Common Skin Conditions and Diabetes - I goofed Flashcards
(68 cards)
1
Q
Drugs that can change the color of your skin
A
- brown: entacapone, levodopa, methyldopa
- brown/yellow: nitrofurantoin
- black/green: iron changes the color of your stool
- orange/yellow: sulfasalazine
- yellow/green: propofol
- red/orange: phenazopyridine, rifampin
- red: anthracyclines
- blue: methylene blue, mitoxantrone
- blue/gray: amiodarone
2
Q
how long does it take for retinoids to work?
for acne
A
4-12 weeks and it may worsen initially
3
Q
what tests are required before starting a PO retinoid
A
- pregnancy
- liver
- lipids
4
Q
treatment for acne
first line and alternatives for mild, moderate, severe
A
- mild: topical benzyl peroxide or topical retinoid (alt: combo of both, switch the retinoid, or add topical dapsone)
- moderate: combo of topical benzy peroxide or retinoid OR can add a PO ABX (alt: switch the ABX, add OC or spironlactone for females, or add PO isotretinoid
- severe: PO isotretinoin OR combo topicals + PO ABX (alt: same as moderate)
5
Q
what acne medication canNOT be used in pt with G6PD deficiency
A
dapsone gel
6
Q
PO isotretinoin pregnancy rules
A
- sign a form
- 2 negative bith tests before starting
- canNOT be pregant 1 month beofre or 1 month after stopping
- 2 forms of birth control
7
Q
isotretinoin - things you shouldn’t take while on it
A
- Vit A supplements
- tetracyclnes
- progestin only contraceptives
- St. jon’s wort
8
Q
FDA indication for isotretinoin
A
severe refractory nodular acne
9
Q
treatment of cold sores
including natural remedy
A
- natural product: lysine
- OTC: docosanol (Abreva) - apply x5 a day at first sign of outbreak
- Rx: topcial acyclovir - x5 a day for 4 days
10
Q
dandruff treatment
A
OTC
- ketoconazole shampoo 1% - use twice weekly for up to 8 weeks
- selenium sulfide
- pyrithiione zinc shampoo
- coal tar shampoo
Rx
- ketoconazole shampoo 2%
11
Q
things that can cause alopecia
including drugs and conditions
A
- chemo (duh)
- valproate
- lamotrigine
- taccrolimus
deficiency in one of the following: biotin, zinc, selenium, and vitD
12
Q
drugs that can be used to treat alopecia
A
- finasteride - can take 3+ months to see effect
- Baricitinb (Olumiant) - not underlined, just know that there’s a JAKi
- topical minoxidil
- bitamoprost (for eyelashes)
13
Q
eczema treatment
A
- TOC: aquaphor, eucerin
- topical steroids
- topical calcineurin inhibitors (tacro or pimecrolimus)
- topical PDE-4 inhibitor: crisaborole
- mAb: dupilumab, tralokinumab
- JAKi: abrocitinib, upadacitinib ruxilitinib
do NOT use CNIs in pts < 2 because of lymphoma and skin cnacer risk
14
Q
fungal skin infectiosn; these are alt reated with some for of topical antifungal - what are those?
