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Flashcards in Exam 3 Deck (79):
1

Prophylactic migraine tx

Beta-blockers
Anticonvulsants
CCB
Tricyclic antidepressants
Gabapentin
ACE inhibitors
SSRIs

2

Common causative organism:

Impetigo

Staph aureus
GAS

3

Common causative organism:

Seborrheic dermatitis

S. malassezia (fungal)

4

Common causative organism:

Carbuncle/furuncle

MRSA

5

Common causative organism:

Cellulitis

Staph aureus
GAS

6

Common causative organism:

Allergic contact dermatitis

Poison ivy, oak, sumac

7

Common causative organism:

Diaper dermatitis

Candida

8

Common causative organism:

Onychomycosis

e. floccososu
t. rubrum
t. mentagrophytes
c. albicans
aspergillus
fusarium
scopulariopsis

9

Common causative organism:

Tinea versicolor

malassezia furfur

10

Viruses:

HSV-1

Above waist, skin, face

11

Viruses:

HSV-2

Genitalia

12

Common causative organism:

Scabies

Sarcoptes scabiei

13

Tx of abscess

Incision and drainage
Doxycycline, clindamycin, bactrim

Staph A covered with augmentin or cephalosporin

14

Tx of abscess with S&S of sepsis

IV vancomycin or linezolid

15

Tx of cellulitis

PCN, VK, amoxicillin/clavulate, dicloxacillin (GAS)

16

Tx of MRSA

TMP-SMZ, minocycline, clindamycin, linezolid

17

Patho of acne

Abnormal keratinization causes retention of sebum in the pilosebaceous follicle, producing open comedones (blackheads) and closed comedones (whiteheads)

18

Benzoyl peroxide MOA

1) Comedolytic and bactericidal agent specific to p. acnes

2) Decreases p. acnes levels, decreases inflation caused by leukocytic and monocytic attraction to pilosebaceous follicle

19

Benzoyl peroxide SE

Irritation

20

Benzoyl peroxide patient education

Could bleach clothing/towels
D/C OTC products before using Rx strength

21

Retinoid MOA

Decreases sebum production, follicular obstruction, and number of skin bacteria

22

Topical tx of acne

Retinoic acid (Tretinoin)
adapalene (Differin)
tazarotene gel (Tazorac)
Benzoyl peroxide
Azelaic acid (Azelex)

23

How to differentiate acne vulgaris from acne rosacea

Rosacea occurs between ages 30-50, really red cheeks rather than pustules

24

Tx of acne rosacea

Topical metronidazole and PO doxy/azithromycin

25

Acne medication education

1) Avoid prolonged exposure to sun/wear sunscreen formulated for face
2) Use contraception
3) Stop OTC benzoyl products when starting Rx strength
4) Hypopigmentation may occur with azelaic acid in dark skinned pts

26

Before starting accutane

1) Two negative pregnancy tests
2) Two types of contraception

27

Accutane monitoring

CBC, CMP, fasting triglyceride and cholesterol levels at baseline and one month after start of therapy

28

Accutane education

1) Avoid pregnancy for 1 month of D/C of therapy
2) BBW—increased aggressive/violent behaviors, back pain, arthralgias
3) Do not initiate in teens; drug may cause premature closure of epiphyses

29

Tx of lice & MOA

1) Permethrin & spinosad (ovicidal and insecticidal)
2) MOA—causes neuronal excitation of lice which then paralyzes them

30

Only non-neurotoxic tx for lice

Benzyl alcohol

31

Non-pharm tx of lice

1) nit comb
2) hair conditioner
3) mayo
4) olive oil
5) petroleum jelly

32

Acne vulgaris OTC TX

Salicylic acid and benzoyl washes

33

Atopic dermatitis is also known as _________.

Eczema

34

Patho behind atopic dermatitis

High IgE, immune response, chronic

35

Tx for atopic dermatitis

1) Avoid irritants
2) Antihistamines, topical corticosteroids (avoid more potent corticosteroids around eyes, lips, groin, areas of sensitivity)
--Start with low-intermed steroid applied BID, if no improvement;
--Try higher potency steroid rather than increasing freq of low potency
--Systemic steroids used for widespread dermatitis (tapered dose, decreased q2d for at least 2 weeks)
--Medrol dose packs too short and may cause rebound
3) Emollients

36

Tx of psoriasis (1st, 2nd, 3rd)

First line—topical steroids (high or very high potency ointment) and emollients

Second line—3-4 rounds of high-potency topical steroids, then maintenance application, add vitamin D analog (Calcipotrene/dovonex)

Third line—Refer to derm

**Be aware of pregnancy/lactation**

37

Teaching for tinea capitis tx griseofulvin

1. May decrease efficacy of OCPs
2. May cause serious unpleasant reaction to alcohol
3. More effective with high fat meal*

38

Topical azoles MOA

Impair the synthesis of ergosterol, allowing for increased permeability and leakage of cellular components and results in cell death

39

Topical azoles use

Apply once or twice a day x 2-4 weeks, continue therapy for 1 week after lesions clear

40

Topical azoles caution

1) Not recommended in pregnancy/lactation
2) Admin cautiously in hepatocellular failure
3) Ketoconazole avoided in pts with sulfite sensitivity

41

Topical azoles SE

Pruritis, stinging, irritation

42

How do topical meds work for onychomycosis?

