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Derm Pharm Exam 2 Flashcards

1
Q

Pathogens causing cellulitis?

A

Staph aureus* (MSSA, MRSA, CA-MRSA)
Anaerobes
Gram + cocci
Gram - bacilli
Strep pyogenes

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2
Q

How is cellulitis diagnosed?

A

Blood culture is positive in only 30% of cases

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3
Q

What are some methods to approach cellulitis treatment?

A
  1. Mark margins before treatment
  2. Start empiric therapy
  3. Definitive therapy if known source
  4. Antimicrobial therapy for 7-10 days
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4
Q

Regular cellulitis treatment if mild/early infection?

A

Dicloxacillin or Cephalosporin
*Erythromycin if penicillin allergy

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5
Q

Regular cellulitis treatment if more severe infection?

A

Nafcillin or ceftriaxone IV

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6
Q

MSSA and strep pyogenes cellulitis treatment?

A

Cephalexin, dicloxacillin, clindamycin (all oral)

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7
Q

What is an oral option for CA-MRSA (not severe) to treat cellulitis?

A

Clindamycin, Trimethoprim-sulfamethoxazole

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8
Q

Severe CA-MRSA cellulitis treatment?

A

IV Vancomycin (go to), Linezolid, Daptomycin

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9
Q

What are causative pathogens of folliculitis?

A

Staph aureus (most common)
CA-MRSA
Pseudomonas aeruginosa (most often with pools and hot tubs)

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10
Q

What are some things to remember about folliculitis treatment?

A

Antibiotics are usually not necessary for smaller boils and warm saline compresses can be used to promote draining

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11
Q

Where do furuncles typically occur?

A

areas of friction or perspiration

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12
Q

Where are carbuncles typically found?

A

usually on the back of the neck

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13
Q

Who is at an increased risk of carbuncles?

A

Diabetics

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14
Q

How should MSSA or Strep pyogenes furuncle/carbuncle be treated?

A

Antibiotic course 7-10 days:
Dicloxacillin
Cephalexin
Clindamycin

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15
Q

How should CA-MRSA furuncle/carbuncle be treated?

A

Clindamycin, T/S, Linezolid
*may require IV therapy with Vancomycin

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16
Q

Most common organisms for impetigo?

A

Strep pyogenes and staph aureus

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17
Q

How is impetigo spread/environment?

A

Hot/humid climate and close contacts

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18
Q

What are topical treatment options for impetigo?

A

Mupirocin ointment 3x per day for 7-14 days

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19
Q

What topical treatment for MSSA impetigo?

A

Retapamulin ointment 1% twice daily for 5 days

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20
Q

Impetigo systemic antibiotics?

A

Dicloxacillin, cephalexin, clindamycin, amoxicillin/clavulanate

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21
Q

Mupirocin MOA

A

inhibits RNA synthesis, gram + bacteria, Bacteriostatic at lower doses and bacteriocidal at higher doses

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22
Q

Retapamulin MOA

A

Inhibitis bacterial protein synthesis by binding to a unique site on ribosomal 50S unit

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23
Q

What is retapamulin limited to?

A

impetigo; alternative to mupirocin

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24
Q

What is important to note about retapamulin?

A

Has a distinct mechanism that targets specific cross-resistance with other antibiotics does not occur

