atrophy heading.
Topical corticosteroids: 7 day use of potent corticosteroids under occlusion may lead to skin atrophy
True. Atrophy of the epidermis can be seen within 7 days of superpotent TCS (i.e. Clobetasol) under occlusion.
Topical corticosteroids: Tachyphylaxis resolves after a 3-4 day rest period
True. Recovery generally occurs after a 3-4 day rest period. Pg 498
35. Prednisone: pg 166
Prednisone: Prednisone induced lipodystrophy may be reversed by decreasing dose to less than 10mg daily
True. Prednisolone dosing <10mg/day will generally allow reversal of lipodystrophy.
Prednisone: There is a significant risk of osteoporosis with prednisone between 2.5-5mg daily
True. There is a significant risk of CS-induced osteoporotic fractures with pred doses between 2.5-5mg daily
Prednisone: Menstrual abnormalities are not infrequently caused by prednisone 20mg daily
True. Up to 40% of premenopausal women on at least 20mg/day experience significant menstrual abnormalities.
Prednisone: There is a significant osteonecrosis risk with prednisone for <3 months
False. Long term (at least 3 months) continuous CS therapy increases the risk of osteonecrosis. Pg 167
True pg 146 table 12-2 decreased NK cell activity.
Systemic corticosteroids effects: Increases neutrophils and lymphocytes
False. Causes apoptosis of lymphocytes. Cannot find statement of neutrophils per se.
Systemic corticosteroids effects: Causes increase in cellular immunity versus humoral immunity
True pg 146. Has more of an effect on cellular immunity vs humoural immunity.
Systemic corticosteroids effects: Causes increased apoptosis of lymphocytes and eosinophils
True (Causes apoptosis of autoreactive T cells (in autoimmune disorders) and neoplastic T cells (in various lymphomas); AP-1 and caspase cascade probably involved in process. Apoptosis of eosinophils with potential implications for various allergic disorders) (Table 12-2, p146).
37. Anthralin/Dithranol: Pg 634
Anthralin/Dithranol: Irritant contact dermatitis is a more common adverse effect of anthralin than allergic contact dermatitis
True. Irritant contact dermatitis and staining of clothing, skin, hair and nails are all commonly observed adverse reactions with anthralin therapy. pg 634
Anthralin/Dithranol: Usual initial starting concentration is 0.1% to 1%
True pg 634
Anthralin/Dithranol: Can be used with UVB
True. Has been combined with UVB but does not have to be.
Anthralin/Dithranol: Is also known as crystalip
False. Crystalip encapsulates the anthralin in a matrix of semi-crystalline monogylcerides which protects the anthralin from oxidation and promotes stability. Chrysarobin is the natural product comes from araroba tree in south America.