Skin Meds

Question 1

Use of high-potency topical corticosteroids is contraindicated on which area of the body?

A. Face
B. Palms
C. Legs
D. Trunk

Answer 1

A. Use of high-potency or very high-potency agents on the face, groin, or axilla is contraindicated.

Question 2

Which area would the APN expect to provide the greatest rate of absorption when a topical agent is applied?

A. Palms of the hands
B. Scrotum
C. Soles of the feet
D. Abdomen

Answer 2

B. Low-potency topical corticosteroids should be used on body sites with a thinner stratum corneum layer (face, scrotum, axilla, and skinfolds) because these provide the greatest absorption. The abdomen should be treated with low-potency topical corticosteroids because it is a large surface area, but it does not have a thinner stratum corneum layer. The palms of the hands are resistant to treatment, so higher-potency agents should be used for this area. They are not the most absorbent.

Question 3

Which recommendation should the APN make when treating an adult male patient for scabies?

A. Only symptomatic members of the household should be treated.
B. All members of the household should be treated.
C. The patient may be infectious up to 6 months after treatment.
D. The patient should receive 2 treatments to effect cure.

Answer 3

B. All household members should receive treatment, even if asymptomatic, because they may be in the incubation period (4 weeks), and so all need treatment to prevent recurrence.

Question 4

Which of these would be first-line therapy for mild acne vulgaris with closed comedones?

A. Doxycycline
B. Topical tretinoin
C. Hydrocortisone cream
D. Benzoyl peroxide

Answer 4

D. Acne is classified as mild, moderate, or severe, and pharmacological intervention is based on the severity of acne. Benzoyl peroxide has antibacterial activity against P. acnes, the predominant organism in sebaceous follicles and comedones of acne vulgaris. Tretinoin does not affect the bacteria found in P. acnes.

Question 5

The relative potency of a topical corticosteroid product depends on which of these?

A. Distribution of the drug
B. Length of treatment
C. The patient’s condition
D. Vasoconstrictor assay

Answer 5

D. The relative potency of a product depends on several factors, including the characteristics and concentration of the drug, the vehicle used, and the vasoconstrictor assay. Length of treatment does not affect a product’s relative potency. However, a product’s potency should affect length of treatment. Treatment with very high-potency topical corticosteroids should not exceed 2 consecutive weeks.

Question 6

Which finding is accurate about the mechanism of irritant contact dermatitis?

A. There is an autoimmune triggered response.
B. Removal of the source leads to resolution of symptoms.
C. Clinical effects are seen systemically.
D. It occurs via protein sensitization.

Answer 6

B. If removed from the irritant source, then clinical symptoms will resolve. Irritant contact dermatitis is caused by contact of the skin with an irritating substance. The effect may be mild to severe. Irritating substances can be acid or alkali, solvents, or detergents. There is no immunological response as part of the inflammatory response in irritant contact dermatitis.

Question 7

Which topical medication emollient offers the greatest amount of absorption?

A. Cream
B. Gel
C. Ointment
D. Lotion

Answer 7

C. Ointments provide the most occlusive barrier.

Question 8

The APN is assessing an adult male patient who presents with complaints of mild to moderate itching on left lower arm. Inspection of the area reveals mild raised bumps with no defining pattern. Which treatment should the APN prescribe?

A. Doxycycline
B. OTC Tylenol
C. OTC Benadryl
D. OTC zinc oxide

Answer 8

C. Antipruritics are used to control the itching associated with eczema and to break the itch–scratch–itch cycle. Commonly used oral agents are the antihistamines diphenhydramine (Benadryl) and hydroxyzine (Atarax). These drugs have antipruritic and sedative actions. OTC zinc oxide is indicated for treatment of burns, cuts, or diaper rash.

Question 9

Which topical corticosteroid is the least potent?
A. Clobetasol 0.05% cream
B. Hydrocortisone 2.5% ointment
C. Desonide 0.5% lotion
D. Triamcinolone acetonide 0.025% lotion

Answer 9

B. Hydrocortisone 2.5% ointment has the least potency. Clobetasol 0.05% cream has super-high potency.

Question 10

The APN is assessing an adult female patient who presents with irritated facial skin and a moderate amount of comedones on cheeks bilaterally who has been prescribed topical retinoid therapy. Which instruction should the APN provide?

A. Use of this medication will be lifelong to achieve remission.
B. Minimal side effects occur from this type of therapy.
C. Symptoms should resolve within a few months.
D. Use of an astringent is recommended with this type of therapy.

Answer 10

C. Patients should be reassured that their faces will clear after approximately 6 to 8 weeks of treatment.

Question 11

A 3-year-old patient presents to the clinic with his mother. The mother states that the patient has had a rash around his feet and ankles for 3 days. The papular rash is erythematous and itchy, and the patient won’t stop scratching. His 8-month-old sister has a similar rash on her head and neck. Which treatment is most appropriate for this condition?

A. Crotamiton
B. Permethrin
C. Topical corticosteroids
D. Pyrethrin

Answer 11

B. Permethrin 5% cream is the drug of choice for treating scabies, particularly in young children and pregnant women, due to its 90% cure rate.

