HEENT/ DERM Flashcards
(122 cards)
1
Q
AOM first line treatment adults
A
Amoxicillin 500 mg P.O. TID
X5-7 days (mild to moderate infection)
X10 days (severe infection)
Without tympanic membrane perf
2
Q
2nd line AOM treatment for adults
A
Amox/ Clav 500 mg TID or 875 mg BID
X5-7 days ( mild to mod infection)
X10 days (severe infection)
3
Q
Penicillin allergy adult AOM
A
Clarithromycin 250-500 mg BID x 10 days
4
Q
AOM with ventilation tubes
A
Ciprodex 4 drops BID x 7 days
5
Q
AOM treatment first line children without risk factors
A
Amoxicillin 40-60 mg/kg/day divided TID
6
Q
AOM children first line with risk factors
A
Amoxicillin 80mg/kg/day divided TID
X 10 days
7
Q
2nd line AOM children
A
Amoxicillin/ clavulanate 40-80mg/kg/day divided BID x 10 days
8
Q
Penicillin allergy AOM children
A
Clarithromycin 15mg/kg/day divided BID x 10 days
9
Q
First line treatment for dry eyes
A
Ocular lubricants
Bio Tears 1-2 drops BID-TID
Refresh optive 1-2 drops BID- TID
10
Q
First line for dry eyes related to allergies
A
Ophthalmic antihistamines:
Olopatadine 0.1% 1 drop q6h
Olopatadine 0.2% 1 drop daily
Olopatadine 0.7% 1 drop daily
Mast cell stabilizers:
Cromolyn eye drops 1-2 drops q6h/ day
11
Q
Red eye acute viral conjunctivitis
A
No antibiotics
Consider cold Compresses or artificial tears
12
Q
Red eye bacterial conjunctivitis OTC
A
Polysporin drops 1 drop q4h x5-7 days
13
Q
Bacterial conjunctivitis rx
A
Erythromycin 0.5% 1/2 - 1inch QID
Fusidic Acid 1% 1 drop BID
X5-7 days
14
Q
Severe cases of bacterial conjunctivitis first line
A
Moxifloxaxin 0.5% drops 1 drop TID x 7 days
Besifloxacin 0.6% drops 1 drop TID x 7 days
15
Q
HSV keratoconjunctivitis first line
A
Viroptic opthalmic solution 1% 1 drop q2h while awake (no more than 9 drops/ day) x 7 days r/a for re-epithelialization at 7 days
16
Q
Herpes Zoster Opthalmicus first line
A
Send referral to ophthalmologist
Famciclovir 500mg TIDx 7-10 days
Valacyclovir 1g TID x 7-10 days
17
Q
Bacterial blepharitis first line
A
Erythromycin 0.5% ointment 1/2 inch qHS
18
Q
Bacterial blepharitis second line
A
Tobramycin 0.3% ointment 1/2 inch qHS
19
Q
OTC - otitis externa
A
Polysporin eye and ear drop 1 drop QID
X7 days
20
Q
First line otitis externa without perf
A
Ciprodex otic suspension 4 drops BID x 7 days
21
Q
First line otitis externa with perf
A
Ciprodex otic suspension 4 drops BID x 7 days
22
Q
First line therapy for intermittent allergic rhinitis
A
Oral antihistamine
Preferably the 2nd generation:
(Cetirizine, loratidine, desloraridine, ruppal)
23
Q
Dosing for cetirizine
A
Cetirizine (reactine) 5-10mg q24 (>6yo)
Cetirizine 2.5 mg q24 ( 6 months >)
24
Q
First line for persistent allergic rhinitis
A
Intranasal corticosteroid
25
Name dosing for beclomethasone and and adverse reaction
Beclomethasone 2 sprays( 50mcq/ spray) in each nostril BID x 7 days ?
