ENT + Skin Flashcards

Question

Adrenergic Alpha-2 Agonists for glaucoma: -Drugs/Brands -MOA -AVEs -Warnings

Answer 1

Drugs: bimonidine (Alphagan P, Lumify - OTC for ocular redness), apracolonidine (Iodipine) MOA: *increases aqueous humor outflow AND reduces aqueous humor production* AVEs: sedation, dry mouth, dry nose Warnings: CNS depression (caution w/ heavy machinery or driving)

Answer 2

Brand: Rhopressa MOA: *rho kinase inhibitor that increases aqueous humor outflow* ROA: eye drops Administration: store in refrigerator before opening; once opened, store at room temperature for

Answer 3

1. Latanoprost + Netarsudil 2. *Timolol + Dorzolamide* 3. *Timolol + Brimonidine* 4. Binzolamide + Brimonidine

Answer 4

Conjunctivitis: "pink eye" - swelling, itching, burning, and redness of conjunctiva, the protective membrane of the eyelids and covers the white parts of the eye -*Highly contagious and mostly in children* *Non-pharmacological:* avoid touching eyes, hand hygiene, change towels and washcloths daily, discard eye cosmetics (especially mascara) Types: -Chemical: flush out eye, no specific TX -*Viral:* adenovirus (most common), sometimes zoster or HIV (severe) -Bacterial: *S. aureus*, S. pneumoniae, H. influenzae, M. catarrhalis (*most seveve: N. gonorrhea or Chlamyida*) -*Allergic:* common allergens (pollen, dust mites, animal dander, molds) *TX:* NOT necessarily needed if non-severe and typically self-limiting -Viral: no topical TX, self-limiting -Bacterial: ABX eye drops or ointments (ex. moxifloxacin, neomycin/polymyxin B/dexamethasone, ofloxacin, trimethoprim/polymyxin B, azithromycin - store in fridge, stable for 14 days at room temp) -Allergic: mast cell stabilizers (cromolyn, lodoxamide, nedocromil), antihistamines (azelastine, olopatadine, cetrizine, epinastine), antihistamine/mast cell stabilizer (ketotifen - OTC, alacftadine); severe: prednisolone/steroid eye drops (NOT long term due to increasing IOP)

Answer 5

1. Vigamax 2. Maxitrol 3. Ocuflox

Answer 6

1. Polytrim 2. Pataday 3. Alaway, Zaditor

Answer 7

Blepharitis: eyelid inflammation - inflammation, irritation, and itchy -*Warm compress over eye then warm, moist washcloth to remove debris* -Some cases: artifical tears, steroid eye drops, or ABX ointments Inflammation: *cold compress, steroid eye drops (prednisolone - Pred Forte, Pred Mild*; others: dexamethasone, fluromethalone, loteprednol), or *NSAIDs (ketorolac - Acular*; others: nepafenac, bromfenac, diclofenac, flurbiprofen) -*Steroid eye drops should be used short-term due to increased IOP risk*

Answer 8

Dryness: *Refresh (OTC), Systane (OTC)*, Liquifilm Tears (OTC), others --> *referred to as "Artificial Tears"* -Administered multiple times PRN -Common lubricants: mineral oil, glycerin, propylene glycol, dextran, hypromellose Chronic Dry Eye: *cyclosporine emulsion eye drops (Restasis)*, others: liftegrast, loteprednol, varnicline nasal spray -Restasis: indicated for keratoconjunctivitis sicca Redness: *naphazoline (Clear Eyes Redness Relief: OTC), naphazoline/pheniramine (Naphacon A, Visine A: OTC), tetrahydrozoloine (Visine: OTC)*, brimonidine (Lumify: OTC) -Can be used in allergic conjunctivitis

Answer 9

1. Preservatives are toxic to bacteria and irritating to sensitive tissues in eyes, some drugs as well burn 2. 15 minutes; preservatives can get trapped in lenses and damage eyes 3. 5 minutes; 5-10 minutes