Question 12

A 4-month-old patient presents with her mother to the clinic. Her mother tells the APN that the patient is irritable and constantly rubbing at her belly. The APN’s exam reveals red-brown vesiculopapular lesions on the patient’s trunk. Which would be the drug of choice to manage the most likely condition?

A. Permethrin
B. Calamine lotion with topical diphenhydramine
C. Lindane
D. Crotamiton

Answer 12

A. Prescription-strength permethrin is first-line therapy for scabies. Permethrin should not be used on infants younger than 2 months.

Question 13

A 28-year-old female patient comes into the clinic with complaints of fever and malaise. She also complains of a painful sore in her vaginal area. Given the most likely diagnosis, which of these drugs would the APN prescribe?

A. Topical calamine lotion
B. Topical docosanol
C. Topical penciclovir
D. Topical acyclovir

Answer 13

D. Acyclovir is indicated for the treatment of recurrent herpes labialis (cold sores); herpes genitalis; and limited, non–life-threatening mucocutaneous herpes simplex virus (HSV) infections in immunocompromised patients.

Question 14

Which of these findings is accurate about psoriasis?

A. It is seen more in males than in females.
B. There is no impact from lifestyle factors.
C. There is genetic predominance.
D. It is considered an acute disease process.

Answer 14

C. Genetics play a strong role in developing psoriasis; with a positive family history in both parents, a child has a 50% chance of developing the disease.

Question 15

Which property characterizes topical corticosteroids?

A. Immunostimulant
B. Vasoconstrictive
C. Inflammatory
D. Proliferative

Answer 15

B. Vasoconstrictive

Question 16

After topical administration, some topical corticosteroids are metabolized and excreted via which pathway?

A. Bloodstream
B. Lungs
D. Skin
E. Small intestine

Answer 16

C. Some topical preparations are partially metabolized in the skin.

Question 17

When applying a topical steroid to psoriasis lesions, the best long-term outcomes come from which method?

A. Occlusion with plastic
B. Applying the ointment two or three times a day
C. Using a moderate- to high-potency steroid
D. Intermittent or “pulse” therapy

Answer 17

D. Intermittent or “pulse” therapy minimizes some of the adverse effects and has the best long-term outcome.

Question 18

A 21-month-old patient with an intensely pruritic scalp, mainly in the occipital region, is brought into the clinic by her mother. Physical examination reveals excoriated lesions at the base of the shaft. Additionally, around the scalp and attached to the hair are what appear to be eggs. Which therapy should the APN recommend in this situation?

A. The hair should be washed and conditioned just before using the treatment.
B. Hair should be washed 1 hour after treatment.
C. The entire family should be treated with lindane 1%.
D. Treatment with permethrin cream rinse should be repeated in 1 week, regardless of whether signs of infestation are present.

Answer 18

D. Treatment with a permethrin cream rinse should be repeated in 1 week, regardless of whether signs of infestation are present. The cream rinse is left in the hair for 10 minutes and then rinsed out.

Question 19

Which of these enhances absorption of topical corticosteroids?

A. Dehydration
B. Covering with an occlusive dressing
C. Combination with a high-fat diet
D. Applying to skin surfaces with a thick stratum corneum layer

Answer 19

B. Occlusive dressings enhance skin penetration and increase drug absorption.

Question 20

The APN is seeing a 6-year-old female patient in the clinic who presents with an amber-crusted rash on the left nasolabial fold. Her grandmother reports the rash is spreading quickly and seems to have gotten much worse overnight. Upon assessment, you note nine distinct lesions. Which treatment choice is most appropriate?

A. Over-the-counter (OTC) antibiotic ointments
B. Warm compresses and over-the-counter (OTC) steroid ointments
C. Mupirocin twice a day for 5 days
D. Mupirocin three times a day, plus oral antibiotics

Answer 20

D. Patients who have numerous lesions (impetigo) or who are not responding to topical agents should receive oral antimicrobials effective against both S. aureus and S. pyogenes.

Question 21

Which of these is first-line therapy for a mild case of impetigo with fewer than five 2-cm lesions on the left leg of a 10-year-old patient?

A. Topical mupirocin
B. Topical triple antibiotic
C. Topical double antibiotic
D. Oral dicloxacillin

Answer 21

A. First-line therapy for impetigo is mupirocin unless it is a moderate to severe case.

Question 22

Mupirocin is bactericidal and has a wide range of coverage against gram-positive bacteria, including methicillin-resistant S. aureus, and limited coverage against some gram-negative organisms. Mupirocin acts by which mechanism?

A. Inhibiting bacterial protein synthesis
B. Inhibiting bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall
C. Binding the 30s subunit of the bacterial ribosome to inhibit protein synthesis
D. Binding to bacterial isoleucyl-tRNA synthetase

Answer 22

D. Mupirocin is bactericidal at concentrations achieved by topical administration of the 2% ointment. Mupirocin acts by binding to bacterial isoleucyl-tRNA synthetase. Bacitracin is primarily active against gram-positive organisms; it inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall.

