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DEENT > Exam 4 Material > Flashcards

Exam 4 Material Flashcards

1
Q

FTU scalp

A

3

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2
Q

FTU face and neck

A

2.5

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3
Q

FTU One hand (front and back) including fingers

A

1

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4
Q

FTU One arm including entire hand

A

4

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5
Q

FTU elbows

A

1

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6
Q

FTU both soles

A

1.5

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7
Q

FTU one foot including toes

A

2

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8
Q

FTU one leg including foot

A

8

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9
Q

FTU buttocks

A

4

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10
Q

FTU knees

A

1

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11
Q

FTU trunk both sides

A

14 (7 FTU each side)

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12
Q

scaly dermatoses

A

dandruff
seborrheic dermatitis

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13
Q

location of dandruff

A

scalp

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14
Q

exacerbating factors of dandruff

A

generally stable; increases in dry climate, cold temperature, or stress

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15
Q

appearance of dandruff

A

thin, white, or grey flakes on scalp

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16
Q

inflammation of dandruff

A

absent

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17
Q

epidermal hyperplasia of dandruff

A

absent

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18
Q

epidermal kinetics of dandruff

A

2x’s faster than normal

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19
Q

location of seborrheic dermatitis

A

scalp, face, and trunk

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20
Q

exacerbating factors of seborrheic dermatitis

A

immunosuppression, neurologic conditions, environmental factors, stress

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21
Q

appearance of seborrheic dermatitis

A

macules, patches and thin plaques of discrete yellow, oily scales on red skin

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22
Q

inflammation of seborrheic dermatitis

A

present

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23
Q

epidermal hyperplasia of seborrheic dermatitis

A

present

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24
Q

epidermal kinetics of seborrheic dermatitis

A

3x’s faster than normal

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25
Q

location of psoriasis

A

scalp, elbows, knees, trunk, lower extremities

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26
Q

exacerbating factors of psoriasis

A

environmental factors, infection, medications, stress, alcohol, tobacco

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27
Q

appearance of psoriasis

A

discrete symmetrical, red plaques with sharp borders; silvery white scales, bleeding points

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28
Q

inflammation of psoriasis

A

present

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29
Q

epidermal hyperplasia of psoriasis

A

present

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30
Q

epidermal kinetics of psoriasis

A

8x’s faster than normal

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31
Q

dandruff

A

chronic and non-inflammatory hyperproliferative epidermal scalp condition
-accelerated epidermal cell turnover and abnormal keratinization
-presence of Malassezia fungi
-causes mild inflammation, flaking, and pruritus

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32
Q

treatment goals of dandruff

A

reduce epidermal turnover rate of scalp skin and reduce the # of Malassezia fungi
minimize the cosmetic embarrassment of visible scarring
minimize itching

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33
Q

general treatment approach of mild dandruff

A

non-medicated shampoo: daily or every other day

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34
Q

mild presentation of dandruff

A

intermittent dandruff, mild inflammation

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35
Q

general treatment approach of moderate-severe dandruff

A

OTC medicated shampoos (pyrithione zinc, selenium sulfide, coal tar)
-leave on scalp for 3-5 min
-rinse well with water
-daily for 1 week, then 2-3 times weekly for 2-3 weeks, then once a week

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36
Q

moderate-severe presentation of dandruff

A

daily dandruff
moderate-severe inflammation

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37
Q

seborrheic dermatitis

A

chronic inflammatory disorder in areas of sebaceous gland activity (face, scalp, and chest)
involves Malassezia species and accelerated epidermal proliferation
no specific cure
neither harmful nor contagious
affects infants, adolescents, and adults

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38
Q

presentation of seborrheic dermatitis in infants

A

greasy or dry scaling of the scalp
aka cradle cap

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39
Q

presentation of seborrheic dermatitis in adolescents/adults

A

yellow, greasy scales in patches or plaques with exudates and crusting on red inflamed skin
-head, ear, face
-chest, mid-upper trunk and gluteal crease
-intertriginous areas
persons with darker pigmentation may present with hypopigmentation

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40
Q

increased risk and triggers seborrheic dermatitis

A

Malassezia
physical stress, fatigue, travel
zinc deficiency
change of season-worsens in cold weather
HIV infection; AIDS
Parkinson’s disease

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41
Q

treatment goals of seborrheic dermatitis

A

reduce inflammation and epidermal turnover rate
minimize or eliminate visible erythema and scaling

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42
Q

general treatment approach of seborrheic dermatitis

A

loosen and remove scales and crusts
inhibit yeast colonization (Malassezia)
reduce erythema and itching
avoid perfumes, aftershave, ointments, soaps
control secondary infections

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43
Q

seborrheic dermatitis can be softened with

A

mineral oil or olive oil
cream containing salicylic acid or sulfur

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44
Q

seborrheic dermatitis skin should be washed _________ than 2x daily

A

more; may use dishwashing liquid

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45
Q

decreasing fungal growth for seborrheic dermatitis

A

wash the scalp with OTC antifungal shampoo
face and body: topical treatment with antifungal creams
UV light therapy

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46
Q

wash the scalp with OTC antifungal shampoo for seborrheic dermatitis

A

ketoconazole (1st line) or selenium sulfide, pyrithione zinc, cicpirox, coal tar (2nd lines)
-leave on scalp for 3-5 min
-daily for 1-2 weeks
-2-3 times a week for 4 weeks
-if see improvement after 4 weeks, may reduce the frequency to once weekly
-if disorder worsens or symptoms persist longer than 7 days, a health care provider should be consulted