A
- athlete’s foot (tinea pedis)
- jock itch (tinea cruris)
- ringworm (tiea corporis)
- cutaneous candida infection
- OTC: terbinafinebutenafine, clotrimazole, miconazole, tolnaftate, undecylenic acid
- Rx: betamethasone/clotrimazole, ketoconazole
- apply med 1-2 inches beyond the rash and use for at least 2-4 weeks even if it looks healed
15
Q
nail fungl infection name and treatment
A
- onychomycosis - treated with PO itraconazole (avoid in HF) and PO terbinafine (risk of hepatotox)
- intermittent use can reduce cost and tox but may not be ass effective
dx with 20% potassium hydroxide
16
Q
vaginal fungal infection
A
- treat longer in preggers (7-10 day course, usually 1, 3, or 7 for everyone else)
- pH > 4.5 unlikely to be fungal infection (OTC kits available)
- if 4+ episodes in a year or recurrence within 2 months, MD referral
- probiotics unlikely to be effective
- topical OTC: clotrimazole, miconazole
- Topical RX: butoconazole, terconazole
- PO RX: fluconazole, ibrexafungerp
- recurrent vulvovaginal candidiasis: oteseconazole
17
Q
diaper rash: prevetion and treatmetn
A
- ppx: petrolatum +/- zinc (zinc dries out the skin but may be preferred in pts prone to rash)
- treatment: if yeast is thought to be involved: clotrimazole, miconazole, nystatin; otherwise hydrocortisone
18
Q
hemorrhoid treatment
A
- dietary fiber to help reduce straining
- ** topical phenylephrine **to shrink hemorroid and reduce burninng/itching
- hydrocortisone to reduce itching adn inflmmation
- witch hazel for mild itcing
19
Q
pinworm dx and treatment
vermicularis
A
- more common in children presents as itching - dx with tape test, stick a piece of tape around in the anus in the morning adn send in for microscopic eval
- treat whole family
- OTC: pyrantel pamoate
- Rx: albendazole, mebendazole (ADR: HA, nausea, hepatotox) - may need to give steroids and anti-seizure meds alongside the anti-worm agent)
20
Q
lice treatment
A
- first line: pyrethrins adn permethrin
- malathion lotion is an option but it can cause skin irritation
- lindane shampoo off market dt neurotox
21
Q
scabies treatment
A
- permethrin 5% cream
- PO ivermectin
22
Q
improtant topica steroid potencies
i’m lazy and will only be doing the bolded ones, sorry futre me
A
- very high: clobetasole 0.05% in any formulation, fluocinonide 0.1% cream
- high potency: betamethasone 0.05% cream, fluocinonide 0.05% oint, mometasone 0.1% oint
- high-medium: fluocinonide 0.05% cream
- medium: mometasone furoate 0.1% lotion, triamcinolone 0.1% cream and 0.147 spray
- low: hydrocortisone cream 1%
23
Q
physiology time: diabetes - role of insulin and glucagon
A
- insulin: moves glucose out of blood and into cell (for use or storage)
- glucagon - produced when BG is low, yanks glucose off of glycogen and releases it back into blood
- if glycogen is low, glucagon signals fat cells to make ketones
24
Q
type 1 vs type 2 diabetes causes
A
type 1: desturction of beta cells leading to inability to produce insulin
type 2: insulin resistance and (relative) insulin defiicinety
25
preferred medication in gestational diabetes
insulin (though metformin and glyburide can be used too)
26
classic s/s of diabetes
- polyuria
- polyphagia
- polydipsia
27
when should diabetes screening happen
- in everyone over the age of 35
- any adult who is overweight with an additional risk factor should be screened (age doesn't matter)
| if test is normal, screen q3y
28
diabetes dx
- A1C
- plasma glucose (fasting for > 8 hrs)
- OGTT (oral glucose tolerance test) - this is when they test you 2 hrs after a really sugary drink
## Footnote
- **A1C**: diabetes if >6.5, pre-diabetes if >5.7
- **fasting BG**: diabetes if >126, pre-diabetes if >100
- **random BG**: diabetes if >200
- **OGTT**: diabetes if >200, pre-diabetes if > 140
29
diabetes treatment goals
- **A1C**: <7
- **preprandial**: 80-130 (if pregnant, < 95)
- **2 hrs postprandial**: <180 (if pregnant, <140 at the 1 hr mark, < 120 at the 2 hr mark)
30
often to test A1C in a diabetic person