Answer 10

Retinal changes/retinopathy: chloroquine, hydroxychloroquine -Optic neuropathy: amiodarone (plus corneal deposits), ethambutol, linezolid -IFIS: alpha-blockers (ex. tamsulosin) -Color discoloration: digoxin (w/ toxicity - yellow/green vision), PDE5is (sildenafil - greenish tinge around objects), voriconazole (color vision changes) -Vision loss/abnormal vision: digoxin (w/ toxicity - blurriness, halos), PDE5is (vision loss, can be permanent, one or both eyes), isotretinoin (decrease night vision which can be permanent, dyness, irritation), topiramate (visual field defects), vigabatrin (permanent vision loss - high risk), voriconazole (abnormal vision, photophobia)

Answer 11

Tinnitus: NO drug TX (caused by drug toxicities such as salicylates, noise exposure, or idiopathic) Cerumen: removal in medical office or cerumenolytics to soften ear wax (ex. water, saline solution, mineral oil, hydrogen peroxide, *carbamide peroxide - Debrox*) --> limit to 3-5 days with follow-up Optic externa: "swimmer's ear" -Mild cases: *acetic acid and a glucocorticoid (VoSol HC)* -Moderate/severe: toptical otic ABXs (*ciprofloxacin and dexamethasone - Ciprodex*, ciprofloxacin and hydrocortisone (Cipro HC), neomycin/colistin/hydrocortisone/thonzonium - Cortisporin TC) -Pain treatment: oral APAP, ibuprofen

Answer 12

Brown: entacapone, levodopa, methyldopa Brown/yellow: nitrofurantoin (urine) Black/green: iron (black stool) Orange/yellow: sulfasalazine Yellow/green: propofol

Answer 13

Red/orange: phenazopyridine, rifampin Red: anthracyclines Blue: methylene blue, mitoxantrone Blue/gray: amiodarone

Answer 14

1. Aloe - sunburn, psoriasis --> soothing effect 2. Tree oil - acne, onchomycosis (potentially, but will NOT eradicate infection) 3. PO or topical lysine - cold sores prevention and TX 4. Biotin - hair loss, brittle nails 5. Topical vitamin D - diaper rash, psoriasis

Answer 15

Causes: *androgen activity (primary determinant), prescene of bacteria (Cutibacterium acnes), sebum in oil* Classifications: whiteheads (closed comedones), blackheads (open comedones), papules, pustules, nodules ("cysts") *TX:* -Weaker efficacy: salicycllic acid -Mild (few occasional pimples): benzoyl perioxide (BPO) or retinoid or topical combination (first-line); alternatives: add topical retinoid or BPO, switch to another retinoid, or topical dapsone -Moderate (inflammatory papules): topical combinaion or PO ABX + BPO + topical retinoid (+/- topical ABX); alternatives: other combinatoin, switch PO ABX, add oral contraceptive pill (OCP) or spirinolactone (females) or PO isotretinoin -Severe (nodules): topical combination + PO ABX or PO isotretinoinl; alternatives: switch PO ABX, add OCP or spirinolactone (females), or PO isotretinoin if NOT previously tried

Answer 16

Drugs: *tretinoin (Atralin, Renova, Retin-A, Retin-A Micro, Altreno*, Avita), *adapalene (Differin)*, tazarotene (Tazorac, Fabior, Tazora, Arazlo), trifarotene (Aklief) OTC: Differin gel MOA: *vitamin A derivatives that reduce coheisoin of follicular epithelial cells, increasing cell turnover and unblocking pores* Warnings: *topical retinoids should be avoided in pregnancy -CI in pregnancy: tazarotene* Irritation: -Less: Altreno (lotion form of tretinoin), Retin-A Micro (microsphere gel) and Avita (polymerized cream or gel) which have slower release -More: Fabior (tazarotene foam)

Answer 17

-*Apply daily usually at bedtime about 20 minutes after washing* face (wash only w/ mild soap BID) -*If irritation occurs, use lower strength or decrease frequency to every other night* --> may need to reduce contact initially (wash off if skin irritated) -*A pea-sized amount is sufficient for facial application* --> smooth over enter surface NOT just on acne -Avoid salicyclic acid scrubs or astringents --> worsen irritation -*Takes 4-12 weeks to see response* --> may worsen acne initially -*Limit sun exposure*

