Week 10: Derm

Question 1

Bacterial infections of the skin usually caused by:

Answer 1

Staph aureus or MRSA
Strep pyogenes (group A strep)

Question 2

Nonpharm care of bacterial skin infections:

Answer 2

Good hygiene
Warm compresses
Elevation of lower extremity
If severe infections: I and D with culture

Question 3

Topical antibiotics used for bacterial skin infections:

Answer 3

Mupriocin (Bactroban)

Gentamycin

Question 4

What topical antibiotic is effective against S. Aureus and used to decolonize carriers?

Answer 4

Mupirocin (bactroban)

Question 5

What topical antibiotic is used for group a strep, s. Aureus, and pseudomonas?

Answer 5

Gentamycin

Question 6

Folliculitis is a superficial bacterial infection of hair follicle that is primarily caused by?

Answer 6

Staph aureus

Question 7

Folliculitis in the groin could be caused by?

Answer 7

Candidiasis

Question 8

Folliculitis from swimming pool/hot tub exposure is caused by?

Answer 8

Pseudomonas

Question 9

Topical therapy for folliculitis?

Answer 9

Bactroban or clindamycin gel

Question 10

If folliculitis is severe/diffuse how would you treat?

Answer 10

Cephalexin, keeled, or augmentin for staph

Question 11

Antibiotics are recommended for abscesses associated with:

Answer 11

Severe or extensive disease(involving multiple sites)
Rapid progression in presence of associated cellulitis
Signs/symptoms of systemic illness
Associated comorbidities
Extremes of age
Abscess in area difficult to drain (face, hands, or genitalia)
Associated septic phlebitis
Lack of response to I and D alone

Question 12

Antibiotic therapy for abscess:

Answer 12

1st line: broad-spectrum penicillin or first generation cephalosporins (cephalexin)

Question 13

Second line antibiotic therapy for abscess:

Answer 13

2nd/3rd generation cephalosporins or fluoroquinolones (ciprofloxacin- good for pseudomonas)

Question 14

Treatment for abrasion:

Answer 14

Clean, apply bacitracin, triple antibiotic ointment and cover until it’s healed

Question 15

Treatment of abscess with CA-MRSA:

Answer 15

I and D
Systemic antibiotics- if there is surrounding inflammation or induration:
-bactrim 
- mino /doxycycline 
- zyvox
- Vancomycin for serious infections

Question 16

Treatment of mild acne:

Answer 16

BP or topical retinoids or combo of both

Question 17

Treatment of moderate acne:

Answer 17

Combo of BP+ antibiotic or retinoid or oral antibiotic plus topical retinoid and BP

Question 18

Pharmacological treatment for acne with comedolytics:

Answer 18

Topical retinoid - core of topical treatment but use at a different time then BP
Benzoyl Peroxide

Question 19

Side effects of topical retinoids:

Answer 19

Dryness/peeling, erythema, photosensitivity, pregnancy class C

Question 20

MOA of Azelex:

Answer 20

Interferes with DNA synthesis of P. Acnes, antibacterial and anti inflammatory

Question 21

Caution with azelex:

Answer 21

Can cause pigment changes in dark skin

Question 22

Topical antibiotics for acne treatment include:

Answer 22

Erythromycin and clindamycin

Question 23

MOA of topical antibiotics and acne:

Answer 23

Reduce microbial colonization and decrease inflammatory response, best used in combo with a comedolytic

Question 24

Oral antibiotics are used in what type of acne?

Answer 24

Moderate to severe

Question 25

First line oral antibiotic in acne:

Answer 25

Tetracycline- educate of photosensitivty

Question 26

Other oral antibiotic options in acne:

Answer 26

Erythromycin and bactrim

Question 27

Adverse events of accurate:

Answer 27

Monitor for lipids, osteoporosis, depression Dryness, itching of mucous membranes and skin Muscle aches, corneal opacities Teratogenic- pregnancy class x- must use 2 forms of birth control!

Question 28

Cutaneous vascular disorder of increased reaction of capillaries to heat that is present for at least 3 months and starts between the ages of 30-50.

Answer 28

Acne rosacea

Question 29

First line therapy for acne rosacea:

Answer 29

Topical: Metronidazole gel/cream/lotion Sodium sulfacetamide with sulfur Azelaic acid

Question 30

Nonpharmacologic treatment of acute dermatitis:

Answer 30

Avoidance of perfumes, irritants such as smoke, detergent, soaps, and bubble bath Decrease frequency of bathing, temp of water, and duration of shower/bath Loose/cotton clothing

Question 31

Cornerstone of atopic dermatitis therapy:

Answer 31

Emollients- 1-4 times daily and after bathing with no alcohol or fragrance

Question 32

1st line pharmacologic treatment of atopic dermatitis:

Answer 32

Topical steroids: work on immune cells interfering with antigen processing and suppressing the release of proinflammatory cytokines

Question 33

Where to use low-potency topical steroids:

Answer 33

Face, mucous membranes, genitalia, intertriginous areas

Question 34

What type of steroids are needed in the palms and soles?