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47
Q

OTC antifungal shampoo first line

A

ketoconazole

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48
Q

OTC antifungal shampoo 2nd line

A

selenium sulfide, pyrithione zinc, cicopirox, coal tar

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49
Q

how long should you wait to consult a health care provider regarding seborrheic dermatitis

A

if disorder worsens or symptoms persist > 7 days

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50
Q

reduce erythema and itching of seborrheic dermatitis

A

corticosteroid lotion for scalp
corticosteroid cream for other parts of the body
use moisturizing emollients after washing
ketoconazole shampoo and corticosteroid lotion most often are combined in therapy resistant cases

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51
Q

ketoconazole shampoo and corticosteroid lotion are combined together for

A

therapy resistant cases of seborrheic dermatitis

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52
Q

seborrheic dermatitis treatment in infant’s scalp

A

massage scalp with baby oil or vegetable oil
then shampoo with non-medicated shampoo
use soft bristled brush
for severe cases salicylic acid 3-5% in olive oil or water-soluble base

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53
Q

seborrheic dermatitis treatment in infant’s face

A

wash with mild soap or cleanser, apply facial emollient
DO NOT suggest corticosteroids

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54
Q

psoriasis

A

common chronic inflammatory disease
involves adaptive and innate immunity
T cell mediated inflammatory

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55
Q

predisposing and precipitating factors of psoriasis

A

multiple genetic factors
injury to the skin
a viral or strep skin infection
alcohol consumption
smoking cigarettes
obesity/metabolic syndrome
stress
medications

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56
Q

predisposing and precipitating medications for psoriasis

A

lithium
NSAIDs
antimalarials
B blockers
fluoxetine
withdrawal of corticosteroids

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57
Q

possible comorbidities of psoriasis

A

psoriatic arthritis
CV diseases
-MI
-stroke
-peripheral vascular disease
metabolic syndrome
malignancy
-T cell lymphoma
inflammatory bowel diseases
-Crohn’s
-ulcerative colitis
psychological illness
-anxiety
-depression
renal disease

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58
Q

treatment factors for psoriasis

A

age/sex
socio-economic status
comorbidities
past/current treatment
location of lesions
severity of disease

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59
Q

mild psoriasis

A

BSA < 5%

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60
Q

moderate psoriasis

A

BSA >8%

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61
Q

severe psoriasis

A

BSA > 10%

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62
Q

lifestyle recommendations for psoriasis

A

reduce stress
regular exercise
weight management
moderation of alcohol
cessation of smoking

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63
Q

non-pharm treatments of psoriasis

A

moisturizers/emollients
oatmeal baths
sunscreen

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64
Q

pharm therapies for mild to moderate psoriasis

A

topical agents->topical agents + phototherapy->topical agents + systemic agent
+ nonpharm

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65
Q

topical agents of psoriasis (mild-moderate)

A

corticosteroids
vitamin D3 analogue
retinoids
anthralin
coal tar
salcylic acid
calcineurin inhibitor-pimecrolimus

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66
Q

corticosteroids for psoriasis

A

apply 2-4 times daily: cream or lotion-day, ointment-night
low potency for face, skin fold. limit duration and SA

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67
Q

vitamin D3 analogue (calcipotriene) for psoriasis

A

apply once or twice daily (ointment); twice daily (cream or foam)

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68
Q

retinoids for psoriasis

A

tazarotene, adapalene
apply once daily at bedtime

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69
Q

anthralin for psoriasis

A

applied only to the thick plaque lesions for 2 hrs or less and then wiped off (use Zn oxide around edges to protect normal skin)
SCAT therapy

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70
Q

coal tar for psoriasis

A

apply in evening, wash off in morning

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71
Q

salicylic acid for psoriasis

A

shampoo for scalp lesions

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72
Q

calcineurin inhibitors for psoriasis

A

pimecrolimus
apply to intertriginous areas (skin folds)

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73
Q

treatment for moderate to severe psoriasis

A
  1. systemic agent =/- topical agent or phototherapy; consider biologic agent esp if comorbidities exist
  2. more potent systemic agent or biologic agent (or less commonly 2 or more systemic agents in rotation) +/- topical agent
  3. biologic agent (if not already used) +/- other agents
    + nonpharm
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74
Q

systemic agent options for psoriasis

A

apremilast (otezla)
tofacitinib (xeljanz)
acitretin
methotrexate
cyclosporine
abatacept (orencia)

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75
Q

apremilast/otezla

A

PDE-4 inhibitor
dose titration to max 30 mg BID over 1st week
renal impairment-once daily dosing
should see response by week 4
ADRs-N/V/D, depression, weight loss

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76
Q

tofacitinib/xeljanz

A

JAK inhibitor
psoriatic arthritis after fail on MTX
immunosuppressive
DO NOT use with DMARDs or with potent immunosuppressants; NO live vaccines
high risk of serious invasive infections
monitor lymphocytes, neutrophils, hemoglobin, liver enzymes, and lipids
BBW: serious cardiac events

