Module 9 Flashcards by Kelly Walker

Side effects associated with topical glucocorticoids used for acne include (choose all that apply):

a) thinning of skin
b) hypotrichosis (hair loss)
c) telangiecasia (spider veins)
d) diarrhea
e) local irritation

Answer: a) thinning of skin and c)telangiecasia

Other side effects include: stretch marks, purpura, hypertrichosis (hair growth), and possible systemic toxicity (adrenal suppression, growth retardation)

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Systemic side effects seen with glucocorticoid use in acne include:

a) hypotension
b) blood dyscrasias
c) growth retardation
d) hepatotoxicity

Answer: c) growth retardation

Growth retardation can be seen in kids. Other systemic SE include adrenal suppression. These are seen more with higher doses/long-term treatment.

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First line topical acne treatment is ______ and second line topical acne treatment is ________.

Answer:

1st line topical: benzoyl peroxide
2nd line topical: antibiotics (Clindamycin and erythromycin)

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Most topical agents for acne are targeting what organism?

P. acnes

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What is the MOA of benzoyl peroxide (choose all that apply)

a) kills bacteria
b) creates a barrier which decreases the environment suitable for bacterial proliferation
c) keratolytic
d) dries the skin which decreases nutrients needed for P. acnes
e) reduces inflammation

Answer: a) kills bacteria & c) keratolytic (thins/softens the skin)

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True or false, monotherapy with Clindamycin or Erythromycin can increase resistance in P. acnes?

True. These are usually combined with benzoyl peroxide to decrease the resistance.

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What is the MOA of retinoids?

Answer: e) reduces inflammation

Retinoids also unplug comedones and prevent new; they will improve the penetration of other topical agents

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Which of the following statements are inaccurate regarding retinoids?

a) sunscreen must be used while using these drugs
b) can make acne worse initially
c) can be used without regard to pregnancy
d) irritation can last up to 4 weeks
e) require a pregnancy test before initiation

Answer: c & e

Retinoids CANNOT be used in pregnancy but they do not require a pregnancy test before treatment initiation.

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Which retinoid can not only be used for acne & wrinkles, but can also be used for psoriasis?

a) tretinoin
b) adapalene (Differin)
c) tazarotene (Avage/Tazorac)
d) retinoid acid

Answer: c) tazarotene (Avage/Tazorac)

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Azelaic acid (Azelex/Finacea) can be used to treat (choose all that apply):

a) hormonal acne
b) psoriasis
c) acne
d) actinic keratosis
e) rosacea

Answer: c)acne and e)rosacea

It works by suppressing P. acnes and decreasing keratinocytes (thins skin)

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Keratolytic drugs work by _____.

Decreasing keratinocytes which thin the skin. Drugs used in this group include azelaic acid (Azelex/Finacea) and salicylic acid.

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Which oral antibiotics used for acne has resistance been associated with (choose all that apply)?

a) doxycycline
b) clindamycin
c) tetracycline
d) erythromycin

Answer: c) tetracycline & d)erythromycin

They can be used orally but are not first line due to the emergence of resistance.

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If a patient needs oral antibiotics for acne but cannot take tetracycline, what is a suitable alternative?

a) pencillin
b) ciprofloxacin
c) azithromycin
d) metronizadole

Answer: c) azithromycin

Remember that oral tetracycline and erythromycin are 2nd line oral options due to resistance seen in these drugs used for acne treatment.

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Which drug requires the iPledge agreement?

a) retinoids
b) isotretinoin
c) denosumab
d) permethrin

Answer: b)isotretinoin

This agreement is between the pharmacist, provider, and patient due the severe side effect profile this drug carries.

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What drugs can increase the adverse effects of isotretinoin (choose all that apply)?

a) warfarin
b) vitamin A
c) amoxicillin
d) theophylline
e) tetracyclines

Answer: b) vitamin A and e)tetracyclines

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Which is not an adverse effect of isotretinoin (choose all that apply)?

a) photosensitivity
b) depression
c) bone fractures
d) impaired hearing
e) hepatitis

Answer: e) hepatitis

Other severe SE: pancreatitis, elevated triglycerides, teratogen

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Which is not a mild SE of of isotretinoin (choose all that apply)?

a) hair loss
b) headache
c) ocular inflammation
d) constipation
e) nosebleeds

Answer: d) constipation

Other mild SE include: drying, rash, skin peeling

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True or false, when combination oral contraceptives are used for acne, the benefits are derived from the progestin?