Max 12 sprays for adults
Max 8 sprays for kids
AE/ growth retardation in kids
26
Ciclesonide (omnaris) dosing
2 sprays (50 mcq/spray) in each nostril daily
Adults and children >12
27
Flonase dosing
Flonase (fluticasone) 2 sprays(50 mcq/spray) in each nostril daily (>12 yo)
1-2 spray in each nostril (4-11)
28
Medications used in patients with concomitant asthma as an alternative to INCS
Montelukast ( Singulair ) 10mg qHS P.O.
Have reported SI, depression while on it
29
Decongestants
Dristan Nasal mist ( pheniramine/ phenylphrine)
0.25% or 0.5% solution: 2-3 drops/ sprays per nostril q4)
30
Impetigo infections. Localized , what is the treatment
Mupirocin 2% cream apply sparingly TID x7-10 days
Or
Fusidic acid 2% cream apply sparingly TID x 7-10 days
31
What are the systemic antibiotics required for impetigo
Cephalexin (keflex) 250-500 mg QID x 5-7 days (adults)
Cephalexin 50-100mg/kg/day divided QID x5-7 days (children)
32
What if you need systemic antibiotics for impetigo and they have a penicillin allergy ?
Clindamycin 150-300mg QID x5-7 days
Clindamycin 10-20 mg/kg/day divided QID x5-7 days
33
What are some non pharm approaches to impetigo? What can they do at home?
Crusted lesions may be removed with thorough gentle washing with mild soap and water
Water compress 3-4 times a day
Hand hygiene
Not sharing personal items (razors etc)
34
First line for folliculitis
Hot compresses and antiseptic cleanser may be beneficial
May respond to drying measures (aluminum chloride hexohydrate solution or hydro-alcoholic solution)
35
Second line for folliculitis
Mupiricin 2% cream apply sparingly TID x7 days
Fusidic acid 2% cream apply sparingly TID x7 days
36
First line for furuncles
Small boils can use hot compress, usually are sufficient and antiseptic cleanser
Large boils will need drainage
Culture of recurrent >2 in 6 months
37
Second line for furuncles
Mupirocin 2% cream apply sparingly TID x 7 days
Fusidic acid 2% cream apply sparingly TID x 7 days
38
First line treatment for carbuncles
Cephalexin (keflex) 500 mg QID x 7 days
50-100mg/ kg/day divided QID x 7 days
39
Second line treatment for carbuncles/ PNC allergy
Clindamycin 300-450 mg QID x 7 days
Clindamycin 10-20mg/kg/day divided QID x 7 days
40
Third line for carbuncle if you want MRSA coverage
Doxycycline 100mg BID for one day then 100 mg daily x 6 days
Or
TMP/SMX 1 DS tab BID x 7 days ?
41
Cellulitis first line therapy
Cephalexin 500mg QID x 5 days
50-100mg/kg/day divided QID x 5 days
42
Second line mild cellulitis therapy
Cloxacillin 500 mg QID x 5 days
50mg/kg/day divided QID x 5 days
43
Third line / MRSA coverage
For mild cellulitis
Doxycycline 100mg BID(>8 yo)
Or
TMP/SMX 1 DS tab BID x 5 days
8-12 mg/kg/day TMP component divided q12h
44
PNC allergy cellulitis
Think high end of 150-300 of usual dose, kids are doubled of usual dose 10-20
Clindamycin 300mg QID x 5 days
Clindamycin 20-40 mg/kg/day divided QID x 5 days
45
Which pathogens are associated with purulent cellulitis
S. aureus
46
Which pathogen is associated with nonpurulent cellulitis
GAS
47
First like for erypselas
Penicillin V 300 -600mg QID x 5 days
Or amoxicillin (unsure of dose)
48
Second line for erypselas if PNC allergy ?
Cefuroxime
49
What is the first line therapy for flushing in rosacea ?
Topical Birmonidine 0.33% gel applied once daily
50
Rosacea with papules and pustules, what is the first line treatment ?
