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PEBC- OTC > Skin infection, fungal nail, itch, psoriasis, rossacea, scabies and lice > Flashcards

Skin infection, fungal nail, itch, psoriasis, rossacea, scabies and lice Flashcards

1
Q

how to treat impetigo

A

saline compress 10-15 min 2-3 times per day to remove crusts, apply topical antibiotic (mupiroc or fuc) f7-10d, if no improvement in 48 hours PO abx (cephalex 7-10 days)

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2
Q

what is onychomycosis and what is it usually caused by

A

fungal nail infection- dermatophytes

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3
Q

non drug treatment for onychomycosis

A

footwear and socks that minimize humidity, dry feet and in between toes thoroughly after washing, use footwear to avoid transmission, keep nails clean and short, avoid sharing nail clippers or footwear, prevent further trauma to nail, emollients on cracked skin to prevent further entry points for fungus, control DB/vascular diseases

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4
Q

treatment (pharm) for onychomycosis

A

not always necessary just monitor- if patient wants, multiple nails, severe, DM or immunocomp, can treat. Can use cipclopirox lacquer or oral terbinafine. Topical less effective and longer healing but can be used for early mild.

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5
Q

how to use ciclopirox for nail infections

A

apply topically for 48 weeks. daily application, weekly removal of lacquer with ruing alcohol and trim any damaged parts of nail throughout therapy

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6
Q

is fluconazole (PO) CI in preg?

A

only doses over 400mg per day

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7
Q

which TCA may be helpful in treating itch

A

doxepin- has some potent antihistamine properties for chronic urticaria or psychogenic causes of itch

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8
Q

antihistamines of choice in pregnancy

A

loratidine and cetirizie on sedating, or desloratidine. If want sedating, chlorpheniramine, diphehydramie or hydroxyzine all safe

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9
Q

what is characteristic of psoriasis

A

increased cell skin turnover, thick silvery scales

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10
Q

therapy for psoriasis

A

emollients and avoid triggers, then topical steroids along or in combination with other topicals (tar, vitamin D derivatives, tazarotene, anthralin), then UVB/PUVA, then systemic MTX, cyclosporine, bioligics etc

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11
Q

principles of treating scalp psoriasis

A

remove scales- use oil based product with or without SA or calcipotriol, with or without medium potency CS (betamethasone)

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12
Q

principles of treating facial psoriasis

A

HC 1%, then calcineurin inh (tacrolimus, pimecrolimus)

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13
Q

principles of treating psoriasis of hands and feet

A

frequent petrolatum and a medium to high potency CS with or without SA

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14
Q

compare the therapies (CS, Tar, antifungals) for psoriasis, tinea and eczema

A

order for best in psoriasis: tar, CS. Tinea only antifungals. Eczema CS, tar.

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15
Q

principles of treating body and extremity psoriasis

A

medium-high potency CS, vitamin D derivatives (calcipotriol, calcitriol), tazarotene, tar, anthralin ] all alone or in combo

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16
Q

non pharm for rosaccea

A

avoid extremes of weather as it can irritate (protect skin from sun-suncreen- and harsh winds),

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17
Q

what is rosaccea often misdiagnosed as

A

acne

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18
Q

how to treat rosaccea

A

topical metroidazole usually, or topical brimonidine if no papules or pustules, or systemic ABX if severe/recurrent. Isotretinoin low dose if treatment resistant

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19
Q

how soon can you expect improvement with topical metronidazole or azelaic acid for rosaccea

A

2-4 weeks - but treatment may need to continue indefinitely

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20
Q

what things worsen rossacea

A

steroids and sunlight

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21
Q

how long do lice typically survive away from a person

A

48 hours

22
Q

why is retreatment recommended in lice and when should you do it

A

to get full lifecycle (eggs too)- 7-10 days later

23
Q

why are isopropyl and dimeticone recommended over pyrethin and permethrin?

A

lice can develop resistance to them as they have a neurotoxic mode of action. Others are physicial agents ie isopropyl disrupts wax layer and dehydrates them and dimeticone coat surface and suffocate them

24
Q

what product is approved for pubic lice? scabies?

A

permethrin 1% or pyrethins. 5% perm for scabies

25
Q

why do signs and sx of anemia occur

A

oxygen carrying capacity of blood is unable to meet oxygen requirement of body tissues

26
Q

what kind of anemia is iron deficiency

A

microcytic

27
Q

sx of iron deficiency anemia

A

depression, fatigue, N, low ski temp and pallor, exertional dyspnea, chest pain, tachycard

28
Q

which is better- heme or non heme iron? What can limit or enhance absorption of iron?

A

heme has better F. Sources of heme iron are liver, red meats, seafood. Vitamin C enhances absorption of non heme (plant based). Phytates in coffee and tea can inhibit iron absorption

29
Q

what is the target iron dose per day- how long should you take the iron supplement?

A

120mg elemental- most clinicians say use for 3 months after reaching target Hb to replensish stores. But can also stop when stores repleted and have patient watch for signs of anemia coming back

30
Q

how are iron salts best absorbed

A

empty stomach- N and epigastric pain are more common this way though

31
Q

how can you help increase tolerance to iron

A

start low go slow, take with an orange (vit C), take with food if absolutely necessary,

32
Q

comment on enteric coated iron

A

poorly absorbed- should avoid

33
Q

what are megaloblastic anemias

A

b12 an folate

34
Q

signs of B12 deficiency

A

dementia, weakness, sensory neuropathy and parasthesias

35
Q

what might mask a B12 deficiency

A

folate

36
Q

what are sources of B12

A

meat and dairy. Typical canadian diet exceeds recommended amounts so no supplements needed unless absorption abnormal. Stores are often sufficient in people to last several years

37
Q

who is at risk of B12 deficiency

A

vegans esp during preg when B12 demands are higher

38
Q

most common cause of B12 deficiency

A

malabsorption from pernicious anemia, gastritis, crohn’s, certain drugs (neomycin, metformin, PPI)

39
Q

dietary sources of folate

A

leafy greens, liver, legumes

40
Q

folic acid vs folate

A

folic acid is synthetic version

41
Q

most common causes of folic acid deficiency

A

dietary and alcoholism

42
Q

when are there increased folic acid requirements

A

pregancy, hemolytic anemia, certain drugs (phenytoin, MTX, trimethoprim)

43
Q

how much b12 is given for deficiency

A

1000ug- doses greater than 100ug are not absorbed but it is not toxic as it is readily excreted by the kidneys

44
Q

which route is b12 given by and why

A

parenterally- deficiency is most often due to malabsorption, and most cases of malabsorption are due to pernicious anemia (lack of intrinsic factor)

45
Q

why is b12 deficiency not treated with just folate on its own

A

although it can help some sx (and mask a def) and improve hematologic parameters, there is a potential for worsening neurologic sx which may become permanent

46
Q

what is it important to make sure of before supplementing with folate

A

no B12 def- since folate does not treat the neurologic manifestations

47
Q

how soon should you see improvement with B12 or folate therapy

A

reticulocytes respond in 3-4 days, Hb improves by day 10, and full resolution of anemia in about 2 months

48
Q

in anemias, the rapid production of new hematopoietic cells can do what to K?

A

shift it intracellularly with may cause hypokalemia. Older patients on diuretics are at highest risk. Monitor K and give supplements if low or borderline levels

49
Q

how long does it take neurologic deficits to resolve with b12 supplementation

A

6 months or more- severe may even persist

50
Q

what are the different iron salts

A

gluconate (11%), sulfate (20%), fumarate (30%), ferramax (polysaccharide iron complex- 150mg elemental per iron)

PEBC- OTC (21 decks)

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