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25
Antibiotics that inhibit cell wall synthesis
Penicillins cephalosporins Meropenem Vancomycin
26
Antibiotics that inhibit bacterial protein synthesis?
Macrolides Linezolid Clindamycin
27
Antibiotics that inhibit nuclein acid synthesis
Fluoroquinolones Rifampin
28
Antibiotics that inhibit folic acid synthesis
sulfonamides Trimethoprim
29
Antibiotic that inhibit free radical formation
Metronidazole
30
What bite is more likely to cause infection
Cat bites
31
What to consider when choosing empiric therapy for bite treatment
Based on the oral flora of the biting animal Consider MRSA Pasturella in 50% dog wounds and 75% cat wounds
32
When to use parenteral antibiotic for bite
Systemic signs of toxicity Deep infection/osteomyelitis Rapid progression of erythema Progression after 48 hours of oral therapy Proximity to an indwelling device
33
Non-pharm options for burn treatment
Cool the burned area Avoid ice Wash but do not scrub Do not remove blisters less than 6mm and intact Cover burns with dressings
34
When do you update tetanus when treating a burn?
greater than 1st degree burn
35
Pain management options for burn?
NSAIDs, topical diclofenac (not on open wounds) and last resort is opioids
36
First degree burns topical agents?
Aloe vera Antibiotic ointments
37
Second degree burn topical agents?
Topical antimicrobial and occlusive dressing
38
Lyme disease symptoms
Bull's-eye rash and flu-like symptoms
39
How to prevent tick bites?
Wear protective clothing Routine antimicrobial prophylaxis NOT recommended
40
When should Lyme prophylaxis be considered?
Attached tick identified as I. scapularis for 36+ hours within 72 hours of tick removal Doxycycline 200mg orally once CI in pregnancy and children <8 years old Patient should be monitored for at least 30 days after the tick bite
41
Early Lyme disease treatment?
Doxycycline 100mg BID x 14 days Children: Amoxicillin
42
Lyme meningitis/Neurological disease treatment?
Ceftriaxone 2 grams IV daily for 14 days or Doxycycline 200-400 mg orally Pediatrics: Ceftriaxone 50-75mg/kg/day IV
43
Lyme carditis treatment?
Parenteral therapy 14-21 days
44
Lyme arthritis treatment?
Oral antibiotics for 28 days
45
HPV wart notes?
Warts will regress but virus will progress Cervical warts
46
Medical treatment for HPV wart treatment?
Liquid nitrogen
47
HPV non pregnant limited vaginal disease treatment?
Trichloroacetic acid, possible laser ablation
48
HPV non pregnant limited vulvular disease
Compliance with self therapy - Imiquimod Non compliant - Trichloroacetic acid
49
Describe Trichloroacetic acid HPV treatment
Applied by healthcare provider Can be used on vulva, vagina, and in pregnancy Weekly application for 4-6 weeks Large thick lesions may not respond
50
Describe imiquimod treatment for HPV
immune response modifier Wash hands before and after application
51
How is Aldara applies for HPV
3 days per week for up to 16 weeks
52
How is Zyclara applied for HPV
daily for up to 8 weeks
53
HPV recurrence?
30% have a recurrence within 12 weeks
54
HPV vaccination?
Gardasil 9
55
Who can get Gardasil 9?
All male and female patient ages 11-12 through age 26 if not yet vaccinated
56
How should Gardasil 9 be administered?
Before HPV exposure Not during pregnancy
57
When is HSV-1 developed?
Childhood
58
When is HSV-2 developed?
Sexually transmitted
59
What is the clinical presentation of HSV?
Mucocutaneous and Meningoencephalitis
60
How can HSV be treated?
Acyclovir and valacyclovir (against HSV-1 and HSV-2)
61
How is VZV transmitted?
aerosolized droplets or direct contact
62
When does VZV infectivity begin
48 hours before onset of rash and ends when all skin lesions have fully crusted
63
What us the clinical presentation of VZV?
Chickenpox Shingles Sever pain before lesion appears Postherpetic neuralgia
64
Chickenpox treatment?
Antiviral not indicated for children Acyclovir 800mg 5x daily for adults IV acyclovir for immunocompromised
65
Shingles treatment?
