Exam 3 Flashcards

Question

(ND) sunscreen SPF formulations

Answer 1

- 2-14: help prevent sunburn, must carry skin cancer/aging alert - >15: decreased risk of skin cancer and early skin aging, will be required to meet min UVA/B protection - >60: benefit up to 60, 60-80 must go through NDA

Answer 2

- **15-30 mins** before UV exposure - Reapply **Q2H** - Apply 22.5 mL or 4.5 teaspoons (~2 fingers) total in each application

Answer 3

- Apply sunscreen 15 mins before exposure - Avoid sun exposure & other UVR sources - Sun rays are the most direct & damaging from 10 am - 4 pm - Sunburn on cloudy or overcast day: 0-90% of UVR penetrates clouds - SPF 15 provides the greatest protection, wear protective clothing - Check expiration date

Answer 4

- Thermal - Electrical, chemical --> refer to emergency department

Answer 5

- Abrasions: rubbing/friction on the epidermal layer of skin - Lacerations: cuts/punctures from sharp edged objects piercing through skin layers - **Rule of Nine Method**: estimate BSA into multiples of 9%

Answer 6

Continuous cooling - Running water

Answer 7

Wound cleansing - Clean tap water - Do not pull loose or burned skin (small blisters <6 mm) - Large blisters may rupture on their own: wash with soap and water, apply moist wound dressing

Answer 8

- Temporary relief of pain, rapid onset - Benzocaine, lidocaine, pramoxine

Answer 9

- Short term for minor skin injury - ASA, naproxen, ibuprofen, APAP

Answer 10

- Emollients, moisturizers - Protect from irritation, promote moist healing, prevent scarring - Petrolatum, dimethicone, zinc oxide, glycerin, cocoa butter

Answer 11

- Antibiotic activity - Chlorhexidine, hydrogen peroxide, povidone-iodine solution

Answer 12

- **Prevention**, not treatment - Bacitracin, neomycin, polymixin B

Answer 13

- Suspected non-accidental injury - Chemical, electrical, or inhalation burns - Skin injury that worsens/ does not heal in 7 days - Deep partial or full thickness, or subdermal injury - Signs of infection - Circumferential burns - Pre-existing conditions that could prolong recovery/ mortality - Injuries larger than 3 in in diameter - Site of injury: face, hands, feet, major joints, genitals

Answer 14

- Suspected non-accidental injury - Injuries larger than 3 in in diameter - Wound secondary to animal bite - Deep partial or full thickness, or subdermal injury - Signs of infection - Chronic wounds - Pre-existing conditions that could prolong recovery/ mortality - Wound containing foreign matter after irrigation - Site of injury: face, hands, feet, major joints, genitals - Skin injury that worsens/ does not heal in 7 days

Answer 15

Scaly, erythematous, edematous, papular, crusty

Answer 16

- Depends on age, severity, sites of lesions - Education on trigger avoidance and skin hydration - Lifestyle changes: avoid irritating fabrics/fragrances, lukewarm & short baths, mild nonsoap cleaners, moisturize - Moisturizer: hypoallergenic/fragrance free, lotions have higher water content (can be drying), **ointments** more effective in dermal penetration (can be greasy and less tolerable)

Answer 17

- Topical **hydrocortisone**: safe for short period of time, >2 yrs, cream is most tolerable, ointments preferred for thick skin or lesions that are dry/lichenified/scaly - If no improvement >2-3days --> refer - Antipruritics not recommended

Answer 18

- Moderate-severe condition with intense pruritus - Involvement of large area of body - <1 yr - Infection - Face or intertriginous areas

Answer 19

Roughness, scaling, cracking, fissuring, erythema, pruritus

Answer 20

- Bathing & moisturizing: tepid water, w/i 3 mins out of shower apply body moisturizer, moisturize at least 3x during the day - Environmental factors: humidity, hydration, limit alcohol, caffeine, spicy foods - Cleansers: gentle, non-soap, glycerin soap - Moisturizers: humectants, emollients, occlusives, skin protectants

Answer 21

- Ointments: dry, scaly skin - Creams: less potent but less oily - Avoid gels, foams, mousses

Answer 22

Hydrocortisone - If needed for excessive itching - Apply a thin layer under moisturizer 1-2x daily for no more than 7 days - If no improvement after 7 days --> refer

Answer 23

Scalp scaling --> sloughing of small white/gray loosely bound flakes

Answer 24

1. Routine shampooing: mild-moderate 2. Cytostatic agent: pyrithione zinc, selenium sulfide 3. Non-rx ketoconazole shampoo 4. Keratolytic agent: salicylic acid, sulfur

Answer 25

- Demarcated, dull, yellowish, oily, scaly areas on reddened skin - Infantile form: cradle’s cap with scalp concentration - Darker skinned individuals may have hypopigmentation and lack yellow scales

