Exam 3 Flashcards
Prophylactic migraine tx
Beta-blockers Anticonvulsants CCB Tricyclic antidepressants Gabapentin ACE inhibitors SSRIs
Common causative organism:
Impetigo
Staph aureus
GAS
Common causative organism:
Seborrheic dermatitis
S. malassezia (fungal)
Common causative organism:
Carbuncle/furuncle
MRSA
Common causative organism:
Cellulitis
Staph aureus
GAS
Common causative organism:
Allergic contact dermatitis
Poison ivy, oak, sumac
Common causative organism:
Diaper dermatitis
Candida
Common causative organism:
Onychomycosis
e. floccososu
t. rubrum
t. mentagrophytes
c. albicans
aspergillus
fusarium
scopulariopsis
Common causative organism:
Tinea versicolor
malassezia furfur
Viruses:
HSV-1
Above waist, skin, face
Viruses:
HSV-2
Genitalia
Common causative organism:
Scabies
Sarcoptes scabiei
Tx of abscess
Incision and drainage
Doxycycline, clindamycin, bactrim
Staph A covered with augmentin or cephalosporin
Tx of abscess with S&S of sepsis
IV vancomycin or linezolid
Tx of cellulitis
PCN, VK, amoxicillin/clavulate, dicloxacillin (GAS)
Tx of MRSA
TMP-SMZ, minocycline, clindamycin, linezolid
Patho of acne
Abnormal keratinization causes retention of sebum in the pilosebaceous follicle, producing open comedones (blackheads) and closed comedones (whiteheads)
Benzoyl peroxide MOA
1) Comedolytic and bactericidal agent specific to p. acnes
2) Decreases p. acnes levels, decreases inflation caused by leukocytic and monocytic attraction to pilosebaceous follicle
Benzoyl peroxide SE
Irritation
Benzoyl peroxide patient education
Could bleach clothing/towels
D/C OTC products before using Rx strength
Retinoid MOA
Decreases sebum production, follicular obstruction, and number of skin bacteria
Topical tx of acne
Retinoic acid (Tretinoin) adapalene (Differin) tazarotene gel (Tazorac) Benzoyl peroxide Azelaic acid (Azelex)
How to differentiate acne vulgaris from acne rosacea
Rosacea occurs between ages 30-50, really red cheeks rather than pustules
Tx of acne rosacea
Topical metronidazole and PO doxy/azithromycin
Acne medication education
1) Avoid prolonged exposure to sun/wear sunscreen formulated for face
2) Use contraception
3) Stop OTC benzoyl products when starting Rx strength
4) Hypopigmentation may occur with azelaic acid in dark skinned pts
Before starting accutane
1) Two negative pregnancy tests
2) Two types of contraception
Accutane monitoring
CBC, CMP, fasting triglyceride and cholesterol levels at baseline and one month after start of therapy
Accutane education
1) Avoid pregnancy for 1 month of D/C of therapy
2) BBW—increased aggressive/violent behaviors, back pain, arthralgias
3) Do not initiate in teens; drug may cause premature closure of epiphyses
Tx of lice & MOA
1) Permethrin & spinosad (ovicidal and insecticidal)
2) MOA—causes neuronal excitation of lice which then paralyzes them
Only non-neurotoxic tx for lice
Benzyl alcohol
Non-pharm tx of lice
1) nit comb
2) hair conditioner
3) mayo
4) olive oil
5) petroleum jelly
Acne vulgaris OTC TX
Salicylic acid and benzoyl washes
Atopic dermatitis is also known as _________.
Eczema
Patho behind atopic dermatitis
High IgE, immune response, chronic
Tx for atopic dermatitis
1) Avoid irritants
2) Antihistamines, topical corticosteroids (avoid more potent corticosteroids around eyes, lips, groin, areas of sensitivity)
- -Start with low-intermed steroid applied BID, if no improvement;
- -Try higher potency steroid rather than increasing freq of low potency
- -Systemic steroids used for widespread dermatitis (tapered dose, decreased q2d for at least 2 weeks)
- -Medrol dose packs too short and may cause rebound
3) Emollients
Tx of psoriasis (1st, 2nd, 3rd)
First line—topical steroids (high or very high potency ointment) and emollients
Second line—3-4 rounds of high-potency topical steroids, then maintenance application, add vitamin D analog (Calcipotrene/dovonex)
Third line—Refer to derm
Be aware of pregnancy/lactation
Teaching for tinea capitis tx griseofulvin
- May decrease efficacy of OCPs
- May cause serious unpleasant reaction to alcohol
- More effective with high fat meal*
Topical azoles MOA
Impair the synthesis of ergosterol, allowing for increased permeability and leakage of cellular components and results in cell death
Topical azoles use
Apply once or twice a day x 2-4 weeks, continue therapy for 1 week after lesions clear
Topical azoles caution
1) Not recommended in pregnancy/lactation
2) Admin cautiously in hepatocellular failure
3) Ketoconazole avoided in pts with sulfite sensitivity
Topical azoles SE
Pruritis, stinging, irritation
How do topical meds work for onychomycosis?
