U\u010dinkovitost kateregakoli topijskega zdravila je odvisna od:<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravilne u\u010dinkovine (njene mo\u010di)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mesta nanosa<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nosilca (na\u010din na keteri sestavine vnesemo v ko\u017eo)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Koncentracije zdravilne u\u010dinkovine<\/p>\n
U\u010dinkovitost topijskega zdravila je odvisna od vsega, razen od (obkro\u017ei en odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravilne u\u010dinkovine<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Nosilca<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 \u010casa nanosa zdravila<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Mesta nanosa zdravila<\/p>\n
Najpogosteje uporabljani nosilci topijskih zdravil v dermatologiji so (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Mazilo<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Krema<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Vosek<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Gel<\/p>\n
Mazila (npr. vazelin): zamastijo ko\u017eo, okluzivni (zapirajo\u010di) u\u010dinek;<\/p>\n
Najbolj primerna za gladko, nepora\u0161\u010deno ko\u017eo; suhe, zadebeljene, poro\u017eenele spremembe<\/p>\n
Mazila so sestavljena iz vodnih kapljic suspendiranih v neprekinjeni fazi olja (V\/O) ali iz inertnih podlag kot je vazelin.<\/p>\n
Glede topnosti v vodi, mazila so lahko topna v vodi, lahko se emulgirajo z vodo ali so mazila, ki so popolnoma netopna v vodi<\/p>\n
Mazila je najprimernej\u0161e predpisati za spremembe na ko\u017ei, katere so (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Suhe in zadebeljene<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Vla\u017ene in zadebeljene<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Z razjedo na povr\u0161ini<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Poro\u017eenele<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Eritematozne<\/p>\n
Mazila so vedno popolnoma netopna v vodi:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 DA<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 NE<\/p>\n
Kreme (izginejo, ko jih vtremo v ko\u017eo): manj mastne, su\u0161ijo; neokluzivne, lahko pe\u010dejo, lahko dra\u017eijo (konzervansi \/di\u0161ave)<\/p>\n
Uporabljati za akutne, vla\u017ene, vnete spremembe, za pregibe<\/p>\n
Kreme so poltrdne emulzije olja in vode (O\/V) \u2013 kako pove\u010dujemo dele\u017e olja in zni\u017eujemo dele\u017e vode, pripravek postaja bolj viskozen in v enem trenutku ne bo ve\u010d krema, ampak ga bomo ozna\u010dili kot mazilo<\/p>\n
Kreme vsebujejo ve\u010d vode ter zato \u0161tevilne emulgatorje in konservanse in so bolj dra\u017ee\u010de za ob\u010dutljivo ko\u017eo.<\/p>\n
Kreme (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Vsebujejo ve\u010d dodatnih snovi (kot so emulgatorji, konservansi…) v primerjavi z mazili<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Primernej\u0161e so za vla\u017ene in akutne spremembe<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Primernej\u0161e so za pregibne povr\u0161ine<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Imajo bolj izrazit protivnetni u\u010dinek v primerjavi z mazili<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 So emulzija vode v olju<\/p>\n
Losjoni (teko\u010dine): manj mastni, manj okluzivni; lahko vsebujejo alkohol (su\u0161ijo vla\u017ee\u010de spremembe); lahko predirajo<\/p>\n
Uporabljati za pora\u0161\u010dene dele telesa<\/p>\n
Losjoni so suspenzija pra\u0161kov v vodi, tinkture so pa alkoholne ali hidroalkoholne raztopine.<\/p>\n
Ve\u010dino pripravka tvorita voda ali alkohol, ki v kratkem \u010dasu izhlapita ter hladita in su\u0161ita ko\u017eo. Nato losjoni pustijo enakomerni sloj pra\u0161kaste snovi na ko\u017ei.<\/p>\n
Losjoni (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko vsebujejo alkohol<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Primerni so za suhe in kroni\u010dne spremembe na obrazu<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Primerni so za lasi\u0161\u010de in druge pora\u0161\u010dene dele telesa<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Ne uporabljamo jih na rokah<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 So emulzija olja v vodi<\/p>\n
Olja: manj dra\u017eijo od losjonov ali raztopin<\/p>\n
Uporabljati na lasi\u0161\u010du, posebej pri osebah z grobimi ali zelo skodranimi lasmi<\/p>\n
Geli: lahko vsebujejo alkohol, nemastni, najmanj okluzivni; hitro se posu\u0161ijo<\/p>\n
Uporabljati za akne, vla\u017eno vnetje (npr. akutni dermatitis; v lasi\u0161\u010du in pora\u0161\u010deni ko\u017ei<\/p>\n
Gel je prozorna in brezbarvna poltrdna emulzija, ki se raztaplja ob stiku s ko\u017eo in su\u0161i ustvarjajo\u010d tanek, nemasten, neokluziven in brezbarven film.<\/p>\n
Geli so lahko na osnovi vode, acetona, alkohola ali propilen glikola, a gelirajo\u010de spojine so organski polimeri kot so agar, \u017eelatina, metilceluloza, pektin in polietilen glikol.<\/p>\n
Za gele velja vse na\u0161teto, razen (obkro\u017ei en odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Nemastni so<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Primerni so samo za pregibe<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Hitro se raztapljajo ob stiku s ko\u017eo<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Vsebujejo organske polimerje<\/p>\n
Pudri (pra\u0161ki) imajo su\u0161ilni u\u010dinek na ko\u017eo.<\/p>\n
Danes jih zelo redko uporabljamo, predvsem za pregibne povr\u0161ine z namenom zmanj\u0161anja vla\u017enosti, maceracije in trenja.<\/p>\n
Nekateri so inertni, drugi pa vsebujejo zdravilne snovi. Lo\u010dimo neabsorptivne (npr. talk) in absorptivne pra\u0161ke (npr. celuloza). Slednji po vpijanju teko\u010dine tvorijo majhne grudice in lahko dodatno po\u0161kodujejo ko\u017eo!<\/p>\n
Pene: lahko jih je razmazati, lahke za nanos; dra\u017eje<\/p>\n
Uporabljati na pora\u0161\u010denimi in vnetimi povr\u0161inami<\/p>\n
Pr\u0161ila: aeosoli (redko jih uporabljamo)<\/p>\n
Pene so (obkro\u017ei en odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Najprimernej\u0161e za pora\u0161\u010dene predele in vnetne spremembe<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Najprimernej\u0161e za nepora\u0161\u010dene predele in vnetne spremembe<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Zelo mastne so<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Niso primerne za starej\u0161e<\/p>\n
TOPIJSKI KORTIKOSTEROIDI<\/p>\n