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77
Q

what can you not take/use with tofacitinib/xeljanz

A

biologic DMARDs or with potent immunosuppressants
NO live vaccines

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78
Q

tofacitinib/xeljanz BBW

A

serious cardiac events such as heart attack or stroke, cancer, blood clots, and death

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79
Q

acitretin for psoriasis

A

retinoid (oral)
NOT immunosuppressive
max response 3-6 months
DO NOT drink alcohol
reproductive aged women-should not be pregnant or plan to become pregnant within 3 years following drug discontinuation

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80
Q

methotrexate for psoriasis

A

T cell and cytokine suppressors-oral DMARD
onset of action: 3-6 weeks
administer with folic acid
screen: CBC, LFTs
CI: pregnancy, cirrhosis, blood dyscrasias
increased risk of hepatotoxicity

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81
Q

what should you administer with MTX

A

folic acid

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82
Q

what are the contraindications of MTX

A

pregnancy, cirrhosis, blood dyscrasias

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83
Q

cyclosporine for psoriasis

A

T cell and cytokine suppressors-oral DMARD
not recommended for prolonged use (< 4 months bc of nephrotoxicity
dose on actual body weight
many drug interactions
CI: systemic malignancy, untreated HTN or infections
increased risk for elderly-HTN

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84
Q

what is the longest time frame that you can be on cyclosporine

A

4 months

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85
Q

contraindications of cyclosporine

A

systemic malignancy, untreated HTN or infections

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86
Q

abatacept/orencia

A

blocks T cell activation
SQ injection
screen: TB
interactions: live vaccines, COPD

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87
Q

biologics counseling points

A

NO live vaccines
screen for TB prior and during therapy (PPD annually)
discontinue therapy during active infection

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88
Q

adverse effects of biologics

A

increased risk of infections
contraindicated in patients with active infections/sepsis
hypersensitivity rxns
lymphoma and other malignancies
worsening or new onset heart failure: TNFa inhibitors

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89
Q

Biologic agents for psoriasis

A

adalimumab (humira)
etanercept (enbrel)
infliximab (remicade)
golimumab (simponi)
certolizumab (cimzia)
ustekinumab (stelara)
tildrakizumab (ilumya)
risankizumab (skyriza)
guselkumab (tremfya)
secokinumab (cosentyx)
ixekizumab (taltz)
brodalumab (siliq)

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90
Q

TNFa inhibitors

A

adalimumab (humira)
etanercept (enbrel)
infliximab (remicade)
golimumab (simponi)
certolizumab (cimzia)

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91
Q

TNFa inhibitors comments

A

TB testing should be performed on all patients, annually
Hep B screening recommended
monitor: CBC and LFTs
DO NOT use with:
-live vaccines
-patients with or with 1st degree relatives with a demyelinating disease or multiple sclerosis (MS)
-congestive heart failure

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92
Q

who can you not use TNFa inhibitors with

A

-live vaccines
-patients with or with 1st degree relatives with a demyelinating disease or multiple sclerosis (MS)
-congestive heart failure

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93
Q

ustekinumab/stelara

A

IL-12 and 23
avoid in ACTIVE TB; do not give concurrently with live vaccines
PPD monitoring

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94
Q

tildrakizumab/ilumya

A

IL-23
avoid in active TB; no live vaccines

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95
Q

risankizumab

A

IL-23
avoid in active TB; no live vaccines

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96
Q

guselkumab/tremfya

A

IL-23
avoid in active TB; no live vaccines

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97
Q

secukinumab/cosentyx

A

Crohn’s

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98
Q

ixekizumab/taltz

A

IL-17A

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99
Q

brodalumab/siliq

A

IL-17A
BBW: increased suicide risk
must complete REMS

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100
Q

safety considerations for use of ALL biologics

A

serious infections, including TB
malignancies and lymphomas
anaphylaxis

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101
Q

safety considerations for use of anti-TNFs biologics

A

heart failure worsening
demyelinating disease
Hep B reactivation
cytopenias
lupus-like syndrome

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102
Q

safety considerations for use of anti-ILs biologics

A

inflammatory bowel disease
depression worsening

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103
Q

photochemotherapy for psoriasis

A

need skin biopsy of lesion to confirm diagnosis of psoriasis
90% efficacy with oral psoralens + UVA light
reserved for patients with severe, refractory psoriasis

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104
Q

side effects of photochemotherapy for psoriasis

A

serious burns, blistering, peeling, itching, nausea, potential increase in certain cancer rates (basal/melanoma), photoaging

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105
Q

MOA of photochemotherapy for psoriasis

A

psoralen cross-links with DNA in presence of UVA light; effects immune response in skin and lymphocytes

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106
Q

integrative and alternative medicine for psoriasis

A

traditional chinese medicine
herbal therapies
diet/dietary supplements
mind/body therapies

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107
Q

plant contact dermatitis is caused by what

A

urushiol

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108
Q

urushiol

A

active irritant, oily liquid
sensitization phase
elicitation phase

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109
Q

sensitization phase of urushiol/plant contact dermatitis

A

enters skin within 10 min of contact
urushiol binds to epidermal proteins to form an antigen

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110
Q

elicitation phase of urushiol/plant contact dermatitis

A

upon continued/subsequent exposures, hypersensitivity rxn occurs
rash may appear 2-48 hr after exposure
rash continues for 1-3 weeks
fast onset, long recovery

