Exam Flashcards
What is Cellulitis?
Acute bacterial infection of the skin involving the deep dermis and subcutaneous fat
What are the pharmacological treatment options of treating cellulitis?
Flucloxacillin:1 g every 6–8 hours for 5 days with or without food; for elderly,
Amoxicillin and clavulanic acid (augmentin) provide broad-spectrum cover if resistance bacteria are suspected. 625 mg every 8-12 hours TWICE daily for 7 days
Erythromycin
Why did the doctor draw a line around the cellulitic area?
To monitor for the spread of infection (if infection is systemic vs local)
What are cold sores?
viral infection
HSV.
In cold sore in the latent stage HSV stays in the
nerves ending
heals in 6-10d
What are the symptoms to check for, to make a diagnosis of cold sore?
Fluid filled blisters: that appear on the skin, usually on the lips, chin, cheeks or nostrils.
Burning / tingling sensation: often felt just prior to skin lesions developing.
Sores generally localised in and around the facial area
Impetigo
Blistering on any areas
honey coloured crust
mild itch
Which treatment option(s) for cold sore would you recommend and why?
Aciclovir(Zovirax) (G topical, rx oral) – 200 mg 5 times daily for 5 days (topical acyclovir and or systemic given orally with prescription).
Topical aciclovir applied 5x daily for 5-10 days
Famciclovir (R) – as a single dose of 3 x 500 mg (unfunded)
Valacyclovir
Compeed patches - applied for 24h to keep the area moist and heal faster.
Take pain relief such as paracetamol or ibuprofen.
Would there anything better treatment available from a GP on prescription for cold sore?
Aciclovir tablets (Prescription only medicine). 200mg 5 times daily for around 5-7days Famciclovir tablets 3 x 500mg once
How does famciclovir work?
Famciclovir, the prodrug of penciclovir. It inhibits viral replication by interfering with viral DNA polymerase and through incorporation into viral DNA, resulting in early chain termination.
What are the Patients counselling for the drug used to treat Cold sore?
Avoid cold sore affected people
Avoid using other family members towels or other family members personal items.
What are Aphthous ulcers (mouth ulcers)?
Painful sore on the inner lining of the mouth
Swollen skin around the sore
What are the pharmacological options of treating mouth ulcers?
Bonjela gel (choline salicylate) - OTC medicine every 3-4 hours
Lignocaine gel - OTC medicine every 3-4 hours (anesthetics)
Triamcinolone dental paste ORACORD (topical steroid) - Pharmacist only or Rx if packet with >5g
Chlorhexidine gluconate Mouthwash for antiseptic use
What advice would you give about topical anaesthetics or antiinflammatory products (e.g. lignocaine mouth gel or choline salicylate gel)?
Do not use more than once every 3 hours
Avoid prolonged or excessive use, especially in infants
Is it possible to recommend triamcinolone(ORACORD) dental paste for the patient and how should it be used?
it is a Corticosteroid
4x daily after meals
Can be pharmacist only if less than 5g given otherwise prescription only
What is Oral thrush?
Yeast infection
What are the symptoms to check for, to make a diagnosis?
Appearance of creamy white spots on the inside of the mouth or the tongue
Common in babies, people with immunodeficiencies
What are the pharmacological approaches to treating oral thrush (oral candidiasis)?
Miconazole oral gel (pharmacist only)
Nystatin: (Oral drops): Pharmacist only (polyene antifungal)
Triamcinolone acetonide paste (KENALOG)
Chlorhexidine gluconate: General sale med for antiseptic purpose
For babies: Nystatin topical use.
What are the patient’s (Nystatin or miconazole) advice on using?
Nystatin advice:
four times a day extra 2 days after symptoms have subsided
Shake the bottle well before use Nystatin oral drops
Hold in your mouth or swish around for as long as possible before swallowing.
What are the timeframes for symptom control or recovery for the various treatment recommendations made?
Oral thrush should begin to see improvement within 1 week so nystatin needs to be continued extra 2 days after that week.