Protivnetni u\u010dinek v ko\u017ei
\nU\u010dinkoviti so v stanjih, ki jih zaznamujejo hiperproliferacija, vnetje i aktivacija imunskega sistema
\nBla\u017eijo tudi ob\u010dutek pe\u010denja in srbenja
\nKortikosteroidi so razvr\u0161\u010deni v razrede na osnovi svoje mo\u010di (potence)
\nMo\u010d je funkcija same molekule, ne njene koncentracije v pripravku
\nKoristno je poznati mo\u010di topijskih steroidov, ki jih predpisujejo zdravniki s katerimi sodelujete
\nMo\u010d
\nRazred
\nPrimer zdravila
\nZelo visoka
\nI
\nklobetazol propionat 0,05%
\nVisoka
\nII
\nBetametazon-dipropionat 0,05%
\nSrednja
\nIII \u2013 V
\nTriamcinolon acetonid 0,1%<\/p>\n
Mometazon furoat 0,1%<\/p>\n
Metilpednizolon aceponat 0,1%
\nNizka
\nVI \u2013 VII
\nAlklometazon dipropionat 0,05%<\/p>\n
Hidrokortizon 1%
\nBodite pozorni na razred, ne na odstotek!<\/p>\n
Opazite, da je betametazon 0,05% mo\u010dnej\u0161i od hidrokortizona 1%.<\/p>\n
Triamcinolon mazilo je mo\u010dnej\u0161e od triamcinolon kreme ali losjona zaradi narave nosilca!<\/p>\n
Steroide zelo visoke mo\u010di (razred I) uporabljamo pri te\u017ekih dermatozah z izjemo obraza in pregibov<\/p>\n
Lasi\u0161\u010de, dlani, podplati, in debele plo\u0161\u010de na ekstenzornih povr\u0161inah<\/p>\n
Srednji do visoko mo\u010dni steroidi (razredi II-V) so primerni za blago do zmerno vnetje na povr\u0161inah z izjemo obraza in pregibov<\/p>\n
V omejenem obdoju jih lahko nan\u0161amo tudi na pregibne povr\u0161ine<\/p>\n
Steroide nizke mo\u010di (razredi VI, VII) lahko uporabljamo na ve\u010djih povr\u0161inah in na tanj\u0161i ko\u017ei<\/p>\n
Obraz, veke, genitalne in pregobne povr\u0161ine<\/p>\n
Lokalni stranski u\u010dinki topijskih kortikosteroidov vklju\u010dujejo:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Atrofijo ko\u017ee \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Akne<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Telangiektazije\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Rozaceo<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Strije\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hipopigmentacijo<\/p>\n
Vi\u0161ja mo\u010d, ve\u010dja verjetnost stranskih u\u010dinkov.
\nV cilju zmanj\u0161anja tveganja, izbrati je treba najmanj mo\u010den steroid za najkraj\u0161e obdobje, vendar dovolj u\u010dinkvit za obolenje, ki ga zdravimo
\nSistemski stranski u\u010dinki so izjemno redki zaradi majhne absorpcije
\nLahko se pojavijo:
\n\u00a7\u00a0 Glavkom (ko steroide nana\u0161amo ob o\u010desu)<\/p>\n
\u00a7\u00a0 Supresija hipotalamo-hipofizne osi<\/p>\n
\u00a7\u00a0 Cushingov sindrom<\/p>\n
\u00a7\u00a0 Hipertenzija<\/p>\n
\u00a7\u00a0 Hiperglikemija<\/p>\n
Vi\u0161ja mo\u010d, ve\u010dja mo\u017enost stranskih u\u010dinkov
\nV cilju zmanj\u0161anja tveganja, izbrati je treba najmanj mo\u010den steroid za najkraj\u0161e obdobje, vendar dovolj u\u010dinkvit za obolenje, ki ga zdravimo
\nTrajanje zdravljenja je omejeno, med drugim, s stranskimi u\u010dinki
\nNa splo\u0161no:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zelo mo\u010dni: nana\u0161aj <3 tedne<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Visoko in srednje mo\u010dni: <6-8 tednov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nizko mo\u010dni: stranski u\u010dinki so redki. Nana\u0161ati na obraz, pregibe, in genitalije najve\u010d 1-2 tedna<\/p>\n
Ustaviti nana\u0161anje ko spremebe izzvenijo
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izogniti se hitrem poslab\u0161anju s postopnim zmanj\u0161anjem pogostosti nana\u0161anja in mo\u010di steroida npr. vsaka 2 tedna<\/p>\n
\u010ce se bolnik ne odzove na zdravljenje na ta na\u010din, na\u010deloma ga je treba napotiti k dermatologu
\nZa topijske kortikosteroide je to\u010dno da (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Imajo protivnetni u\u010dinek v ko\u017ei<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 U\u010dinkoviti so v stanjih, ki jih zaznamujejo hiperproliferacija, vnetje i aktivacija imunskega sistema<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko povrzro\u010dijo zni\u017eanje krvnega pritiska<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Razvr\u0161\u010deni so v razrede na osnovi svoje mo\u010di (potence)<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Mo\u010d je funkcija same molekule, ne njene koncentracije v pripravku<\/p>\n
Najmanj mo\u010dan topijski kortikosteroid je (obkro\u017ei samo en odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Betametazon-dipropionat 0,05%<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Hidrokortizon 1%<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Mometazon furoat 0,1%<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Klobetazol propionat 0,05%<\/p>\n
Lokalni stranski u\u010dinki topijskih kortikosteroidov so (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Atrofija ko\u017ee<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Akne<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Telangiektazije<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Strije<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Vse na\u0161teto<\/p>\n
Za predpisovanje topijskih kortikosteroidov velja vse, razen:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Dovolj jih je nana\u0161ati enkrat dnevno<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Po zmanj\u0161anju vnetja jih lahko doziramo samo dvakrat tedensko<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Za pregibe vedno predpisujemo zelo mo\u010dne kortikosteroide<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Srednje mo\u010dne kortikosteroide, brez posveta z dermatologom, ne smemo predpisovati za \u010das dalj\u0161i od 6-8 tednov.<\/p>\n
<\/p>\n
Doziranje topijskih kortikosteroidov (enota konice prsta):<\/p>\n
Koli\u010dina topijskega zdravila (iztisnjenega iz odprtine tube premera 5 mm)
\nEnota konice prsta za 2% PT
\nEnota konice prsta pomeni (obkro\u017eite vse to\u010dne odogovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Koli\u010dina pripravka zadostna za 2% telesne povr\u0161ine<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Pomeni koli\u010dino, ki zadostuje za dvakratni nanos<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Koli\u010dina 0,5 g mazila<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Koli\u010dina 1 g mazila<\/p>\n
<\/p>\n
Zdravljenje aken:<\/p>\n
Benzoil peroksid<\/p>\n
BP deluje antibakterijsko in komedoliti\u010dno
\nPri nas je na voljo kot pripravek v obliki gela (IALUXID), ki ostane na ko\u017ei, sicer pa se v tujini dobi 4% preipravek, ki se po 2 minutah spere s ko\u017ee.