False. Benefits are derived from the estrogen.

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Hormonal options for acne control include (choose all that apply):

a) combination OCs
b) IUD
c) spironolactone
d) Depot injections

Answer: a) combination OCs (ortho tri-cyclen, YAZ, Beyaz, estrostep) & c) spironolactone (used if OC inadequate)

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Side effects of spironolactone include (choose all that apply):

a) hyperkalemia
b) teratogen
c) depression
d) lymphoma

Ansewr: a) hyperkalemia and b)teratogen

Other SE: menstrual irregularities and breast tenderness

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Suncreens provide protection from UVA or UVB primarily?

Answer: UVB

UVB is responsible for tanning/sunburn even though UVA penetrates deeper

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Broad spectrum sunscreen covers UVA & UVB but must contain what ingredient in order to achieve this?

a) titanium oxide
b) dapsone
c) avobenzone
d) zinc

Answer: c) avobenzone

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Which medication does not increase photosensitivity?

a) aldendronate
b) TCA
c) sulfonamides
d) phenothiazine

Answer: a) aldendronate (Fosamax)

Drugs which increase photosensitivity include: TCA, sulfonamides, sulfonylureas, phenothiazine, TETRACYCLINE, FLUOROQUINOLONES

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Organic sunscreens are _____ (physical/chemical) barriers, whereas inorganic sunscreens are ______ (physical/chemical) barriers.

Organic=chemical barrier

Inorganic=physical barrier (zinc and titanium oxide)

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SPF indicates the amount of protection against _____(UVA/UVB)?

Answer: UVB SPF is the amount of protection against UVB

Dapsone (Aczone) can be used to modestly improve acne and can also be used in what other diagnosis? a) Paget's b) veneral warts c) leprosy d) actinic keratosis

Answer: c) leprosy The MOA of Dapsone is unknown.

First line treatment of psoriasis would be: a) vitamin A derivatives b) vitamin D analogs c) ointment d) topical glucocorticoids

Answer: d) topical glucocorticoids They are anti-inflammatory. Note that moderate-to-high strength needed due to plaque resistance to steroids.

Calcipotriene can be used to treat: a) osteoporosis b) Paget's c) psoriasis d) leprosy

Answer: c) psoriasis It is a vitamin D analog used topically in psoriasis. It suppresses lymphocyte activity. It can be used long term.

Which is not a treatment for psoriasis: a) immunosuppressants b) vitamin D analogs (Calcipotriene) c) Anthralin d) tar

Answer: all of these are used for psoriasis

Which drug has the side effect of staining skin and clothes? a) Zetar b) Methotrexate c) Risedronate d) Anthralin

Answer: d) Anthralin It is used topically for psoriasis

Which are systemic drugs used to treat psoriasis (choose all that apply)? a) Zetar b) Methotrexate c) Entancercept d) Anthralin

Answer: b) methotrexate & c) entancercept Zetar (tar) and Anthralin are used topically

Procedures to treat psoriasis include: a) tanning beds b) cryotherapy c) photochemotherapy d) podophyllin

Answer: c) photochemotherapy with a UVB light Will produce long lasting remission (2-4 months) Sometimes tar is used as an adjunct to the light.

True or false, 50% of all skin cancers start as actinic keratosis?

True. These are rough scaly brownish-red papules which develop due to chronic sun exposure.

Which is not a treatment for actinic keratosis? a) tacrolimus b) fluorouracil c) diclofenac sodium d) imiquimod

Answer: a) tacrolimus Tacrolimus is used for eczema. Other treatments for AK are aminolaevulinic acid+blue light and crytotherapy.