1. Metrogel 0.75% applied daily for 9 weeks
1. Metronidazole 1% cream applied daily for 9 weeks
Or
Azelaic acid 15% gel BID
(More harsh then metro, use as second line)
Or
Ivermectin 1% applied daily for 16 weeks
51
What if topical treatment is inadequate for papules and pustules rosacea ? What is the next thing to do
Doxycycline 100mg daily x12 weeks
Or
Apprilon 40mg daily x 12 weeks
Or
Tetracycline
500 mg BID x 2 weeks
Then 500 mg daily until controlled
Then 250 mg daily x3-4 weeks
Last resort:
Could trial low dose accutane or topical retinoids
0.2-0.3 mg/kg/day x4-5 months
52
What is the treatment for telangiectasia
Vascular laser systems
53
first line for phyma rosacea?
Think it’s so bad - go straight to the oral stuff
Oral doxy 100 mg daily x 12 weeks
Or oral tetracycline
500 mg BID x 2 weekS, then 500mg daily until controlled then 250 mg daily x3-4 weeks
Could trial low dose accutane or topical retinoids
0.2-0.3 mg/kg/day x4-5 months
And laser
54
Ocular involvement rosacea ?
Eye lid hygiene
Artificial tears
Oral doxy or tetracycline
- should refer to opthalmologist with persistent ocular involvement
55
What topical should you avoid with rosacea ?
Topical corticosteroids
56
What non pharm things can you do with rosacea V
Avoid triggers
Soap free/ fragrance free cleansers and moisturizers
Wear SPF 30 on your face daily
Camouflage makeup with green tint if you have erythema
57
Lyme disease treatment for erythema migrans for adults and children
Doxycycline 100mg BID x 10 days
>8years: doxycycline 4mg/kg/day divided BID x 10 days -> this is 2nd line for children.
First line is amoxicillin 50mg/kg/day divided TID x 14-21 days
Remember: evidence said doxy was good for 10 days instead of the usual 14-21 days
58
Second line if penicillin allergy for Lyme disease
Cefuroxime 500mg BID x 14-21 days
Cefuroxime 50mg/kg/day BID x14-21 days
CPS kids says 14 days
59
Scabies treatment first line
Permethrin 5% cream - apply everywhere including genitalia and nails , leave on for 14 hours then wash off
Second application 7-10 days
Generally one adult body can use a 30g bottle
60
Second line scabies
Eurax (crotamiton) 10% cream,50 g tube Q24h x 2 days
-apply everywhere, repeat in 24 hours and wash off 48 hours after last application.
- in children >2 months apply daily x3 days then rinse 48 hours after last application
In children <2 months = sulfur 5-10% ointment QHS x 3 days ??? Cps
61
Off label use for scabies
Ivermectin 0.2mg/kg single dose
Repeat in 2 weeks
Ivermectin interacts with warfarin
62
Pediculosis treatment first line
1. Permethrin 1% (NIX) cream rinse
2. Resultz (isopropyl myristate)
3. R&C shampoo
(Pyrethrins/piperonyl butoxide)
*** do not use RC shampoo if allergic to ragweed or chrysanthemum
63
Natural pediculosis treatment
Anise oil (some data to this)
Apply, 15 min then rinse and repeat 7-10 days
64
Non pharm for pediculosis and scabies
-avoid contact with others until treatment complete
-children may return to school once treatment complete
-wash clothes linen infested person during 3 days prior to treatment in soap and hot water or seal in bag for 7 days
-vaccum everything
-assess STI (scabies) it’s considered a sexual transmitted infection
65
Post exposure prophylaxis of Lyme
Single dose of doxy 200mg within 72 hours of tick removal
Needs to be <24hours since time of attachment
66
Acute rhinosinusitis - when to treat
>10 days of persistent symptoms without evidence of improvement or worsened symptoms = bacterial involvement
67
First line for acute rhinosinusitis for adults and children
Amoxicillin 500mg TID x 10 days
Amoxicillin 80mg/kg/day divided TID x 10 days
Could also do 40-60mg/kg divided TIDx 10 days in children > 2 yo