\nPogosti stranski u\u010dinki:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Belenje dlake, obarvanih tkanin ali preprog<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko dra\u017ei ko\u017eo<\/p>\n
Na voljo kot krema, suspenzija, lotsjon ali gel
\nTopijski antibiotiki<\/p>\n
Namen: zmanj\u0161ati \u0161tevilo P. acnes ter vnetje
\nNikoli jih ne uporabljati samostojno!
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Obi\u010dajno s topijskim retinoidom, npr. tretinoinom, eritromicin 2% (ZALNA\u00a0 gel, krema)<\/p>\n
Metronidazol 0,75%, 1% (krema, gel) v zdravljenju rozacee
\nTopijski retinoidi<\/p>\n
Derivati vitamina A: tretinoin, adapalen, tazaroten.
\nIndikacije: akne, po\u0161kodbe ko\u017ee izzvane s soncem, hiperpigmentacija
\nOpozoriti na pogoste stranske u\u010dinke:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Suhost, srbenje, rde\u010dica, lu\u0161\u010denje<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 fotosnezitivnost<\/p>\n
Na voljo kot kreme ali geli
\nNikoli ne nana\u0161ati skupaj s BP (oksidira tretinoin!)
\nTopijsko zdravljenje aken<\/p>\n
Topijska zdravila proti aknam pogosto dra\u017eijo in su\u0161ijo ko\u017eo
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V pri\u010detku retinoide ali BP lahko bolnik nana\u0161a vsak II. dan<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neomejena uporaba vla\u017eilcev zmanj\u0161a dra\u017ee\u010di u\u010dinek.<\/p>\n
Do vidnega u\u010dinka je treba potrpeti 2-3 mesece
\nBolniki neredko nehajo z nana\u0161anjem zdravila prezgodaj zaradi \u201crde\u010de in lu\u0161\u010de\u010de se ko\u017ee brez izbolj\u0161anja aken\u201d
\nNavodila so klju\u010dnega pomena za uspe\u0161no zdravljenje aken.
\nOralni antibiotiki<\/p>\n
Tetraciklin, doksiciklin, azitromicin
\nZa zmerene do te\u017eje vnetne akne
\nPogosto jih predpi\u0161emo skupaj z BP v cilju zmanj\u0161anja rezistence.
\nTetraciklini so:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kontraindicirani v nose\u010dnosti in pri otrocih mlaj\u0161ih od 8 let<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko povzro\u010dijo prebavne te\u017eave (peko\u010di ob\u010dutek v \u017eelodcu, slabost, bruhanje ali drisko)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fotosenzitivnost (la\u017eje se ope\u010dejo na soncu; nujna bolja za\u0161\u010dita pred sobcem!). Filtri tudi z UVA blokom.<\/p>\n
Navodila bolnikom, ki u\u017eivajo tetracikline<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010ce jih u\u017eivajo zaradi aken, lahko jih zau\u017eijejo s hrano in z mle\u010dnimi izdelki kar pomaga v prepre\u010ditvi stranskih u\u010dinkov v prebavnem traktu<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zau\u017eiti s polnim kozarcem vode; ne ule\u010di se takoj po zau\u017eitju!<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tetraciklini ne zmanj\u0161ujejo u\u010dinek oralne kontracepcije<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Po\u010dakati je treba 2-3 mesece do opaznega izbolj\u0161anja<\/p>\n
Oralni izotretinoin<\/p>\n
Derivat retinoi\u010dne kisline za te\u017eje oblike aken
\nPredpi\u0161e ga samo dermatolog z bogatimi izku\u0161njami v zdravljenju s tem zdravilom
\nObi\u010dajno v ciklih zdravljenja, ki trajajo 6-12 mesecev
\nIzotretnoin je teratogen in je absolutno kontraindiciran\u00a0 med nose\u010dnostjo
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Obvezna je uporaba dveh metod kontracepcije tekom zdravljenja i \u0161e en mesec po prenehanju u\u017eivanja izotretinoina<\/p>\n
Stranski u\u010dinki oralnega izotretinoina<\/p>\n
Pogosti stranski u\u010dinki:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Suha ko\u017ea<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Heilitis<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Povi\u0161anje jetrnih encimov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hipertrigliceridemija<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ekcem<\/p>\n
Izrazit glavobol je lahko posledica redkega stranskega u\u010dinka, tako imenovanega psevdotumorja mozga
\n <\/p>\n
Topijski benzoil peroksid (obkro\u017ei vse to\u010dne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 deluje antibakterijsko in komedoliti\u010dno<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 nanj se ne pojavlja rezistenca bakterij<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 ni primeren za zdravljenje otro\u0161kih aken<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 lahko oksidira tkanine (beli jih)<\/p>\n
Za topijske retinoide velja vse razen:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 So derivati vitamina A kot tretinoin, adapalen, tazaroten<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Pogosto povzro\u010dajo suho ko\u017eo, rde\u010dico in lu\u0161\u010denje<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Vedno jih uporabljamo v istem pripravku s benzoil peroksidom<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Vedno jih uporabljamo lo\u010deno od benzoil peroksida<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Na u\u010dinek je treba po\u010dakati 8-10 tednov redne uporabe<\/p>\n
Za oralni izotretinoin velja (obkro\u017ei vse to\u010dne odhovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Kontraindiciran v nose\u010dnosti<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Uporabljamo ga skupaj z oralnim tetraciklinom<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Naju\u010dinkovitej\u0161e zdravilo proti aknam<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Najpogostoje povzro\u010da suho ko\u017eo in rde\u010dico<\/p>\n
Psoriaza<\/p>\n
V osnovi nekaterih dermatoz je hitra delitev celic povrhnjice.