Question 23

The APN is examining an elderly patient with a long-standing history of chronic eczema. Which statement by the patient indicates that teaching has been effective related to care and management of this condition?

A. “I apply petrolatum to the affected areas.”
B. “The product I use has perfume in it, which makes it smell nice.”
C. “I apply the cream once a day before I go to sleep.”
D. “I change products frequently based on whatever is on sale at the time, so at times my skin acts up.”

Answer 23

A. Use of petrolatum is effective and inexpensive for a patient who is on a fixed income. Topical medication should be applied several times a day, one to four times after bathing, to have the greatest effect.

Question 24

Which of these is recommended to eradicate nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA)?

A. Mupirocin nasal ointment to both nares twice a day for 5 days
B. Oral amoxicillin/clavulanic acid twice a day for 10 days
C. Over-the-counter (OTC) triple antibiotic nasal ointment to both nares twice a day for 5 days
D. Parenteral third-generation cephalosporin daily for 10 days

Answer 24

A. Eradication of nasal MRSA colonization in adult patients and healthcare workers may be achieved with intranasal mupirocin. Intranasal mupirocin is supplied in 1 g single-use tubes administered twice a day. The patient applies approximately half the ointment from a single-use tube of nasal ointment into one nostril and the other half into the other nostril in the morning and evening for 5 days.

Question 25

A 38-year-old male patient has been exposed to poison oak. The APN should tell the patient that he will remain on corticosteroid therapy for how long?

A. 1 week
B. 2 months
C. 7 to 10 days
D. A minimum of 2 weeks

Answer 25

D. A 2- to 3-week course of therapy may be needed for severe cases, with 2 weeks usually the minimum length of therapy required for severe poison oak or poison ivy dermatitis.

Question 26

What is the first-line treatment for cutaneous Candida infections.

Answer 26

clotrimazole and miconazole

Question 27

What is the another first-line treatment for cutaneous candida infections when -azoles are not tolerated?

Answer 27

Nystatin cream.

Question 28

What medication is approved for newborns and infants with thrush?

Answer 28

Nystatin suspension

Question 29

Second-line treatment for cutaneous candida?

Answer 29

Ketoconazole

Question 30

What does ketoconazole 2% shampoo treat?

Answer 30

Tinea Capitis (ringworm scalp)

Question 31

Which topical treatment would you NOT choose for tinea corporis (ringworm)?
A. clotrimazole
B. ketoconazole
C. nystatin
D. butenafine

Answer 31

D. Nystatin is not effective.

Question 32

What topical treatment would you choose to treat tinea cruris (jock itch)?

A. permethrin
B. ketoconazole
C. tretinoin
D. mupirocin

Answer 32

B. ketoconazole is an antifungal that is one of the medications used to treat tinea cruris.

Question 33

An adolescent presents to the clinic with moderate acne. They have been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education would include:
Question 1 options:

a) Adapalene may cause bleaching of clothing.
b) He should see an improvement in his acne within the first week of treatment.
c) If there is no response in a week, double the daily application of adapalene (Differin).
d) He may see an initial worsening of his acne that will improve in 6 to 8 weeks.

Answer 33

D. (p. 664)

Question 34

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:
Question 2 options:

a) Clobetasol Ointment
b) Over-the-counter (OTC) topical azole (clotrimazole, miconazole)
c) Bacitracin Ointment
d) Oral terbinafine

Answer 34

B. (p. 654)

Question 35

When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include:
Question 4 options:

a) The permethrin is washed off after 10 minutes.
b) Permethrin is flammable and to avoid open flame while the medication is being applied.
c) Do not use if pregnant.
d) All members of the household should also be treated.

Answer 35

D. (p.681)

Question 36

When prescribing topical acyclovir (Zovirax) for the treatment of herpes labialis (cold sores) patient education would include:

Question 6 options:

a) Acyclovir should be used a minimum of 1 month to prevent recurrence.
b) Acyclovir is pregnancy category D
c) Start using acyclovir at the first sign of a cold sore outbreak.
d) Spread acyclovir liberally all over lips, area surrounding lips, and neck.

Answer 36

C. (p. 657)

Question 37

Appropriate initial treatment for psoriasis would be:
Question 7 options:

a) Adapalene (Differin)
b) Intermittent therapy with intermediate potency topical corticosteroids
c) Clotrimazole 1% cream
d) An immunomodulator (Protopic or Elidel)

Answer 37

B. (p.668)

Question 38

Topical diphenhydramine (Benadryl) is available OTC to treat itching. Regarding the use of topical diphenhydramine, patients or parents should be instructed that:
Question 8 options:

a) Laboratory monitoring is required for long term use of topical diphenhydramine.
b) Topical diphenhydramine should be avoided in children younger than age 2, due to increased risk of toxic psychosis.
c) Topical diphenhydramine is the treatment of choice for treating chickenpox or measles.
d) For maximum effectiveness in treating itching use for at least 14 days.

Answer 38

B. (p. 675)