Module 9 Flashcards
Side effects associated with topical glucocorticoids used for acne include (choose all that apply):
a) thinning of skin
b) hypotrichosis (hair loss)
c) telangiecasia (spider veins)
d) diarrhea
e) local irritation
Answer: a) thinning of skin and c)telangiecasia
Other side effects include: stretch marks, purpura, hypertrichosis (hair growth), and possible systemic toxicity (adrenal suppression, growth retardation)
Systemic side effects seen with glucocorticoid use in acne include:
a) hypotension
b) blood dyscrasias
c) growth retardation
d) hepatotoxicity
Answer: c) growth retardation
Growth retardation can be seen in kids. Other systemic SE include adrenal suppression. These are seen more with higher doses/long-term treatment.
First line topical acne treatment is ______ and second line topical acne treatment is ________.
Answer:
1st line topical: benzoyl peroxide
2nd line topical: antibiotics (Clindamycin and erythromycin)
Most topical agents for acne are targeting what organism?
P. acnes
What is the MOA of benzoyl peroxide (choose all that apply)
a) kills bacteria
b) creates a barrier which decreases the environment suitable for bacterial proliferation
c) keratolytic
d) dries the skin which decreases nutrients needed for P. acnes
e) reduces inflammation
Answer: a) kills bacteria & c) keratolytic (thins/softens the skin)
True or false, monotherapy with Clindamycin or Erythromycin can increase resistance in P. acnes?
True. These are usually combined with benzoyl peroxide to decrease the resistance.
What is the MOA of retinoids?
a) kills bacteria
b) creates a barrier which decreases the environment suitable for bacterial proliferation
c) keratolytic
d) dries the skin which decreases nutrients needed for P. acnes
e) reduces inflammation
Answer: e) reduces inflammation
Retinoids also unplug comedones and prevent new; they will improve the penetration of other topical agents
Which of the following statements are inaccurate regarding retinoids?
a) sunscreen must be used while using these drugs
b) can make acne worse initially
c) can be used without regard to pregnancy
d) irritation can last up to 4 weeks
e) require a pregnancy test before initiation
Answer: c & e
Retinoids CANNOT be used in pregnancy but they do not require a pregnancy test before treatment initiation.
Which retinoid can not only be used for acne & wrinkles, but can also be used for psoriasis?
a) tretinoin
b) adapalene (Differin)
c) tazarotene (Avage/Tazorac)
d) retinoid acid
Answer: c) tazarotene (Avage/Tazorac)
Azelaic acid (Azelex/Finacea) can be used to treat (choose all that apply):
a) hormonal acne
b) psoriasis
c) acne
d) actinic keratosis
e) rosacea
Answer: c)acne and e)rosacea
It works by suppressing P. acnes and decreasing keratinocytes (thins skin)
Keratolytic drugs work by _____.
Decreasing keratinocytes which thin the skin. Drugs used in this group include azelaic acid (Azelex/Finacea) and salicylic acid.
Which oral antibiotics used for acne has resistance been associated with (choose all that apply)?
a) doxycycline
b) clindamycin
c) tetracycline
d) erythromycin
Answer: c) tetracycline & d)erythromycin
They can be used orally but are not first line due to the emergence of resistance.
If a patient needs oral antibiotics for acne but cannot take tetracycline, what is a suitable alternative?
a) pencillin
b) ciprofloxacin
c) azithromycin
d) metronizadole
Answer: c) azithromycin
Remember that oral tetracycline and erythromycin are 2nd line oral options due to resistance seen in these drugs used for acne treatment.
Which drug requires the iPledge agreement?
a) retinoids
b) isotretinoin
c) denosumab
d) permethrin
Answer: b)isotretinoin
This agreement is between the pharmacist, provider, and patient due the severe side effect profile this drug carries.
What drugs can increase the adverse effects of isotretinoin (choose all that apply)?
a) warfarin
b) vitamin A
c) amoxicillin
d) theophylline
e) tetracyclines
Answer: b) vitamin A and e)tetracyclines
Which is not an adverse effect of isotretinoin (choose all that apply)?
a) photosensitivity
b) depression
c) bone fractures
d) impaired hearing
e) hepatitis
Answer: e) hepatitis
Other severe SE: pancreatitis, elevated triglycerides, teratogen
Which is not a mild SE of of isotretinoin (choose all that apply)?
a) hair loss
b) headache
c) ocular inflammation
d) constipation
e) nosebleeds
Answer: d) constipation
Other mild SE include: drying, rash, skin peeling
True or false, when combination oral contraceptives are used for acne, the benefits are derived from the progestin?