Answer 18

Brand: Benzac, Clearasil, PanOxyl Yes, OTC Administratoin: -Start w/ 2.5-5%, generally adequate and less irritating -Can *bleach clothing* and hair -Limit sun exposure

Answer 19

1. -Clean face, shake if lotion, and apply thin layer QD or BID -Avoid contact w/ eyes --> if occurs, rinse with cold water -Takes 2-6 weeks for effect and up to 12 weeks for full benefit 2. *Dapsone gel* 3. *Clascoterone - topical androgen receptor inhibitor* indicated in those 12 yo and older 4. -*Brands: Minocin, Solodyn -Approved in those 12 yo and older -AVEs: photosensitivity*, rash, dizziness, diarrhea, somnolence, *fetal harm, discoloration in teeth*

Answer 20

Brand: *Absorica, Amnesteem*, Claravis, Myorisan, Zenatane MOA: *vitamin A derivatives that reduce coheisoin of follicular epithelial cells, increasing cell turnover and unblocking pores* ROA: *PO (capsules)* TX: *only FDA approved for severe, refractory nodular acne* REMS program: -Pts who can get pregnant must sign patient informatin/*informed consent form about birth defects -Must have 2 negative pregnancy test prior to starting TX -Do NOT get pregnant for 1 month before, during, and for 1 month after D/C (use two forms of birth control and pregnancy testing on monthly basis)* -Do NOT breastfeed or donate blood until at least 1 month after D/C -*do NOT use vitamin A supplements, tetracyclines, progestin-only contraceptives, St. John's Wort,* or steroids -Must swallow capsules whole or puncture and sprinkle on applesauce or ice cream (this may irritate esophagus) Warnings: *dry skin, chapped lips, dry eyes/eye irritation* (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgas, skeletal hyperostosis (calcificatin of ligaments that attach to spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TGs) and BG BBW: *birth defects (only dispense through REMS iPLEDGE - RX only 1 month at a time, fill within 7 days wtih yellow sticker attached)*

Answer 21

Topicals: *docosanol (Abreva) - OTC, acyclovir (Zovirax)*, penciclovir cream (Denavir) -Oral antivirals more effective -*Natural product: lysine for prevention and TX* Counseling: -Start treatment during prodromal period -*Abreva: apply 5x daily at first sign of outbreak, continue until healed -Zovirax: apply 5x daily for 4 days (can be used on genital sores)* -Denavir: apply Q2H during hours for 4 days

Answer 22

TX: -OTC:* ketoconazole 1% shampoo (Nizoral A-D), selenium sulfide (Selsun*, Dandrex), *pyrithione zinc (Head & Shoulders), coal tar shampoo (T/Gel*, Suave, or store brand "dandruff" shampoos) -Rx: *ketoconazole 2% shampoo (Nizoral)* Counseling: -Rub shampoo in well, leave in for 5 minutes then rinse out -Shampoo daily. If shampoo stops working, switch products -Nizoral A-D: apply twice weekly for up to 8 weeks, do NOT use on open sores, can cause skin irritation

Answer 23

Causes: *hereditary male-pattern baldness (most common)*, hormonal changes in women (childbirth, pregnancy, or menopause), hypothyroidism, scalp infections, *some autoimmune conditions (ex. lupus, alopecia, areata), chemotherapy, other drugs (valpraote, lamotrigine, tacrolimus*, heparin, interferons, some OCs), *vitamin/mineral deficiencies (biotin, zinc, selenium, vitamin D)* TX: medications work modestly for hair loss -*Finaseteride (Propecia): 1mg tablet PO QD, can take >/=3 months to see effects (do NOT use Proscar for BPH); Warning: hazardous for females of childbearing potential; CI: pregnancy* -Barictinib (Olumiant): janus kinase inhibitor for severe alopecia areata; *BBW: serious infections, malignancy, thrombosis* -*Minoxidil (Rogaine): 5% strength more effect and must be used indefinitely or condition reoccurs; flammable: do NOT use near heat source* -*Bimatoprost (Latisse): for thinning eyelashes (hypotrichosis); do NOT use w/ prostaglandin analog for glaucoma; apply QHS with applicator brush to the skin at the base of the upper eyebrows only (do NOT apply to lower lid)*, blot any excess and repeat on other eye; AVEs: itchy eyes, eye redness, eyelid skin darkening, hair growth in other areas that solution touches