Answer 26

Similar to dandruff, but more aggressive due to inflammatory nature - 1st line = antifungal ketoconazole - If scales difficult to remove: olive or mineral oil - Regular use of medicated shampoo: pyrithione zinc and selenium sulfide - Keratolytic agents: salicylic acid, sulfur

Answer 27

Usually self-limiting so oil massages + non-medicated shampoo → refer

Answer 28

- Symmetrical lesions - ~90% pts have a plaque - Well demarcated and covered with a silvery-white scales - Painful and itchy - Common sites: extensor surface of elbows/knees, lumbar region of the back, scalp, genital area - Auspitz Sign: when scale is lifted and pinpoint bleeding occurs

Answer 29

- Mild cases: hydrocortisone + removal of loose scales - Most: refer! - Thick scales: salicylic acid

Answer 30

- <2 yrs - Worsening symptoms or no improvement after 2 wks of proper use

Answer 31

- Involvement of more than 5% BSA or face - Presence of joint pain - More than a few lesions - Lesions larger than a quarter

Answer 32

- Inflamed, swollen, erythematous skin - Delayed onset - Dry or macerated, painful, cracked skin - Chronically can cause lichenification &/or discoloration of skin

Answer 33

- Wash exposed area with lots of lukewarm water - Cleanse with mild or hypoallergenic soap - Saline soak (1 tsp salt in 1 pint of water)

Answer 34

1. Burrow's solution (Aluminum acetate): remove irritant 2. Liberal emollient: restore moisture 3. Topical hydrocortisone: reduce inflammation, relieve itching

Answer 35

Protective clothing/gloves/equipment, frequent changing of coverings, routine post-exposure barrier cream use

Answer 36

- <2 yrs - Involvement of eyes, eyelids, mouth, face, neck, genitals - Dermatitis involving more than 10% of BSA - No improvement in 1 wk of proper self-tx or evidence of chronic dermatitis

Answer 37

- Rash, papules, small vesicles, bullae - Urushiol-induced: linear distribution over wide area

Answer 38

Resolves on its own 10-21 days - Limit exposure: wash clothes, remove jewelry, wash with mild soap - Cold/lukewarm soapless showers - Clipping nails

Answer 39

- Inflammation: hydrocortisone cream 1% - Itching: colloidal oatmeal bath (slippery, clog drain), calamine lotion (pink stain), oral 1st gen antihistamine benadryl for sedation - Weeping: Burow’s solution (aluminum acetate): astringent

Answer 40

- <2 yrs - Involvement of eyes, eyelids, mouth, face, neck, genitals - Dermatitis involving >10% of BSA (20% if urushiol) - S/S of infection: >100 oF, pus/tenderness on rash - Numerous large bullae - No improvement in 1 week of proper self-tx or evidence of chronic dermatitis

Answer 41

**ABCDE** - Air: let skin air dry frequently, allow diaper free time - Barrier: use barrier skin protectant liberally with each change - Cleansing: gently cleanse with soft cloth or baby wipe if stool present - Diaper: change frequently (Q2H) and as soon as it’s soiled, use absorbent diapers if possible - Education: Educate all parents & caregivers about diaper hygiene & appropriate pharmacotherapy

Answer 42

Skin protectants - Zinc oxide: most commonly used, need soap to remove - Petrolatum/white petrolatum - Calamine - Topical cornstarch and talc: loose powders, reduce moisture & friction, risk respiratory SEs

Answer 43

Usually resolves w/o pharmacologic intervention - Decrease sweating, loose, light colored/weight clothing, do not apply occlusives

Answer 44

Emollients, antipruritics, skin protectants

Answer 45

- Secondary infection - Onion-skin like appearance or bulla formation - Chronic or frequently recurring - Systemic symptoms: fever, VND, swollen lymph nodes, rapid pulse, rash/lesions on other body parts) - Comorbid conditions (HIV, organ transplant, immunosuppressive therapy, hx of hepatitis w/ skin manifestations)

Answer 46

1. Cardiovascular & Metabolic diseases 2. Lung cancer

Answer 47

ENDS (Electronic, Nicotine, Delivery, Systems)

Answer 48

- CYP1A2 - Caffeine, clozapine, olanzapine, ropinirole, tizanidine, oral contraceptives

Answer 49

1. How soon after waking do you smoke your first cigarette? 2. Do you find it difficult to refrain from smoking in places where it is forbidden? 3. Which cigarette would you hate to give up? 4. How many cigarettes a day do you smoke? 5. Do you smoke more frequently in the morning? 6. Do you smoke even if you are sick in bed most of the day?