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Npr. povrhnjica\u00a0 se v psoriazi ustvarja zelo hitro<\/p>\n
Topijska zdravila katera zavirajo delitev keratinocita uporabljamo v zdravljenju luskavice
\nLe-ta vklju\u010dujejo:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Analoge vitamina D<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 katrane<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tazaroten<\/p>\n
Analogi vitamina D:<\/p>\n
Kalcipotrien (kalcipotriol)
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zavira proliferacijo keratinocitov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Najpogostej\u0161i stranski u\u010dinek je iritacija<\/p>\n
Kalcitriol
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zavira proliferacijo keratinocitov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Spodbuje dozorevanje keratinocitov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zavira prolferacijo limfocitov T<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na ob\u010dutljivej\u0161ih delih ko\u017ee je manj dra\u017ee\u010d od kalcipotriola<\/p>\n
Katrani in tazaroten<\/p>\n
Katran 2-5%
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antiproliferacijski u\u010dinek<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Slabe strani: obarva obleko\/dlake\/ko\u017eo; fotosenzitivnost<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko ga kombiniramo s salicilno kislino kar pove\u010da predor v debele plo\u0161\u010de<\/p>\n
Tazaroten 0,05% in 0,1%
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Topijski retinoid, ki ga uporabljamo v zdravljenju aken, rozacee in luskavice<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Slabe strani: dra\u017ei ko\u017eo; teratogen; fotosenzitivnost<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko ga kombiniramo s kortikosteroidi II. razreda v cilju zmanj\u0161anja iritacije<\/p>\n
<\/p>\n
V zdravljenju psoriaze uporabljamo vse razen:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Topijske derivate vitamina D<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Topijski benzoil peroksid<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Biolo\u0161ka zdravila<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Fototerapijo<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Antihistaminike<\/p>\n
<\/p>\n
Druge oblike zdravljenja v dermatologiji:<\/p>\n
Fototerapija<\/p>\n
Fotodinami\u010dna terapija<\/p>\n
Krioterapija<\/p>\n
elektrokirurgija<\/p>\n
dermatokirurgija<\/p>\n
kemi\u010dni pilingi<\/p>\n
dermalna polnika<\/p>\n
botulinski toksin<\/p>\n
Laserji v dermatologiji<\/p>\n
\u00d8\u00a0 seva svetlobo z eno samo valovno dol\u017eino -MONOHROMATSKI \u017dAREK v natan\u010dno dolo\u010deni smeri.<\/p>\n
\u00d8\u00a0 Valovna dol\u017eina je lahko v vidnem delu spektra, lahko je infrarde\u010da<\/p>\n
\u00d8\u00a0 Z le\u010dami opti\u010dnega sistema se dose\u017ee, da se svetloba ne razcepi, zato se lahko skozi vrtljivo ro\u010dico usmeri v dolo\u010deno to\u010dko – ciljno mesto, kjer ima veliko mo\u010d.<\/p>\n
\u00d8\u00a0 RAZLI\u010cNI LASERJI USTVARIJO SVETLOBO RAZLI\u010cNIH VALOVNIH DOL\u017dIN – BARV<\/p>\n
\u00d8\u00a0 DOLO\u010cENA VALOVNA DOL\u017dINA SVETLOBE, KI JO NEK LASER USTVARI, JE KLJU\u010c DO U\u010cINKA TEGA LASERJA<\/p>\n
\u00d8\u00a0 RAZLI\u010cNE BARVE SE ABSORBIRAJO V RAZLI\u010cNIH BARVAH KO\u017dNIH PIGMENTOV<\/p>\n
P\/\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 v Hb se absorbira rumenozelen<\/p>\n
Selektivna fototermoliza<\/p>\n
\u00d8\u00a0 monohromatski \u017earek dolo\u010dene valovne dol\u017eine (RUMENO \u2013 ZELEN)\u00a0 – 520 nm do 600 nm potuje skozi povrhnje plasti ko\u017ee in se absorbira v krvnem pigmentu hemoglobinu<\/p>\n
\u00d8\u00a0 Proces selektivne fototermolize privede do termi\u010dne po\u0161kodbe krvnih elementov in \u017eilne stene (enakomerne koagulacije) \u2013 v ciljni strukturi temp ve\u010dja od 100 st. C<\/p>\n
\u00d8\u00a0 S\u010dasoma se krvni elementi absorbirajo v okolnem tkivu<\/p>\n
\u00d8\u00a0 EPIDERMIS ohranjen s pomo\u010djo aktivnega ohlajanja<\/p>\n
Intenzivna pulzna svetloba<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pri IPL je, podobno kot pri laserjih, osnovni princip delovanja absorpcija fotonov s strani endogenih ali eksogenih kromofor v ko\u017ei<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na ta na\u010din nastaja toplota, ki potem po\u0161koduje tar\u010dne strukture<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010ceprav selektivna fototermoliza ni pogojena z koherentnostjo ali monokromati\u010dnostjo, je brez dvoma, selektivnost IPL aparature precej manj\u0161a v primerjavi z lasersko<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Med postopkom so hemoglobin, melanin in voda so\u010dasne tar\u010de – NESELEKTIVNOST<\/p>\n
<\/p>\n
Karakteristike laserske svetlobe klju\u010dne za njeno klini\u010dno u\u010dinkovitost so (obkro\u017ei vse to\u010dne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Ena sama valovna dol\u017eina (monokromati\u010dnost)<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Dolo\u010dene valovne dol\u017eine absorbirajo dolo\u010dene kromofore (nrp. hemoglobin ali melanin)<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Absorbcija svetlobe povzro\u010da spro\u0161\u010danje toplotne energije<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Absorpcija svetlobe povzro\u010da spro\u0161\u010danje toksi\u010dnih snovi<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Laserska svetloba je vedno vidna svetloba<\/p>\n
Intenzivna pulzna svetloba je (eden to\u010den odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Selektivna podobno laserski svetlobi<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Bolj primerna za pora\u0161\u010deno ko\u017eo<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Obsega svetlobo razli\u010dnih valovnih dol\u017ein v enema samem snopu<\/p>\n
<\/p>\n
Vzroki kroni\u010dne ulceracije na nogi:<\/p>\n
Najpogosteje:
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vensko popu\u0161\u010danje 45-60%<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Arterijska insuficienca 10-20%<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kombinirano 10-15%<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Diabetes15-25%<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Maligni tumorji, vaskulitis, sistemske bolezni vezivnega tkiva, zdravila…<\/p>\n
Kajenje in debelost sta neodvisna dejavnika tveganja za nastanek in trajanje razjede
\nNajpogostej\u0161i vzrok kroni\u010dne ulceracije na nogi je (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Vensko popu\u0161\u010danje<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Arterijska insuficienca<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Diabetes<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Tumorji<\/p>\n
<\/p>\n
Vensko popu\u0161\u010danje<\/p>\n
Stazni dermatitis je znak venskega popu\u0161\u010danja.