Acyclovir 800mg 5 times daily x 7-10 days Initiate within 72 hours IV therapy if immunocompromised or severe
66
Acyclovir MOA?
Prodrug that requires activation DNA synthesis is prevented w/o affecting normal host cell functions
67
What all can acyclovir treat?
HSV-1, HSV-2, VZV
68
Pharmokinetics of acyclovir?
Oral, IV, topical Poor absorption CSF penetration
69
What drugs interact withe acyclovir?
Cyclosporine Sirolimus Tacrolimus
70
Safety/education for acyclovir?
Treatment is not curative Does not prevent spread Precautions are necessary
71
What does valacyclovir turn into?
Acyclovir
72
What is the benefit of valacyclovir?
Liquid option Greater availability than acyclovir
73
What type of vaccine is varicella zoster vaccine?
Live vaccine Routine childhood vaccine - 2 doses
74
Who is Shingrix recommended for and how is it administered?
Recommended for immunocompromised adults >50 years old 2 doses separated by 2-6 months Avoid in pregnancy
75
Zostavax?
No longer available
76
What to note about systemic fungal infections?
Invasive Candida is responsible in 90% of cases
77
Two classes of antifungals and two in each class?
Imidazole - Ketoconazole and Clotrimazole Triazole - fluconazole and itraconazole
78
Azole antifungal MOA?
Disrupts fungal cell membrane integrity
79
What species are Azoles effective against?
Candida, dermatophytes NOT effective against Aspergillus
80
How are azoles offered?
IV, oral, topical
81
Absorption effects with different azoles?
Fluconazole - food no effect Ketoconazole - variable Itraconazole - INCREASED absorption with food
82
What azole crosses the BBB
fluconazole
83
Important drug interaction with azole?
They are CYP INHIBITORS
84
What are CYP substrates effected by azoles? (increased concentration)
Warfarin Phenytoin Carbamazepine Cyclosporine Tacrolimus
85
What will decrease the absorption of azoles?
Antacids
86
BBW of azoles?
itraconazole - CHF ketoconazole - hepatotoxicity, QT prolongation
87
What to note about nystatin resistance?
Rare
88
Nystatin antifungal spectrum?
candida albicans
89
Pt. education with nystatin?
Do not eat or drink for 20 minutes after use
90
How to take nystatin with esophageal candidiasis?
swish and SWALLOW
91
How to take nystatin with oral candidiasis?
Swish and SPIT
92
How to treat mild oral candidiasis?
Clotrimazole troches
93
How to treat oral candidiasis moderate/severe/unresponsive to topical therapy?
Fluconazole 100-200mg
94
How to treat refractory oral candidiasis?
Nystatin suspension
95
Uncomplicated vulvovaginal candidiasis treatment?
Fluconazole 150mg x 1
96
How to treat vulvovaginal candidiasis with severe symptoms?
Fluconazole 150mg every 72 hours for 2-3 doses
97
How to treat recurrent vulvovaginal candidiasis?
Fluconazole 150mg every 72 hours for 2-3 doses + maintenance 150mg per week for 6 months
98
How to treat vulvovaginal candidiasis in pregnancy?
Topical clotrimazole or miconazole
99
What is first line treatment for topical antifungal infections?
Terbinafine 1%
100
When should systemic therapy be considered for fungal infections?
topical therapy failure
101
What are systemic antifungal treatment options?
Terbinafine Itraconazole Fluconazole
102
What is the gold standard treatment for onychomycosis?
Oral antifungal agents
103
What is the only topical option for onychomycosis?
Ciclopirox
104
What are some therapeutic options for diaper dermatitis?
Barrier preparations Topical corticosteroids Antifungal agents
105
What should be avoided for diaper dermatitis due to systemic toxicity risk?
Baking soda
106
What are some barrier ointment options for diaper dermatitis?
OTC - Petrolatum and zinc oxide Rx - sucralfate
107
What are some antifungal agents for diaper dermatitis?
Nystatin and ketoconazole for candida
108
What is an example of mild to moderate treatment for diaper dermatitis?
Zinc oxide products
109
How to treat a bacterial superinfection caused by diaper dermatitis?
Topical or oral antibiotics *oral only for very severe infections

Anatomy & Physiology (6 decks)

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