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Anatomy & Physiology > Derm Pharm Exam 2 > Flashcards

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
Q

Antibiotics that inhibit cell wall synthesis

A

Penicillins
cephalosporins
Meropenem
Vancomycin

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26
Q

Antibiotics that inhibit bacterial protein synthesis?

A

Macrolides
Linezolid
Clindamycin

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27
Q

Antibiotics that inhibit nuclein acid synthesis

A

Fluoroquinolones
Rifampin

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28
Q

Antibiotics that inhibit folic acid synthesis

A

sulfonamides
Trimethoprim

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29
Q

Antibiotic that inhibit free radical formation

A

Metronidazole

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30
Q

What bite is more likely to cause infection

A

Cat bites

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31
Q

What to consider when choosing empiric therapy for bite treatment

A

Based on the oral flora of the biting animal
Consider MRSA
Pasturella in 50% dog wounds and 75% cat wounds

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32
Q

When to use parenteral antibiotic for bite

A

Systemic signs of toxicity
Deep infection/osteomyelitis
Rapid progression of erythema
Progression after 48 hours of oral therapy
Proximity to an indwelling device

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33
Q

Non-pharm options for burn treatment

A

Cool the burned area
Avoid ice
Wash but do not scrub
Do not remove blisters less than 6mm and intact
Cover burns with dressings

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34
Q

When do you update tetanus when treating a burn?

A

greater than 1st degree burn

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35
Q

Pain management options for burn?

A

NSAIDs, topical diclofenac (not on open wounds) and last resort is opioids

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36
Q

First degree burns topical agents?

A

Aloe vera
Antibiotic ointments

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37
Q

Second degree burn topical agents?

A

Topical antimicrobial and occlusive dressing

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38
Q

Lyme disease symptoms

A

Bull’s-eye rash and flu-like symptoms

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39
Q

How to prevent tick bites?

A

Wear protective clothing
Routine antimicrobial prophylaxis NOT recommended

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40
Q

When should Lyme prophylaxis be considered?

A

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

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41
Q

Early Lyme disease treatment?

A

Doxycycline 100mg BID x 14 days

Children: Amoxicillin

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42
Q

Lyme meningitis/Neurological disease treatment?

A

Ceftriaxone 2 grams IV daily for 14 days or
Doxycycline 200-400 mg orally
Pediatrics: Ceftriaxone 50-75mg/kg/day IV

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43
Q

Lyme carditis treatment?

A

Parenteral therapy 14-21 days

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44
Q

Lyme arthritis treatment?

A

Oral antibiotics for 28 days

45
Q

HPV wart notes?

A

Warts will regress but virus will progress

Cervical warts

46
Q

Medical treatment for HPV wart treatment?

A

Liquid nitrogen

47
Q

HPV non pregnant limited vaginal disease treatment?

A

Trichloroacetic acid, possible laser ablation

48
Q

HPV non pregnant limited vulvular disease

A

Compliance with self therapy - Imiquimod
Non compliant - Trichloroacetic acid

49
Q

Describe Trichloroacetic acid HPV treatment

A

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
Q

Describe imiquimod treatment for HPV

A

immune response modifier
Wash hands before and after application

51
Q

How is Aldara applies for HPV

A

3 days per week for up to 16 weeks

52
Q

How is Zyclara applied for HPV

A

daily for up to 8 weeks

53
Q

HPV recurrence?

A

30% have a recurrence within 12 weeks

54
Q

HPV vaccination?

A

Gardasil 9

55
Q

Who can get Gardasil 9?

A

All male and female patient ages 11-12 through age 26 if not yet vaccinated

56
Q

How should Gardasil 9 be administered?

A

Before HPV exposure
Not during pregnancy

57
Q

When is HSV-1 developed?

A

Childhood

58
Q

When is HSV-2 developed?

A

Sexually transmitted

59
Q

What is the clinical presentation of HSV?

A

Mucocutaneous and Meningoencephalitis

60
Q

How can HSV be treated?

A

Acyclovir and valacyclovir (against HSV-1 and HSV-2)

61
Q

How is VZV transmitted?

A

aerosolized droplets or direct contact

62
Q

When does VZV infectivity begin

A

48 hours before onset of rash and ends when all skin lesions have fully crusted

63
Q

What us the clinical presentation of VZV?

A

Chickenpox
Shingles
Sever pain before lesion appears
Postherpetic neuralgia

64
Q

Chickenpox treatment?

A

Antiviral not indicated for children
Acyclovir 800mg 5x daily for adults
IV acyclovir for immunocompromised

65
Q

Shingles treatment?

A

Acyclovir 800mg 5 times daily x 7-10 days
Initiate within 72 hours
IV therapy if immunocompromised or severe

66
Q

Acyclovir MOA?