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111
Q

prevention of plant contact dermatitis

A

protective clothing and gloves

112
Q

if exposed to urushiol, what should you do

A

rinse with large volumes of water
wash area with soap and water, remember under the nail

113
Q

plant contact dermatitis signs/symptoms

A

early lesions of small blisters
appears in a line where the skin has brushed against the plant
severe respiratory symptoms
may occur following inhalation of burning poison ivy, oak, or sumac plants
itching
erythema
vesicles/papules

114
Q

topical hydrocortisone

A

insect bites and stings
plant dermatitis (wet or dry)
atopic dermatitis
v mild psoriasis
treats pruritis and inflammation
do not use < 2 years

115
Q

topical anesthetics products

A

pramoxine
benzocaine
dibucaine
lidocaine

116
Q

topical anesthetics derm condition

A

insect bites and stings
plant dermatitis (dry)
sunburn

117
Q

topical anesthetics comments

A

relieves pain and pruritis by numbing skin
do NOT use under occlusive dressing or on broken skin
caines-methemoglobinemia

118
Q

topical antihistamines derm condition

A

insect bites and stings

119
Q

topical antihistamine comments

A

relieve pain and pruritis
AVOID use in:
-chicken pox
-PLANT DERMATITIS
-sunburn
-broken, oozing skin

120
Q

antipruritic or counterirritants products

A

phenol
camphor
menthol
benzyl alcohol
calamine

121
Q

antipruritic or counterirritants derm condition

A

insect bites and stings
dry plant dermatitis

122
Q

antipruritic or counterirritants comments

A

relieves pain and pruritis
many combo products
DO NOT use on broken skin or wound

123
Q

astringent products

A

aluminum acetate
witch hazel

124
Q

astringent derm condition

A

wet or weeping plant or atopic dermatitis

125
Q

astringent comments

A

reduce inflammation by vasoconstriction
cool and dry the skin by evaporation
slows down oozing, weeping, or bleeding lesions

126
Q

topical antibiotics products

A

bacitracin
neomycin
polymyxin B sulfate
mupirocin

127
Q

topical antibiotics derm condition

A

minor burns
minor cuts

128
Q

topical antibiotics comments

A

prevent or treat minor infection
contact MD if no improvement after 7 days

129
Q

1st line of treatment for plant contact dermatitis for itching

A

oral antihistamine

130
Q

what products do you NOT use for reducing itchiness in plant contact dermatitis

A

topical antihistamines or antibiotics

131
Q

plant contact dermatitis follow up

A

refer to a physician if:
-do NOT see any improvement after 7 days
-symptoms become worse
-rash covers large area of face or swelling of eyelids
-rash involves genitalia
-secondary infection

132
Q

insect bits

A

nonvenomous
mosquitos, fleas, bedbugs, ticks, most spiders
local effects
mild pruritis, erythema, papules

133
Q

insect stings

A

venomous and contain allergenic proteins
bees, wasps, yellowjackets, hornets, fire ants
pain, pruritis, and irritation

134
Q

prevention of insect bites

A

use insect repellants
avoid contact with insect
-cover skin

135
Q

insect bites nonpharm measures

A

apply ice pack
avoid scratching area, keep nails trimmed
do NOT wear rough clothing over bite area
remove ticks with tweezers->disinfect skin with rubbing alcohol

136
Q

insect bites treatment

A

any one or combo of following
-skin protectants (can be used in children <2)
-hydrocortisone
-topical anesthetics
-topical counterirritants
-oral antihistamines
-topical antihistamines

137
Q

mosquito borne diseases

A

prevention
-protective clothing
-repellant
malaria, west nile, dengue fever, zika, etc

138
Q

flea borne diseases

A

murine typhus
bubonic plaque

139
Q

murine typhus

A

cats, rodents, possums
incubation period: 6-14 days
symptoms: headache, fever, nausea, and body aches
rash on trunk that spreads to arms and legs
give doxycycline

140
Q

bubonic plague

A

rodents, pets, cats/dogs
give streptomycin, ciprofloxacin, levofloxacin, moxifloxacin, doxycycline, aminoglycosides

141
Q

tick borne diseases

A

lyme disease
rickettsial spotted fevers
tularemia
erlichiosis

142
Q

when do symptoms occur for tick-borne diseases

A

2-14 days after bit

143
Q

symptoms of tick borne diseases

A

fever, headache, myalgias, rheumatoid rxn, rash

144
Q

lyme disease prophylaxis treatment

A

within 72 of detaching tick
-doxycycline

145
Q

lyme disease acute skin lesion treatment

A

early localized disease
doxycycline
amoxicillin
cefuroxime
2nd line: azithromycin

146
Q

southern tick associated rash illness (STARI)

A

lone star tick
NO antibiotic rec

147
Q

rickettsial spotted fevers

A

tick borne disease
doxycycline

148
Q

insect bite follow up

A

refer if:
-symptoms persists after 7 days of treatment
-symptoms worsen
-develops secondary infection (fever, joint pain, lymph node enlargement, neurologic symptoms)

149
Q

bee sting treatment

A

remove bee stinger
wash area with soap and water
apply ice pack
can use skin protectants, hydrocortisone, topical anesthetics, topical counterirritants, oral antihistamines, topical antihistamines
-if pain not relieved by topical, consider oral analgesic

