Module 9 BBB Flashcards
True or false: bacterial skin infections are best treated with systemic pharmacologic agents?
False: Topical agents appropriately treat mild infections
AminoglycosidesBBW
Nephrotoxic
True or false: burned, broken, or denuded skin increases systemic absorption of the applied topical medication.
True. The area is open so it can work quicker
Which is an evidence-based resource for the treatment of MRSA?
a) CDC
b) PDR
c) Most recent editions of peer-reviewed pharm books
CDC
What is the current recommended treatment for MRSA abscess?
I&D; culture and sensitivity. Antibiotics are not recommended initially without systemic or severe symptoms.
Which wart treatments can be self-applied?
Imiquimod (Aldara, Zyclara), podofilox (Conylox), kunecatechins (Sinecatechins, veregen)
Which wart treatments must be applied by the practitioner? Why?
Podophylin (podophyllum resin) (podocon-25, podofilm), bichloroacetic acid (BCA) and trichloroacetic acid (TCA)
Why? It is highly toxic
What are systemic “azoles” known for as far as interacting with other drugs?
CYP450 inhibitor: increase warfarin, theophylline, macrolides, statins.
Which “azoles” are approved for systemic use?
Page 717: Fluconazole, itroconazole, posaconazole, ketoconazole, voraconazole, isovuconzonium.
Which are the hardest tinea to treat and may require systemic treatment?
Nail and scalp-often require systemic antifungals
What safety lab or monitoring is needed for long term systemic antifungal treatments?
LFTs and possibly EKG for itracanozole (cardio-suppression)
Acne treatment is based on ___.
Severity
How is mild acne treated?
Topical methods: antibiotics: clindamycin. Paired with benzole peroxide to prevent resistance. Retinoids
Bonzole peroxide does NOT cause resistance
How is moderate acne treated?
Oral antibiotics: doxy, minocycline, retinoids, ozalaic acid
Combined OCs
How long may it take for patients to see improvement with PO treatment of acne?
8-12 weeks
With COC: up to 6 months
What is severe acne treated with?
Accutane
Your patient who was assigned male at birth has moderate to severe acne. He has not had an adequate response to topical antibiotics. Can he try Spironolactone? COC?
No-they block androgens/sex hormones
COC have only been approved for those assigned female at birth, past menarce, and still have female organs.
What OC would not be used for acne?
Progesterone only
Why do COC work for acne?
Decrease androgen activity, and decrease
production of sebum.
What safety information do we need to know about accutane?
It is extremely teratogenic and may cause spontaneous abortions!! Must use two forms of BC and take two negative pregnancy tests each month before and during use. Need one month wash out period.
Do males using accutane need to worry about birth defects?
Yes- it is in the sperm. They should use latex condoms
Can patients using accutane donate blood?
No because the patient recieving blood can be passed those medications. It may cause teratogenic effects if the patient is pregnant
Can a patient breatfeed during accutane use?
No because it can pass to the baby
What is IPledge?
The required program/training to prescribe accutane
Can topical tretinoins be used in pregnancy?
No. Tertinoins are a derivative of vitamin E and can cause teratogenic effects
True or false: Topical antibiotics are appropriate for cellulitis
False; typically IM or IV antibiotics are used. Cellulitis may lead to sepsis.
What is a fingertip unit?
Measurement for topical meds-500 mg
What are some general rules with topical steroid use?
**Carefuly chose potency from low to high
Choose the delivery vehicle based on the goal of therapy
Oitnments are more occlusive and therefore more potent
Creams are less occlusive and usually less potent
Lotions are usually the least potent
Gels, aerosols, lotions, and solutions are useful in hair-bearing areas
What is the max topical steroids should be used in children and adults?
Adults: 2 weeks
Children: 1 week
How do occlusive dressing effect topical medications?
It makes them stronger acting/more potent.
How can topical drugs lead to skin thinning?
High potentcy
Prolonged use
Occlusive dressings over the drug
What may we see with topical steroid use?
Striae and telangiectasia (spider veins)
What systemic symptoms may we see with topical steroids?
HPA axis suppression, Cushing syndrome, Hyperglycemia, Glucosuria
How can we prevent systemic side effects of steroids?
Prescribe the smallest amount and potency to treat the condition
What are the safety concerns regarding immunosuppresive drugs?
Increased risk of infection, reactivation of infections (ex. TB)
Which vehicle of delivery is most potent? Why?
Ointments, they are the most occlusive
What body sites should a lower potency topical steroid be used?
On the body sites with thin skin (face, scrotum, axilla, skin folds) and large surface areas
What body sites should high potency topical steroids be used? What is the max time they should be used for?
Palms of hands and soles of feet
Max: 2 weeks in adults, 1 in children
A patient is frustrated that their moderate acne has not completely resolved by 4 weeks after starting treatment. What is your best response?
It is typical to take 6-8 weeks to have full response to treatment
A patient is frustrated that their mild acne has not completely resolved by 2 weeks after starting treatment. What is your best response?
It is typical to take 4-6 weeks
A patient is frustrated that their acne has not completely resolved by 8 weeks after starting treatment wit COC. What is your best response?
It may take up to 6 months to fully resolve
Is Flagyl safe for use in pregnancy, and which vehicles for delivery?
Yes, per vagina or per mouth-CDC says it is safe in any trimester
What is the first line of treatment of head lice?
Permethrin 1% and pyrethrins (neutoxic to lice)
Which lice medication is safest in pregnancy?
Permethrin 1% (Nix)
What education should be reviewed with patients being treated for lice?
The lice may be resistant and a second treatment may be indicated
What type of dermatologic side effects can prolonged steroid use cause?
Skin thinning, striae, and spider veins
What vehicle is most useful in hair-bearing areas?
Gels, aerosols, lotions and solutions
What vehicle is the less occlusive and usually less potent?
Creams
What will increase penetration of the vehicle/drug?
Occlusive dressings and diapers
What vehicle is more occlusive and therefore more potent?
Ointments
What vehicle is the least potent?
Lotions
True or False? There are many reasoins APRNs should prescribe optic glucocorticosteroids
False-If they are needed the patient should be referred. Misdiagnoses can lead to blindness (if it is viral or fungal)
True or false: Silvadene or sulfadiazine cream is safe for treatment of a burn in a sulfa allergic patient?
False-The patient is allergic
Can silvadene or sulfadiazine be used in a patient that is pregnant?
It should not be used near term-can cause kernicterus
True or false: select fluoroquinolones may be used for a perforated TM?
True, but they must be the sterile formulation (Ciprodex or floxin)
**Ciprofloxin HC CANNOT be used
True or False: Otitis externa is treated only with PO antibiotics?
False
True or False: Because optic beta blockers are not systemically absorbed, optic beta blockers are the preferred drug of choice of glaucoma in people who have contraindications to systemic beta blockers.
False-they do have systemic effects. The same contraindications apply.
What drug from the BBB prolongs the QT?
Flucanozole