A

Prodrug that requires activation
DNA synthesis is prevented w/o affecting normal host cell functions

67
Q

What all can acyclovir treat?

A

HSV-1, HSV-2, VZV

68
Q

Pharmokinetics of acyclovir?

A

Oral, IV, topical
Poor absorption
CSF penetration

69
Q

What drugs interact withe acyclovir?

A

Cyclosporine
Sirolimus
Tacrolimus

70
Q

Safety/education for acyclovir?

A

Treatment is not curative
Does not prevent spread
Precautions are necessary

71
Q

What does valacyclovir turn into?

A

Acyclovir

72
Q

What is the benefit of valacyclovir?

A

Liquid option
Greater availability than acyclovir

73
Q

What type of vaccine is varicella zoster vaccine?

A

Live vaccine

Routine childhood vaccine - 2 doses

74
Q

Who is Shingrix recommended for and how is it administered?

A

Recommended for immunocompromised adults >50 years old

2 doses separated by 2-6 months

Avoid in pregnancy

75
Q

Zostavax?

A

No longer available

76
Q

What to note about systemic fungal infections?

A

Invasive
Candida is responsible in 90% of cases

77
Q

Two classes of antifungals and two in each class?

A

Imidazole - Ketoconazole and Clotrimazole
Triazole - fluconazole and itraconazole

78
Q

Azole antifungal MOA?

A

Disrupts fungal cell membrane integrity

79
Q

What species are Azoles effective against?

A

Candida, dermatophytes

NOT effective against Aspergillus

80
Q

How are azoles offered?

A

IV, oral, topical

81
Q

Absorption effects with different azoles?

A

Fluconazole - food no effect
Ketoconazole - variable
Itraconazole - INCREASED absorption with food

82
Q

What azole crosses the BBB

A

fluconazole

83
Q

Important drug interaction with azole?

A

They are CYP INHIBITORS

84
Q

What are CYP substrates effected by azoles? (increased concentration)

A

Warfarin
Phenytoin
Carbamazepine
Cyclosporine
Tacrolimus

85
Q

What will decrease the absorption of azoles?

A

Antacids

86
Q

BBW of azoles?

A

itraconazole - CHF
ketoconazole - hepatotoxicity, QT prolongation

87
Q

What to note about nystatin resistance?

A

Rare

88
Q

Nystatin antifungal spectrum?

A

candida albicans

89
Q

Pt. education with nystatin?

A

Do not eat or drink for 20 minutes after use

90
Q

How to take nystatin with esophageal candidiasis?

A

swish and SWALLOW

91
Q

How to take nystatin with oral candidiasis?

A

Swish and SPIT

92
Q

How to treat mild oral candidiasis?

A

Clotrimazole troches

93
Q

How to treat oral candidiasis moderate/severe/unresponsive to topical therapy?

A

Fluconazole 100-200mg

94
Q

How to treat refractory oral candidiasis?

A

Nystatin suspension

95
Q

Uncomplicated vulvovaginal candidiasis treatment?

A

Fluconazole 150mg x 1

96
Q

How to treat vulvovaginal candidiasis with severe symptoms?

A

Fluconazole 150mg every 72 hours for 2-3 doses

97
Q

How to treat recurrent vulvovaginal candidiasis?

A

Fluconazole 150mg every 72 hours for 2-3 doses + maintenance 150mg per week for 6 months

98
Q

How to treat vulvovaginal candidiasis in pregnancy?

A

Topical clotrimazole or miconazole

99
Q

What is first line treatment for topical antifungal infections?

A

Terbinafine 1%

100
Q

When should systemic therapy be considered for fungal infections?

A

topical therapy failure

101
Q

What are systemic antifungal treatment options?

A

Terbinafine
Itraconazole
Fluconazole

102
Q

What is the gold standard treatment for onychomycosis?

A

Oral antifungal agents

103
Q

What is the only topical option for onychomycosis?

A

Ciclopirox

104
Q

What are some therapeutic options for diaper dermatitis?

A

Barrier preparations
Topical corticosteroids
Antifungal agents

105
Q

What should be avoided for diaper dermatitis due to systemic toxicity risk?

A

Baking soda

106
Q

What are some barrier ointment options for diaper dermatitis?

A

OTC - Petrolatum and zinc oxide
Rx - sucralfate

107
Q

What are some antifungal agents for diaper dermatitis?

A

Nystatin and ketoconazole for candida

108
Q

What is an example of mild to moderate treatment for diaper dermatitis?

A

Zinc oxide products

109
Q

How to treat a bacterial superinfection caused by diaper dermatitis?

A

Topical or oral antibiotics
*oral only for very severe infections

Anatomy & Physiology (6 decks)

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