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PC 707 Pharmacology > Module 9: Study Guide > Flashcards

Module 9: Study Guide Flashcards

1
Q

What are the common pathogens that cause skin infections?

A

Staphylococcus aureus and Streptococcus pyogenes. Both are gram-positive.

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2
Q

When is a topical agent appropriate for a skin infection? When would you use a systemic? (How do we base treatment)?

A

Topical agents effectively treat a localized, mild infection.

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3
Q

What are the current treatment recommendations for a MRSA abscess?

A

incision and drainage, culture and sensitivity, education on wound care and hygiene, and follow-up in the absence of systemic symptoms, severe local symptoms, and immunosuppression.

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4
Q

Podophyllin (podophyllum resin) indication

A

venereal warts

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5
Q

Podophyllin MOA

A

cellular death and erosion of the wart

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6
Q

Safety Podophyllin

A

highly caustic and can lead to systemic absorption leading to toxicity.
Soap and water or alcohol should be used a few hours after application to decrease the risk of toxicity.
This drug should not be used in pregnancy or lactation.

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7
Q

What drugs can you use to treat warts?

A

Podophyllin (podophyllum resin), Bichloroacetic acid (BCA), and Trichloroacetic acid (TCA).
At home: Imiquimod (Aldara, Zyclara), Podofilox (Condylox), and Kunecatechins (Sinecatechins/Veregen)

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8
Q

Bichloroacetic acid (BCA), and Trichloroacetic acid (TCA) MOA

A

high concentration (80-90%) and destroy warts by chemical coagulation.

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9
Q

Safety BCA and TCA

A

caution must be used to minimize the spread of the solution to surrounding healthy tissue.

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10
Q

Imiquimod MOA

A

intensify the immune response to HPV by stimulating the production of interferon-alpha, TNF, and several interleukins

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11
Q

Safety Imiquimod

A

Imiquimod is approved for those 12 years and older. It should be avoided in pregnancy.

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12
Q

Podofilox MOA

A

inhibits mitosis like podophyllin.

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13
Q

Podofilox safety

A

No available dosing for children and should not be used in pregnancy or lactation

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14
Q

Kunecatechins MOA

A

Antioxidative effects, apoptosis, and inhibition of telomerase

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15
Q

Kunecatechins safety

A

minimal systemic absorption however, safety in pregnancy is unknown.

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16
Q

What is the effect of topical creams or ointments on condoms and diaphragms?

A

If you use an oil-based product, it can weaken condoms and diaphragms.

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17
Q

What is first-line treatment for acne?

A

Facial hygiene

Avoiding oil-based facial products and cosmetics, using earbuds when talking on a cell phone, and changing the pillowcase regularly are all daily practices that may help prevent exposure to excess oils and the development of acne.

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18
Q

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

A

-Comedolytic bactericidal agent (Benzoyl peroxide)
-Comedolytic agent (Retinoic Acid)
-Topical antibiotic (Clindamycin 2% or Erythromycin 2-3%)
-Benzoyl peroxide (2.5% to 5%)
-Retinoic Acid (Retin-A, Avita)

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19
Q

What are the most commonly used medications for moderate to severe acne?

A

Tetracyclines, clindamycin, and erythromycin are most commonly used.

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20
Q

How should the APRN care for severe or unresponsive acne?

A

Refer the patient to dermatology

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21
Q

How can cystic acne be treated?

A

Accutane

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22
Q

What acne treatments are contraindicated in pregnancy?

A

All retinoid products, systemic salicylates, and tetracyclines

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23
Q

What medications can be used in pregnancy?

A

Many antibiotics considered safe in pregnancy include–in order of preference–the penicillins, cephalosporins, erythromycin, and other macrolides (i.e., Azithromycin).

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24
Q

How is acne rosacea treated?

A

Acne Rosacea is initially treated with topical metronidazole (Flagyl, Metro-Gel). If that fails, other topical antibiotics or oral antibiotics may be used including oral metronidazole.

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25
Q

How long should topical steroids be used with children?

A

No more than 1 week for children.

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26
Q

How long should topical steroids be used with adults?

A

No more than 2 weeks for adults

27
Q

What is blepharitis?

A

Blepharitis is an infection and/or irritation of the eyelid margin.

28
Q

How is blepharitis treated?

A

Topical antibiotics such as bacitracin ointment or erythromycin 0.5% ophthalmic ointment are first-line.

29
Q

When should a patient with blepharitis be referred?

A

If improvement is not noted after several weeks or if the condition worsens, refer to an ophthalmologist.

30
Q

What are the classes of drugs used to manage bacterial conjunctivitis?

A

Fluoroquinolones are preferred.

31
Q

Review patient education in regard to managing expectations for acne treatment. When should they expect results for acne treatments?

A
32
Q

What are the differences in medication delivery systems? Compare ointments, creams, lotions, and solutions.

A
33
Q

Review topical steroid use. What are the adverse effects of long-term use of topical steroids?

A
34
Q

What are the appropriate areas of use for low potency steroids? High potency steroids?

A
35
Q

How do systemic corticosteroids work?