if no risk factors (daycare use, frequent antibiotic use, no treatment failure etc (not necessarily perfered tho)
68
Second line for acute rhinosinusitis
Amox/ clav 875 mg BID x 10 days
Amox / clav 40-80 mg/kg/day divided BID x 10 days
69
If the pt had a type IV hypersensitivity (rash) for acute rhinosinusitis
Cefuroxime 250-500mg BID x 10 days
Cefuroxime 30-40 mg/kg/ day divided BID x 10 days
70
If the patient has a type I hypersensitivity (anaphylaxis) to PNC for acute rhinosinusitis
Clarithromycin 500 mg BID x 10 days
Clarithromycin 15mg/kg/ day divided BID x 10 days
Or
Azithromycin 500mg Dailyx1 day then 250 mg daily x 4 days
Azithromycin 10mg/kg/day x1 day then 5mg/kg/day x4 days
71
What are adjunct therapies you can do for acute rhinosinusitis
- saline irrigation
-rest/ hydration
-warm facial packs/ compresses
-humidifiers
-head of bed elevated
Adjuncts:
- oral decongestants or nasal decongestants
(Dristan Nasal Mist 0.25% or 0.5% 2 sprays q4h prn) max 6 doses/ day
- intranasal corticosteroids
(Omnaris or Flonase)
50mcq/spray : 2 sprays in each nostril daily
72
Pertussis first line treatment and second line
If >3 weeks of cough = don’t treat : pt is infectious up until 3 weeks after onset of cough without therapy until 5 days after the start of therapy
Erythromycin 1-2g BID (adults only)
Or
Clarithromycin 250-500 mg BID x5-7 days
Or Clarithromycin 15mg/kg/day divided BID x5-7 days
Or
** preferred macrolide <1 month old**
Azithromycin 500 mg daily x1 day then 250 mg daily x 4 days
Azithromycin 10mg/kg/day x1 then 5mg/kg/day x4
Second line:
>2 years:
TMP/SMX 1 DS tab BID x5-7 days
TMP/ SMX 5-10 mg/kg/ day divided BID x5-7 days
73
Croup treatment in clinic
In clinic:
Mild- moderate group
0.6 mg/kg/dose may be repeated 6-24 hours (no added benefit for a repeat dose)
R/a in 24 hours
Improvement is seen generally 2-3 hours after a single dose is given and continues for 24-48 hours
In hospital:
Severe croup
Epinephrine 0.5 ml in 3 ml NS neb
74
Signs of epiglottis
Strider
Drooling
High fever
Unwell appearance
Severe sore throat
If client has drooling and no cough = epiglotttis
If client has cough and no drooling = croup
-> medical emergency
-> do not look inside throat ***
75
What vaccine helps with epiglottis
Hib
H. Influenza
Vaccine 2,4,6, 18 months
76
Laryngitis treatment
Nonpharm
- rest vocal cords
-sleep
-fluids
-avoid smoking or drinking
-lozenges
-salt water gargles
77
Group A pharyngitis sore throat score
Absent cough 1
>38 Fever 1
Tonsil exudate or swelling 1
Swollen and tender anterior cervical lymph nodes 1
Age 3-14= 1
Age 15-44= 0
Age >45 = -1
Score:
>4 treat
3 treat only if positive gas
2 perform culture
0-1 nothing
If the antigen test is negative, then culture is still required for children in adults, a negative antigen alone is good enough
78
GAS first line
Penicillin V 600 mg BID or 300mg TID x 10 days
<27 kg: 40 mg/kg/ day divided BID (max 750 mg/day)
>27kg: use adult dosing
Penicillin suspensions come in 25mg/ml (125 mg/5ml) or 60mg/ml (300mg/5ml)
Or
** remember that in GAS it’s BID Amox not TID , only time **
Amoxicillin 500mg BID x 10 days
Amoxicillin 40mg/kg/ day divided BID x10 days
Comes in 25mg/ml (125mg/5ml)
And 50mg/ml (250 mg/5 ml)
79
If PNC allergy for GAS
(Type IV)
Cefuroxime 250 mg BID x 10 days
Cefuroxime 20mg/kg/dose divided BID x10 days
Dosing is HALF of Amoxicillin
80
If PNC type I allergy GAS treatment
Clarithromycin 250 mg BID x 10 days
Clarithromycin 15mg/kg/day BID x 10 days
Or
Azithro 500mg x1 then 250 mg x 4
Azitro 12mg/kg/day for 5 days (very different then normal 10mg/kg/)
81
Typical side effects of amoxicillin
Occasional GI upset, nausea, vomiting, diarrhea, rash
82
Typical side effects of penicillin V and what kind of suspension ?