What condition is commonly seen in patients with eczema? a) AKs b) asthma c) arthritis d) absorption disorders (Celiac, Crohn's)

Answer: b) asthma

What is considered first line treatment for eczema (atopic dermatitis)? a) glucocorticoids (oral) b) immunosuppressants c) antihistamines d) moisturizers

Answer: d) moisturizers and TOPICAL glucocorticoids Key is to keep area moist. 2nd line agents: ORAL glucocorticoids

If moisturizers+topical glucorticoids & oral glucocorticoids are not successful in treating eczema, what is the next step? a) higher dose glucocorticoids b) immunosuppressants c) antihistamines d) monoclonial antibodies

Answer: b) immunosuppressants These are 3rd line agents in eczema. These include tacrolimus & pimecrolimus

Tacrolimus (an immunosuppressant) used in eczema carries what side effects? a) blood dyscrasias b) cancer c) hepatoxicity d) P450 substrate

Answer: b) cancer Other SE: lymphoma These drugs work by blocking calcineurin

True or false, venereal warts can be eliminated with adequate treatment.

False. Neither drugs nor physical measures will eliminate the virus.

Podophyllin is used to treat venereal warts. What side effects does this drug carry (choose all that apply)? a) highly caustic b) blood dyscrasias c) cancer d) teratogen e) CNS/PNS neuropathy

Answer: a, b, d, e Podophyllin SE: blood dyscrasias, CNS/PNS neuropathy, teratogen, and kidney damage Drug resin should be washed off a few hours after application.

Bichloracetic acid (BCA) & trichloracetic acid carry what side effects? a) blood dyscrasias b) cancer c) local tissue injury d) P450 substrate

Answer: c) local tissue injury They are used to treat venereal warts.

At home treatments of venereal warts DO NOT include: a) imiquimod b) podophyllin c) podoflox d) kunecatechins

Answer: b) podophyllin This drug is used IN OFFICE.

True or false, kunecatechins are not recommended in HIV patients, immunocompromised, or those with genital herpes.

True. This drug is an at home treatment for venereal warts.

Common warts are caused by: a) HPV 1 b) HPV 8 c) HPV 23 d) HPV 5

Answer: a) HPV-1 Also caused by HPV-2 & HPV-3

Common warts can be chemically removed by using which of these drugs (choose all that apply): a) podophyllin b) imiquimod c) fluorouracil d) bichloracetic acid e) podofilox

Answer: a,b,c,e Chemical removal drugs: salicylic acid, podophyllin, podofilox, imiquimod, trichloroacetic acid, topical fluorouracil

Drugs used for both common warts and venereal warts are: a) podophyllin b) trichloroacetic acid c) podofilox d) imiquimod

Answer: all of the above Imiquimod & podofilox can be used at home.

What patient is it appropriate to use Botox with/for? a) pregnant/breastfeeding patient b) female aged 55 c) male aged 70 d) patient taking tetracycline e) M. gravis

Answer: b) female aged 55 & d) patient taking tetracycline Botox should be avoided in the other groups. Those aged 65 will have little benefit from botox. Patients taking other neuromuscular drugs are at risk. Patients taking aminoglycosides should avoid.

Patients at risk for a reaction to botox include those who: a) are allergic to human albumin b) concurrently taking a neuromuscular blocking drug c) have a seizure disorder d) are taking tetracycline antibiotics

Answer: a & b Risks include those allergic to human albumin and concurrently taking a neuromuscular blocking drug or an aminoglycoside.

What organism is responsible for impetigo? a) S. pyogenes b) P. acnes c) S. aureus d) Candida intertrigo

Answer: c) staphylococcus aureus It is common in children aged 2-5 and appears often on the hands/feet/legs

Most (70%) of cases of impetigo are _____ (bullous/nonbullous).

Answer: nonbullous It usually is a small macule which evolves into an oozing vesicle (yellow-brown exudate) and dries into a honey-colored crust.