- Q3mo if not at goal
- Q6mo if at goal
31
how to interpret A1C
- A1C is the estimated average of BG across the past 3 months
## Footnote
- A1C of 6 is an estimated average of 126, every additional 1% increase correlates with a 28 BG increase
32
diabetes complications
| micro and macro vascular
- **micro**: retinopathy, diabetic kidney disaese, neuropathy
- **macro**: CVA, CAD, PAD
33
how often to check for diabetic retinoptahty
- 1-2 years for everyone
- annually if confirmed
34
what vaccinations should diabetics get
- hepB
- flu
- pneumoccal
- COVID
- RSV
35
how often should diabetics be checked for neuroapthy
- sensatio test annually
- comprehensie foot exam annually
36
diabetics and bone health screening
- DEXA q 2-3 years for anyone over 65 (or earlier if risk factors)
- consider teratment if T-score < -2
37
cholesterol control in diabetics
| when to give what intensity statin
- **high intesity**: anyone w CAD, CVA, PAD (goal LDL < 55); age 40-75 with 1+ risk factor (LDL goal < 70)
- **moderate intensity statin**: everyone over the age of 40; start in pts over the age of 20 if risk facotrs
38
diabetic kidney disease and treatment
- **defined** as eGFR < 60 and/or urine albumin > 30 (monitor anually if normal kidney function)
- **treatment**: ACEi or ARB or SGLT2 (can add finerenone if on max ACE or ARB)
39
type 2 diabetes algorithm
- **if goal is weight loss or just BG lowering**; start with GLP1-a
- **if cardiorenal risk** (CKD, HF, CVA, PAD, CAD): can start with SGLT2i or GLP1-a (preference of SGLT2 in HF though)
- after than it's just start a GLP1-Ra if you haven't - or do what ever
| if sole goal is BG lowering, can start with anything, really
## Footnote
combos to avoid
- DPP4i and GLP1a: overlapping MOA
- SU + insulin
40
how do GLP-1a work
analog of incretin hormon GLP1 -> increase insulin secretion, decrease glucagon secretio, slow gastric emptying
| slow gasstric emptying -> early satiety
41
GLP-1a: dosing schedule, renal cut offs
- l**iratglutide/Victoza**: daily
- **dulaglutide/Trulicity**: weekly
- **semaglutide/Ozempic**: weekly (PO is QD)
- **exenatide/Byetta IR**: given 60 min before meals BID, NOT recommended if CrCl < 30
- **exenatide/Bydureon ER**: weekly, NOT recommended if eGFR 45
42
GLP-1a safety considerations
- everything excet for exenatide IR has a risk of thyroid C cell carcinoma
- pancreatitis
- NOT recommende if severe GI diseases or gastroparesis
- exenatide ER can cause serious injection site reactions (including necrosis)
43
metformin MOA
- decreased hepatic glucose production
- increased insulin sensitivity
- decreased intestinal absorption of glucose
44
metformin fun facts
- vitB12 deficiency - monitor every 1-2 years
- lowers A1C by 1-2%
- ER formualtion can leave a ghost tablet in the stool
45
SU MOA
insulin secretagogues - stimulate insulin secretion -. decrease post-prandial glucose
46
SU safety consdierations
- CI in sulfa allergy (though unlikely to cross react)
- very hypoglycemia
- glipizide IR needs to be taken 30 min AC, all others are QD with breakfast (hold if NPO)
- glipizide ER can leav ghost tablet in stool
47
DPP4i MOA and safety consdierations
- MOA: prevent breakdown of incretin hormones GLP-1a, and GIP
| only linagliptin (Tradjenta doesn't have renal dose adjustment)
## Footnote
- pancreatitis
- severe arthralgia
- renal failure
- risk of HF with saxagliptin and alogliptin
48
TZD MOA
peroxisone proliferator activated receptor gamma agonist -> increase insulin sesitivity -> increased uptake and utilization of glucose (insulin sestizer)
48
TZD safety considerations
- can cause or exacerbate HF, avoid in class III, IV
- edema
- risk of fractures
- can stimulate ovulation -> unintended pregnancy
| rosiglitazole off market
49
PO diabetes combinations
- metformin + SU
- metformin + TZD
- metformin + DPP4i
- metformin + SGLT2
- metformin + empagliflozin + linagliptin
- SU + TZD
- DPP4i + TZD
- DPP4i + SGLT2
50
which insulins are basal, which are imediate acting, which are short and which are long acting