Answer 24

Non-pharmacological TX: -Avoidance of triggers (ex. environmental, allergens, stress, weather changes) -*Hydration and moisturizers (ex. Aquaphor, Eucerin*, Keri - contain petrolatum, lanolin) TX: -*Oral antihistamines for itching -Standard options: topical steroids (occassional PO courses), topical calcineurin inhibitors (tacrolimus, peimcrolimus)* -*Mild/moderate: topical PDE4is* (crisaborole - Eucrisa), *topical Janus kinase inhibitors* (ruxolitinib - Opzelura) -*Severe, refractory: SC interluekin receptor antagonists* (dupilumab - Dupixent, tralokinumab - Adbry), *oral Janus kinase inhibitors* (abrocitinib - Cibinqo, upadacitnib - Rinvoq), other oral immunosuppressants may be used off-label Considerations: -ALL topical products: *wash hands after application*, apply thin layer to affected skin BID, use smallest amount needed to control symptoms -Topical calcineurin inhibitors: *do NOT use in <2 yo, associated w/ lymphoma and skin cancer* (avoid exposure to natural or artifical sunlight, AVEs: HA, skin burning, itching, cough, flu-like symptoms) -MABs: avoid live vaccines, injection site rxns and URTIs -Janus kinase inhibitors: *BBW for serious infections (ex. herpes zoster) and higher rates of malignancy, thrombosis*, major CV events and mortality

Answer 25

Hyperhidrosis: excessive sweating TX: glycopyrronium topical (Qbrexza - RX), antiperspirants (Secret Clinical Strength, Certain Dri, others - OTC) Counseling (glycopyyronium): topical anticholinergic -do NOT use in medical conditions exacerbated by anticholinergics (ex. glaucoma, ulcerative colitis, masthenia gravis) -Use on clean, dry skin -Use one premoistened pad for both underarms -Wash hands with soap and water afterwards

Answer 26

Tinea pedis: "Athlete's Foot" - itching, peeling, redness, mild burning, and sometime sores on foot Tinea cruris: "Jock Itch" - red, itchy rash that can be ring-shaped on gentials, inner thighs, or buttocks Tinea corporis: "Ringworm" - circular,red, flat sore where middle is normal, but outer part is raised (occassionally rash does NOT present and skin is just red and itchy) Tinea capitis - ringworm on scalp Cutaneous Candidia infections - red, itchy rashes commonly in groins, armpits, or anywhere with skin folds TX options: -OTC: *terbinafine (Lamisil AT), butenafine (Lotrimin AF*, Pro-Ex Antifungal, Shopko Athletes Foot), *miconazole (Lotrimin AF*, Cruex, Desenex, Jock Itch), miconazole/petrolatum (Baza), *tolnaftate (Tinactin), undecylenic acid* (Toelieva) -RX: *betamethasone/clotrimazole (Lotrisone)*, ketoconazole (Extina), luliconazole (Luzu) Counseling: -*If infection on foot, do NOT walk barefoot to avoid spreading -Apply medication 1-2 inches beyond rash -Use for 2-4 weeks even if appears healed -Reduce moisture to infected area* -Creams typically work best (solutions can be easier to apply, powders typically do NOT work well but for prevention)

Answer 27

Onychomycosis: fungal infection of nail from tinea unquium TX: -Mild: topical antifungals (*terbinafine - Lamisil AT*, ciclopirox, tavaborale, efinaconazole) -*Itraconazole and terbinafine often used (off-label: fluconazole, posaconazole, rarely: griseofulvin) -Pulse therapy (intermittent) to reduce costs, but possibly toxic* and not as effective (20% potassium hydroxide - KOH smear for diagnosis) -Takes long time for nail bed appearance to improve - sometimes up to a year Considerations: -Systemic antifungals are hepatotoxic, can cause QT prolongation, and are CYP3A4 substrates and inhibitors -N/D common -*Itraconazole: BBW in heart failure*; requires gastric acid for absorption (do NOT use with strong acid-suppressing drugs) -Recurrence common - pratice proper foot care and keep nails dry, keep BG controlled, do NOT smoke

