ch 79

Question 1

superficial mycoses fungal pathogens

Answer 1

Candida species

dermatophytes (epidermophyton, trichophyton, microsporum)

Question 2

ringworm (dermatophytic infections)

Answer 2

Tinea pedis
tinea corporis
tinea cruris
tinea capitis

Question 3

most common dermatophytic

Answer 3

tinea pedis

Question 4

pt ed for tinea pedis

Answer 4

wear absorbent cotton socks
change shoes often
dry feet after bathing

Question 5

tinea corporis treat

Answer 5

topical azole or allylamine

continue for 1 week after symptoms clear

severe may need systemic - griseofulvin

Question 6

tinea cruris

Answer 6

treat continue for 1 week after dcleared,

severe wil need systemic – clotrimazole

Question 7

tinea capitis

Answer 7

difficult to treat
topical not likely to work
oral griseofulvin for 6-8 weeks
oral terbinafine 2-4 weeks may be more effective

Question 8

vulvovaginal candidiasis is caused by

Answer 8

candida albicans most of the time

Candida glabrata can also (esp in pt with HIV/AIDS)

Question 9

factors that predispose to candida are

Answer 9

pregnancy
obesity
diabetes
debilitation
HIV infection
use of certain drugs such as 
oral contraceptives
systemic glucocorticoids
anticancer agents
immunosuppressants
systemic abx

Question 10

oral candidiasis

Answer 10

thrush

nystatin
clotrimazole
miconazole
all topical

in immunocompromised host
fluconazole
ketoconazole are usually needed

Question 11

difficult to eradicate and requires prolonged treatment

can by from dermatophytes or candida

Answer 11

Onychomycosis

Question 12

oral for onychomycosis

Answer 12

terbinafine (lamisil)
itraconazole (sporanox)

work against both dermatophytes and candida
treat for 3-6 months
cure rate is 50%

Question 13

side effects for terbinafine and itraconazole

Answer 13

headaches
gi -n/v/abd pain
skin reactions - rash, itching

Question 14

topical therapy for onychomycosis

Answer 14

ciclopirox (penlac nail lacquer)

Question 15

ciclopirox (penlac nail lacquer)
topical
is only active against what

Answer 15

Trichophyton rubrum

applied once a day to nails and immediately adjacent skin

new coats are applied over old ones

once a week remove coats with alcohol

Question 16

treats onychomycosis from dermatophytes T. Rubrum and Trichophyton mentagrophytes.

Answer 16

Tavaborole (Kerydin)

apply to entire nail surface and under the tip of affected toenails once daily for 48 weeks

Question 17

azole for onychomycosis

Answer 17

Efinaconazole
cover the entire nail, including the folds, bed and undersurface of the toenail plate.
daily for 48 weeks

Question 18

what should you not give st johns wort with and why

Answer 18

SSRI
SNRI
MAOI
TCAs (amitriptyline, clomipramine)

serotonin syndrome

Question 19

St Johns is a CYP _____

what drugs does this effect

Answer 19

inducer
increases metabolism of those drug
digoxin
warfarin

Question 20

what SERM given for prevention and treatment of osteoporosis protects against estrogen receptor positive breast cancer

Answer 20

Raloxifene (Evista)

Question 21

Black box for Raloxifene (Evista)

Answer 21

increased r/o DVT and PE

Question 22

someone with mild acne
tried salicylic acid
whats next?

Answer 22

Topical retinoid (Retin-A)
Benzoyl peroxide (topical antibiotic and keratolytic)

Question 23

mild fungal ear infection

Answer 23

acetic acid drops

Question 24

prescribe someone tinolol

monitoring eye drops

Answer 24

bradycardia
hypotension
bronchospasm

Question 25

DMARD with antimalarial actions RA

Answer 25

Hydroxychloroquine (Plaquenil)

Question 26

pt ed with Hydroxychloroquine (Plaquenil)

Answer 26

eye dr every 6 mos to check for retinal damage need a thorough eye exam prior to starting treatment d/c first sign of retinal injury also needs an EKG -Prolong QT

Question 27

when taking Hydroxychloroquine (Plaquenil) what can you do for the GI distress

Answer 27

take with food or milk

Question 28

how is Hydroxychloroquine (Plaquenil) metabolized

Answer 28

primarily by liver

Question 29

mixing insulins

Answer 29

NPH and regular can be mixed NPH can be mixed with short acting - regular, lispro, aspart, glulisine) draw up short acting first

Question 30

what insulin can you give without regard to meals

Answer 30

intermediate and long acting such as NPH - intermediate glargine (Lantus) - long acting

Question 31

type of insulin - rapid, short, intermediate, long, ultralong lispro (humalog)

Answer 31

rapid -

Question 32

type of insulin - rapid, short, intermediate, long, ultralong insulin aspart (novoLog)

Answer 32

rapid

Question 33

type of insulin - rapid, short, intermediate, long, ultralong insulin glulisine (apidra)

Answer 33

rapid

Question 34

type of insulin - rapid, short, intermediate, long, ultralong Humulin R, Novolin R (regular Insulin)

Answer 34

short acting

Question 35

Hypoglycemia is uncommon when these drugs are used alone. what severe hypersensitivity reaction is possible but rare

Answer 35

Dipeptidyl Peptidase-4 inhibitors DPP4 - Gliptins Sitagliptin (Januvia) Saxagliptin (ONglyza) Linagliptin (Tradjenta) Alogliptin (Nesina)