Answer 50

Ask, Advise, Assess, Assist, Arrange

Answer 51

**5 R's Method**: Relevance, Risks, Rewards, Roadblocks, Repetition

Answer 52

**STAR Method**: Set a quit date, Tell family/friends/coworkers, Anticipate challenges, Remove tobacco products from environment

Answer 53

Prevent relapse, further counseling, medication refills

Answer 54

>10 cigarettes/day - Weeks 1-4: one 21 mg patch/day - Weeks 5-6: one 14 mg patch/day - Weeks 7-8: one 7 mg patch/day

Answer 55

=<10 cigarettes/day - Weeks 1-6: one 14 mg patch/day - Weeks 7-8: one 7 mg patch/day

Answer 56

- Discard by folding adhesive ends together in trash - Water will not harm so pts may bathe, shower, etc - Remove before MRI to avoid burns - If vivid dreams, only wear for 16 hrs and remove before bed - If skin irritation, rotate site & hydrocortisone OTC

Answer 57

- Smoke 1st cigarette w/i 30 mins of waking → 4 mg - Smoke 1st cigarette after 30 mins of waking → 2 mg

Answer 58

- Weeks 1-6: 1 piece Q1-2H - Weeks 7-9: 1 piece Q2-4H - Weeks 10-12: 1 piece Q4-8H

Answer 59

9 pieces of gum or lozenges daily

Answer 60

- Gum: 24 pieces - Lozenges: 20

Answer 61

- May **delay weight gain** associated with smoking cessation - May use a second piece w/i the hr for strong or frequent cravings; **do not continuously use one piece after another (SEs)**

Answer 62

- Seizure disorder - Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs - History of bulimia or anorexia nervosa - Use of MAO inhibitor w/i previous 14 days - Initiation in pts receiving linezolid or intravenous methylene blue

Answer 63

- AEs: mostly insomnia - Weight loss (delay weight gain)

Answer 64

Study did not show a significant increase in neuropsychiatric AEs attributable to varenicline or bupropion relative to nicotine patch or placebo

Answer 65

- TTH: bilateral, diffuse aching, "tight", "pressing", cold increases pain - MH: unilateral, throbbing +/- aura - Sinus: localized to facial area, pressure behind eyes/face - Medication Overuse: "withdrawal" HA

Answer 66

- At least **5** attacks lasting **4-72 hrs** per year - At least **2** of the following: unilateral, pulsating pain, intensity affecting daily function, aggravated by physical activity - At least 1 of the following: N/V, light or sound sensitivity

Answer 67

>=3 times/week for >=3 mo

Answer 68

- Severe head pain - >10 days (w/ or w/o tx) [vs. fever >3 days refer] - Migraine HA symptoms w/o diagnosis - <8 yrs, <2 yrs w/o MD advice or previous tx - Pregnancy 3rd trimester - High fever or signs of serious infection - Hx liver disease or 3 drinks/day Secondary HA

Answer 69

- MoA: **irreversible** COX1&2 inhibitor - MMD: **4g** - Avoid in **=<15 yrs (Reyes syndrome), pregnancy (3rd trimester), surgical pts (stop 2-7 days before)**

Answer 70

- MoA: **reversible** COX1&2 inhibitor - IBU: **5-10 mg/kg Q6-8H** - Avoid in pregnancy

Answer 71

- MoA: central PG inhibition **w/o inflammatory** - Dose: **<12 yrs; 10-15 mg/kg Q4-6H prn, MDD = 5 doses** - MDD adult = 3 g - Counsel: do NOT exceed 3g in 24 hrs, do NOT consume alcohol, NOT for inflammation

Answer 72

>=3 times/week

Answer 73

- Suspected infection - Impaired immune function, oxygen utilization - CNS damage - Children w/ hx of seizures or febrile seizures - <6 months w/ rectal temp 101 oF (38.3 C) - >6 months w/ rectal temp 104 oF (40 C) - At risk for hyperthermia - **>3 days w/ or w/o treatment** [vs. HA >10 days refer]

Answer 74

Hydration, loose clothing, remove blanket

Answer 75

- Alternating IBU, APAP not recommended - APAP infant drops vs oral susp: same [ ] - IBU infant drops vs oral susp: 2x more [ ]

Answer 76

Precipitating & palliative factors, Quality, Region, Severity, Time, yoU

Answer 77

- Increased intensity or change in character of pain - Severe pain that limits function - Pelvic or abdominal pain

Answer 78

- Lasts >10 days - Continues >7 days after tx w/ a topical analgesic

Answer 79

- <2 yrs - Pregnant

Answer 80

- Accompanying N/V, fever, signs of systemic infection/disorder - Back pain and loss of bowel and/or bladder control - Visually deformed joint, abnormal movement, weakness in any limb, numbness, or suspected fracture

Answer 81

- NSAIDs (IBU, NAP) - Ice

Answer 82

- N/A - Massage, heat

Answer 83

- NSAIDs +/- topical - Stretching before activities, ergonomics - T: RICE - B: rest, immobilization

