72. Common Skin Conditions Flashcards
Zoe is a fifteen year old girl who was hiking in the woods near her home in California. She picked up a rash that is itchy and spreading. The pharmacist suspects the rash is from contact with poison oak. The pharmacist should offer the following advice to Zoe: (Select ALL that apply.)
A. You can use a product such as Aveeno or Caladryl that may provide relief. Cold compresses may help.
B. The skin should be washed with soap and water-it is best to try and remove the toxin.
C. If the rash worsens you can ask your physician for stronger medicine, such as an oral steroid.
D. Avoid baths until the rash is healed.
E. Remove the oil from the skin using 70% propyl alcohol.
A, B, C. Do not touch the rash and then touch your face-especially around your eyes. Ivy Block (bentoquatam) or other barrier blocks may have been helpful if applied prior to the hike. Clothing should cover legs that may come into contact with poison ivy (east coast), sumac or oak.
Counseling instructions for the use of a topical antifungal for athlete’s foot (tinea pedis) should include all of the following except:
A. Apply the medicine directly on the rash; you do not need to extend the application beyond the visible rash.
B. Use for at least 2-4 weeks, even if the rash appears to be healed.
C. Do not walk barefoot to avoid spreading it.
D. Wear sandals in public showers to avoid catching it.
E. All of the above are correct statements.
A. Apply the medicine 1-2 inches beyond the rash.
Which of the following statements concerning athlete’s foot are correct? (Select ALL that apply.)
A. It is also called tinea cruris.
B. It is usually treatable with topical OTC agents.
C. Symptoms include itching, peeling and redness.
D. Pharmacists should not recommend OTC treatment without first obtaining a potassium hydroxide smear.
E. Patients should be careful to wear sandals or other foot coverings in public showers and locker rooms in order to avoid infection (and avoid spreading it).
B, C, E. Athlete’s foot is tinea pedis. Jock itch is tinea cruris. Skin fungal infections (unlike nailbed fungal infections) are primarily treated by symptoms, unless the patient has a condition such as an immune-compromised state.
If systemic ketoconazole is used to treat onychomycosis, which of the following medications must be stopped during the ketoconazole therapy?
A. Amlodipine
B. Carvedilol
C. Rabeprazole
D. Multivitamin/mineral supplement
E. Digoxin
C. Ketoconazole and itraconazole are used for onychomycosis. These agents require an acidic medium for adequate absorption. No acid-suppressive agents of any type concurrently.
Which of the following agents is used for alopecia?
A. Avodart
B. Valproic Acid
C. Tegretol
D. Minoxidil
E. Proscar
D. Do not mix up finasteride products (Propecia for alopecia and Proscar for BPH). They are the same drug, but with different doses and indications. They are not used concurrently. Minoxidil topical can be used for both men and women for hair loss, but must be used indefinitely for continued efficacy.
Which of the following prescription agents may be prescribed to a teenager with acne?
A. Solodyn
B. Ketoconazole
C. Lamisil AT
D. Nizoral
E. Clearasil
A. Ketoconazole is an OTC shampoo used for dandruff (usually if less expensive options have failed). Lamisil AT contains terbenafine, and is for topical fungal infections. Minocycline (Solodyn) is a popular agent for acne. If used long-term it can discolor teeth. Use caution in the sun. Check case for tetracycline allergy.
Which of the following steroid topical formulations are available over-the-counter? (Select ALL that apply.)
A. Hydrocortisone 2.5%
B. Hydrocortisone 0.5%
C. Hydrocortisone 1%
D. Betamethasone 0.25%
E. Betamethasone 0.5%
B, C. OTC steroids are low potency: hydrocortisone 0.5% (infants, sensitive skin, groin area) and 1% for mild conditions. Hydrocortisone 2.5% is Rx.
A patient asks the pharmacist to recommend a sunscreen that is “broad spectrum”. What is the correct meaning of the term “broad spectrum” when used for a sunscreen? (Select ALL that apply.)
A. It provides and SPF of at least 30.
B. It provides and SPF of at least 60.
C. It protects against UVA, which causes aging.
D. It protects against UVB, which causes burning.
E. It provides and SPF of at least 15.
C, D. Sunscreen products are allowed to be labeled “broad spectrum” if they provide protection against both UVA and UVB rays.
Choose the correct statement concerning Nizoral A-D:
A. It is first-line treatment for OTC dandruff treatment.
B. Shampoo daily.
C. It contains itraconazole.
D. Rub shampoo in well and leave in for 5 minutes, then rinse out, use twice weekly
E. Is less expensive than most OTC dandruff shampoos.
D.