\nFiziolo\u0161ko, venska kri se vra\u010da iz povrhnjega venskega, delno preko prebodnih ven, v globoki venski sistem.
\nVenski zastoj ali obratni tok krvi nastaneta ob zapori globokih ven ali nefunkcionalnosti zaklopk kar povzro\u010di vensko hipertenzijo.
\nZgodnji znaki venskega popu\u0161\u010danja:
\nOb\u010dutljivost
\nEdema
\nHiperpigmentacija
\nPozni znaki:
\nLipodermatoskleroza (vnetje podko\u017ene ma\u0161\u010dobe, katero zamenja fibroti\u010dno tkivo, ki dodatno zavira venski in limfati\u010dni pretok)
\nVenska razjeda
\nBele, zvezdaste atrofi\u010dne brazgotine
\nKlini\u010dna slika kroni\u010dnega venskega popu\u0161\u010danja obsega vse razen:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Venska razjeda<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Stazni dematitis<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Edem<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Lihenoidne papule<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Hiperpigmentacija<\/p>\n
<\/p>\n
Lipodermatoskleroza<\/p>\n
\u201cobrnjena steklenica penine\u201d
\nBolniki z lipodermatosklerozo lahko imajo akutne zagone vnetja, ki jh lahko zamenjamo za celulitis
\nElephantiasis verrucosa nostra<\/p>\n
Vnetje limfnih \u017eil ob ponavljajo\u010dem se celulitisu povzro\u010da limfedem
\nKo\u017ea je hiperkeratoti\u010dna, groba, nepravilna
\nRazjeda na tako spremenjeni\u00a0 ko\u017ei (z venskim in limfnim popu\u0161\u010danjem)\u00a0 precej te\u017eje celi
\nZapleti venskega popu\u0161\u010danja:<\/p>\n
Ponavljajo\u010de se razjede
\nCelulitis (razjeda je mesto vstopa bakterij)
\nKontaktni alergijski dermatitis
\nVenska tromboza
\nZapleti venskega popu\u0161\u010danja so (obkro\u017ei pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Osteomielitis<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Celulitis<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Kontaktni alergijski dermatitis<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Limfedem<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Venska tromboza<\/p>\n
<\/p>\n
Zdravljenje:<\/p>\n
Pomembno je zdraviti tako dermatitis kako vzrok kroni\u010dnega venskega popu\u0161\u010danja
\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje venskega popu\u0161\u010danja<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mo\u010dni topijski kortikosteroid na podro\u010dje drmatitisa<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kompresijske nogavice ali povoji<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Obloge, odvisno od stanja razjede<\/p>\n
Znotraj\u017eilni postopki zdravljenja varikoznih \u017eil so:<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sklerozacija s peno<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Laserska ablacija<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Radiofrekven\u010dna ablacija<\/p>\n
<\/p>\n
Klju\u010dni postopek v zdravljenju venske razjede, ki je posledica popu\u0161\u010danja safenskih ven je (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Hidrokoloidne obloge<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Kompresijski povoji<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Kompresijske nogavice<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Odstranitev obolele vene (kirur\u0161ko ali z razli\u010dnimi znotraj\u017eilinimi posegi)<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Mikronizirani flavonoidi<\/p>\n
<\/p>\n
Arterijska razjeda<\/p>\n
\u201ciz\u0161tancana\u201d ulcera z ostro omejenimi robovi
\nMinimalni eksudat in okoli\u0161ki eritem
\nPraviloma netipen pulz nad a. dorsalis pedis
\nABI \u00a3 0.8
\nBolezen perifernih arterij
\nObi\u010dajno na goleni, na mestih pritiska ali po\u0161kodbe: pretibijalno, supramaleolarno ter na prsteh ali petah
\nDrugi znaki ishemije so izguba dlak na nogah, sijajna atrofi\u010dna ko\u017ea
\nIntermitenta klavdikacija in bole\u010dina
\nDiabetesna razjeda:<\/p>\n
Periferna nevropatija, pritisk in po\u0161kodbe imajo pomembno vlogo v nastanku diabeti\u010dne razjede
\nObi\u010dajno na plantarni povr\u0161ini stopala nad glavicami metatrzalnih kosteh ali na prsteh
\nPonavljajo\u010di se mehanski pritisk ustvarja kalus (\u017eulj) kateri je najpomembnej\u0161a preulcerozna sprememba nevropatskega stopala
\nVerjetnost, da bolnik z diabetesom razvije razjedo stopala dosega 25%
\nDejavniki tveganja za razjedo stopala so:
\nkajenje
\nPredhona razjeda
\nObolenje perifernih arterij
\nPredhodna amputacija
\nOdstraniti kalus okoli razjede skupaj z mrtvim tkivom
\nSondirati razjedo z namenom razkritja sinusov, ki potekajo proti kosti ali lateralno
\nRadiografija ali CT
\n\u010ce obstaja sum na osteomielitis sprejem v bolni\u0161nico zaradi zdravljenja
\nZ ustrezno oblogo vzdr\u017eevati vla\u017eno okolje
\nGel z rastnim faktorjem trombocitov izbolj\u0161uje celjenje diabeti\u010dnega stopala
\nZa\u0161\u010dititi razjedo pred pretiranim pritiskom
\nPosebna obutev
\nOmejiti te\u017eo na obolelem udu<\/p>\n
<\/p>\n
Arterijska razjeda (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Razjeda je ostro omejen, z minimalnim eksudatom in okoli\u0161kim eritemom<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Gle\u017eenjski indeks (ABI) manj\u0161i od 1,5<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Obi\u010dajno na goleni, pretibijalno, supramaleolarno ter na prsteh ali petah<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Drugi znaki ishemije so izguba dlak na nogah, sijajna atrofi\u010dna ko\u017ea<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Mo\u010dan edem goleni<\/p>\n
Diabetesna razjeda (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Periferna nevropatija, pritisk in po\u0161kodbe imajo pomembno vlogo v nastanku diabeti\u010dne razjede<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Obi\u010dajno na plantarni povr\u0161ini stopala nad glavicami metatrzalnih kosteh ali na prsteh<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Razjeda je izjemno bole\u010da na dotik<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Pogojuje ji kroni\u010dno vensko popu\u0161\u010danje<\/p>\n
<\/p>\n
NUJNA STANJA V DERMATOLOGIJI<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Oku\u017ebe<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 bakterijske<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 virusne<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izpu\u0161\u010daji povzro\u010deni z zdravili<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Eritroderma<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nevtrofilne dermatoze<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bulozne dermatoze<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Urtikarija in angioedem<\/p>\n
Znaki, ki ka\u017eejo na nujno stanje:<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vro\u010dina in izpu\u0161\u010daj<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vro\u010dina in bule ali erozije<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izpu\u0161\u010daj pri imunosuprimiranem bolniku<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tipna (palpabilna) purpura<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Eritroderma – \u201crde\u010dica celega telesa\u201d<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Spremebe na sluznicah<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Slabo po\u010dutje<\/p>\n
<\/p>\n
Kateri so znaki, ki ka\u017eejo, da je izpu\u0161\u010daj lahko nujno stanje? (obkro\u017ei najbolj\u0161i odgovor)<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Vro\u010dina<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Tipna (palpabilna) purpura<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Eritroderma – \u201crde\u010dica celega telesa\u201d<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Erozije na sluznicah<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Slabo po\u010dutje<\/p>\n
f)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vse na\u0161teto<\/p>\n
<\/p>\n