150
Q

bee/wasp/scorpion stings-referral and follow up

A

emergency care immediately if
-severe rxn history
-at any time after sting-experiences hives, dizziness, N/V, difficulty breathing
triage to provider, if symptoms worsen or don’t improve after 7 days

151
Q

insect stings nonpharm measures

A

apply ice pack
avoid scratching area, keep nails trimmed
do NOT wear rough clothing over bite area
remove stinger and venom sac with tweezers->disinfect skin with rubbing alcohol

152
Q

local anesthetics, counterirritants for insect bites/stings

A

apply to area 3-4 times daily
do NOT use in < 2 year
do NOT use > 7 days

153
Q

pramoxine or benzyl alcohol

A

less likely to cause sensitization or adverse effects of the local anesthetics

154
Q

skin protectants for insect bites/stings

A

zinc oxide or calamine
reduce irritation or inflammation
may use in bacterial infection
apply up to 4 times daily
< 2 can use

155
Q

do NOT use __________________ on scabies, bacterial infections, or fungal infections

A

hydrocortisone

156
Q

types of pediculosis

A

head lice
body lice
pubic lice

157
Q

lice nonpharm treatment

A

nit come
airalle
avoid direct physical contact
do not share combs, brushes, towels, caps, and hats
wash clothing, bedding, hairbrushes, combs in hot water
clean home

158
Q

lice exclusions

A

no live lice seens
hypersensitivity to chrysanthemums, ragweed, or pediculicide ingredients
presence of secondary skin infection
< 2 years for pyrethrin treatment
< 2 months old for permethrins treatment
lice infestation of eyelids or eyebrows
preg or breast-feeding
presence of active tumors

159
Q

wetting/occlusive agents for lice

A

cetaphil cleanser and hair dryer
dimethicone lotion
lycelle
natrum muriaticum

160
Q

counseling points of head lice

A

apply enough to wet hair and scalp
allow treatment to stay for 10 minutes
rinse with water
use nit comb to remove dead lice and eggs
repeat process in 7-10 days if more are seen

161
Q

follow up on lice

A

if live lice are found after 2 treatment round 1 week apart, need to refer to PCP to get a Rx product

162
Q

scabies

A

contagious parasitic skin infection caused by arachnid mite
needs prolonged physical contact to transfer
impregnated female is responsible
weakened immune systems and elderly are at risk for secondary infection

163
Q

scabies symptoms

A

inflammation and itching

164
Q

scabies OTCs

A

permethrin 5%
crotamiton 10%
sulfur 5-10%
lindane 1%
ivermectin PO

165
Q

how low can pruritus last after scabies treatment

A

4 weeks due to hypersensitivity rxns

166
Q

what can you use for hypersensitivity rxns of scabies

A

oral antihistamines
topical steroids

167
Q

venomous spiders found in texas

A

brown recluse
black widow

168
Q

venomous spider bites first aid

A

clean wound with soap and water
apply cold pack
elevate limb to reduce swelling
may give tylenol
if possible, kill or capture spider in sealed container
bring spider and patient to ER

169
Q

venomous snakes

A

pit vipers (rattle snakes, copperheads)
elapidae (coral snake)

170
Q

prevention of venomous snakes

A

eliminate rock piles, brush piles, wood piles and areas of tall grass
wear thick work gloves and boots
control insect and rodent pop

171
Q

snake bite first aid

A

keep patient calm
identify the snake
remove any constrictions from limb
wash bite with soap and water
immobilize bitten area and keep it even with or slightly lower than the heart
check for signs of envenomation (swelling and tenderness, pain, lab studies)
call poison control

172
Q

snake bite medical care

A

tetanus injection
consider antibiotic therapy

173
Q

coral snake bite medical care

A

NO antivenom
supportive care ONLY

174
Q

pit viper bite medical care

A

should be scored to assess need for antivenom
many bites do NOT inject venom (dry bite)
symptoms usually evolve over several hours

175
Q

mild or moderate envenomation

A

provide supportive therapy

176
Q

severe envenomation

A

give antivenin, if available
provide supportive therapy
call surgery

177
Q

rabies bit

A

most common
raccoons, bats, foxes, skunks, cats and dogs

178
Q

non bite rabies

A

rare
scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or other potentially infectious material from a rabid animal

179
Q

untreated rabies is

A

fatal

180
Q

rabies postexposure prophylaxis (PEP) not previously vaccinated

A

wound cleansing
human rabies immune globulin (HRIG)
rabies vaccine

181
Q

rabies postexposure prophylaxis (PEP) previously vaccinated

A

wound cleansing
do NOT administer Human rabies immune globulin (HRIG)
rabies vaccine

182
Q

poison control number

A

1-800-222-1222

183
Q

patient risk to UVR induced problems

A

fair skin
blond, red, or light brown hair
freckles
a history of bad sunburns
a previous growth on skin or lips caused by UVR exposure
previous or current UV induced disorder
fam member with melanoma
increased UVR exposure
taking photosensitizing or immunosuppressive meds
a history of autoimmune disease

184
Q

medications associated with increased sun sensitivity

A

antibiotics (doxy)
antihistamines
NSAIDs*
Combo oral contraceptives* and estrogens
retinoids*
*=may contribute

185
Q

meds that MAY contribute to photosensitivity

A

anticonvulsants
antidepressants/antipsychotics
antihypertensives/diuretics
NSAIDs
oral contraceptives
retinoids

