Pharm Blessings Flashcards
Which acne medication can induce bronchospasm?
Isotrentinoin [accutane]
What is the DOC for a person with acne AND asthma?
Topical trentinoin [Retin-A micro]
What is the PG category of topical trentinoin?
C
(less than 10% absorbed topically)
What is the MOA of trentinoin [retin-a micro]?
unclogging pores and antiinflammatory effect
Bind to RARs & RXRs to regulate gene expression & increase epidermal cell turnover
What are some side effects of trentinoin [retin-a micro]?
redness, drying, peeling
may initially have increase in acne
In what populations should you avoid prescribing trentinoin [retin-a micro]?
PG
Children under 12
When should you instruct your pt to apply trentinoin (retin-a micro)?
at night
Your pt. has a bacterial sinusitis, and needs an abx. However, she usually gets vaginal yeast infections when she goes on abx.
What will you prescribe for her?
Augmentin for ABS
Fluconazole [diflucan] for yeast infection
can also use topical/oral nystatin [mycostatin], ciclopirox olamine [loprox], or terbinafine [lamisil] for yeast
What is the DOC for mild psoriasis?
short-term topical steroids (e.g. betamethasone or triamcinolone or clobetasol proprionate)
OR
topical calcipotriene [dovonex]
(Vitamin D)
What’s the issue with Rxing long-term topical steroids?
Can develop tachyphylaxis
What comorbid diseases might be seen with those with psoriasis?
Psoriatic arthritis
CVD
lymphoma
Your pt is on low dose ICS for asthma. He was treated with a burst of steroids and really liked it, and would like po steroids long term. What are you going to do for him?
NOT LT STEROIDS.
Give him a spacer or increase his dose of ICS.
Hollllaaaaaaaa
You have an asthma patient who requires a short burst of po steroids. He also has psoriasis. How will the tx affect his psoriasis?
It will start to clear up with the steroids, but will come back when the course is done.
What is the DOC for episodic OR maintenance of recurrent herpes outbreaks?
Acyclovir [zovirax]
For how long can you prescribe acyclovir [zovirax] without having adverse effects?
10 years!
Then decreased efficacy, renal damage
Which HSV virus causes genital herpes?
HSV2
How do you rx acyclovir [zovirax] for a pt with CKD?
Can still rx, but need to adjust dosing.
***Dosing is in Sanford guide…somewhere***
Herpes can still be transmitted when there is no outbreak, but the risk of transmission is reduced by ___%.
50%
How much is HSV shedding decreased when on acyclovir?
by 90-97%
What is the DOC for rosacea?
Mostly this will be referred to derm.
In a PC office, we will treat with avoidance of triggers and topical abx (metranidazole, erythro, clindamycin)
What is rosacea?
Dilitation of the blood vessels in the face
Sometimes can give them a big bulbous nose
Well shiiiieeeetttt. Your patient rolled around in poison ivy. It’s everywhere. Like, everywhere.
What will you probably give him?
Oral steroids for 3 weeks.
Taper. 40 mg to 20 mg to 10 or 5 mg.
What is usually the DOC for poison ivy?
Uusally not steroids unless it’s widespread, or is on your face or your junk.
Usually conserative tx: oatmeal, ice, calamine lotion
What is the most absorbant tissue in the body?
Scrotum
Followed by other mucus membranes: vagina, rectum, eyes, lips (I think in that order)
Your 2y.o. patient has a honey-colored rash that she’s picking at on her face. What will you rx?
This is impetigo so there’s a 90% chance she has a staph inf.
DOC = mupirocin [bactroban]
Does mupirocin [bactroban] cover for MRSA?
YES BABY YES
What ingredient is in mupirocin [bactroban] that could cause burning/stinging?
polyethylene glycol
Mupirocin [bactroban] is AWESOME for staph. Why does it only come in topical form?
Oral form would cause…get ready for it…………….
nephrotoxicity (shocker)
Is impetigo contagious?
HIGHLY.
Educate family about this.
Do you want to give topical steroids for diaper rash?
No way man.
Can still be absorbed into their system and cause issues.
Does bacitracin cover Gm + or Gm -?