Akutna urtikarija<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pogosto po akutnih virusnih oku\u017ebah<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Urtike, ki trajajo manj kot 24 ur, razli\u010dnih oblikah<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Z ali brez angioedema<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Traja nekaj dni ali teden<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antihistaminiki so ali niso u\u010dinkoviti<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 V glavnem, ni potrebe po zdravljenju<\/p>\n
Stafilokokni sindrom oparene ko\u017ee<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vzrok<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Razcep povrhnjice v granuloznem sloju zaradi delovanje toksina\u00a0 (ETA in ETB), najpogosteje zlatega stafilokoka<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dejavniki tveganja: novorojenci, otroci ali odrasli z ledvi\u010dno slabostjo<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dna slika:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Eritem okoli naravnih odprtin, na obrazu, vratu, v pazduhah in dimljah. Potem generalizacija znotraj\u00a0 48 urah<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ko\u017ea ob\u010dutljiva na dotik<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mlahave bule s pozitivnim znakom Nikolskega<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010cez 1-2 dni se povrhnjica v pregibih prelevi<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Popolna reepitelizacija v 2 tednih<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dni znaki:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vro\u010dina, slabo po\u010dutje, grlobol<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zapleti:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Smrtnost 3% pri otrocih, > 50% pri odraslih ter skoraj 100% pri odraslih s pridru\u017eeno boleznijo<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010ce se pojavi v porodni\u0161nici, zahteva izolacijo<\/p>\n
Zaslediti je treba morebitnega nosilca stafilokoka<\/p>\n
<\/p>\n
Za akutno urtikarijo je zna\u010dilno (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Najpogosteje jo povzro\u010dijo akutne virusne oku\u017ebe<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Zelo pogosto jo spremljajo bole\u010dine v sklepih<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Posamezne urtike trajajo v glavnem samo nekaj ur, a vedno kraj\u0161e od 24 ur<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Nikoli se ne pojavlja oteklina ustnic<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje v glavnem ni potrebno<\/p>\n
Stafilokokni sindrom oparene ko\u017ee je posledica:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Hemolizina zlatega stafilokoka<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Egzotoksina zlatega stafilokoka<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Protiteles proti zlatemu stafilokoku<\/p>\n
Stafilokokni sindrom oparene ko\u017ee prizadane najpogosteje (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Nose\u010dnice<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Novorojen\u010dke<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Adolescente<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Odrasle z ledvi\u010dno odpovedjo<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Odrasle z odpovedjo jeter<\/p>\n
<\/p>\n
Nekrotizirajo\u010di fasciitis:<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Etiologija:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nekroza podko\u017enega tkiva zaradi oku\u017ebe<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tip I: me\u0161ani anaerobi, gram-negativni aerobni bacili \u00a0in enterokoke<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tip II: streptokoke grupe A<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dejavniki tveganja: diabetes, bolezen perifernega o\u017eilja, imunosupresija<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermatolo\u0161ki pregled:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Difuzni edem in eritem prizadete ko\u017ee -> bule-> bordo barva -> gangrena<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hude bole\u010dine, anestezija, krepitacije, eksudat<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dna slika:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0160ok in odpoved organov<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Magnetna resonanca!<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kirur\u0161ki debridma ter agresivno antibioti\u010dno zdravljenje<\/p>\n
Meningokokcemija<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Etiologija<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neisseria meningitidis (gram-neg. diplokok) prena\u0161e se prek dihal<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pogosto pri majhnih otrocih in mladih<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dejavniki tveganja: asplenija, deficiencije imunoglobulinov ali kon\u010dnih komponent komplementa<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dna slika:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Naglo pojav makulopapul ali petehij\u00a0 na akralnih povr\u0161inah, trupu ali nogah -> \u0161irjenje purpure v nakaj urah<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nepravilni robovi sa kovinsko-sivkastim sredi\u0161\u010dem<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 +\/- spremembe na sluznicah<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dna slika:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vro\u010dina, drhtavica, mrzlica, slabost<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 DIK, \u0161ok, smrt<\/p>\n
<\/p>\n
Dejavniki tveganja za nekrotizirajo\u010di fasciitis so (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Diabetes<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 bolezen perifernega o\u017eilja<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 imunosupresija<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 vse na\u0161teto<\/p>\n
<\/p>\n
Pri nekrotizirajo\u010dem fasciitisu lahko najdemo (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Bule in gangreno<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Urtike in angioedem<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Hude bole\u010dine<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Srbenje<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 \u0160okno stanje z odpovedjo ve\u010d organov<\/p>\n
<\/p>\n
Za meningokokcemijo je to\u010dno (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Vrzo\u010dnik je Neisseria meningitidis<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Najpogosteje pri majhnih otrocih in mladih v kolektivih<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Dejavniki tveganja so asplenija, deficiencije imunoglobulinov ali kon\u010dnih komponent komplementa<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Karakteristi\u010dan je pojav makulopapul ali petehij na akralnih povr\u0161inah, trupu ali nogah<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Vedno najdemo znake meningitisa<\/p>\n
f)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vse na\u0161teto<\/p>\n
[wp_ad_camp_1]<\/p>\n
Eczema herpeticum<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Etiologija:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Herpes virus: HSV1 > HSV2<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dejavniki tveganja: bolezni, ki po\u0161kodujejo barierno funkcijo ko\u017ee (atopijski dermatitis)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermatolo\u0161ki pregled:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2-3 mm umbilicirane vezikule -> erozije -> hemoragi\u010dne kruste<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko tudi sistemska prizadetost<\/p>\n
<\/p>\n
Herpeti\u010dni ekcem je zna\u010dilen za (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Urtikarijo<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Atopijski dermatitis<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Alergijski kontaktni dermatitis<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Psoriazo<\/p>\n
<\/p>\n