False. Benefits are derived from the estrogen.
Hormonal options for acne control include (choose all that apply):
a) combination OCs
b) IUD
c) spironolactone
d) Depot injections
Answer: a) combination OCs (ortho tri-cyclen, YAZ, Beyaz, estrostep) & c) spironolactone (used if OC inadequate)
Side effects of spironolactone include (choose all that apply):
a) hyperkalemia
b) teratogen
c) depression
d) lymphoma
Ansewr: a) hyperkalemia and b)teratogen
Other SE: menstrual irregularities and breast tenderness
Suncreens provide protection from UVA or UVB primarily?
Answer: UVB
UVB is responsible for tanning/sunburn even though UVA penetrates deeper
Broad spectrum sunscreen covers UVA & UVB but must contain what ingredient in order to achieve this?
a) titanium oxide
b) dapsone
c) avobenzone
d) zinc
Answer: c) avobenzone
Which medication does not increase photosensitivity?
a) aldendronate
b) TCA
c) sulfonamides
d) phenothiazine
Answer: a) aldendronate (Fosamax)
Drugs which increase photosensitivity include: TCA, sulfonamides, sulfonylureas, phenothiazine, TETRACYCLINE, FLUOROQUINOLONES
Organic sunscreens are _____ (physical/chemical) barriers, whereas inorganic sunscreens are ______ (physical/chemical) barriers.
Organic=chemical barrier
Inorganic=physical barrier (zinc and titanium oxide)
SPF indicates the amount of protection against _____(UVA/UVB)?
Answer: UVB
SPF is the amount of protection against UVB
Dapsone (Aczone) can be used to modestly improve acne and can also be used in what other diagnosis?
a) Paget’s
b) veneral warts
c) leprosy
d) actinic keratosis
Answer: c) leprosy
The MOA of Dapsone is unknown.
First line treatment of psoriasis would be:
a) vitamin A derivatives
b) vitamin D analogs
c) ointment
d) topical glucocorticoids
Answer: d) topical glucocorticoids
They are anti-inflammatory. Note that moderate-to-high strength needed due to plaque resistance to steroids.
Calcipotriene can be used to treat:
a) osteoporosis
b) Paget’s
c) psoriasis
d) leprosy
Answer: c) psoriasis
It is a vitamin D analog used topically in psoriasis. It suppresses lymphocyte activity. It can be used long term.
Which is not a treatment for psoriasis:
a) immunosuppressants
b) vitamin D analogs (Calcipotriene)
c) Anthralin
d) tar
Answer: all of these are used for psoriasis
Which drug has the side effect of staining skin and clothes?
a) Zetar
b) Methotrexate
c) Risedronate
d) Anthralin
Answer: d) Anthralin
It is used topically for psoriasis
Which are systemic drugs used to treat psoriasis (choose all that apply)?
a) Zetar
b) Methotrexate
c) Entancercept
d) Anthralin
Answer: b) methotrexate & c) entancercept
Zetar (tar) and Anthralin are used topically
Procedures to treat psoriasis include:
a) tanning beds
b) cryotherapy
c) photochemotherapy
d) podophyllin
Answer: c) photochemotherapy with a UVB light
Will produce long lasting remission (2-4 months)
Sometimes tar is used as an adjunct to the light.
True or false, 50% of all skin cancers start as actinic keratosis?
True.
These are rough scaly brownish-red papules which develop due to chronic sun exposure.
Which is not a treatment for actinic keratosis?
a) tacrolimus
b) fluorouracil
c) diclofenac sodium
d) imiquimod
Answer: a) tacrolimus
Tacrolimus is used for eczema.
Other treatments for AK are aminolaevulinic acid+blue light and crytotherapy.
What condition is commonly seen in patients with eczema?
a) AKs
b) asthma
c) arthritis
d) absorption disorders (Celiac, Crohn’s)
Answer: b) asthma
What is considered first line treatment for eczema (atopic dermatitis)?
a) glucocorticoids (oral)
b) immunosuppressants
c) antihistamines
d) moisturizers
Answer: d) moisturizers and TOPICAL glucocorticoids
Key is to keep area moist.