First line treatment of impetigo involves: a) cephalexin orally b) clindamycin topically c) Eucerin ointment d) mupirocin topically

Answer: d) mupirocin topically Other topical option is retapamulin. 2nd line treatments are oral ABX

Antibiotics used orally for impetigo include: a) clindamycin b) doxycycline c) cephalexin d) dicloxacillin

Answer: a) clindamycin, c) cephalexin, and d) dicloxacillin ``` ABX orally: Cephalexin Clindamycin Clavulanate/amoxicillin DiCloxacCillin ```

The organism responsible for seborrheic dermatitis usually is: a) Candida Balantis b) P. acnes c) S. aureus d) Candida intertrigo e) Malassezia

Answer: e) Malassezia It is a yeast microbe which causes scaling of scalp/face Treatment is topical ketoconazole

Which statement is true regarding seborrheic dermatitis (choose all that apply)? a) initial treatment involves topical ketoconazole b) initial treatment involves a yeast-suppressing shampoo c) initial treatment involves terbafine d) initial treatment involves glucocorticoids

Answer: a & d Initial treatment involves topical ketoconazole but often a concurrent glucocorticoid will be used which accelerates the response. Remission can be maintained with a yeast-suppressing shampoo (Head & Shoulders; Selsun blue)

true or false, tinea capitis usually involves ORAL itraconazole/fluconazole/ or griseofulvin.

True. It is poorly responsive to topical treatment.

Tinea corporis (ringworm) is usually treated with: a) itraconazole b) terbinafine c) griseofulvin d) ketoconazole

Answer: d) ketoconazole

Drugs that increase the risk of osteoporosis include (Check all that apply): ``` A) Oral combined contraceptives B) Carbamazepine C) CCBs D) High doses of Vitamin D E) Glucocorticoids F) Levothyroxine ```

Answer: B) carbamazepine, E) glucocorticoids, F) levothyroxine

SERMs treat osteoporosis by selectively: A. Inhibiting magnesium resorption in the kidneys B. Increasing calcium absorption from the GI tract C. Acting on the bone to inhibit osteoblast activity D. Selectively acting on the estrogen receptors in the bone

Answer: D) selectively acting on the estrogen receptors in the bone

``` he ongoing monitoring for patients over age 65 taking alendronate or any other bisphosphonate is: A. Annual DEXA scans B. Annual Vitamin D level C. Annual renal function evaluation D. Electrolytes every 3 months ```

Answer: C) annual renal function evaluation

IV forms of bisphosphonates are used for (Check all that apply): A. severe gastric irritation with oral forms B. Known cancer mets to the bone C. Persons with advancing renal dysfunction D. Progression of bone loss on oral meds E. After menopause for prevention of osteoporosis

Answer: A, B, D

T or F: Both UVA and UVB rays promote damage to DNA and can cause premalignant actinic keratoses, basal cell, squamous cell and melanoma.

True

Tacrolimus and pimecrolimusare used for atopic dermatitis. What do both carry the potential for: A. Both can cause skin cancer and lymphoma B. Both can cause renal failure C. Both can cause liver failure D. They have no side effect

Answer: A) both can cause skin cancer and lymphoma

Which is not considered a low potency topical steroid cream? a) Desonide 0.05% / Desowen b) Hydrocortisone 2.5% c) Triamcinolone Acetonide 0.1% d) Hydrocortisone 1%

Answer: c) Triamcinolone Acetonide is considered medium potency Both hydrocortisone options are the LOWEST potency available

Which is the only drug approved for hair growth in women? a) finasteide b) eflornithine c) selenium sulfide d) minoxidil

Answer: d) minoxidil Only the 2% solution is approved for women

What is the preferred treatment for onchomycosis? a) itraconazole b) ketoconazole c) terbinafine d) griseofulvin

Answer: c) terbinafine 6-12 weeks for fingernails and 3-6 months for toes

Treatment options for jock itch include (choose all that apply)? a) itraconazole b) ketoconazole c) terbinafine d) griseofulvin

Answer: a) itraconazole and b) ketoconazole think alphabetically: "I, J, K" I&K treat Jock itch

Finasteride carries what side effects: a) reduced ejaculate volume b) orthostatic hypotension c) blood dyscrasias d) teratogen e) nausea

Answer: a,b,d The drug is used for hair growth and BPH. Side effects are: decreased libido, ED, impaired ejaculation, reduced ejaculate volume, orthostatic hypotension, dizziness, teratogen Note: women should not take, or handle broken/crushed drug.

What use does eflornithine have? a) atopic dermatitis b) increases bone formation c) facilitates hair removal d) actinic keratosis

Answer: c) facilitates hair removal Side effect is possible fetal harm

Module 9 Flashcards

(68 cards)