Gm + like S. aureus
Does polymixin b sulfate cover Gm + or Gm -?
Gm - like pseudomonas
Throwback:
What do you prescribe for giant cell arteritis?
And who ya gonna call?
Rx HD oral steroids
Refer to ophthalamology, ENT, rheum, ghostbusters
Your pt has T2DM and you’re putting them on prednisone. What should you monitor closely?
Hyperglycemia
How do you tx oral candidiasis?
Nystatin swish n swallow!
Your pt has a rash on the T7 dermatome of his R thorax. What will you rx?
he’s got shingles (VZV)
ACYCLOVIR [zovirax] 5x daily
Your next pt has shingles too! This one’s got CKD. What are you going to give him?
Still acyclovir, but 3x daily
How do you write prescriptions for topical creams?
Multiples of 15; measured in grams
smallest is 15g, largest is 120g
make it an appropriate amount for what they need!
What are 2 diseases that we are likely to see with long term steroid use?
Cushing’s disease
Osteopenia/porosis
What can happen if you taper someone off of steroids too fast?
Hypotension
(may take 3-4 months to get someone off long term steroids)
Your patient has psoriatic arthritis. He’s already on topical calcipotriene [dovonex]. What will you rx?
Sulfasalazine and/or methotrexate
AND folic acid
How do you categorize psoriasis that has progressed to psoriatic arthritis?
What is this pt at an increased risk for now?
it has progressed from mild to moderate/severe psoriasis
Increases risk for CVD
Are MTX and sulfasalazine indicated for psoriatic arthritis?
Not really!
Off-label use!
Let’s not forget the MOA of etanerept [enbrel]…..
binds to TNF on cells to decrease inflammation
Patient has 25% of her body covered in blisters with loose, peeling skin after taking an abx. What disease does this sound like?
Stephen-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
What abx most commonly causes SJS?
BACTRIM
Why does it matter that 25% of the body is covered (known as body surface area or BSA)?
What does it mean if it were less or more?
Erythema Multiforme is < 10% BSA centrally and no epidermal detachment
SJS is < 10% BSA and sloughing
TEN is > 30% BSA and sloughing
Involvement of 15-30% BSA is SJS/TEN together
What do you do for a patient with SJS or TEN?
Stop Bactrim.
Admit to burn center.
Wound care and burn precautions (fluids and electrolytes, nutrition, temp/pain mgmt, ocular care, monitor superinfection)
Your pt. has a hx of SJS and now has a UTI. What will you treat them with?
Usually you would give a sulfa drug, but with hx of SJS probably wouldn’t want to.
Can give ciprofloxacin
SCABIES. How do you treat?
DOC = topical permethrin 5% [elemite]
How do you instruct pts to use permethrin [emelite]?
Apply head to toe, leave on overnight (8-14h), then wash with water in the morning.
Apply once, then repeat in 7 days
What else is important to give to your patient with scabies? (Hint: it’s not a drug)
Literature about how to clean bed linens, clothing, treating family, etc.
(typically you wash everything in hot water, then bag it for 2-3 days)
pt. has head lice. how can you treat?
permethrin [elemite] 1% cream rinse
How do you instruct your patient to use the permethrin [elimite] cream rinse?
Shampoo hair, towel dry, and put cream on. Then use comb to remove nits.
Wash out over sink rather than in shower.
Can a kid with lice still go to school?
You betcha.
How do you treat onchyomycosis?
oral terbinifne [lamisil] for 12 weeks
What comorbid disorder should you NOT use terbinafine [lamisil] in?
liver/renal disease
(and these are heavy hitter drugs, so confirm the dx in everyone)
What other conditions can give you funky toenails?
melanoma, psoriasis
What are the 2 most common presentations of a penicillin allergy?
- Immediately or 24h after, anyphylaxis
- After course of abx, fine pruritic rash over torso & occasionally hives
What is a low potency topical steroid?
betamethasone 0.2% [celestone]
What is an intermediate potency topical steroid?
triamcinolone acetonide 0.1% [kenalog]
What is a high potency topical steroid?
halcinonide 0.1% or triamcinolone acetonide 0.5% [kenalog]
What is a highest potency topical steroid?
clobestasol propionate [temovate]