Counseling for a parent treating lice in a child should include all of the following except:
A. Soak combs and brushes in hot water for 10 minutes.
B. Wash clothes and bedding in hot water, followed by a hot dryer.
C. Vacuum the carpet well.
D. In addition to the OTC treatment, remove the live lice and nits by inspecting the hair in 1-inch segments and using a lice comb.
E. Check all family members and treat anyone with an infestation except those over the age of 70 years old.
E.
A 29 year-old male patient uses the local gym daily. He was not careful to use sandals in the shower and his feet are itchy, particularly between the toes. Choose appropriate OTC medications that will eradicate the infection and are recommended for this purpose: (Select ALL that apply.)
A. Lamisil AT
B. Hydrocortisone 1% cream
C. Diphenhydramine oral tablet
D. Clotrimazole 7-day treatment
E. Lotrimin AF
A, E. Lotrimin AF contains clotrimazole, and Lotrimin Ultra contains butenafine–if the name has Lotrimin, it is an antifungal for somewhere on the skin, and these come in creams and sprays.
Which OTC acne product is considered the first-line recommendation due to higher efficacy for acne than the others?
A. Salicylic acid
B. Benzoyl peroxide
C. Sulfur
D. Resorcinol
E. Lactic acid
B. Benzoyl peroxide is useful in a cream or as “spot” treatments. If OTC products are not sufficient, the usual next step is a topical retinoid.
A patient approaches the pharmacy counter to ask if she should purchase a steroid cream, ointment or lotion. She wants to treat an itchy rash on her palm. She reports that she sometimes gets topical reactions to things that she touches, which appear similar to the current reaction and it generally dissipates on its own. The skin appears thick and calloused. Which formulation would be most appropriate?
A. An ointment
B. A cream
C. A lotion
D. To treat the palm, she needs a systemic product.
E. She should be referred to the physician.
A. Ointments are used for thick or dry skin and provide the best moisture barrier. Creams are generally less potent than ointments. Lotions, gels and foams are best for hairy skin.
A father is picking up a prescription of Elidel for his child. Counseling statements should include the following: (Select ALLthat apply.)
A. Use the smallest amount needed to control symptoms. Continue as long as signs and symptoms persist; discontinue if resolution occurs.
B. Wash your hands after application. Keep the skin well hydrated by using a good moisturizer.
C. This medication cannot be used in children who are not at least 36 months of age; use is contraindicated in infants.
D. Limit sun and ultraviolet ray exposure if using this medication.
E. This drug may add to your child’s chance of getting lymphoma or other cancers.
A, B, D, E. This medication cannot be used in children who are not at least two years of age (boxed warning).
Occasionally antifungal agents such as ketoconazole are given as intermittent “pulse” therapy when being used long-term. What is the purpose of pulse therapy?
A. Less side effects and less costly
B. Easier to remember to take the doses as prescribed.
C. Increased hair growth.
D. Higher risk of liver damage than with daily administration.
E. It kills the organism more efficiently.
A. Generally, the efficacy is similar.
What are the ingredients in the OTC “Triple Antibiotic” products?
A. Polymyxin, bacitracin, amikacin
B. Polymyxin, bacitracin, neomycin
C. Polymyxin, bacitracin, gentamicin
D. Polymyxin, bacitracin, colistin
E. Polymyxin, bacitracin, mupirocin
B. The triple antibiotic ointment (Neosporin, store brands) contains polymyxin, bacitracin and neomycin. It is used to prevent infections from minor cuts, scrapes or burns. Bacitracin comes as a stand-alone OTC product that is used for the same purpose.
Which medications cannot be used if a patient is taking oral isotretinoin? (Select ALL that apply.)
A. Vitamin D supplements
B. Vitamin A supplements
C. Tetracyclines
D. Steroids
E. St John’s wort
B, C, D, E.
Which of the following brand-generic matches are correct? (Select ALL that apply.)
A. Terbinafine-Lamisil AT
B. Butenafine-Lotrimin Ultra
C. Tolnaftate-Tinactin
D. Clotrimazole-Lotrimin
E. Undecylenic acid-Desenex
A, B, C, D, E. The same brand name can mean different active ingredients; be careful when making recommendations that the patient gets the product intended.
A father will apply Neosporin on a scrape on the outer surface of his ten-year old son’s hand. He asks if he should cover it with a Band-Aid. How should the pharmacist respond?
A. Yes, use a bandage during the day since his hand is likely to get dirty.
B. No, bandages are not recommended for light scrapes.
C. No, we only use bandages currently for burn wounds.
D. No, bandages will delay healing of the scrape.
E. Your son should get a tetanus shot if it has been over 15 years from his last tetanus vaccination.
A. Make sure the tetanus vaccine is current (every 10 years for adults). If the wound is large, dirty or infected, refer out. Tetanus may need to be re-administered if more than 5 years since last booster and the wound is alarming. Bandage if the wound is likely to get dirty.
