Module 9 Forum Questions/Module Highlights

Question 1

Which vehicle is transparent and usually have water or alcohol as a base?

Answer 1

Gels

Question 2

Which vehicle is oil and water based and are not typically as thick as ointments, but they are thicker than lotion.

Answer 2

Creams

Question 3

Which vehicle tends to be thick and greasy? They can have oil or Vaseline as a base.

Answer 3

Ointments

Question 4

When are Ointments best used?

Answer 4

Dry and thick skin

Question 5

When are topical agents used?

Answer 5

To treat a localized, mild infection.

Question 6

What wart medications must be provided by the provider?

Answer 6

Podophyllin (podophyllum resin) (Podocon-25, Podofilm), Bichloroacetic acid (BCA), and Trichloroacetic acid (TCA)

Question 7

What is a concern when using BCA and TCA?

Answer 7

They are highly caustic and can lead to systemic absorption leading to toxicity

Question 8

What medications do the “azoles” interact with?

Answer 8

Drugs ending in “azole” are notorious for interacting with warfarin, theophylline, macrolides, statins, and other drugs metabolized through the CYP450 metabolic pathway.

Question 9

What is an intertriginous area?

Answer 9

Where two skin areas may touch or rub together.

Question 10

What monitoring should be done with oral antifungals?

Answer 10

LFTs

Question 11

What is first-line treatment for mild to moderate acne?

Answer 11

Topical treatment is first-line and may include a comedolytic bactericidal agent (Benzoyl peroxide), comedolytic agent (Retinoic Acid), or a topical antibiotic (Clindamycin 2% or Erythromycin 2-3%). Benzoyl peroxide (2.5% to 5%) can be used as single-drug therapy but its activity is enhanced when combined with other agents.

Question 12

What is the typical treatment for moderate to severe acne?

Answer 12

Tetracyclines, clindamycin, and erythromycin

Question 13

How can cystic acne be treated?

Answer 13

With a vitamin A derivative, Accutane (isotretinoin)

Question 14

What is the month after retinoids referred to?

Answer 14

The “washout” period

Question 15

How is contact dermatitis treated?

Answer 15

Identification of cause and its removal, then topical corticosteroids. For severe cases, PO steroids.

Question 16

How long should systemic steroids be administered for poison ivy/oak?

Answer 16

2 weeks

Question 17

When is Silver sulfadiazine (Silvadene, Thermazene, and SSD cream) contraindicated?

Answer 17

In patients with sulfa allergies. Silver sulfadiazine (Silvadene) should not be used in pregnant patients at term or with patients with G6PD deficiency.

Question 18

What risk is increased when systemic corticosteroids are used with NSAIDs?

Answer 18

GI bleed

Question 19

What drugs in this module prolong the QT?

Answer 19

Fluconazole, azithromycin, ciprofloxacin, levofloxacin

Question 20

What is the preferred treatment for bacterial conjunctivitis in contact users?

Answer 20

Fluoroquinolones

Question 21

What may be used to treat allergic conjunctivitis?

Answer 21

mast cell stabilizers, topical antihistamines, or oral antihistamines

Question 22

When should a patient with allergic conjunctivitis be referred?

Answer 22

If topical corticosteroids are needed/a severe infection

Question 23

What adverse effects are associated with daily/cont. use of dry eye medications?

Answer 23

Nothing is they are preservative-free

Question 24

When are topical beta-blockers contraindicated?

Answer 24

Topical beta-blockers are contraindicated for use in patients with bradycardia or AV block. Be sure to review cautions regarding the use of beta-blockers in your text. Do not prescribe oral beta-blockers with ophthalmic beta-blockers as they have an additive effect.

Question 25

What may be needed in the case of significant canal edema when treating OE?

Answer 25

An ear wick may be used to facilitate the delivery of topical medications into the medial canal

Question 26

Which medications can be used with a perforated TM?

Answer 26

Selected fluoroquinolone drops: ciprofloxacin/dexamethasone (Ciprodex) and ofloxacin (Floxin)

Question 27

Which medications can not be used with a perforated TM?

Answer 27

Ciprofloxacin+ hydrocortisone (ciprofloxacin/dexamethasone otic)

Question 28

When using ear drops on an adult the ear should be..

Answer 28

pulled up and back

Question 29

What does treatment of parasites involve?

Answer 29

Treatment of these infestations involves killing live mites or lice and killing the larvae in egg sacks in the hair or burrows.

Question 30

What is a contraindication of Lindane?

Answer 30

In premature infants and individuals with known uncontrolled seizure disorders.

Question 31

What patient education should be reviewed for scabies treatment?

Answer 31

-Be sure to take a bath or shower before applying the medicine
-Apply the medicine from neck to toes
-If you wash your hands after applying the medicine, be sure to reapply the medicine to your hands
-The day you start treatment, wash your clothes, bedding, towels, and washcloths
-Vacuum your entire home on the 1st day of treatment

Question 32

How do we base our treatment of acne?