2nd line agents: ORAL glucocorticoids
If moisturizers+topical glucorticoids & oral glucocorticoids are not successful in treating eczema, what is the next step?
a) higher dose glucocorticoids
b) immunosuppressants
c) antihistamines
d) monoclonial antibodies
Answer: b) immunosuppressants
These are 3rd line agents in eczema. These include tacrolimus & pimecrolimus
Tacrolimus (an immunosuppressant) used in eczema carries what side effects?
a) blood dyscrasias
b) cancer
c) hepatoxicity
d) P450 substrate
Answer: b) cancer
Other SE: lymphoma
These drugs work by blocking calcineurin
True or false, venereal warts can be eliminated with adequate treatment.
False. Neither drugs nor physical measures will eliminate the virus.
Podophyllin is used to treat venereal warts. What side effects does this drug carry (choose all that apply)?
a) highly caustic
b) blood dyscrasias
c) cancer
d) teratogen
e) CNS/PNS neuropathy
Answer: a, b, d, e
Podophyllin SE: blood dyscrasias, CNS/PNS neuropathy, teratogen, and kidney damage
Drug resin should be washed off a few hours after application.
Bichloracetic acid (BCA) & trichloracetic acid carry what side effects?
a) blood dyscrasias
b) cancer
c) local tissue injury
d) P450 substrate
Answer: c) local tissue injury
They are used to treat venereal warts.
At home treatments of venereal warts DO NOT include:
a) imiquimod
b) podophyllin
c) podoflox
d) kunecatechins
Answer: b) podophyllin
This drug is used IN OFFICE.
True or false, kunecatechins are not recommended in HIV patients, immunocompromised, or those with genital herpes.
True.
This drug is an at home treatment for venereal warts.
Common warts are caused by:
a) HPV 1
b) HPV 8
c) HPV 23
d) HPV 5
Answer: a) HPV-1
Also caused by HPV-2 & HPV-3
Common warts can be chemically removed by using which of these drugs (choose all that apply):
a) podophyllin
b) imiquimod
c) fluorouracil
d) bichloracetic acid
e) podofilox
Answer: a,b,c,e
Chemical removal drugs: salicylic acid, podophyllin, podofilox, imiquimod, trichloroacetic acid, topical fluorouracil
Drugs used for both common warts and venereal warts are:
a) podophyllin
b) trichloroacetic acid
c) podofilox
d) imiquimod
Answer: all of the above
Imiquimod & podofilox can be used at home.
What patient is it appropriate to use Botox with/for?
a) pregnant/breastfeeding patient
b) female aged 55
c) male aged 70
d) patient taking tetracycline
e) M. gravis
Answer: b) female aged 55 & d) patient taking tetracycline
Botox should be avoided in the other groups. Those aged 65 will have little benefit from botox. Patients taking other neuromuscular drugs are at risk. Patients taking aminoglycosides should avoid.
Patients at risk for a reaction to botox include those who:
a) are allergic to human albumin
b) concurrently taking a neuromuscular blocking drug
c) have a seizure disorder
d) are taking tetracycline antibiotics
Answer: a & b
Risks include those allergic to human albumin and concurrently taking a neuromuscular blocking drug or an aminoglycoside.
What organism is responsible for impetigo?
a) S. pyogenes
b) P. acnes
c) S. aureus
d) Candida intertrigo
Answer: c) staphylococcus aureus
It is common in children aged 2-5 and appears often on the hands/feet/legs
Most (70%) of cases of impetigo are _____ (bullous/nonbullous).
Answer: nonbullous
It usually is a small macule which evolves into an oozing vesicle (yellow-brown exudate) and dries into a honey-colored crust.
First line treatment of impetigo involves:
a) cephalexin orally
b) clindamycin topically
c) Eucerin ointment
d) mupirocin topically
Answer: d) mupirocin topically
Other topical option is retapamulin.