GI upset, nausea, vomiting, diarrhea, rash
Low palatable for kids
25mg/ ml
60mg /ml
83
Meningitis- close contacts with H. Influenza
PHU needs to be aware
Those <10 unvaxed should be brought up to date
All home contacts should be given rifampin 20mg/kg/ day x 4 days
(Max 600mg/ day)
84
Meningitis - close contact with meningococcal )neisseria meningitidis
Chemoprophylaxis for all close contacts. Contact PHU for direction
ciprofloxacin 500mg single dose
Cipro 250 mg single dose ( children)
<5, 30 mg/kg up to max 125 mg
Cipro> rifampin (in pregnancy too)
85
Meningitis - pneumococcal
No chemoprophlaxis required
86
Other types of meningitis
No chemoprophylaxis required
87
Tamiflu dosing adults for treatment of influenza
Suspect influenza: known to be circulating in the community, fever/ chills, abrupt onset of constitutional and respiratory signs and symptoms, myalgia, headache, severe malaise, loss of appetite and non productive cough
>13 yo: 75 mg PO BID x 5 days
***no more than 48 hours later after onset of symptoms ***
Should be reserved for more complicated Moderate to severe presentation and those with risk factors like underlying comorbidies and those living in institutional settings
88
Tamiflu dosing for pediatrics treatment
23-40 kg
15-23 kg
<15 kg
What is the usual oral suspension concentration
On AIG 1-12yo needs to consult drug monograph
>12 can use 75 mg BID x 5 days
>40kg = 75mg BID
23-40 = 60mg BID
15-23 = 45mg BID
<15 = 30mg BID
Usual suspension: 6mg/ml
Only use in children with chronic conditions or if illness is severe enough to require hospitalization
89
Tamiflu prevention / after exposure
Therapy should begin within 48 hours after exposure and continue for at least 10 days
Prophylaxis is daily x 10 days
Treatment is BID x 5 days
1–12 yo= consult drug monograph
>12 yo = 75 mg po daily x 10 days
> 13 = 75 mg po daily
1-12 = same as treatment
75 once daily x 10 days
60
45
30
90
Covid first line prevention for 12-29 yo
Pfizer (cominarty) = decreased risk of myocarditis
IM at 0, 4-8 weeks after ; later if immunocompromised
91
Covid - just read
> 6 months - 5 years = discretionary
> 5 years = recommended
Immunocompromised should have Moderna
92
Outpt treatment for Covid
Paxlovid 300 mg nirmatrelvir (two 150mg tabs) with 100 mg ritonavir ; take BID x 5 days
If renal impairment
Decease dose to 150mg/ 100mg x 5 days
Should be offered to:
Older age
Obesity
Current smoker
CKD
DM
Immunosuppressive disease
Sickle cell disease
Neurodevelpmental disorder
Active cancer
93
Mainstay therapy for diaper dermatitis
Barrier products like zinc oxide 10-20%
Bathe q2days, moisturizer daily
94
How do you know if diaper rash is colonized by candida / what’s the treatment ?
