Derm Pharmaco/management

Question 1

1st choice antibiotic for treatment of cellulitis. PO and IV. Full prescription.
(Simple cellulitis, likely infected with Strep or Staph. Aureus.

Answer 1

Cefadroxil 500-1000 mg PO BID x 5 to 10 days.

Cefazolin 1000-2000 mg IV TID x 5 to 10 days

Question 2

1- 1st choice Antibiotic for cellulitis from Animal bite.
(Same as 1st choice Tx Antibiotic for cellulitis of Sinusal or simple periorbital origin.)

2- This is also the 2nd choice for what other type of cellulitis?

Answer 2

1- Amoxicillin/Clavulanate 875/125 mg PO BID for 7 to 10 days.

2- Cellulitis of dental origin

Question 3

1st choice anitibiotic for cellulitis of dental origin?

Answer 3

Amoxicillin 500 mg PO TID for 5 to 10 days.

Question 4

1st choice antibiotic for Cellulitis with suspicion of MRSA?

Answer 4

Doxycycline 100 mg PO BID x 5 to 10 days.

Question 5

Treatment for
1- isolated
2- Diffuse Actinic Keratosis

Answer 5

1- 2 cycles of liquid nitrogen.
2- Topical fluorouracil (antineoplastic agent)(Efudex cream) BID 5/7 x 2 to 4 weeks,

Question 6

Pharmacological approach for Atopic dermatitis for.
1- Body
2- Face

Answer 6

1- Moderate to strong cordiocosteroid BID x4-6 weeks
2- low potency corticosteroid on face BID x2-4 weeks.

Question 7

Which class of corticosteroid will you use for more sensitive areas, including face?

Answer 7

Class 7 (least potent) and 6 (low potentcy).

Question 8

What classes are considered moderate strength corticosteroids (numbers)?

Answer 8

4 (medium potency) and 5 (lower-mid potency)

Question 9

Which classes are considered high potencycorticosteroids?

Answer 9

2 and 3

Question 10

Which class is considered super-high potentcy? (Corticosteroids)

Answer 10

1

Question 11

Which classes do you use in children for:
1- at risk zones (name the areas)
2- Rest of body/no risk zones

Answer 11

1- Low potentcy Class 6. (Face, neck, under the diaper, folds)
2- class 4 (medium potency) or 5. (Lower-mid potency)

Question 12

After how many weeks of topical corticosteroid use to you start to worry about side effects?

Answer 12

4 to 6 weeks.

Question 13

Name side effects of topical corticosteroids (8)

Answer 13

1-Atrophy
2- stretch marks
3- acne
4- periorifice dermatitis
5- Exacerbation of cutaneous fungus infections
6- Delays in healing
7- contact allergic dermatitis
8- Glaucoma / cataracts

Question 14

After initiation of treatmetn for Actinic keratosis, when do you reassess?
What do you do if the lesion
1- is gone
2- persists

Answer 14

In 4 months.
1- FU q 2years.
2- Derm consult.

Question 15

Psoriasis:
1- Tx for nails, palmoplantar and body
2- Tx for Face and folds
3- Tx for hair/scalp

Answer 15

1- Class 2 and 3 (High potency). Dovobet Gel (Nails HS, Palmoplantar HS, Body DIE)
2- Desonide cream dIE (Class 6 Low potency)
3- Shampoo containing salicyc acid 3x/week OR Dovobet gel (class 2 and 3, high potency) 3x week HS.

Question 16

How long after psoriasis tx do you FU with patient?

Answer 16

6 months after tx start.

Question 17

Atopic dermatitis treatment for adults.
1- Pharmacology Body
2- Pharmacolgy Face
3- Non pharmacology
4- 2 options for pruritis
5- add on if no response

Answer 17

1- Medium to high potency corticosteroid BID x 4-8 weeks
2- Low potency corticosteroid BID x 2-4 weeks
3- Emollient BID regularly
4- 1st (drowsiness) or 2nd (non drowsy) generation antihistamine
5- Topical calcineurin inhibitor. 2-3x per week to daily.