Is there anything better on prescription if recommending referral for Oral candida?
Fluconazole an oral antifungal medication - associated with more adverse effects thus considered 2nd line treatment to topical miconazole or oral nystatin drops.
How will you differentiate bacterial and viral and allergic red eyes and which product you will choose for a variety of pathogens?
For allergic and viral both eyes tend to be infected.Viral and allergic tends to have clear and watery discharge. Allergic eye conditions have a characteristic intense itch to them.
Allergic conjunctivitis tends to affect one eye first then spreads to the next eye within a few days
Bacterial tends to affect one eye first then second eye becomes infected soon after. Bacterial also has a purulent sticky, yellowish discharge
Bacterial and viral eye conditions tend to have a gritty feeling in the mo
What are the pharmacological options to treat bacterial conjunctivitis with counseling points for patients?
Chloramphenicol 0.5% eye drops - antibiotic (pharmacist only)
Chloramphenicol 1% eye ointment - antibiotic (pharmacist only)
Propamidine - antiseptic - (pharmacy only)
What are the pharmacological options to treat allergic conjunctivitis with counseling points for patients?
Naphcon-A eye drops (naphazoline + pheniramine) - pharmacist only
Clear eyes eye drops (naphazoline) - pharmacy only
Livostin eye drops (levocabastine) - pharmacy only
When conditions of the eye may warrant a referral?
Cloudy cornea - can indicate cataracts
Foreign object in eye - needs to removed by doctor
Photophobia
Changes in vision
Redness localised around the pupil area
Irritant conjunctivitis caused by a chemical
What is a red eye? How will you diagnose red eyes?
Deficiency or dysfunction of the tear film which typically lubricates and moistens the eye
Feeling of dryness/grittiness in both eyes
Worsens throughout the day
Eyes watering when exposed to wind
People who wear contact lenses or work in windy environment are more at risk
What are the pharmacological options to treat red eyes with counseling points for patients?
Systane Ultra eye drops (polyethylene glycol + propylene glycol) (general sale)
Poly tears eye drops (hypromellose + dextran) (general sale)
Hylo-fresh eye drops (sodium hyaluronate) (general sale)
What is the eye drop rules for subsidy
Diagnosed by slit lamp with severe dry eye
Patient using more than 4 times daily
Patient experiencing allergic reaction with formulation excipients confirmed by the GP
Tinea corporis/capitis/pedis Treatment options
- Topical terbinafine for 4 weeks
- Both terbinafine (250–500 mg/day for 2–6 weeks) and itraconazole (100–200 mg/day for 2–4 weeks) appear to be effectived
Pityriasis versicolor Treatment options
Topical antifungal agents such as imidazoles, selenium sulphide. Oral agents (itraconazole or fluconazole) may be used for extensive or if topical treatment has failed. Note terbinafine is not effective for malassezia infections.
-it effects Melanosites
Onychomycosis Treatment options
Amolrofine topical
Terbinafine Oral
Seborrhoeic dermatitis/cradle cap Treatment options
Ecozite
salicylic acid
Impetigo Treatment options
Cleansing of wound, topical antiseptic or topical antibiotic (increasing prevalence of bacterial resistance to topical (fusidic acid or mupirocin) and oral antibiotics is an emerging problem so watch and wait approach is sometimes advocated), oral antibiotic if extensive. If the impetigo is extensive or longstanding, an oral antibacterial such as flucloxacillin (or suitable alternative in penicillin-allergy) should be used. Mild antiseptics can be used to soften crusts.
Cellulitis Treatment options
Should refer immediately as can progress rapidly! Can draw around edge of swollen area to monitor spread
Requires systemic antibacterial treatment. Rest/elevate affected limb. Oral/IV antibiotics according severity and local guidelines.
Nappy rash Treatment options
Protective creams and ointments help prevent the damage to the skin which causes nappy rash. Co-existing fungal infections can be treated with products containing drugs such as miconazole.
