Skin infection, fungal nail, itch, psoriasis, rossacea, scabies and lice Flashcards
how to treat impetigo
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)
what is onychomycosis and what is it usually caused by
fungal nail infection- dermatophytes
non drug treatment for onychomycosis
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
treatment (pharm) for onychomycosis
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.
how to use ciclopirox for nail infections
apply topically for 48 weeks. daily application, weekly removal of lacquer with ruing alcohol and trim any damaged parts of nail throughout therapy
is fluconazole (PO) CI in preg?
only doses over 400mg per day
which TCA may be helpful in treating itch
doxepin- has some potent antihistamine properties for chronic urticaria or psychogenic causes of itch
antihistamines of choice in pregnancy
loratidine and cetirizie on sedating, or desloratidine. If want sedating, chlorpheniramine, diphehydramie or hydroxyzine all safe
what is characteristic of psoriasis
increased cell skin turnover, thick silvery scales
therapy for psoriasis
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
principles of treating scalp psoriasis
remove scales- use oil based product with or without SA or calcipotriol, with or without medium potency CS (betamethasone)
principles of treating facial psoriasis
HC 1%, then calcineurin inh (tacrolimus, pimecrolimus)
principles of treating psoriasis of hands and feet
frequent petrolatum and a medium to high potency CS with or without SA
compare the therapies (CS, Tar, antifungals) for psoriasis, tinea and eczema
order for best in psoriasis: tar, CS. Tinea only antifungals. Eczema CS, tar.
principles of treating body and extremity psoriasis
medium-high potency CS, vitamin D derivatives (calcipotriol, calcitriol), tazarotene, tar, anthralin ] all alone or in combo
non pharm for rosaccea
avoid extremes of weather as it can irritate (protect skin from sun-suncreen- and harsh winds),
what is rosaccea often misdiagnosed as
acne
how to treat rosaccea
topical metroidazole usually, or topical brimonidine if no papules or pustules, or systemic ABX if severe/recurrent. Isotretinoin low dose if treatment resistant
how soon can you expect improvement with topical metronidazole or azelaic acid for rosaccea
2-4 weeks - but treatment may need to continue indefinitely
what things worsen rossacea
steroids and sunlight
how long do lice typically survive away from a person
48 hours
why is retreatment recommended in lice and when should you do it
to get full lifecycle (eggs too)- 7-10 days later
why are isopropyl and dimeticone recommended over pyrethin and permethrin?
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
what product is approved for pubic lice? scabies?
permethrin 1% or pyrethins. 5% perm for scabies
why do signs and sx of anemia occur
oxygen carrying capacity of blood is unable to meet oxygen requirement of body tissues
what kind of anemia is iron deficiency
microcytic
sx of iron deficiency anemia
depression, fatigue, N, low ski temp and pallor, exertional dyspnea, chest pain, tachycard
which is better- heme or non heme iron? What can limit or enhance absorption of iron?
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
what is the target iron dose per day- how long should you take the iron supplement?
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
how are iron salts best absorbed
empty stomach- N and epigastric pain are more common this way though
how can you help increase tolerance to iron
start low go slow, take with an orange (vit C), take with food if absolutely necessary,
comment on enteric coated iron
poorly absorbed- should avoid
what are megaloblastic anemias
b12 an folate
signs of B12 deficiency
dementia, weakness, sensory neuropathy and parasthesias
what might mask a B12 deficiency
folate
what are sources of B12
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
who is at risk of B12 deficiency
vegans esp during preg when B12 demands are higher
most common cause of B12 deficiency
malabsorption from pernicious anemia, gastritis, crohn’s, certain drugs (neomycin, metformin, PPI)
dietary sources of folate
leafy greens, liver, legumes
folic acid vs folate
folic acid is synthetic version
most common causes of folic acid deficiency
dietary and alcoholism
when are there increased folic acid requirements
pregancy, hemolytic anemia, certain drugs (phenytoin, MTX, trimethoprim)
how much b12 is given for deficiency
1000ug- doses greater than 100ug are not absorbed but it is not toxic as it is readily excreted by the kidneys
which route is b12 given by and why
parenterally- deficiency is most often due to malabsorption, and most cases of malabsorption are due to pernicious anemia (lack of intrinsic factor)
why is b12 deficiency not treated with just folate on its own
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
what is it important to make sure of before supplementing with folate
no B12 def- since folate does not treat the neurologic manifestations
how soon should you see improvement with B12 or folate therapy
reticulocytes respond in 3-4 days, Hb improves by day 10, and full resolution of anemia in about 2 months
in anemias, the rapid production of new hematopoietic cells can do what to K?
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
how long does it take neurologic deficits to resolve with b12 supplementation
6 months or more- severe may even persist
what are the different iron salts
gluconate (11%), sulfate (20%), fumarate (30%), ferramax (polysaccharide iron complex- 150mg elemental per iron)
