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Paige: Derm > Pharm Blessings > Flashcards

Pharm Blessings Flashcards

1
Q

Which acne medication can induce bronchospasm?

A

Isotrentinoin [accutane]

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2
Q

What is the DOC for a person with acne AND asthma?

A

Topical trentinoin [Retin-A micro]

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3
Q

What is the PG category of topical trentinoin?

A

C

(less than 10% absorbed topically)

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4
Q

What is the MOA of trentinoin [retin-a micro]?

A

unclogging pores and antiinflammatory effect

Bind to RARs & RXRs to regulate gene expression & increase epidermal cell turnover

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5
Q

What are some side effects of trentinoin [retin-a micro]?

A

redness, drying, peeling

may initially have increase in acne

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6
Q

In what populations should you avoid prescribing trentinoin [retin-a micro]?

A

PG

Children under 12

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7
Q

When should you instruct your pt to apply trentinoin (retin-a micro)?

A

at night

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8
Q

Your pt. has a bacterial sinusitis, and needs an abx. However, she usually gets vaginal yeast infections when she goes on abx.

What will you prescribe for her?

A

Augmentin for ABS

Fluconazole [diflucan] for yeast infection

can also use topical/oral nystatin [mycostatin], ciclopirox olamine [loprox], or terbinafine [lamisil] for yeast

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9
Q

What is the DOC for mild psoriasis?

A

short-term topical steroids (e.g. betamethasone or triamcinolone or clobetasol proprionate)

OR

topical calcipotriene [dovonex]

(Vitamin D)

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10
Q

What’s the issue with Rxing long-term topical steroids?

A

Can develop tachyphylaxis

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11
Q

What comorbid diseases might be seen with those with psoriasis?

A

Psoriatic arthritis

CVD

lymphoma

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12
Q

Your pt is on low dose ICS for asthma. He was treated with a burst of steroids and really liked it, and would like po steroids long term. What are you going to do for him?

A

NOT LT STEROIDS.

Give him a spacer or increase his dose of ICS.

Hollllaaaaaaaa

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13
Q

You have an asthma patient who requires a short burst of po steroids. He also has psoriasis. How will the tx affect his psoriasis?

A

It will start to clear up with the steroids, but will come back when the course is done.

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14
Q

What is the DOC for episodic OR maintenance of recurrent herpes outbreaks?

A

Acyclovir [zovirax]

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15
Q

For how long can you prescribe acyclovir [zovirax] without having adverse effects?

A

10 years!

Then decreased efficacy, renal damage

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16
Q

Which HSV virus causes genital herpes?

A

HSV2

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17
Q

How do you rx acyclovir [zovirax] for a pt with CKD?

A

Can still rx, but need to adjust dosing.

***Dosing is in Sanford guide…somewhere***

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18
Q

Herpes can still be transmitted when there is no outbreak, but the risk of transmission is reduced by ___%.

A

50%

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19
Q

How much is HSV shedding decreased when on acyclovir?

A

by 90-97%

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20
Q

What is the DOC for rosacea?

A

Mostly this will be referred to derm.

In a PC office, we will treat with avoidance of triggers and topical abx (metranidazole, erythro, clindamycin)

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21
Q

What is rosacea?

A

Dilitation of the blood vessels in the face

Sometimes can give them a big bulbous nose

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22
Q

Well shiiiieeeetttt. Your patient rolled around in poison ivy. It’s everywhere. Like, everywhere.

What will you probably give him?

A

Oral steroids for 3 weeks.

Taper. 40 mg to 20 mg to 10 or 5 mg.

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23
Q

What is usually the DOC for poison ivy?

A

Uusally not steroids unless it’s widespread, or is on your face or your junk.

Usually conserative tx: oatmeal, ice, calamine lotion

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24
Q

What is the most absorbant tissue in the body?

A

Scrotum

Followed by other mucus membranes: vagina, rectum, eyes, lips (I think in that order)

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25
Q

Your 2y.o. patient has a honey-colored rash that she’s picking at on her face. What will you rx?

A

This is impetigo so there’s a 90% chance she has a staph inf.

DOC = mupirocin [bactroban]

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26
Q

Does mupirocin [bactroban] cover for MRSA?

A

YES BABY YES

27
Q

What ingredient is in mupirocin [bactroban] that could cause burning/stinging?

A

polyethylene glycol

28
Q

Mupirocin [bactroban] is AWESOME for staph. Why does it only come in topical form?

A

Oral form would cause…get ready for it…………….

nephrotoxicity (shocker)

29
Q

Is impetigo contagious?

A

HIGHLY.

Educate family about this.

30
Q

Do you want to give topical steroids for diaper rash?

A

No way man.

Can still be absorbed into their system and cause issues.

31
Q

Does bacitracin cover Gm + or Gm -?