Answer 84

- APAP, NSAIDs (inflammatory or severe) - N/A - Adjunctive: topicals, glucosamine/chondroitin, heat pads

Answer 85

- 10-15 mg/kg/dose - MDD = 5 doses/day - FDA label for >2 yrs - Arthritis = ER --> **do not crush/chew/split**

Answer 86

- 5-10 mg/kg/dose 3 to 4 times/day - MDD = 4 doses/day - 6 mo to 12 yrs - GI upset --> take with food

Answer 87

- **NOT recommended for pain** - Dosing: CV indication lower dose - C/I: <2 yrs - GI --> take with food

Answer 88

1. Diclofenac 1% gel: may take up to 7 days, avoid using >21 days, C/I: hx of anaphylaxis to ASA or other NSAIDs 2. Lidocaine: may take up to 7 days

Answer 89

- Burned/damaged skin - <2 yrs - Tight bandages or heat therapy - Salicylates formulations in pts on anticoagulants

Answer 90

- C/I: hypersensitivity to ASA, NSAIDs, salicylates - Avoid in <18 yrs

Answer 91

1. Camphor: avoid in children 2. Menthol

Answer 92

- RICE: Rest, Ice, Compression, Elevation - Heat therapy - Heat wraps: no topicals, avoid in pregnant, rheumatoid arthritis, diabetes - TENS: avoid on irritated/infected/broken skin

Answer 93

- Fever 100.4 oF - Chest pain - Shortness of breath - Worsening symptoms or development of additional symptoms during self-treatment - Underlying chronic cardiopulmonary disease - Immunosuppressant therapy - Frail pts of advanced age - Infants 3 months of age - Hypersensitivity to recommend OTC medications

Answer 94

- Maintenance of fluid intake, adequate rest, nutritious diet, increased humidification - Handwashing: soap and water for **at least 20 secs** - Hand sanitizers

Answer 95

1. Zinc: **early use w/i 24 hrs**, >=12 yrs, avoid drinking/eating for 15 mins after & citrus drinks for 30 mins, frequent use Q2-4H while awake 2. Vitamin C

Answer 96

Local anesthetics: lozenges, throat sprays, oral disintegrating strips

Answer 97

Diphenhydramine (Benadryl) - Avoid: HTN, BPH, CHF, hyperthyroidism, glaucoma, GI, MAOIs - Elderly: avoid due to increased delirium/fall - COPD/Asthma: avoid - Peds: potential excitability and irritability - Counsel: sedation/dizziness, blurred vision, urinary retention, dry mouth, constipation, confusion - Do **NOT** consume alcohol

Answer 98

Decongestants - Systemic: **CNS & CV stimulation** - Topical: propellant-vehicle-associated, trauma from administration - **Rebound congestion**: use <3 days - W/P: BPH, diabetes, elevated intraocular pressure, heart disease, HTN, hyperthyroidism

Answer 99

MAOIs (phenelzine, tranylcypromine), linezolid, methyldopa, TCAs (amitriptyline, notriptyline, imipramine)

Answer 100

OTC cold meds **not recommended** <2 yrs (guidance: refer to MD <4 yrs)

Answer 101

1. Acute = <3 weeks 2. Subacute = 3-8 weeks 3. Chronic = >8 weeks

Answer 102

1. Nonproductive = (-) 2. Productive = (+) - Effective: secretions expelled - Ineffective: secretions present but not expelled

Answer 103

- Thick tan, yellow or green phlegm - 1 of the following: Unintended weight loss, profuse night sweats, hemoptysis, chest pain, SOB, swollen legs/ankles, cyanosis, rash, persistent headache - High fever 103 F - Low fever not resolving with selfcare - Chronic underlying disease: asthma, COPD, chronic bronchitis, CHF, drug associated cough - Lasting >7 days - Worsens as cold/flu resolves - Associated with inhalation of dust, particles, objects

Answer 104

- Use: Ineffective productive cough - MoA: expectorant/protussive; thins and loosens respiratory tract secretions - Avoid: asthma, COPD, LRTI - Peds >4 yrs - Drink plenty of water, **NOT recommended to use guaifenesin + DXM** (unless ineffective productive disturbing sleep)

Answer 105

- Use: nonproductive cough - MoA: antitussive; increase cough threshold - Caution: use w/ MAOIs/SSRIs, HTN, hyperpyrexia, arrhythmias, myoclonus, substance use - Elderly: start low and titrate up - COPD/Asthma: avoid if LRTI - Peds: abuse potential

Answer 106

- Camphor and Menthol = FDA approved - Camphor + Menthol + Eucalyptus: 2+ yrs - Rosemary + Lavender + Eucalyptus: 3+ mo - Counsel: do not place in mouth or nose (usually chest), apply and cover loosely

Exam 3 Flashcards

(133 cards)