Question 18

Atopic dermatitis in children
1- Pharamcology body
2- Pharmacology face
3- non pharmaceutical
4- for pruritis
5- Severe cases or recurrence

Answer 18

1- Class 4-5 corticosteroid (medium to lower-mid potency) BID x 4-8 weeks
2- Class 6-7 (Low potency to least potent) BID x 2-4 weeks
3- Emollient BID regularly
4- 1st generation antihistamine TID according to weight.
5- Topical Calcineurin ihibitor 2-3x/week to daily

Question 19

Contra indications to Topical calcineurin inhibitor (2)

Answer 19

1- Pregnant
2- Breastfeeding

Question 20

Atopic dermatitis infection treatment:
1- mild
2- severe (adults and children)

Answer 20

1- Topical antibiotic ointment.
2- cefadroxil 500-1000 mg PO BID x 5 to 10 days for adults.
OR cefadroxil 30mg/kg/day PO divided BID.

Question 21

Counseling for atopic dermatitis (6)

Answer 21

1- Hydrate skin +++
2- Use fragrance free soap and detergent.
3- Short showers
4- Avoir extreme temperatures
5- ER if fever.
6- Do not use corticosteroids longer than indicated.

Question 22

Ddx for atopic dermatitis (6)

Answer 22

1- Seborrheic dermatitis
2- Rosacea
3- Psoriasis
4- Lupus
5- Uritcaria
6- Contact dermatitis

Question 23

Signs of infection atopic dermatitis (2)

Answer 23

1- Fever, chills
2- Yellow crusts

Question 24

Important history taking for acne. (7)

Answer 24

1- Age of onset
2- Use of medication
3- Family history
4- Psychologic impact (suicidal ideation or depressive symptoms)
5- What has been tried so far?
6- link with menstrual cycle? Hyperandrogenism signs
7- Sudden onset?

Question 25

Important history taking for acne. (7)

Answer 25

1- Age of onset
2- Use of medication
3- Family history
4- Psychologic impact (suicidal ideation or depressive symptoms)
5- What has been tried so far?
6- link with menstrual cycle? Hyperandrogenism signs
7- Sudden onset?

Question 26

Treatment for Comedones

Answer 26

Topical retinoid HS and reevaluate in 2-3 months.

Question 27

If tx for comedones 1- (name tx for comedones) is ineffective. 2- What do you do?
OR
Tx for mild inflammatory papules and pustules (1 and 2)
3- When to reevaluate?

Answer 27

1- Topical retinoid was ineffective
2- add benzyol peroxyde HS
3- 2 to 3 months

Question 28

Two options for moderate inflammatory papules and pustules.
1- with nodules
2- without nodules

Answer 28

1- Topical retinoid + benzoyl peroxide + Topical antibiotic
2- Topical retinoird + Benzoyl peroxide + oral antibiotic

Question 29

Whats the oral antibiotic for acne

Answer 29

Doxycyclin 100mg PO DIE or BID x 3-6 months.

Question 30

If a female with acne, when do you add oral contraception?
.

Answer 30

After 6 months of Topical tx, before trying oral antibiotic

Question 31

Systemic retinoid (oral isotretinoin) contra-indications. (7)

Answer 31

1- less than 12 years old
2- Breasfeeding
3- Pregnancy
4- Renal/hepatic insufficiency
5- uncontrolled dyslipidemia
6- uncontrolled depression
7- inflammatory bowel
8-more….

Question 32

Systemic retinoid blood work to start. (5)

Answer 32

Creat, ALT, HbA1C, lipids, Beta-Hcg

Question 33

Woman taking systemic retinoid MUST be on:

Answer 33

Contraceptives

Question 34

Counselling for patient or systemic retinoid. (4)

Answer 34

1- Emollient on lips and hand
2- No anitibiotics
3- No aesthetic treatment
4- Sun protection ++++