Cause leakage of fungal cell wall membrane

43

Criteria to prescribe antiviral

1) Treat if rash has been present fewer than 72 hours or if new lesions are still developing
2) Any pt older than 50 yrs and immunocompromised should be treated

44

Tx of seborrheic dermatitis & education

1) Antiseborrheic shampoos (Selsun blue, head & shoulders)
2) Low dose topical steroid lotion/gel (desonide) to help with itching
3) Avoid contact with eyes and rinse thoroughly

45

Tx for candidias

1) Nystatin
2) Topical antifungal creams
3) Diflucan

46

Monitoring for onychomycosis tx

ALT (alanine aminotransferase) and AST (aspartate aminotransferase) before start of tx and 6-8 weeks into therapy

47

Ketoconazole & fluconazole

1) Ketoconazole—not recommended for pts with sulfite sensitivity
2) AE of both—GI upset, rash, fatigue, hepatic dysfunction, edema, hypokalemia
3) Should not be used in pregnancy
4) Interactions—severe hypoglycemia w/hypoglcyeic drugs; avoid anticholingergics, H2 blockers, and antacids within 2 hours so that absorption is not compromised

48

Tx of herpes simplex

Topical acyclovir (oral if immunocompromised)

49

Tx of herpes zoster

1) Acyclovir 800 mg 5x/day 7-10 days
2) Valacyclovir 1 g TID x 7 days
3) Faciclovir 500 mg TID x 7 days
4) PO gabapentin/lyrica for pain

50

S&S of tinea versicolor

Round/oval macules w/an overlay of scales that may coalesce to form larger patches; often on trunk, upper arms, neck; Mild itching.

Dx by positive KOH test—budding yeast and hyphae

51

Tx of tinea versicolor

Selenium sulfide shapoo (Selsun Blue)—apply daily, leave on 10-15 mintes x 1 week

Topical azole BID x 2-4 weeks

52

ADHD meds – considerations before prescribing

1) Nonpharmacologic treatment (behavior modification, parent training, family therapy, etc)
2) Age, whether or not they can swallow a pill
3) Cardiac, tic disorder, substance abuse history
4) Short acting vs long acting
5) Nutrition/lifestyle changes

53

Progression for ADHD meds

Stimulant medication, increase medication dose, nonstimulant, buproprion

54

Common side effects of stimulants

Decreased appetite & delayed sleep onset

55

Common side effects of nonstimulants

GI discomfort, appetite decreases, mood swings, BP increase

56

Common side effects of clonidine & guanfacine for ADHD

Hypotension, dry mouth, oversedation, rebound HTN if abruptly stopped

57

ADHD and anxiety considerations

Avoid prescribing methylphenidate

58

First line tx of ADHD

Stimulants—methylphenidate or amphetamine salts (no preference, but methylphenidate usually started in children)

59

What are SSRIs used to treat?

Anxiety, depression, OCD

60

What drugs cause serotonin syndrome?

Certain cardiac medications, MAOIs, St. John’s wort, dosage too high

61

Monitoring and education for SSRIs

1) Monitor for depression, BBW for suicidal thoughts, sexual dysfunction, weight gain, substance use
2) Rigorous medication inventory
3) Watch for signs of serotonin syndrome, myoclonus, hyperthermia, autonomic instability
4) Taper dose to avoid withdrawal

62

Why cautiously prescribe benzos?

High potential for dependency

63

TCAs MOA

Inhibit 5-HT and norepinephrine reuptake produce anxiolytic and antidepressant effects

64

Causes of Parkinson

Cause not understood, can be drug-induced (associated with first gen antipsychotics)

65

Medications used for Parkinson's

1) Carbidopa-levodopa (mainstay tx—start when PD affects quality of life)
2) Dopamine agonist, MAO-B inhibitors, COMT inhibitors, amantadine, anticholinergic (benztropine)

66

Mirapex MOA

Stimulation of dopamine D2-type receptors result in improved dopaminergic transmission in the motor area of the basal ganglia

67

Mirapex SE

Fatigue
Nausea
Constipation
Orthostatic hypotension
Hallucinations
Lower extremity edema
**Sleep attacks (counsel about driving)
Avoid in elderly

68

How to dx migraines

1) Obtain thorough headache hx (age at onset, time of day, duration, precipitating/relieving factors; nature, intensity, and location of headache; associated symptoms)
2) Aura symptoms
3) Migraine diary to identify triggers
4) Family hx

69

Tx of migraine in pregnancy

1) Risk vs benefit approach
2) Acetaminophen
3) Ibuprofen (if severe) in first and second trimester only
4) Tylenol w/codeine sparingly

70

Education for abortive therapy for migraines

1) Frequency of medication and max daily dose
2) Administration technique
3) Acetaminophen overdose is common—do not exceed 3,250 mg/day

71

Dilantin monitoring

Therapeutic level is 10-20 mcg/ml in a person with normal albumin

72

Phenobarbital MOA

Binds to the barbiturate-binding site at the GABA receptor complex, leading to enhanced GABA activity

73

First line tx for insomnia

1) Sleep hygiene
2) Benzo, benzodiazepine receptor agonists (Lunesta, ambien, zaleplon), or ramelteon (meltonin receptor agonist)

74

Aricept side effects

1) NVD
2) Bradycardia
3) Insomnia
4) Nightmares (move med to morning if these occur)**

75

Aricept education

1) realistic goals (increase length of time of self-sufficiency, delaying need for nursing home, reduce burden on caregiver)
2) Slow progression of disease
3) No current agents are curative; only modest improvements can be expected
4) Take with or without food

76

Alzheimer's mild to moderate first line tx

Donepezil (cholinesterase inhibitors)

77

Alzheimer's moderate to severe first line tx

Memantine (NMDA)

78

Namenda MOA

Focuses on the glutamatergic system; blocks activation of NMDA receptor, inhibiting neuronal degeneration

79

Namenda caution

Excreted renally (potential for decreased renal clearance of other drugs)