Derm/HEENT

Question 1

Topical retinoids

Answer 1

adapalene, tazarotene, tretinoin
avoid in pregnancy, women should use contraception; photosensitivity
first line therapy for acne

Question 2

Topical antimicrobials

Answer 2

clindamycin, erythromycin

best efficacy for acne when combined with retinoids or benzoyl peroxide

Question 3

benzoyl peroxide

Answer 3

photosensitivity, skin and fabric bleaching

ofen used in combo with oral or topical antimicrobials for acne

Question 4

azelaic acid cream

Answer 4

skin irritation, hypopigmentation possible
adding to topical antimicrobials is more effective than alone
experts believe it has limited efficacy

Question 5

dapsone topical gel

Answer 5

newer drug for acne; still being studied for long-term and combination efficacy
possible decrease in Hgb; photosensitivity

Question 6

oral antibiotics for acne

Answer 6

minocycline, doxy, tretra, and erythromycin are all efficacious
minocycline is most efficacious then doxy and tetra

Question 7

oral isotretinoin

Answer 7

for severe, treatment resistant acne
highly teratogenic (iPledge); suicidal ideations; sunburn risk
monthy monitoring: CBC, glucose, lipids, creatine phosphokinase, liver fxn, mood changes

Question 8

azelastine

Answer 8

intranasal antihistamine
some somnolence and drowsiness
less effective than intranasal corticosteroids
first line therapy for pts with mild disease (possibly more effective than oral antihistamines)

Question 9

leukotriene receptor antagonists

Answer 9

montelukast, zafirlukast, zileuton
rare neuropsychiatric disorders
less effective than intranasal corticosteroids, as effective as oral antihistamines (may be used in combo)
zileuton- drug interactions and liver monitoring
zafirluast- administer 1 hour before or 2 hours after meals

Question 10

permethrin 5%

Answer 10

first line for scabies
may worsen asthma; photosensitivity
cover ALL areas of the body below head, leave on 8-14 hours
age 2 and older
once weekly for up to 3 weeks

Question 11

ivermectin

Answer 11

oral, not FDA approved but used for scabies if not eradicated by permethrin; same for head lice
warnings: symptomatic postural hypotension; association with increased 6-month mortality in long-term care residents
peripheral edema, tachycardia, GI effects, transaminase elevations
single dose repeated after 14 days

Question 12

topical lindane

Answer 12

second-line for scabies for permethrin non-responders
BBW: neurologic toxicity (seizures and death) w/prolonged or repeated exposure
May cause pruritis for several weeks
one total body application (leave on 8-12 hours) - do not retreat!

Question 13

permethrin 1%

Answer 13

first line for pediculosis

may repeat in 7-10 days if nits present

Question 14

malathion 0.5%

Answer 14

for pediculosis when permethrin resistance suspected
flammable; CI in children < 24 months; no safety data for children < 6 years
apply to hair and remove after 8-12 hours (may repeat in one week)

Question 15

spinosad

Answer 15

limited data suggest it is superior to permethrin but not yet in guidelines
Not for infants < 6 months d/t benzyl alcohol (gasping syndrome)
ADE: alopecia
may repeat in 7 days if nits present

Question 16

Bactrim for head lice

Answer 16

can add to permethrin for higher success rate than either agent alone. Add to permethrin if nits and lice are found 2 weeks after first course.
CI: < 2 months old; pregnant/nursing
BID for 10 days

Question 17

AREDS formula

Answer 17

vitamin C, E, (A or beta-carotene) and zinc
effective preventing pts with intermediate macular degeneration from progressing to advanced dx or visual acuity loss
no benefit in pts with age-related macular degeneration
do not use the beta-carotene formulation in smokers or lung cancer pts

Question 18

bevacizumab

Answer 18

intravitreal therapy for neovascular (wet) macular degeneration
not FDA labeled for AMD; however it is more widely used and covered by insurance d/t cost advantage over ranibizumab

Question 19

ranibizumab

Answer 19

intravitreal therapy for neovascular (wet) macular degeneration
most extensively studied but also very expensive

Question 20

prostaglandin analogs

Answer 20

for open-angle glaucoma
bimatoprost, latanoprost, tafluprost, travoprost
CI: macular edema, hx of herpetic keratitis
greatest IOP reduction of the available pharm agents

Question 21

B-antagonists (topical)

Answer 21

betaxolol, timolol, levobunolol, metipranolol, carteolol
adding to prostaglandin analog for OAG decreases variations in IOP
do not use as monotherapy in angle-closure glaucoma

Question 22

a-antagonists

Answer 22

apraclonidine, brimonidine (preferred)
third-line for glaucoma
caution: CV dx, cerebrovascular dx, depression, orthostatic hypotension, Raynaud

Question 23

carbonic anydrase inhibitors

Answer 23

topical: brinzolamide, dorzolamide
oral: acetazolamide, methazolamide
third-line agent for glaucoma
topical used before oral formulations
CI to systemic: aplastic anemia, nephrolithiasis, sulfonamide allergy, thrombocytopenia

Question 24

topical corticosteroids for psoriasis

Answer 24

TOC for mild-mod dx

as effective as vitamin d analog but fewer ADRs

Question 25

calcipotriene

Answer 25

topical vitamin d analog for psoriasis
use in combo with topical corticosteroid (betamethasone best) for added efficacy
NOT contraindicated in UVB phototherapy
ADE: photosensitivy, UV-induced skin tumors, hypercalcemia

Question 26

tazarotene

Answer 26

topical retinoid for psoriasis
preg category X, photosensitivity
use w/topical corticosteroids

Question 27

alefacept

Answer 27

t-cell inhibitor shows improvement in chronic plaque psoriasis
ADE: flulike, elevated hepatic transaminases
once weekly intramuscular inj for 12 weeks then 12 week tx free

Question 28

TNF inhibitors

Answer 28

adalimumab, etanercept, infliximab
for psoriasis
linked with new or worsenign HF
infliximab has greatest decrease in sxs in shortest time (10 vs 12 weeks)
have been combine with methotrexate
subq dosing

Question 29

methotrexate

Answer 29

may be less effective than cyclosporine
reserved for pts w/moderate to severe or refractory psoriasis
probably not as effacacious as t-cell inhibitors or TNF inhibitors

Question 30

cyclosporine

Answer 30

do not use with UV phototherapy
reserved for pts w/moderate to severe or refractory psoriasis
probably not as effacacious as t-cell inhibitors or TNF inhibitors

Question 31

acitretin

Answer 31

preg cat X; less effective than other therapies for psoriasis
reserved for pts w/moderate to severe or refractory psoriasis
probably not as effacacious as t-cell inhibitors or TNF inhibitors