Answer 32

Treatment is stepwise and based on severity.

Question 33

What are options for treatment of mild acne?

Answer 33

For mild acne, nonpharmacologic therapy can be effective. The skin should be cleansed with a gentle non-irritant soap to reduce oiliness, avoiding vigorous scrubbing or abrasives. When drug treatment is needed, milder cases of acne can be treated with topical antibiotics and topical retinoids like Benzoyl peroxide, clindamycin, and erythromycin. It can also be treated with Retinoids like Differin, Tazorac, and Retin-A.

Question 34

What are the options for treatment of moderate acne?

Answer 34

Moderate cases can be treated with oral antibiotics like doxycycline, minocycline, and comedolytics including retinoids and azelaic acid. When young people with female organs do not respond to other drugs, hormonal agents such as spironolactone and combination OCs can be used.

It is important to know that when treating moderate severity of acne, it can take 8-12 weeks for patients to see improvement.

Question 35

What are the options for treatment of severe acne?

Answer 35

Typically, if the patient has severe acne, they may need to advance all the way up to Accutane. The topical treatments will not be of help, nor will most of the systemic abx.

Question 36

Do we treat acne rosacea the same as acne?

Answer 36

Acne rosacea is unique in that it occurs in young through older adults and causes a flushed appearance of the cheeks, forehead, and across the bridge of the nose. Acne rosacea may include papules but not pustules which worsen with eating spicy foods, cold air, alcohol, and stress. Acne Rosacea is initially treated with topical metronidazole (Flagyl, Metro-Gel), and if that fails, other topical antibiotics or oral antibiotics may be used including oral metronidazole. Unfortunately, even with oral treatment, rosacea may not clear up.

Question 37

Regarding “azoles” what are some of the things that are important to consider when prescribing and what are some important education topics we need to have with patients?

Answer 37

“Azoles” can cause prolonged QT and hepatotoxicity. Systemic “azoles” cannot be used in pregnancy or lactation. Azoles interfere with the CYP450 pathways and can lead to increased concentration of warfarin, theophylline, macrolides, statins, and other drugs that use this pathway. When giving oral agents such as griseofulvin you will need to check liver fx and have patients avoid alcohol. When giving patients intravaginal treatment for vulvovaginal candidiasis make sure to educate the patient on the risk of pregnancy as the medication can weaken condoms and diaphragms. Additionally, since these treatments are available over the counter ask patients about the self-treatment of yeast infections during routine visits.

Question 38

What safety info do we need to know about ophthalmic beta blockers?

Answer 38

Ophthalmic beta-blockers are absorbed and can reach systemic levels great enough to create complications in patients with chronic conditions and can cause cumulative effects if both oral and ophthalmic beta blockers are used concurrently.

Question 39

What topical medications may be used in the presence of ruptured tympanic membrane?

Answer 39

There are selected fluoroquinolone drops may be used with perforation of the TM and/or pressure equalization (P.E.) tubes. These are ciprofloxacin/dexamethasone (Ciprodex) and ofloxacin (Floxin).

Ciprofloxacin+ hydrocortisone (ciprofloxacin/dexamethasone otic)- Do not use if TM is not intact (not sterile).

We need to always consider the safety of administering otic medication. Intact versus perforated tympanic membrane is a big consideration.

Question 40

What is a fingertip unit?

Answer 40

A fingertip unit is the standard measure of cream or ointment. It is approximately about 500 mg of the ointment or cream.

Question 41

What are the drugs of choice when the decision is made to treat with antibiotics (per AAP)?

Answer 41

-amoxicillin 80-90 mg/kg/day (in 2 divided doses) for a child with AOM who (AAP Strong recommendation, Grade B)
-amoxicillin-clavulanate 90/6.4 mg/kg/day if any of (AAP Strong recommendation, Grade C)

Question 42

Which antiwart treatments may be self-administered?

Answer 42

Imiquimod (Aldara, Zyclara)
Podofilox (Conylox)
Kunecatechins (Sinecatechins/Veregen)

Question 43

Which antiwart treatments are provider applied?

Answer 43

Podophyllin
Bichloroacetic acid
Trichloroacetic acid

Question 44

What are important consideration and potential side effects for use of topical steroids?

Answer 44

considerations: area for topical steroid will determine low potency vs. high potency (low potency is for area near the face, intertriginous area, high potency is for trunk and extremities). Adults can use topical steroids for 2 weeks, children for 1 week.

potential side effects: atrophy of the skin, ecchymosis, striae, acne, hypertrichosis, cataract formation (if application is close to eye), infection/irritation of the area.

In the case of allergic conjunctivitis- topical glucocorticoids must be prescribed by ophthalmologist.