Viral disorders

Question 1

What virus causes warts?

Answer 1

HPV

Question 2

Explain the pathophysiology of HPV and warts

Answer 2

The virus incorporates itself into the basement membrane of the epidermis. As it moves up through the layers, the virus differentiates and begins to replicate. Lesions form and can cause more lesions in the surrounding area.

Question 3

True or false: cutaneous warts are more common in children?

Answer 3

true

Question 4

What are the different types of warts?

Answer 4

1. common warts
2. filiform warts
3. flat warts
4. plantar warts
5. condylomata acuminate

Question 5

Describe the common wart

Answer 5

1. fingers, hands, and other areas
2. single wart or groups
3. rough scaly appearance

Question 6

Describe the filiform wart

Answer 6

1. face and neck

2. thin, soft, and slender

Question 7

Describe the flat wart

Answer 7

1. face, hands, and lower legs

2. flat papules, with little to no scale

Question 8

Describe the plantar wart

Answer 8

1. bottom of feet
2. pain with lateral pressure
3. elevated or flat and hyperkeratotic

Question 9

Describe condylomata warts?

Answer 9

1. soft, friable, vegetating clusters

2. asymptomatic

Question 10

What factors determine the treatment of warts?

Answer 10

1. type
2. location
3. size
4. amount of distress

Question 11

What are the first line treatments of common and plantar warts?

Answer 11

1. electrodesiccation and curettage
2. cryotherapy with liquid nitrogen
3. salicylic acid

Question 12

What are the second line options for common and plantar warts?

Answer 12

1. Imiquimod
2. duct tape
3. podofilox

Question 13

What are the treatment options for condylomata acuminata?

Answer 13

1. podofilox
2. podophyllin
3. imiquimod
4. liquid nitrogen
5. trichloroacetic acid

Question 14

What are the adverse effects of podofilox?

Answer 14

1. burning (s > g)
2. pain (s > g)
3. inflammation (s > g)
4. itching (s > g)
5. erosion (g > s)
6. bleeding (g)

Question 15

What is the mechanism of action of podofilox?

Answer 15

antimitotic agent

Question 16

What are the two strengths of imiquimod?

Answer 16

5% and 3.75%

Question 17

What is the mechanism of action of imiquimod?

Answer 17

immune response modifier that activates cytokine response

Question 18

What is the warning associated with imiquimod?

Answer 18

Increased chance of sunburn

Question 19

What are the adverse reactions of imiquimod?

Answer 19

erythema, erosion, burning, excoriation/flaking, and edema

Question 20

What is the treatment algorithm for head lice?

Answer 20

1. confirm diagnosis
2. nonpharm + permethrin 1% or other pyrethrin combo
3. other pyrethrin combo or malathion or benzoyl alcohol
4. ivermectin or spinosad with or without TMP/SMX

Question 21

What is the first line treatment for pubic lice?

Answer 21

pyrethrins with piperonyl butoxide or permethrin

Question 22

What is the pathophysiology of scabies?

Answer 22

Mites live 3-7 days away from host. Female burrows through the stratum corneum and lays eggs. They hatch 10 days later and travel to skin surface to mature

Question 23

What are the signs and symptoms of scabies?

Answer 23

1. pruritus
2. thread-like burrows
3. excoriations
4. eczematous dermatitis
5. crusting

Question 24

What are the first line treatments for scabies?

Answer 24

permethrin 5% cream or oral ivermectin

Question 25

When is ivermectin not recommended?

Answer 25

In children < 15 kg or pregnant women

Question 26

What are the indications for pyrethrins?

Answer 26

head, body, and pubic lice

Question 27

What is the MOA of pyrethrins

Answer 27

interferes with neural transmission and piperonyl butoxide augments the activity of pyrethrins by inhibiting metabolism of pyrethrins

Question 28

When are pyrethrins contraindicated?

Answer 28

When patients have allergies to ragweed, chrysanthemums, or other pyrethrin products

Question 29

What is the MOA of permethrin?

Answer 29

acts on neural cell membranes delaying repolarization

Question 30

What are the warnings associated with permethrin?

Answer 30

worsening asthma and photosensitivity

Question 31

What are the adverse effects of permethrins?

Answer 31

pruritus, erythema, rash of the scalp, burning, stinging, and tingling

Question 32

What is the MOA of spinosad?

Answer 32

CNS stimulant that produces louse neuronal excitation, paralysis, and death

Question 33

What are the adverse effects of spinosad?

Answer 33

application site erythema and skin irritation

Question 34

Which version of ivermectin is FDA approved?

Answer 34

The new topical agent for lice

Question 35

What is the MOA of ivermectin?

Answer 35

It is an antihelminthic agents

Question 36

What are the warnings associated with oral ivermectin?

Answer 36

postural hypotension, mortality in long term care residents

Question 37

What are the adverse effects of ivermectin?

Answer 37

peripheral edema, tachycardia, GI SE, and transaminase elevations

Question 38

What is the MOA of malathion?

Answer 38

ovicidal agent

Question 39

When is malathion contraindicated?

Answer 39

In children less than 2 years old

Question 40

What is the adverse effect of malathion?

Answer 40

irritation of scalp and skin

Question 41

What is the MOA of lindane?

Answer 41

CNS stimulant that produces seizures and death of mites

Question 42

When is lindane contraindicated?

Answer 42

in neonates (warning in children < 50 kg)

Question 43

What is the black box warning on lindane?

Answer 43

neurotoxicity

Question 44

What are the adverse effects of lindane?

Answer 44

fertility impairment, use with other drugs that lower seizure threshold

Question 45

When do you add on TMP/SMX to permethrin?

Answer 45

if nits and lice are found 2 weeks after first course of therapy