23: Drugs affecting the integumentary system

Question 1

1. Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive-treatment. Which medication would be the best choice for treatment?
2. Mupirocin (Bactroban)
3. Bacitracin and polymixin B (generic double antibiotic ointment)
4. Retapamulin (Altabax)
5. Oral cephalexin (Keflex)

Answer 1

2. Bacitracin and polymixin B (generic double antibiotic ointment)

Question 2

2. Juakeem is a nasal methicillin resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes:
3. Take the oral medication exactly as prescribed.
4. Insert one-half of the dose in each nostril twice a day.
5. Alternate treating one nare in the morning and the other in the evening.
6. Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients.

Answer 2

2. Insert one-half of the dose in each nostril twice a day.

Question 3

3. Instructions for applying a topical antibiotic or antiviral ointment include:
4. Apply thickly to the infected area, spreading the medication well past the borders of the infection.
5. If the rash worsens, apply a thicker layer of medication to settle down the infection.
6. Wash hands before and after application of topical antimicrobials.
7. None of the above

Answer 3

3. Wash hands before and after application of topical antimicrobials

Question 4

4. When Sam used clotrimazole (Lotrimin AF) for athlete’s foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete’s foot again. What would be a good choice of antifungal for Sam?
5. Miconazole (Micatin) powder
6. Ketoconazole (Nizoral) cream
7. Terbinafine (Lamisil) cream
8. Griseofulvin (Grifulvin V) suspension

Answer 4

3. Terbinafine (Lamisil) cream

Question 5

5. When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to:
6. Mix the griseofulvin with ice cream before administering
7. Take the griseofulvin until the tinea clears, in approximately 4 to 5 weeks
8. Shampoo with baby shampoo daily while taking the griseofulvin
9. Griseofulvin is best absorbed if ingested with a high-fat food.

Answer 5

4. Griseofulvin is best absorbed if ingested with a high-fat food.

Question 6

6. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:
7. OTC topical azole (clotrimazole, miconazole)
8. Oral terbinafine
9. Oral griseofulvin microsize
10. Nystatin cream or ointment

Answer 6

1. OTC topical azole (clotrimazole, miconazole)

Question 7

7. When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include:
8. Spread penciclovir liberally all over lips and area surrounding lips.
9. Penciclovir therapy is started at the first sign of a cold sore outbreak.
10. Skin irritation is normal with penciclovir and it should resolve.
11. The penciclovir should be used a minimum of 2 weeks to prevent recurrence.

Answer 7

2. Penciclovir therapy is started at the first sign of a cold sore outbreak.

Question 8

8. Erika has been prescribed isotretinoin (Accutane) by her dermatologist and is presenting to her primary care provider with symptoms of sadness and depression. A Beck’s Depression Scale indicates she has mild to moderate depression. What would be the best care for her at this point?
9. Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant
10. Refer her to a mental health therapist
11. Contact her dermatologist about discontinuing the isotretinoin
12. Reassure her that mood swings are normal and schedule follow up in a week

Answer 8

3. Contact her dermatologist about discontinuing the isotretinoin

Question 9

9. Drew is a 17-year-old competitive runner who presents with complaint of pain in his hip that occurred after he fell while running. His only medical problem is severe acne for which he takes isotretinoin (Accutane). With this history what would you be concerned for?
10. He may have pulled a muscle and needs to rest to recover.
11. He is at risk for bone injuries and needs to be evaluated for fracture.
12. Isotretinoin interacts with ibuprofen which is the pain medication of choice.
13. Teen athletes are at risk for repetitive stress injuries.

Answer 9

2. He is at risk for bone injuries and needs to be evaluated for fracture.

Question 10

10. Catherine calls the clinic with concerns that her acne is worse 1 week after starting topical tretinoin. What would be the appropriate care for her?
11. Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin.
12. Switch her to an oral antibiotic to treat her acne.
13. Advise her to apply an oil-based lotion to her face to soothe the redness.
14. Reassure her that the worsening of acne is normal and it should improve with continued use.