186
Q

sun safety

A

high risk times are 10am-4pm
check UV index
apply sunscreen
sunglasses
hat (wide brimmed)
clothing
shade/umbrella
avoid tanning beds and devices

187
Q

UVR causes

A

premature skin aging
skin cancers, which can increase risk of other cancers

188
Q

exclusions for sunscreen

A

allergy to all sunscreen ingredients
< 6 months

189
Q

sunscreen selection

A

compare spectrum coverage of ingredients
select from active and inert ingredients
select on specific patient info and characteristics
select product for the intended use/planned activity (ie swimming)
advise at least SPF > 15; prefer SPF 30+

190
Q

physical sunscreen ingredients (sunblock)

A

zinc oxide
titanium dioxide
opaque, reflect and scatter the UVR rays to then protect spectrum coverage

191
Q

chemical sunscreens (sunscreens)

A

absorb and block the transmission of UVR to epidermeris
aminobenzoic acid
benzophenones
cinnoxate
avobenzone

192
Q

sunscreen ingredients to use if patient has sensitive skin or previous allergic rxns

A

AVOID PABA
consider GRASE sunscreen (generally recognized as safe and effective): zinc oxide and titanium dioxide

193
Q

try to avoid this ingredient in sunscreen

A

oxybenzone (long term toxicity)

194
Q

sunscreen application

A

adult: apply ~ 1oz of sunscreen over all exposed skin area 15 min prior to UV exposure
reapply after exposure to moisture or towel drying
reapply every 2 hrs

195
Q

biggest factors leading to sunburn

A

not applying enough
not applying often enough
not apply evenly

196
Q

does sunscreen affect vitamin D in the body

A

NO, it will not compromise vit status in healthy people

197
Q

sunburn

A

peripheral vasodilation in the epidermis from UV light
inflammatory rxn->includes lymphocyte infiltrates
symptoms start ~4 hrs after exposure
erythema peaks ~24 hrs after exposure
may last for up to 5 days

198
Q

skin and eye changes from sun exposure

A

cataract
pterygium
age spots
melasma
wrinkles
carcinoma
melanoma

199
Q

ABCDE skin cancer identifiers

A

asymmetry
border is irregular
color is uneven
diameter increases
evolving-has changed

200
Q

treatment plan of sunburn

A

initial treatment is nonpharm: in past 20 min, immerse in cool water/cool wet cloths
any combo of OTC products depending on symptoms and patient preference

201
Q

sunburn exclusions

A

large areas of blistering
fever
extreme pain
headache or confusion
lightheadedness or vision changes
severe swelling
signs of infection (open blisters)

202
Q

sunburn treatment

A

systemic analgesics
skin protectants

203
Q

systemic analgesics for sunburns

A

prefer one with anti-inflammatory prop (NSAIDs, APAP)
decrease pain, erythema, and edema
longer DoA than topical anesthetics
use for first 1-2 days

204
Q

skin protectants for sunburns

A

help with rehydration and skin irritation
ex: cocoa butter and petrolatum
apply as often as needed
wait until after 24 hrs to start using

205
Q

alternative treatment for sunburn

A

aloe vera
-topical on intact skin
-decrease pain
-avoid internal use->multiple DIs and adverse effects

206
Q

do NOT recommend for sunburn treatment

A

first aid antiseptics
topical anesthetics bc only on small areas of intact skin and may cause hypersensitivity rxn

207
Q

sunburn follow up

A

refer if: burn has progressed or worsened after 24-48 hrs
if not healed in 7 days

208
Q

sun exposure counseling points

A

use broad spectrum sunscreen w/ SPF > 15
-water resistant prop as appropriate
apply 1 oz over exposed areas, AVOID eyes and mucous membranes
apply sunscreen 15 min prior to sun exposure
use most substantive sunscreen available
limit time btwn 10am-4pm
reapply sunscreen at least every 40-80 min (as labelled)
check expiration dates; keep product out of sunlight
if taking photosensitizing drug: use sunscreen and protective clothing
stop using any product that causes redness, itching, rash

209
Q

photoaging

A

associated with cumulative sun exposure and other environmental influences
classification starts at 20 (mild) to >60 (severe)

210
Q

chronologic aging

A

thin skin
fine wrinkles
xerosis
laxity
seborrheic keratoses
senile angiomas

211
Q

photoaging

A

atrophic skin
coarse wrinkles
leathery skin
lentigines
bronzed appearance
yellow cobblestone appearance
telangiectasis
bruising
sun induced dermatitis

212
Q

skin anti-aging approaches

A

cosmetic care
topical meds
invasive procedures
systemic agents
prevention

213
Q

photoaging prevention

A

reduce UVR exposure: sunscreens, protective clothing, sunglasses, hats
reduce exposure to environmental risk factors: air pollution, smoking

214
Q

prevention approach to anti-aging

A

stop smoking
reduce exposure to pollution, UVR radiation, stress
nutrition
physical activity
healthy lifestyle

215
Q

retinoids for anti-aging

A

increase keratinocyte cell division, replacing epidermal cells
enhances new collagen and elastic fibers in dermis
reduces melanin production
improves wrinkles, pigmentary mottling and texture
benefits from long term use
topical SEs
photosensitivity