Izpu\u0161\u010daji povzro\u010deni z zdravili<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dejavniki tveganja:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 HIV ali druga\u010dna imunosupresija<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Starej\u0161i (\u0161tevilna zdravila)<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Genetska nagnjenost<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prenehati z uporabo zdravila<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Podporna nega<\/p>\n
Stevens-Johnsonov sindrom (SJS) in toksi\u010dna nekroliza epiderma (TEN)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Patofiziologija:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Z zdravili povzro\u010dene reakcije na ko\u017ei in sluznicah<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Odgovorna zdravila: Sulfonamidi, antikonvulzanti, slopurinol, NSAIZ. Obi\u010dajno 1-3 tedne pred pojavom izpu\u0161\u010daja<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SJS in TEN sta isto obolenje<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SJS: BSA < 10%<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SJS\/TEN overlap: BSA 10-30%<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 TEN: BSA > 30%<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 +\/- Klini\u010dna slika_<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prodrom: vro\u010dina, drhtavica, slabost<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pe\u010denje v o\u010desih, te\u017eko po\u017eiranje in odvajanje vode<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermatolo\u0161ki pregled:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Oko\u017ea ob\u010dutljiva na dotik<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Temen eritem<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Razcepitev epiderma in deskvamacijation<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Prizadetost sluznic<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Enota za opekline, intenz. nega<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 oftalmolog, urolog<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 IVIG, ciklosporin<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sistemski kortokosteroidi (?)<\/p>\n
DRESS<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 DRESS: Drug Reaction with Eosinophilia and Systemic Symptoms<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sindrom preob\u010dutljivosti na antikonvulzante<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sindrom preob\u010dutljivosti povzro\u010den z zdravili<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sindrom preob\u010dutljivosti<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Z zdravili izzvan sindrom preob\u010dutljivosti v ve\u010d organih<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Patofiziologija:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Te\u017eave z detoksifikacijo zdravila<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izpostavljenost zdravilu pred za\u010detkom bolezni 2-6 tednov<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pogosti spro\u017eilci: aromati\u010dni antikonvulzanti, sulfonamidi, minociklin, alopurinol, antiretrovirusna zdravila, NSAIZ<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermatolo\u0161ki pregled:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 makulopapulozni (morbiliformni) in urtikarijski izpu\u0161\u010daj<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Redkeje: vezikule, bule, pustule, purpura, eritroderma , tar\u010di podobne<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Edem obraza (lahko ga zamenjamo za angioedem)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dna slika<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vro\u010dina, eozinofilija, limfadenopatija,<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Po\u0161kodba jeter (lahko je fulminantna), endokrinopatija, miokarditis , plju\u010dnica, nefritis…<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Sistemski kortikosteroidi s po\u010dasnim zni\u017eevanjem odmerka<\/p>\n
<\/p>\n
Stevens-Johnsonov sindrom (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Povzro\u010da v glavnem preob\u010dutljivost na zdravila<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Tipi\u010dne so eflorescence oblike tar\u010de<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Poleg sprememb na ko\u017ei najdemo erozije na sluznicah<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Vse na\u0161teto<\/p>\n
<\/p>\n
Toksi\u010dna nekroliza epiderma (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Lahko zajame > 30% telesne povr\u0161ine<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Ko\u017ea je ob\u010dutljiva na dotik<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Vzrok so v glavnem akutne virusne oku\u017ebe<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Razcepitev epiderma in deskvamacija<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje v enoti za opekline<\/p>\n
<\/p>\n
Reakcijo na zdravila s eozinofilijo in s sistemskimi simptomi najpogosteje izzivaju (obkro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 aromati\u010dni antikonvulzanti<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 kontrastna sredstva<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 alopurinol<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 nesteroidna protivnetna zdravila<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 penicilin<\/p>\n
<\/p>\n
Reakcijo na zdravila s eozinofilijo in s sistemskimi simptomi zdravimo z:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Antibiotiki<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Sistemskimi kortikosteroidi<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Plazmaferezo<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Obsevanjem<\/p>\n
<\/p>\n
ANGIOEDEM<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Patofiziologija<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pove\u010dana prepustnost postkapilarnih venul<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermatolo\u0161ki pregled:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ostro omejen akutni edem ko\u017ee in podko\u017eja zaradi pove\u010dane prepustnosti \u017eil<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Obraz, ustne, ekstremiteti, genitalije<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bole\u010d, obi\u010dajno BREZ srbenja<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dna slika<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bol v trebuhu<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dispneja<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Etiologija:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pogosto idiopatski<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravila:<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zaviralci ACE pri 10-25% bolnikov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Penicilin<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 NSAIZ<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Alergeni (hrana, kontrastni mediji)<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Fizikalni agensi (hlad, vibracije, itd)<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Primanjkljaj inhibitorja C1 esteraze : dedni vs pridobljeni (avtoimunske bolezni ali mailgni tumorji)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vzdr\u017eevanje dihalne poti<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antihistaminiki<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mrzle obloge<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izogibanje spro\u017eilcem<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Za bolnike z deficitom inhibitorja C1 esteraze :<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Akutna vs kratkotrajna vs dolgotrajna profilaksa: androgeni (danazol in stanozolol),\u00a0 koncentrat inhibitorja C1 esteraze, rekombinantni humani C1 inhibitor (Ruconest), antifibrinolitiki, ikatibant (selektivni antagonist\u00a0 B2 receptorja za bradikinin)<\/p>\n