Answer 28

More common in: *pregnancy* -Also elevated risk: high-dose estrogen, hormone replacement therapy, steroids, immunosuppressants, ABXs, use of lubricants, vaingal douching S/Sx: *itching*, soreness, pain, cotage-cheese like discharge (white, thick, clumpy) Diagnosis: vaginal culture -*pH >4.5 consistent in bacterial vaginosis or trichomoniasis -Testing NOT necessary if women has already been seen for initial infection (if infection occurs more than 4/year or symptoms recur within 2 months ---> refer to physician)* Nonpharmacological: -*Lactobacillus or yogurt w/ cultures (rated possibly ineffective per NatMed)* -Keep vaginal area clean -Wipe front to back after using restroom -Change pads/tampons often -Use cotton underweat, avoid tight-fitting clothing -Remove wet swimsuits or clothing promptly -Avoid using vaginal douches, sprays, or other products that alter vaginal pH

Answer 29

*TX:* -Mild/moderate, infrequent: 1, 3, or 7 day TX with vaginal cream, ointment, or vaginal suppository/tab --> if fails, fluconazole 150mg PO x1 -Complicated infections, preganancy: 7-10 day treatment or refer to healthcare provider Counseling for OTC antifungals: -Prior to using, wash the external genital area with mild soap and water and pat dry w/ towel -Insert applicator/suppository/vaginal tab at night before bed lying down immediately after helps reatin medicine, protective pad can be used -Creams and suppositories: oil-based that can weaken latex condoms and diaphgrams --> avoid sexual intercourse -Complete entire course, continue even if menstrual cycle occurs (do NOT use tampons) -Medical care warranted if symptoms persist/return within 2 months or if >4/year

Answer 30

Prevention: -Change diapers often, do NOT cover diapers w/ plastic -Clean area well w/ unscented wipes or plain water -Leave diaper off when possible to let skin air-dry -*Skin protectants: petrolatum ointment (Vitamin A&D Ointment), petrolatum w/ zinc oxide (Desitin - dessicant to dry out skin)* TX: -*Clotrimazole, miconazole, nystatin for stubborn rashses if yeast involved -Hydrocortisone 0.5-1% cream applied BID, but NOT for more than several days at a time* -Infants should be referred to physician especially in under 6 months, refer toddlers if condition worsens -Rash can have more than one contributing organism (topical ABXs can be used if needed)

Answer 31

Hemorrhoids: swollen blood vessels in lower rectum often from constipation and straining - can cause bright red blood, itching, burning TX: -*Increase fiber intake to reduce straining (ex. psyllium)* -Barrier skin protectants: reduce irritation from stool/urine -Combo products: mineral oil (skin protectant), zinc oxide (desiccant), or pramoxine (anesthetic) -*Phenylephrine (Preparation H): vasoconstrictor to shrink hemorrhoid and reduce burning/itching -- for external symptoms -Hydrocortisone (Anusol-H, Preparation H): reduce itching and inflammation -Witch hazel (Tucks Medicated Cooling Pads): mild astringent that relives mild itching* Phenylephrine Counseling: -Clean skin first with mild soap and warm water. Pat dry. Apply ointment externally up to five times/day. -For suppostiroy: hold wrapped suppository container w/ rounded end up, seperate the foil tabs and slowly peel apart, remove from the wrapper, insert into the rectum up to QID, especially at night and after bowel movements

Answer 32

How to identify: often in children as anal itching; *use tape test:* stick a piece of tape around the anus in the morning prior to voiding defecating then bring to healthcare provider to look under microscope (can take up to three tests to identify) TX: anthelminitics - mebendazole (Emverm), *pyrantel pamoate (Reese's Pinworm Medicine - OTC*), albendazole -Often resistant to TX -Wash hands frequently and treat entire household -*TX for systemic worm infections are toxic - in some cases, steroids and antiseizure medications willl be used for CNS infections* Counseling: -Pyrantel: HAs, dizziness - given as single dose and repeated in 2 weeks -Mebendazole, albendazole: HA, nausea, hepatotoxic -*Albendazole: give w/ high-fat meal to increase absorption*