216
Q

alpha hydroxy acids for anti-aging

A

keratolytic
lactic, glycolic, citric, malic acids
increases dermal thickness:
-improves collagen and elastic fibers
-reduce hyperpigmentation

217
Q

hydroquinone

A

depigmentation
reduces hyperpigmentation associated with sun exposure: melasma, lentigines
in combo products
limit use to 3 months
wear sunscreen

218
Q

photoaging pharm treatments

A

topical retinoids
keratolytics
vitamin supplements
depigmenting agents

219
Q

topical antioxidants

A

niacinamide (vitamin B3), ascorbic acid (vitamin C), D-alpha tocopherol (vitamin E), co-enzyme Q-10
alpha-lipoic acid

220
Q

photoaging counseling points

A

is preventable, cumulative
protect skin from further damage
use broad spectrum sunscreen w/ SPF > 15 and reapply often
clean face 2x daily with mild soap product/cleanser
healthy lifestyle/stop smoking

221
Q

hydroxy acid counseling points

A

apply to dry skin within 15 min of cleansing
SEs: stinging, burning, itching, skin lightening, dryness

222
Q

retinoids counseling points (for photoaging)

A

apply once at night daily to dry skin after cleansing
add moisturizer/foundation product w/ SPF 30+ during day
SEs: scaling, redness, burning, dermatitis

223
Q

types of acute wounds and burns

A

abrasions
punctures: bites, sharp objects
lacerations
burns: thermal, electrical, chemical, UVR

224
Q

stage 1 wound

A

no loss of skin layers, reddened, non-blanching, unbroken skin

225
Q

stage 2 wound

A

blister or partial thickness skin loss, involves all the epidermis and part of the dermis

226
Q

stage 3 wound

A

full thickness skin loss, damage to the entire epidermis, dermis, and dermal appendages, may involve damage to the SQ tissues

227
Q

stage 4 wound

A

further involves the SQ tissue, underlying muscle, tendon, and bone

228
Q

minor burns and wounds exclusions for self treatment

A

face, hands, feet, major joints, genitals, or perineum
injuries larger than 3 inch in diameter
worsen or has not healed in 24-48 hrs and/or 7 days
chemical, electrical, or inhalation burns
deep partial thickness, full thickness, or subdermal skin injuries
signs of infection

229
Q

gauze dressings

A

nonocclusive fiber dressing with loose, open weave
bandage, sterilux bulky gauze

230
Q

nonadherent dressings

A

nonadherent, light coated porous dressings
adaptic, vaseline gauze
less adherent than plain gauze

231
Q

adhesive bandages

A

adhesive bandage with nonadherent pad in the center
band-aid flexible fabric adhesive bandage
less adherent than plain gauze

232
Q

hydrocolloids

A

wafer dressings composed of hydrophilic particles in an adhesive form covered by a water-resistant film or foam
band-aid advanced healing strips
provides moist healing environment
occlusive

233
Q

transparent adhesive films

A

semi-occlusive, translucent dressings with partial or continuous adhesive composed of polyurethane or co-polyester thin film
tegaderm
used for uninfected wounds ONLY
not absorptive

234
Q

minimize scarring by

A

avoid UVR exposure to wound
silicone sheets or gels
laser therapy
appropriate and consistent wound care

235
Q

first aid antibiotics

A

preventative
active ingredients: bacitracin, neomycin, polymyxin B sulfate
apply after cleansing and before bandaging
toxicity risk increases with large areas of application

236
Q

pro topical antimicrobial therapy

A

delivery of conc antimicrobial agent to site
less potential for systemic side effects or toxicity
ensures regular visual inspection of wound

237
Q

con topical antimicrobial therapy

A

limited evidence of clinical efficacy
local allergic rxns
disruption of surrounding skin microbiota
minimal penetration depth
bacterial resistance from unnecessary use
potential for product contamination

238
Q

antibiotic ointment effects

A

reduced health
aquaphor ointment was superior
use for infection prophylaxis in acute, minor, uncomplicated, soft tissue wounds
TAO can cause sensitivity rxns

239
Q

topical anesthetics for wounds

A

temp relief of pain
limited evidence of efficacy or safety
benzocaine, lidocaine, pramoxine

240
Q

first aid antiseptics

A

may cause cytotoxicity reducing wound healing
chlorhexidine, H2O2, povidone-iodine

241
Q

minor burn

A

self care
adult: <15% BSA
child: <10% BSA
<2% deep partial thickness or full thickness burn

242
Q

moderate burn

A

need referral
adult: 15-25% superficial
child: 10-20% superficial
2-10% BSA deep

243
Q

major burn

A

need referral
adult: >25% BSA superficial
child: > 20% BSA superficial
>10% BSA deep
electrical burns
in eyes, ears, face, or genitalia

244
Q

exclusions for self treatment of burns

A

moderate to severe burn to BSA of 2% or more
burns involving eyes, ears, face, or genitalia
chem burns
electrical or inhalation bursn
persons of advanced age
patients with diabetes or multiple medical disorder
immunocompromised patients

245
Q

nonpharm for minor burn

A

cool water: reduces burning sensation, decreases morbidity
honey
aloe vera

246
Q

OTC pharm therapy for minor burns

A

OTC systemic analgesics
skin protectants
topical antiseptics
topical antibiotics
topical anesthetics