A

Gm + like S. aureus

32
Q

Does polymixin b sulfate cover Gm + or Gm -?

A

Gm - like pseudomonas

33
Q

Throwback:

What do you prescribe for giant cell arteritis?

And who ya gonna call?

A

Rx HD oral steroids

Refer to ophthalamology, ENT, rheum, ghostbusters

34
Q

Your pt has T2DM and you’re putting them on prednisone. What should you monitor closely?

A

Hyperglycemia

35
Q

How do you tx oral candidiasis?

A

Nystatin swish n swallow!

36
Q

Your pt has a rash on the T7 dermatome of his R thorax. What will you rx?

A

he’s got shingles (VZV)

ACYCLOVIR [zovirax] 5x daily

37
Q

Your next pt has shingles too! This one’s got CKD. What are you going to give him?

A

Still acyclovir, but 3x daily

38
Q

How do you write prescriptions for topical creams?

A

Multiples of 15; measured in grams

smallest is 15g, largest is 120g

make it an appropriate amount for what they need!

39
Q

What are 2 diseases that we are likely to see with long term steroid use?

A

Cushing’s disease

Osteopenia/porosis

40
Q

What can happen if you taper someone off of steroids too fast?

A

Hypotension

(may take 3-4 months to get someone off long term steroids)

41
Q

Your patient has psoriatic arthritis. He’s already on topical calcipotriene [dovonex]. What will you rx?

A

Sulfasalazine and/or methotrexate

AND folic acid

42
Q

How do you categorize psoriasis that has progressed to psoriatic arthritis?

What is this pt at an increased risk for now?

A

it has progressed from mild to moderate/severe psoriasis

Increases risk for CVD

43
Q

Are MTX and sulfasalazine indicated for psoriatic arthritis?

A

Not really!

Off-label use!

44
Q

Let’s not forget the MOA of etanerept [enbrel]…..

A

binds to TNF on cells to decrease inflammation

45
Q

Patient has 25% of her body covered in blisters with loose, peeling skin after taking an abx. What disease does this sound like?

A

Stephen-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

46
Q

What abx most commonly causes SJS?

A

BACTRIM

47
Q

Why does it matter that 25% of the body is covered (known as body surface area or BSA)?

What does it mean if it were less or more?

A

Erythema Multiforme is < 10% BSA centrally and no epidermal detachment

SJS is < 10% BSA and sloughing

TEN is > 30% BSA and sloughing

Involvement of 15-30% BSA is SJS/TEN together

48
Q

What do you do for a patient with SJS or TEN?

A

Stop Bactrim.

Admit to burn center.

Wound care and burn precautions (fluids and electrolytes, nutrition, temp/pain mgmt, ocular care, monitor superinfection)

49
Q

Your pt. has a hx of SJS and now has a UTI. What will you treat them with?

A

Usually you would give a sulfa drug, but with hx of SJS probably wouldn’t want to.

Can give ciprofloxacin

50
Q

SCABIES. How do you treat?

A

DOC = topical permethrin 5% [elemite]

51
Q

How do you instruct pts to use permethrin [emelite]?

A

Apply head to toe, leave on overnight (8-14h), then wash with water in the morning.

Apply once, then repeat in 7 days

52
Q

What else is important to give to your patient with scabies? (Hint: it’s not a drug)

A

Literature about how to clean bed linens, clothing, treating family, etc.

(typically you wash everything in hot water, then bag it for 2-3 days)

53
Q

pt. has head lice. how can you treat?

A

permethrin [elemite] 1% cream rinse

54
Q

How do you instruct your patient to use the permethrin [elimite] cream rinse?

A

Shampoo hair, towel dry, and put cream on. Then use comb to remove nits.

Wash out over sink rather than in shower.

55
Q

Can a kid with lice still go to school?

A

You betcha.

56
Q

How do you treat onchyomycosis?

A

oral terbinifne [lamisil] for 12 weeks

57
Q

What comorbid disorder should you NOT use terbinafine [lamisil] in?

A

liver/renal disease

(and these are heavy hitter drugs, so confirm the dx in everyone)

58
Q

What other conditions can give you funky toenails?

A

melanoma, psoriasis

59
Q

What are the 2 most common presentations of a penicillin allergy?

A
  1. Immediately or 24h after, anyphylaxis
  2. After course of abx, fine pruritic rash over torso & occasionally hives
60
Q

What is a low potency topical steroid?

A

betamethasone 0.2% [celestone]

61
Q

What is an intermediate potency topical steroid?

A

triamcinolone acetonide 0.1% [kenalog]

62
Q

What is a high potency topical steroid?

A

halcinonide 0.1% or triamcinolone acetonide 0.5% [kenalog]

63
Q

What is a highest potency topical steroid?

A

clobestasol propionate [temovate]

Paige: Derm (2 decks)

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