Answer 33

*Lice (Pediculus humanus capitis): mostly effects elementary school-age children* Lice: attach to hair shaft, insects Scabies: primarily adults, burrow under skin, mites Removal of nits: -Wash clothes and bedding in hot water followed by hot dryer --> if cannot be washed, seal in air-proof bag for 2 weeks or dry clean -Vaccum carpet, soak combs and brushes in hot water for 10 minutes -*After TX, nit comb to remove nits and lice Q2-3 days and continue to check for 2-3 weeks to make sure all gone*

Answer 34

TX options for lice: -First line (lice): typically topical OTC (ex. *permethrin 1% lotion - Nix, pyrethrin/piperonyl butoxide - RID*, LiceMD, ivermectin lotion -Sklice) --> avoid products w/ chrysanthemum or ragweed allergy -*Malathion lotion (Ovide): RX; organophosphate only for those 6 yo and older - causes skin irritation and is flammable* -Spinosad (Natroba): RX; works well, but expensive -*Lindane shampoo - no longer available (neurotoxicity)* Scabies: *RX permethrin cream (Elimite), PO ivermectin* Counseling: -Permethrin: for 2 months and older, pyrethrin/piperonyl butoxide: for 2 yo and older -do NOT use conditioner before using lice medicine --> do NOT re-wash hair in 1-2 days after TX -*Many products (except Sklice) require re-treatment (OTC topicals - repeat on day 9)* -Most products must be left on hair for 10 minutes before rinsing (malathion: left on for 8-12 hours) -Nits are "cemented" to hair shaft and do NOT fall after TX --> need nit removal

Answer 35

Bites: -Animal and human bites: high risk of infection --> seek medical evaluation -Spider bites: spiders tend to stay hidden and are NOT aggressive --> avoid bites with inspection of clothing or equipment, wearing protective clothing; if bitten: wash w/ soap and water, apply cold compress w/ ice, evaluate extremity, and seek medical evaluation -Minor, harmless insect bites: topical steroid or oral antihistamine Burns: -*Characterized as first degree (red/painful, minor swelling), second degree (thicker, produces blisters, very painful), or third degree (damage to all layers of skin - appears white or charred)* -Burns from chemical exposure or in immunosuppressed pts: seek emergency medical care -First or second degree: OTC if area less than two inches in diameter and NOT located on face, over major joint, or on feet or genitals (*DM: mild foot burn could lead to amputation*) -Minor burns: run under cool water for 5-20 minutes (do NOT apply ice as this can damage skin), *ointments (ex. Aquaphor) can protect skin/retain moisture/reduce scarring, and silver sulfadiazine (Silvadene; SSD*) can reduce infection risk and promote healing --> do NOT apply if skin is broken -Burned skin itches as it heals --> skin can be sensitive to sun for up to a year

Answer 36

Cut: uniform and regular Lacerations: irregular wounds w/ ragged edges w/ potential for deeper skin damage and bruising Abrasians: minor injuries to top layer of skin TX: -Clean (if bleeding does NOT stop or wound extends far below surface layers of skin - seek medical attention) -ABX ointment can be applied -Bandage (Tissue adhesives ex. Band-Aid, Liquid Bandage - create polymer layer to bind to skin, Wound Seal - topical powder to quickly form scap over bleeding wound and reduce risk of infection) -If wound is NOT in area that will get dirty or be rubbed by clothing, does NOT need to be covered and uncovering can help dry and heal ABX ointments: -OTC: *polymyxin/bacitracin/neomycin (Neosporin Original*) --> for neomycin allergy, use bacitracin/polmyxin (Polysporin), or bacitracin alone (either sufficient) -RX: *mupirocin (Bactroban) - good staph and strep coverage including MRSA; bacitracin/neomycin/polymyxin B/hydrocortisone (Cortisporin*), collagenase (Santyl) - topical debriding drug for chronic wounds -Application: apply small amount of medication (equal to surface ot tip of finger) to affected area 1-3 times/day, change dressings daily