Answer 10

4. Reassure her that the worsening of acne is normal and it should improve with continued use.

Question 11

11. Li is a 6-month-old infant with severe eczema. She would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include:
12. Apply liberally to all areas with eczema.
13. Double the frequency of application when the eczema is severe.
14. Apply sparingly to eczema areas.
15. Cover the eczema area with an occlusive dressing after applying a corticosteroid.

Answer 11

3. Apply sparingly to eczema areas.

Question 12

12. Jose has had eczema for many years and reports that he thinks his corticosteroid cream is not working as well as it was previously. He may be experiencing tolerance to the corticosteroid. Treatment options include:
13. Increase the potency of the corticosteroid cream.
14. Recommend an interrupted or cyclic schedule of application.
15. Increase the frequency of dosing of the corticosteroid.
16. Discontinue the corticosteroid because it isn’t working any longer .

Answer 12

2. Recommend an interrupted or cyclic schedule of application.

Question 13

13. When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that:
14. Tacrolimus is the most effective if it is used continuously for 4 to 6 months.
15. Tacrolimus should be spread generously over the affected area.
16. The FDA has issued a Black Box warning about the use of tacrolimus and the development of cancer in animals and humans.
17. The FDA recommends patients be screened for cancer before prescribing tacrolimus.

Answer 13

3. The FDA has issued a Black Box warning about the use of tacrolimus and the development of cancer in animals and humans

Question 14

14. Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:
15. High vitamin D levels
16. Hyperkalemia
17. Hypercalcemia
18. Hyperuricemia

Answer 14

3. Hypercalcemia

Question 15

15. Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes instructing them:
16. That tazarotene is applied in a thin film to the psoriasis plaque lesions
17. To apply it liberally to all psoriatic lesions
18. To apply tazarotene to nonaffected areas to prevent breakout
19. That tazarotene may cause hypercalcemia if it is overused

Answer 15

1. That tazarotene is applied in a thin film to the psoriasis plaque lesions

Question 16

16. Instructions for the use of selenium sulfide shampoo (Selsun) to treat scalp seborrhea include:
17. Shampoo daily and rinse well.
18. Worsening of seborrhea for the first week is normal.
19. Seborrhea usually clears up after a few weeks of treatment.
20. Shampoo twice a week for 2 weeks, then weekly.

Answer 16

4. Shampoo twice a week for 2 weeks, then weekly.

Question 17

17. Topical diphenhydramine (Benadryl) is available OTC to treat itching. Patients or parents should be instructed regarding the use of topical diphenhydramine that:
18. For maximum effectiveness in treating itching, combine topical with oral diphenhydramine.
19. Topical diphenhydramine is the treatment of choice in treating poison ivy or poison oak.
20. Topical diphenhydramine should not be used in children younger than age 2 years.
21. When applying topical diphenhydramine, apply the cream liberally to all areas that itch.

Answer 17

3. Topical diphenhydramine should not be used in children younger than age 2 years.

Question 18

18. A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his leg. Normal adverse effects of silver sulfadiazine cream include:
19. Transient leukopenia on days 2 to 4 that should resolve
20. Worsening of burn symptoms briefly before resolution
21. A red, scaly rash that will resolve with continued use
22. Hypercalcemia

Answer 18

1. Transient leukopenia on days 2 to 4 that should resolve

Question 19

19. Instructions for the use of malathion (Ovide) for head lice include:
20. Use a blow dryer to dry the hair after applying.
21. Malathion (Ovide) is used daily for a week until all lice are dead.
22. Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours.
23. Use gloves to apply the malathion (Ovide).

Answer 19

3. Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours.

Question 20

20. When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include:
21. All members of the household and personal contacts should also be treated.
22. Infants should have permethrin applied from the neck down.
23. The permethrin is washed off after 10 to 20 minutes.
24. Permethrin is flammable and to avoid open flame while the medication is applied.

Answer 20

1. All members of the household and personal contacts should also be treated.