Beefy red with scaly border and satellite pustules, involving inguinal folds
Clotrimazole 1% applied BID x 1-2 weeks
Or
Miconazole 2% applied BID x 1-2 weeks
(Think BID = 2 butt cheeks)
Usually apply anti fungals before barrier products
95
Diaper dermatitis education
A - anti fungals, air dry
B- barrier products every time you change the diaper
C- cleansing , compressing (no scent)
D- diapers (change Q4h, soft cloths/ hypoallergenic)
E- education ( avoid scents)
R/a in 48 hours - should see improvement
96
Oral candidiasis treatment for adults and children
Adults: 400 00 units nystatin QID x 7-14 days
Children: 100 000 units nystatin QID x 7-14 days
97
Treatment for Candidal intertrigo
1. Clotrimazole 1% BID x 7-14 days
Or
Miconazole 2% cream BID x 7-14 days
If pronounced inflammation (redness, swelling, pain) could add hydrocortisone low potency for 1-2 weeks
Prevention:
Bathe daily
Avoid excessive rubbing
Loose fitting clothes
zinc oxide paste acts like antiperspirant??
98
First line treatment for tinea capitis
Terbinafine 250 mg PO daily x 4-8 weeks
Or
4-6 mg/kg/day x 2-6 weeks (CPS)
Suspension comes in 25mg/ml
This drug is hepatotoxic, do transaminases (ALT, AST) at baseline and periodically when therapy exceeds 4-6 weeks
99
Treatment for Tinea corporis
Antifungal topical x 2-4 weeks
If ineffective then terbinafine PO
100
First line for tinea pedis
Topical antifungals x 4 weeks
Clotrimazole 1% cream BID x 4 weeks
101
First line for tinea manus
Same as pedis
102
Tinea unguium
Onychomycosis first line
First:
Penlac
(Ciclopirox nail lacquer) 8% apply daily x 4-8 weeks ( CPS- kids) (cps - adults is 48 weeks)
If ineffective :
Terbinafine po 250 mg daily x 6 weeks for fingernails and 12 weeks for toenails
Monitor LFTs at baseline and qMonthly
103
Tinea versicolor
Topical antifungals can be effective but recurrence is common
Topical ketoconazole 2%,
selenium sulphide 2.5% lotion or shampoo (selsun blue)
Apply to affected area x15-30 min nightly x1-2 weeks then qMonthly x 3 months seems effective
104
Tinea cruris first line
Antifungals topicals x2-4 weeks
105
First line for animal bites
Mild infections
Amox/ clav 875 mg BID x 7-14 days (if joint or bone involvement) , CPS says 5 days prophylaxis
40mg/kg/dose divided q8h x7-14 days (children)
Or
Doxycycline 100mg BID first day then 100mg daily x 7-13 days
2-4 mg/kg/day BID, then half dose q24h
106
Moderate to severe infections of animal or human bites
ceftriaxone 1-2 g q24h
And
Metronidazole 500mg BID
If beta Lactam allergy
Ciprofloxacin 500 mg BID
And
Metro 500mg BID
107
HSV 1 continuous suppression (>6 occurrences/ year)
Valacyclovir 500mg daily
Acyclovir 400mg BID
Acyclovir 10mg/kg/dose BID
108
First occurrence episodes
Nothing, could consider OTC things
109
Severe, recurrent >3/ year
Valacyclovir 2g BID x 1 day
(Begin tx within 12hours of prodrome tingling/ burning or within 2 days of onset of lesions to decrease symptoms)
110
Herpes zoster treatment
Not recommended treatment in <12 and immunocompetent
Consider treatment in <11 with chronic disorders
Or may be considered for up to one week after rosy onset if there is a high risk of severe shingles or complications (severe pain, old age). Use of antivirals is strongly advocated in patients >50 years of age with moderate to severe pain, severe rash and non truncated involvement
First line:
Within 72 hours of rash onset
Famciclovir 500mg TID x 7 days
Valacyclovir 1g TID x 7 days
Send to ER if multiple dermatome involvement or trigeminal nerve involvement
111
Pain for herpes zoster
Analgesics, opioids, gabapentin and corticosteroids could be used
Tylenol #1
Avoid NSAID or ASA
(Reyes syndrome)
112
Varicella zoster virus treatment for immunocompetent adults and kids
Oral antivirals cannot be recommended for the treatment of uncomplicated chickenpox in otherwise healthy kids
In children with comorbidies or those >13 , antiviral treatment should be considered if it can be initiated 72 hours from rash onset:
Acyclovir 10-20mg/kg/dose QID x 5-7 days
If child has been exposed within 72 hours
Could offer Varivax vaccine if not vaccinated.