<\/p>\n
<\/p>\n
Angioedem pogosto spro\u017eijo katera zdravila? (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Paracetamol<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Zaviralci encima angiotenzin konvertaze<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Adrenalin<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Doksiciklin<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Oralni kontraceptivi<\/p>\n
<\/p>\n
ERITRODERMA<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermatolo\u0161ki pregled<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Eritem, ki zajame 90% povr\u0161ine telesa<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Srbenje<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Klini\u010dna slika<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vro\u010dina, mrzlica, slabost<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pretirana vazodilatacija -> izguba proteinov in elektrolitov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 hipotenzija, neravnovesje elektrolitov, kongestivno sr\u010dno popu\u0161\u010danje<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Etiologija:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 50% zaradi \u017ee obstoje\u010de dermatoze<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Seboroi\u010dni dermatitis, kontaktni dermatitis, limfom, leukemija, atopijski dermatitis, psorijaza, PRP, idiopatski, zdravila (posebej pri HIV+ bol)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nadomestilo teko\u010din in elektrolitov<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Iskanje osnovne bolezni -> zdravljenje osnovne dermatoze (topijski kortikosteroidi…)<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antibiotiki ob znakih oku\u017ebe<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Smrtnost je 18%<\/p>\n
<\/p>\n
Generalizovana rde\u010dica ko\u017ee (eritroderma) pogosto je posledica poslab\u0161anja katerih bolezni ko\u017ee? (obkro\u017ei vse pravilne odgovore)<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Psoriaza<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Lihen planus<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Atopijski dermatitis<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Seboroi\u010dni dermatitis<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Androgenetska alopecija<\/p>\n
<\/p>\n
KALCIFILAKSA<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Etiologija: kroni\u010dno ledvi\u010dno popu\u0161\u010danje (5% bolnikov na dializi), idiopatski<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Patofiziologija: ishemijska vaskulopatija in kalcifikacija arteriol s trombozo<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Dermatolo\u0161ki pregled:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izjemno bole\u010di nodusi in plo\u0161\u010de<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Livedo reticularis in livedo racemosa<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ulceracije in nekroti\u010dne eshare<\/p>\n
Spro\u017eilci in dejavniki tveganja:<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Debelost<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Naglo huj\u0161anje in podhranjenost<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Infuzija zdravil kot je \u017eelezo dekstran<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Uporaba imunosupresivov, posebej kortikosteroidov<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bolezen jeter<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sladkorna bolezen, injekcije insulina<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 U\u017eivanje vitamina D ter calcium-based phosphate binders<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u017dilne bolezni<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 U\u017eivanje warfarina: zni\u017ean protein C spro\u017ei trombozo v kalcificirani \u017eili ter zni\u017ean matriksni Gla protein (pomemben zaviralec kalcifikacije)<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Smrtnost: 45-80%<\/p>\n
\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravljenje:<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kalcimimetiki (zna\u017eajo PTH)<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zni\u017eati Ca in PO4 v serumu<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bifosfonati<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na-tiosulfat i.v.<\/p>\n
\u2013\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Antibiotiki, antikoagulanti…<\/p>\n
<\/p>\n
Kalcifilaksa je urgetno stanje, ki je posledica hude ishemije zaradi kalcifikacije in tromboze arteriol. Pomembni dejavniki tveganja in\/ali spro\u017eilci tega stanja so (obkro\u017ei najbolj\u0161i odgovor):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Debelost<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Kroni\u010dna ledvi\u010dna odpoved<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Bolezen jeter<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Sladkorna bolezen, injekcije insulina<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Vse na\u0161teto<\/p>\n
<\/p>\n
Primarne eflorescence so vse razen:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Makula<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Papula<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Krusta<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Nodus<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Pustula<\/p>\n
<\/p>\n
Sekundarne eflorescence so vse razen:<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Brazgotina<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Vezikula<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Fisura<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Atrofija<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Skvama<\/p>\n
<\/p>\n
Mikroskopski pregled ku\u017enine odvzete s povr\u0161ine ko\u017ee z dlake ali nohta pogosto uporabljamo za diagnosticiranje (obro\u017ei vse pravilne odgovore):<\/p>\n
a)\u00a0\u00a0\u00a0\u00a0\u00a0 Psorijaze<\/p>\n
b)\u00a0\u00a0\u00a0\u00a0\u00a0 Gljivi\u010dnih oku\u017eb<\/p>\n
c)\u00a0\u00a0\u00a0\u00a0\u00a0 Atopijskega dermatitisa<\/p>\n
d)\u00a0\u00a0\u00a0\u00a0\u00a0 Virusnih oku\u017eb dlake<\/p>\n
e)\u00a0\u00a0\u00a0\u00a0\u00a0 Garij<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
U\u010dinkovitost kateregakoli topijskega zdravila je odvisna od: \u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravilne u\u010dinkovine (njene mo\u010di) \u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mesta nanosa \u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nosilca (na\u010din na keteri sestavine vnesemo v ko\u017eo) \u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Koncentracije zdravilne u\u010dinkovine U\u010dinkovitost topijskega zdravila je odvisna od vsega, razen od (obkro\u017ei en odgovor): a)\u00a0\u00a0\u00a0\u00a0\u00a0 Zdravilne u\u010dinkovine b)\u00a0\u00a0\u00a0\u00a0\u00a0 Nosilca c)\u00a0\u00a0\u00a0\u00a0\u00a0 \u010casa nanosa zdravila d)\u00a0\u00a0\u00a0\u00a0\u00a0 Mesta nanosa zdravila Najpogosteje uporabljani … Preberi ve\u010d o Primer izpita za farmakologijo 2015<\/span><\/a><\/p>\n","protected":false},"author":336,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[705],"tags":[706,3768,3769],"class_list":["post-4584","post","type-post","status-publish","format-standard","hentry","category-2letnik-farmakologija","tag-farmakologija","tag-izpit-za-farmakologijo","tag-primer-izpita-za-farmakologijo"],"_links":{"self":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/4584","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/users\/336"}],"replies":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/comments?post=4584"}],"version-history":[{"count":0,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/4584\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/media?parent=4584"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/categories?post=4584"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/tags?post=4584"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}