2nd line treatments are oral ABX
Antibiotics used orally for impetigo include:
a) clindamycin
b) doxycycline
c) cephalexin
d) dicloxacillin
Answer: a) clindamycin, c) cephalexin, and d) dicloxacillin
ABX orally: Cephalexin Clindamycin Clavulanate/amoxicillin DiCloxacCillin
The organism responsible for seborrheic dermatitis usually is:
a) Candida Balantis
b) P. acnes
c) S. aureus
d) Candida intertrigo
e) Malassezia
Answer: e) Malassezia
It is a yeast microbe which causes scaling of scalp/face
Treatment is topical ketoconazole
Which statement is true regarding seborrheic dermatitis (choose all that apply)?
a) initial treatment involves topical ketoconazole
b) initial treatment involves a yeast-suppressing shampoo
c) initial treatment involves terbafine
d) initial treatment involves glucocorticoids
Answer: a & d
Initial treatment involves topical ketoconazole but often a concurrent glucocorticoid will be used which accelerates the response.
Remission can be maintained with a yeast-suppressing shampoo (Head & Shoulders; Selsun blue)
true or false, tinea capitis usually involves ORAL itraconazole/fluconazole/ or griseofulvin.
True. It is poorly responsive to topical treatment.
Tinea corporis (ringworm) is usually treated with:
a) itraconazole
b) terbinafine
c) griseofulvin
d) ketoconazole
Answer: d) ketoconazole
Drugs that increase the risk of osteoporosis include (Check all that apply):
A) Oral combined contraceptives B) Carbamazepine C) CCBs D) High doses of Vitamin D E) Glucocorticoids F) Levothyroxine
Answer: B) carbamazepine, E) glucocorticoids, F) levothyroxine
SERMs treat osteoporosis by selectively:
A. Inhibiting magnesium resorption in the kidneys
B. Increasing calcium absorption from the GI tract
C. Acting on the bone to inhibit osteoblast activity
D. Selectively acting on the estrogen receptors in the bone
Answer: D) selectively acting on the estrogen receptors in the bone
he ongoing monitoring for patients over age 65 taking alendronate or any other bisphosphonate is: A. Annual DEXA scans B. Annual Vitamin D level C. Annual renal function evaluation D. Electrolytes every 3 months
Answer: C) annual renal function evaluation
IV forms of bisphosphonates are used for (Check all that apply):
A. severe gastric irritation with oral forms
B. Known cancer mets to the bone
C. Persons with advancing renal dysfunction
D. Progression of bone loss on oral meds
E. After menopause for prevention of osteoporosis
Answer: A, B, D
T or F: Both UVA and UVB rays promote damage to DNA and can cause premalignant actinic keratoses, basal cell, squamous cell and melanoma.
True
Tacrolimus and pimecrolimusare used for atopic dermatitis. What do both carry the potential for:
A. Both can cause skin cancer and lymphoma
B. Both can cause renal failure
C. Both can cause liver failure
D. They have no side effect
Answer: A) both can cause skin cancer and lymphoma
Which is not considered a low potency topical steroid cream?
a) Desonide 0.05% / Desowen
b) Hydrocortisone 2.5%
c) Triamcinolone Acetonide 0.1%
d) Hydrocortisone 1%
Answer: c) Triamcinolone Acetonide is considered medium potency
Both hydrocortisone options are the LOWEST potency available
Which is the only drug approved for hair growth in women?
a) finasteide
b) eflornithine
c) selenium sulfide
d) minoxidil
Answer: d) minoxidil
Only the 2% solution is approved for women
What is the preferred treatment for onchomycosis?
a) itraconazole
b) ketoconazole
c) terbinafine
d) griseofulvin
Answer: c) terbinafine
6-12 weeks for fingernails and 3-6 months for toes
Treatment options for jock itch include (choose all that apply)?
a) itraconazole
b) ketoconazole
c) terbinafine
d) griseofulvin
Answer: a) itraconazole and b) ketoconazole
think alphabetically: “I, J, K”
I&K treat Jock itch
Finasteride carries what side effects:
a) reduced ejaculate volume
b) orthostatic hypotension
c) blood dyscrasias
d) teratogen
e) nausea
Answer: a,b,d
The drug is used for hair growth and BPH.
Side effects are: decreased libido, ED, impaired ejaculation, reduced ejaculate volume, orthostatic hypotension, dizziness, teratogen
Note: women should not take, or handle broken/crushed drug.
What use does eflornithine have?
a) atopic dermatitis
b) increases bone formation
c) facilitates hair removal
d) actinic keratosis
Answer: c) facilitates hair removal
Side effect is possible fetal harm