247
Q

topical antiseptics for minor burn

A

only on intact skin, edges of wound, reduces healing if used within wound

248
Q

topical antibiotics for minor burn

A

may reduce the incidence of infection and promote healing when use 1-3x a day
systemic toxicity: neomycin
hypersensitivity rxn: polymyxin B
if improvement is not seen within 7 days, the should see PCP

249
Q

topical anesthetics for minor burns

A

apply for pain max 4x a day
care should be taken to apply small quantities and low conc
systemic toxicity: lidocaine
hypersensitivity rxns: benzocaine, lidocaine
relief for 15-45 min

250
Q

local impaired wound healing factors

A

tissue perfusion
bacterial contamination
foreign bodies
necrotic tissue
eschar

251
Q

systemic impaired wound healing factors

A

poor vascularization
bacterial infection inadequate nutrition
coexisting medical condition
meds

252
Q

Rx med that impede wound healing

A

chemotherapeutic agents
corticosteroids

253
Q

comorbidities that impair wound healing

A

obesity
diabetes
severe anemia
peripheral vascular disease
congestive heart failure

254
Q

social factors that impair wound healing

A

smoking
-vasoconstriction->decrease proliferation of erythrocytes, macrophages, and fibroblasts; decreases tissue O2 delivery

255
Q

chronic wounds

A

start with conservative treatment as acute wounds
pressure relief or compression dressing
nutrition status
control infection
debridement

256
Q

debridement of chronic wounds

A

sharp (removes devitalized tissues with scalpel or devices)
mechanical/enzymatic (removes biofilm and devitalized tissues with abrasion, whirlpool wet to dry dressing, maggot therapy)
surgical: deep tissue or bone biopsy; reconstructive

257
Q

warts

A

caused by HPV
can occur anywhere on the body
transmission from other humans, auto-inoculation or inanimate objects
limited to epidermis
diff types for feet and hands
may resolve without treatment
recurrent or recalcitrant warts should be referred

258
Q

warts characteristics

A

any area of skin susceptible to causative virus
rough cauliflower-like appearance; plantar hs disrupt normal skin ridges
usually not painful
size varies, may grow to 1 inch in diameter
caused by HPV
treat with salicylic acid or cryotherapy

259
Q

corns characteristics

A

over bony prominences in the feet
raised, sharply demarcated, hyperkeratotic lesions with a central core
painful
size varies
caused by friction
treat with salicylic acid

260
Q

calluses characteristics

A

weight bearing areas of feet
raised, yellowish thickening of the skin; broad based with diffuse borders; normal pattern of skin ridges
usually not painful
size varies
caused by friction, walking barefoot, structural problems
treat with salicylic acid

261
Q

the only types of warts that are self-treatable

A

common and plantar

262
Q

warts on hands

A

common

263
Q

warts on face

A

flat
filiform

264
Q

warts on feet

A

plantar
mosaic

265
Q

warts on nails

A

periungual

266
Q

nonpharm treatment of warts

A

AVOID cutting, shaving, or picking at warts
wash hands before and after treating or touching a wart
use a designated towel to dry any wart-affected areas
AVOID sharing towels, razors, socks, shoes
keep wart covered
use foot covering in bathrooms/public spaces
may suggest padding to relieve discomfort

267
Q

wart removers pharm therapies

A

salicylic acid 40%: pads, strips, patches
salicylic acid 17%: gel, liquid, stick
cryotherapy: dimethyl ether and propane
cryotherapy: nitrous oxide

268
Q

salicylic acid 40% counseling points

A

trim plaster to fit the wart, corn, or calluses apply plaster, and cover with an occlusive tape
remove plaster/pad/stick after 48 hrs
repeat every 48 hrs as needed
may use for up to 12 weeks

269
Q

salicylic acid 17% counseling points

A

apply 1 drop at a time to cover the wart, corn, callus; protect adjacent healthy skin from coming into contact with the gel
let solution dry
cover wart with self-adhesive discs or an occlusive tape
repeat 1-2x a day until resolves; may be used up to 12 weeks

270
Q

cryotherapy counseling points for warts

A

wash hands before and after use
before treatment, soak affected area in warm water for 5 min
wash and dry the affected area thoroughly
may use file for surface of wart
do NOT hold canister close to face, body or clothing
FLAMMABLE
have to activate the device
discard single-use applicators after 1 use
repeat after 2 weeks if needed; may be used for up to 3 treatments

271
Q

complementary therapies for warts

A

vitamin A
dietary zinc
garlic->DIs
duct tape

272
Q

corn

A

small, raised, sharply demarcated, hyperkeratotic lesion with a central core; lesion is cause by pressure from underlying bony prominences or joints
on top of foot

273
Q

callus

A

bottom of foot
broad base, with relatively even thickening of skin

274
Q

corns and calluses nonpharm

A

daily soaking of affected skin area for 5 min in warm water
remove any dead tissue gently
use circular foal or gel cushioning pads
use well-fitting, non binding footwear
orthotics

275
Q

corns and calluses pharm counseling point

A

do NOT use on irritated skin, any area that is infected or reddened, moles, birthmarks, wart with hair growing from them, genital warts, warts on face, mucous membranes
do NOT use if diabetic, or poor blood circulation

276
Q

corns and calluses pharm therapies

A

salicylic acid 17%
salicylic acid 40%

DEENT (4 decks)

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