A
36
Q

What are the adverse effects of systemic corticosteroids?

A
37
Q

Review systemic corticosteroids. What are the indications for use in derm? What are the potential common and serious side effects?

A
38
Q

How should bacterial conjunctivitis be managed in a pat who wears contact lenses?

A

Bacterial conjunctivitis is usually self-limiting but for contact users, antibiotics should be used due to the increased risk of keratitis or infection with gram-negative organisms.

39
Q

What are the classes of drugs used to manage allergic conjunctivitis?

A

Mast cell stabilizers (cromolyn sodium, lodoxamide), topical antihistamines, a combination of antihistamine and mast cell stabilizer, or oral antihistamines.

40
Q

What is the expected time of therapeutic relief for allergic conjunctivitis with mast cell stabilizers?

A

Mast cell stabilizers may take several weeks to see a benefit, so this is not usually a first-line treatment.

41
Q

What medications are used for dry eyes? How do they work? What are the adverse effects?

A

Dry eyes are treated with artificial tear substitutes and ocular lubricants. These are to be used daily and there are no adverse effects associated with daily and continuous use of preservative-free solutions.

42
Q

What are ocular decongestants, and what are they used for?

A

For dry eyes due to inflammation. Examples: Naphcon, Opcon, Visine

43
Q

When are glucocorticoids used in the eye? When is it appropriate for the APRN to prescribe glucocorticoids?

A

APRN should never prescribe due to risk of masking an infection. Ophthalmologist may prescribe for severe allergic conjunctivitis.

44
Q

What are the classes of drugs used to treat open-angle glaucoma?

A

Major first-line drugs used for this purpose include beta-blockers, prostaglandin analogs, and alpha-adrenergic agonists.

45
Q

What are the adverse effects of ophthalmic beta-blockers? What type of monitoring is necessary?

A

Heart block, bradycardia, hypotension, stinging, may cause conjunctivitis, blurred vision, photophobia, and dry eyes. Additive effect with systemic beta-blockers.

46
Q

Who is not a candidate for ophthalmic beta-blockers?

A

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. Ophthalmic beta-blockers are pregnancy category C.

47
Q

What is the risk of ophthalmic beta-blockers given with oral beta-blockers?

A

Do not prescribe oral beta-blockers with ophthalmic beta-blockers as they have an additive effect.

48
Q

What are the recommended antibacterial drugs used for AOM?

A

-amoxicillin 80-90 mg/kg/day
-amoxicillin-clavulanate 90/6.4 mg/kg/day

49
Q

Are antibacterial drugs always recommended for AOM?

A

Most cases resolve spontaneously

50
Q

What are the recommended antibacterial drugs used for acute otitis externa?

A

Fluoroquinolone drops with or without steroids. Oral antibiotics are rarely needed.

51
Q

What class of antibiotics are FDA approved for use in treating acute otitis externa when the tympanic membrane is ruptured?

A

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).

52
Q

What pain medications are safe for use in the treatment of pain for acute otitis externa when the tympanic membrane is ruptured?

A

Oral acetaminophen or ibuprofen is helpful for pain relief.. Topical analgesics should not be used for suspected ™ perforation.

53
Q

What class of topical antibiotic is approved for use in treating children with acute otitis externa who have ruptured tympanic membrane?

A

Topical fluoroquinolones can be used in children due to minimal systemic absorption.

54
Q

What is the role of topical otic steroids in treating acute otitis externa?

A
55
Q

Can topical otic steroids be used in the presence of a ruptured tympanic membrane?

A
56
Q

What could happen if you use otic steroids in the presence of herpes zoster?

A

Providing steroids in the presence of varicella can lead to disseminated varicella.

57
Q

What patient education should be given for the use of otic preparations?

A
58
Q

What are the pediculicides/scabicides used in treating lice and scabies?

A
59
Q

Are there any Black Box Warnings or cautions for these medications?

A
60
Q

Why is it important to know if the medication is ovicidal?

A

To know if the eggs will be killed or not.

61
Q

How do we treat lice/scabies in pregnancy?

A

Permethrin (Category B) is considered safe in pregnancy and lactation. With small amounts of topical applications, very little is absorbed. Permethrin is also rapidly metabolized, further reducing infant exposure.

Lindane, a product previously known as Kwell, is only used for recalcitrant cases of pediculosis. This agent was found to be neurotoxic and estrogenic. Lindane is contraindicated in pregnancy, lactation, and with routine use for children.

62
Q

How do we treat lice/scabies in children?

A
63
Q

What education should be provided for Lindane?

A

-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.

64
Q

What education should be provided when treating for Head Lice/Pediculosis/Crabs?

A

-Nit resolution can take months and therefore, requiring a no-nit policy at schools is not recommended by the AAP.
-To confirm the diagnosis, only one louse on the head is necessary.
-For successful eradication of head lice infestation, treating 7-10 days later, according to the life cycle of the lice, provides a better chance of successful treatment.
-Careful attention to environmental cleaning is key in the treatment of any infestation.

PC 707 Pharmacology (39 decks)

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