Cause leakage of fungal cell wall membrane
Criteria to prescribe antiviral
1) Treat if rash has been present fewer than 72 hours or if new lesions are still developing
2) Any pt older than 50 yrs and immunocompromised should be treated
Tx of seborrheic dermatitis & education
1) Antiseborrheic shampoos (Selsun blue, head & shoulders)
2) Low dose topical steroid lotion/gel (desonide) to help with itching
3) Avoid contact with eyes and rinse thoroughly
Tx for candidias
1) Nystatin
2) Topical antifungal creams
3) Diflucan
Monitoring for onychomycosis tx
ALT (alanine aminotransferase) and AST (aspartate aminotransferase) before start of tx and 6-8 weeks into therapy
Ketoconazole & fluconazole
1) Ketoconazole—not recommended for pts with sulfite sensitivity
2) AE of both—GI upset, rash, fatigue, hepatic dysfunction, edema, hypokalemia
3) Should not be used in pregnancy
4) Interactions—severe hypoglycemia w/hypoglcyeic drugs; avoid anticholingergics, H2 blockers, and antacids within 2 hours so that absorption is not compromised
Tx of herpes simplex
Topical acyclovir (oral if immunocompromised)
Tx of herpes zoster
1) Acyclovir 800 mg 5x/day 7-10 days
2) Valacyclovir 1 g TID x 7 days
3) Faciclovir 500 mg TID x 7 days
4) PO gabapentin/lyrica for pain
S&S of tinea versicolor
Round/oval macules w/an overlay of scales that may coalesce to form larger patches; often on trunk, upper arms, neck; Mild itching.
Dx by positive KOH test—budding yeast and hyphae
Tx of tinea versicolor
Selenium sulfide shapoo (Selsun Blue)—apply daily, leave on 10-15 mintes x 1 week
Topical azole BID x 2-4 weeks
ADHD meds – considerations before prescribing
1) Nonpharmacologic treatment (behavior modification, parent training, family therapy, etc)
2) Age, whether or not they can swallow a pill
3) Cardiac, tic disorder, substance abuse history
4) Short acting vs long acting
5) Nutrition/lifestyle changes
Progression for ADHD meds
Stimulant medication, increase medication dose, nonstimulant, buproprion
Common side effects of stimulants
Decreased appetite & delayed sleep onset
Common side effects of nonstimulants
GI discomfort, appetite decreases, mood swings, BP increase
Common side effects of clonidine & guanfacine for ADHD
Hypotension, dry mouth, oversedation, rebound HTN if abruptly stopped
ADHD and anxiety considerations
Avoid prescribing methylphenidate
First line tx of ADHD
Stimulants—methylphenidate or amphetamine salts (no preference, but methylphenidate usually started in children)
What are SSRIs used to treat?
Anxiety, depression, OCD
What drugs cause serotonin syndrome?
Certain cardiac medications, MAOIs, St. John’s wort, dosage too high
Monitoring and education for SSRIs
1) Monitor for depression, BBW for suicidal thoughts, sexual dysfunction, weight gain, substance use
2) Rigorous medication inventory
3) Watch for signs of serotonin syndrome, myoclonus, hyperthermia, autonomic instability
4) Taper dose to avoid withdrawal
Why cautiously prescribe benzos?
High potential for dependency
TCAs MOA
Inhibit 5-HT and norepinephrine reuptake produce anxiolytic and antidepressant effects
Causes of Parkinson
Cause not understood, can be drug-induced (associated with first gen antipsychotics)
Medications used for Parkinson’s
1) Carbidopa-levodopa (mainstay tx—start when PD affects quality of life)
2) Dopamine agonist, MAO-B inhibitors, COMT inhibitors, amantadine, anticholinergic (benztropine)
Mirapex MOA
Stimulation of dopamine D2-type receptors result in improved dopaminergic transmission in the motor area of the basal ganglia
Mirapex SE
Fatigue Nausea Constipation Orthostatic hypotension Hallucinations Lower extremity edema **Sleep attacks (counsel about driving) Avoid in elderly
How to dx migraines
1) Obtain thorough headache hx (age at onset, time of day, duration, precipitating/relieving factors; nature, intensity, and location of headache; associated symptoms)
2) Aura symptoms
3) Migraine diary to identify triggers
4) Family hx
Tx of migraine in pregnancy
1) Risk vs benefit approach
2) Acetaminophen
3) Ibuprofen (if severe) in first and second trimester only
4) Tylenol w/codeine sparingly
Education for abortive therapy for migraines
1) Frequency of medication and max daily dose
2) Administration technique
3) Acetaminophen overdose is common—do not exceed 3,250 mg/day
Dilantin monitoring
Therapeutic level is 10-20 mcg/ml in a person with normal albumin
Phenobarbital MOA
Binds to the barbiturate-binding site at the GABA receptor complex, leading to enhanced GABA activity
First line tx for insomnia
1) Sleep hygiene
2) Benzo, benzodiazepine receptor agonists (Lunesta, ambien, zaleplon), or ramelteon (meltonin receptor agonist)
Aricept side effects
1) NVD
2) Bradycardia
3) Insomnia
4) Nightmares (move med to morning if these occur)**
Aricept education
1) realistic goals (increase length of time of self-sufficiency, delaying need for nursing home, reduce burden on caregiver)
2) Slow progression of disease
3) No current agents are curative; only modest improvements can be expected
4) Take with or without food
Alzheimer’s mild to moderate first line tx
Donepezil (cholinesterase inhibitors)
Alzheimer’s moderate to severe first line tx
Memantine (NMDA)
Namenda MOA
Focuses on the glutamatergic system; blocks activation of NMDA receptor, inhibiting neuronal degeneration
Namenda caution
Excreted renally (potential for decreased renal clearance of other drugs)