Answer 37

*Allergic rxns that result from touching sap of plants, containing toxin urushiol* - could be in ashes of burned plants, on animla, or other objects as well -"Leaf of three, let it be" OTC options -*aluminum acetate solution* (Boro-Packs, Domeboro Soothing Soak): *astringent (drying agent)* -colloidal oatmeal (Aveeno) -colamine lotion/pramoxine (asnesthetic - Caladryl, IvaRest) -Zanfel: binds to urushiol, but LOW evidence for efficacy -*Topical steroid to help rash* Counseling: -Small amounts of urushiol can remain under fingernails for days unless removed w/ good cleaning -Wash urushiol off w/ soap and water and make sure to clean clothing -Cold compresses -*Severe rash: PO steroids*

Answer 38

1. *Ointment > Cream > Lotion > Solutoin > Gel > Spray* 2. Thick or dry: ointments; hair skin: lotions, gels, or foams 3. *Hydrocortisone - 0.05% and 0.1%* 4. Thin skin - on face, eyelids, genitals, skin folds (armpts, groin, under breast)

Answer 39

1. Skin thinning, pigment changes (lighter or darker), telangiectasia (spider veins or small blood vessels seen through skin), rosacea, perioral dermatitis and acne, risk of skin infections, delayed wound healing, irritation/burning/peeling, contact dermatits possibly 2. -Hives: second-gen antihistamines > first gen antihistamines -Histamine-2 receptor antagonists (ex. famotidine) can help in urticaria/hives --> *hydroxyzine often for general hives* -Camphor, menthol, local anesthetics to relieve itching 3. -*"Fingertip" unit: from fingertip to 1st joint is enough to cover one adult ahnd (about 1/2 gram)* -do NOT use more than directed -do NOT apply longer than 2 weeks -High potency steroids: once daily -Low potency steroids: QD or BID -Can be common to see high potency product followed by low potency to treat acute inflammation

Answer 40

Very high: -*Clobetasol propionate 0.05% lotion/shampoo/spray (Clovex), cream/ointment (Temovate), foam (Olux)*, gel -*Fluocinonide 0.1% cream (Vanos)* -Betamethasone dipropionate 0,05% ointment (Diprolene), gel/lotion -Halobetasol propionate 0.05% lotion (Ultravate), cream/ointment -Diflorasone diacetate 0.05% ointment High: -*Betamethasone dipropionate 0.05% cream* (Diprolene AF) *-Fluocinonide 0.05% ointment -Mometasone furoate 0.1% ointment* -Desoximetasone 0.05% gel (Topicort), 0.25% cream (Topicort) -Diflorasone diacetate 0.05% cream -Halcinonide 0.1% cream (Halog) High/medium: -*Fluocinonide 0.05% cream* -Betamethasone valerate 0.12% foam (Luxig) -Desoximetasone 0.05% cream (Topicort) -Fluticasone propionate 0.005% ointment Medium: -*Mometasone furoate 0.1% lotion -Triamcinolone acetonide 0.1% cream* (Triderm), 0.147 mg/g *spray (Kenalog)* -Fluocinolone acetonide 0.025% cream/ointment (Synalar) -Flurandrenolide 0.05% ointment (Cordran) Lowest: *hydrocortisone cream 0.5%, 1% (Cortisone-10)*, 2.5% (MiCort-HC), lotion 1%/2%; ointment: 0.5%/1%/2.5%

Answer 41

1. 10am - 4pm (UV light penetrates clouds even in overcast days) 2. *UVA and UVB* -A for "aging" and B for "burning" 3. Sun protection factor - measure of how well sunscreen deflects UVB rays 4. -AAP (pediatrics): minimum SPF 15; AAD (dermatology): minimum SPF 30 -*Apply at least Q2 hours and reapplied after swiming or sweating -AAP recommends babies less than 6 months old out of sun* 5. *False - no longer permitted to be labeled as this; sunscreens can claim to be "water-resistant" but ONLY for about 40-80 minutes* 6. -Chemical: AAD recommends containing either oxybenzone (can be irritating), avobenzone, octisalate, octocrylene, homosalate, or octinoxate -Physical: alternative to chemical (*zinc oxide and titanium dioxide recommended by AAD*) -Oral: NOT effective and NOT recommended 7. *TTB (w/ sunscreen in minutes) = SPF x TTB (w/o sunscreen)*