- **basal**: glargine, detemir, degludec (onset 3-4 hr, duration 24)
- **intermediate**: NPH (onsest 1-2, peak at 4-12, lasts 12-24)
- **short acting**: R (onset 30 min, peak at 2 hr, lasts 6-10)
- **rapid**: aspart, lispro, glulisine (onset 15 min, peak 1-2 hr, lasts 3-5)
51
when do we use super concentrated insulin (like humulin R U-500)
if pt needs >200 u per day, use special syringe to avoid dosing erors
52
which insulins are clear and whcih are cloudy
everything is clear and colorless except for NPH
53
which insulins are available OTC
- insulin regular
- NPH
- premixed 70% NPH/30% regular
54
insuli dosing for a type 2 diabetic starting an insulinn
- **start basal insulin**: 10 U SQ QD or 0.1-0.2 U/kg/day
- if not at goal, can a**dd a prandial inuslin**: 4 U or 10% of the TDD of basal with ***largest** meal of day*
- if still not at goal: add prandial before ***each* mea**l or start a mixed insulin regimen
55
insulin dosing for type 1 diabetes
start at 0.5 U/kg/day with 50% basal and 50% prandial divided by 3
56
what is the insulin to carb ratio and what is it used for
- used for pt whose mealtime insulin dose is based on the expected amount of carbs that is going to be consumed
## Footnote
- ICR for regular insulin: 450 / total daily dose = grams of carbs covered by 1U of insulin
- ICR for rapid acting insulin: 500 / total daily dose = grams of carbs covered by 1U of insulin
57
correction doses
1. calculate the correction factor - indicates how much the BG will be lowered by 1 U of insulin
2. calcualte the correction dose: ( [current BG - target] / correction factor)
## Footnote
- correction factor for insulin regular: 1500 / total daily dose = correction factor for 1U of regular insulin
- correction factor for rapid acting: 1800 / total daily dose = correction factor for 1U of rapid acting
58
most insulin conversions are 1:1; what is the exception
- NPH BID -> insulin glar: use 80% of NPH dose
- toujeo -> insulin glar: use 80% of toujeo dose
59
how long is an open insulin vial/pen good for?
- **10 days**: humalog mix 50/50 and 75/25 *pens*; humulin 70/30 *pen*
- **14 days**: humulin N *pen*, novolog mix 70/30 *pen*
- **31 days**: humulin R U100, N, and 70/30 *vials*
- **40 days**: humulin R U500 *vial*
- **42 days**: novolin R U100, N, 70/30 *vials*
- **56 days**: tresiba and toujeo
| anything not listed is 28 days
60
insulin syringe colors
humulin R U500 has a green cap and should be used with the needles that hae green covers
| U100 needles have 100 caps
61
counseling instructions for insulin needles
- 4mm/5mm - good for children and thin adults, no pinching required
- 8mm: good for most people, pinch sking before injecting
- 12.7 mm(1/2"): for obese pts, pinch skin before injecting
62
hypoglycemia management
conscious pt
1. ingest 15-20 g glucose (4 oz of juice, 8 oz milk, 4 oz soda, 1 tbsp honey, 3-4 glucose tablets)
2. recheck BG in 15 min
3. repeat 1&2 until BG normal
4. once BG normal, eat a snack
## Footnote
unconscious
- 1mg glucagon SQ or nasal spray
63
non-insulin drugs that lower BG
| only the bolded ones
- BB (can cause ether)
- quinolones (can cause either)
- tramadol
64
drugs that increase BG
- thiazides and loop diuretics
- tacrolimus and cyclosporine
- protease inhibitors
- quinolones (can raise or lower)
- APs
- statins
- steroids
- cough syrups
- niacin
- beta blockers
65
inpatient glucose goals
- 100-180 for nonICU
- 140-180 for ICU
66
DKA s/s vs HHS
- BG > 250
- ketones (fruity breath), abdominal pain, N/V dehydration
- anion gap acidosis (pH , 7.35, gap > 12)
## Footnote
- confusion, delirium
- BG > 600 with high serum osmlality
- extreme dehydration
pH > 7.3, bicarb > 15
67
DKA and HHS treatment
1. start with NS
2. when BG reaches 200, switch to D5W 1/2 NS
3. start a regualr insulin inf: 0.14 U/kg/hr OR 0.1 U/kg bolus followed by 0.1U/kg/hr
## Footnote
- monitor K and if it drops, supplement - keep K between 4 and 5
- if acidosis, to the point of pH < 6.9 can add sodium bicarb