In adults: initiate antivirals within 24 hours of onset of rash
Famciclovir 500mg TID x 7 days
Valacyclovir 1g TID x 7 days
Could also vaccinate if had an exposure within 72 hours of exposure
In pregnancy-send to emerge
113
Plantar Warts treatment
Salicylic acid 5-40% (OTC) dr. Scholls
Apply 1-2 drops daily x 12 weeks
Or
Cryotherapy (liquid nitrogen)
Freeze large 1-2 mm then the diameter of the wart, repeat application every 1-2 weeks for a max of 8 weeks
If lesion persists past 12 weeks - refer
114
Psoriasis to scalp treatment
Mid to high potency corticosteroids
1. Betamethasone dispropionate 0.05% lotion once daily
2. Mometasone 0.1% lotion to scalp daily
Can use clobex shampoo once daily or coal tar shampoo twice weekly
Vitamin D derivitative:
Dovonex 0.005% scalp solution
Apply to dry scalp as needed
115
Face psoriasis treatment
Hydrocortisone 0.5 - 1% BID
Can use dovonex ointment BID (elderly) on CPS says it’s contraindicated for the face and only use for the body
116
Hands and feet psoriasis treatment
Targel once daily #1
Dovonex ointment
Medium to high potency corticosteroid (halobetasol propionate 0.5% BID)
Bethametasone Valerate 0.05% or 0.1% daily x 1 month
Second line
Oral retinoids
Methotrexate
Cyclosporine
117
Psoriasis to body and extremities treatment
Medium to high potency corticosteroids
Vitamin D derivatives (Dovonex)
Targel
118
Topical retinoids name them all
(Ada, Tre, Taza, Tifa)
Adapalene
Treretinoin
Tazarotene
Tifarotene
119
What is the usual pathway to treat acne
1. Benzoyl peroxide products (2.5, 4, 5%) no evidence improved outcomes >5%
2. Topical retinoids (adapalene, treritnoin, tazarotene, tifarotene)
3. If unsuccessful after 12 weeks, could try topical bpo with antibiotics
4. Clindoxyl or Benzamycin or continue BPO and add PO antibiotics
5. If unsuccessful 2-3 months then switch to PO antibiotics
6. doxycycline 100mg daily x 6 weeks
Tetracycline 500 mg BID then 250-1000mg daily for maintenance X6 weeks
Or
Erythromycin 500 mg BID x 6 weeks (If tetracycline allergy)
Could combine hormonal contraceptive too
+/- spironolactone
7. Severe - oral retinoids (accutane)
Initial: 0.5 mg/kg divided BID x 4 weeks
Maintenance: 1mg/kg/day x3-7 months
120
Rosacea treatment for flushing
Topical birmonidine 0.33% gel applied once daily
121
Papules/ pustules treatment rosacea
Ivermectin 1% daily x 16 weeks
Metrogel 0.75% apply daily x 9 weeks then prn
If response inadequate
Doxycycline 100mg daily x 12 weeks
Or
Apprilon 40mg daily x 12 weeks
Or
Tetracycline if GI effect of doxy is concerning
122
Burns when to send to emerge
>10% bsa in adults or >60
>5% bsa in children or <5
Burns involving face, ears , eyelids, arms , perineum, hands or feet, circumferential burns
- electrical burns
- burns of any size
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