Answer 34

Potent

Question 35

Ointment and steroid vehicles is more or less potent?

Answer 35

More potent and good for dry rashes

Question 36

What vehicle for steroids is good for wet rashes?

Answer 36

Creams

Question 37

Second line therapy for atopic dermatitis?

Answer 37

Topical calcineurin inhibitors: elidel and protopic

Question 38

Calcineurin inhibitors can be used in ages:

Answer 38

Elidel: infant and up Protopic: 2 and up (0.3%)

Question 39

Side effects of calcineurin inhibitors:

Answer 39

Viral infections such as HSV, Molly scum, varicella, warts Flu-like symptoms, allergic reaction, asthma, cough, fever, headache Pregnancy cat c

Question 40

Systemic treatment for atopic dermatitis:

Answer 40

Oral antihistamines

Question 41

Skin disorder caused by uncontrolled accelerated replication of the basal epidermal cells, causes redness, flaking, and thickened patches.

Answer 41

Psoriasis

Question 42

Treatment of psoriasis:

Answer 42

``` Emollients Topical steroids-cornerstone Topical immunosuppressives- elidel/protopic Vitamin D derivatives- dovonex, sorilux Keratolytic agent- salicylic acid ```

Question 43

First line treatment in psoriasis:

Answer 43

Emollients | Topical steroids

Question 44

First line therapy in impetigo:

Answer 44

Mupirocin (Bactoban)

Question 45

What medication can be used to treatment inflammatory pustular acne?

Answer 45

Oral tetracycline

Question 46

If you treat a fungus with a steroid cream it will:

Answer 46

Get worse

Question 47

Oral antifungals should be reserved for:

Answer 47

Severe or extensive cases

Question 48

Oral antifungals can cause:

Answer 48

Significant hypoglycemia when a patient is on hypoglycemia meds

Question 49

Preferred agent for tinea capitis and tinea corporis of oral treatment is needed:

Answer 49

Griseofulvin- oral antifungal

Question 50

Yeast/tinea infection of the nails:

Answer 50

Onychomycosis

Question 51

Onychomycosis treatment:

Answer 51

Penlac 8% daily application for 48 weeks

Question 52

MOA of penlac:

Answer 52

Inhibits enzymes responsible for the breakdown of peroxidases within fungal cells,interrupts RNA/DNA synthesis, alternative to systemic treatment for onychomycosis

Question 53

MOA of topical retinoid:

Answer 53

Decreases the cohesion of epidermal and follicular cells

Question 54

Griseofulvin should be taken:

Answer 54

With fatty foods to increase absorption, liquid form is easiest for patients to find

Question 55

Topical antiviral agents:

Answer 55

Acyclovir and pencyclovir

Question 56

Topical antiviral moa:

Answer 56

Inhibiting viral DNA synthesis which decreases healing time

Question 57

Systemic antiviral agents:

Answer 57

Acyclovir, famciclovir, valacyclovir

Question 58

Systemic antivirals are contraindicated in:

Answer 58

Renal disease

Question 59

Side effects of systemic antivirals:

Answer 59

Headache, vertigo, depression, tremors

Question 60

Famciclovir dosing:

Answer 60

HSV: 250 TID x 7-10 days (initial); recurrent 1000mg BID for 1 day or 250mg twice a day Zoster: 500 mg TID x 7 days

Question 61

Acyclovir dosing:

Answer 61

HSV: 200mg 5 times per day initial; recurrent 200 mg 5 times per day x 5 days Zoster: 800 mg 5 times per day x 7 days

Question 62

Valacyclovir dosing:

Answer 62

HSV: initial 1000 mg bid for 10 days Zoster: 1000 mg TID for 7 days

Question 63

First line therapy for warts:

Answer 63

Salicylic acid for 8 weeks if not resolved after 8 weeks- cryotherapy

Question 64

Therapy for genital warts:

Answer 64

Podofilox solution or gel Imiquimod cream Practitioner applied: Cryotherapy Podophyllin Trichloroacetic acid

Question 65

Poison ivy therapy:

Answer 65

May need steroid burst or medrol pack