Podcast
Questions and Answers
R.S. is a 19-year-old college swimmer who comes in with white, soggy skin and fissures between the 4th and 5th toes of both feet. She has no chronic illnesses and takes no medications. She wants the fastest OTC option. Which do you recommend?
R.S. is a 19-year-old college swimmer who comes in with white, soggy skin and fissures between the 4th and 5th toes of both feet. She has no chronic illnesses and takes no medications. She wants the fastest OTC option. Which do you recommend?
- Refer to physician immediately
- Terbinafine 1 % cream bid × 1 week (correct)
- Clotrimazole 1 % cream bid × 4 weeks
- Tolnaftate 1 % powder bid × 4 weeks
Which PPCP step immediately follows identification of medication-related problems?
Which PPCP step immediately follows identification of medication-related problems?
- Plan (correct)
- Implement
- Follow-up
- Assess
J.M. is a 68-year-old man on warfarin who wants to start ginkgo biloba 'for memory.' Which is the BEST response?
J.M. is a 68-year-old man on warfarin who wants to start ginkgo biloba 'for memory.' Which is the BEST response?
- Avoid; ginkgo can increase bleeding risk with warfarin. (correct)
- Take half your warfarin dose while on ginkgo.
- Safe to combine—no interaction reported.
- Switch warfarin to aspirin before using ginkgo.
The lipid lamellae of the stratum corneum are composed primarily of ceramides, free fatty acids, and:
The lipid lamellae of the stratum corneum are composed primarily of ceramides, free fatty acids, and:
Select ALL that apply. Which factors create the skin’s acidic mantle?
Select ALL that apply. Which factors create the skin’s acidic mantle?
A homeopathic 30C dilution corresponds to a final concentration of approximately:
A homeopathic 30C dilution corresponds to a final concentration of approximately:
E.Z., a 4-month-old with mild diaper dermatitis, has been using zinc oxide paste for two days. Parents ask about adding hydrocortisone 1 % ointment. You advise:
E.Z., a 4-month-old with mild diaper dermatitis, has been using zinc oxide paste for two days. Parents ask about adding hydrocortisone 1 % ointment. You advise:
Which SPF blocks ~97 % of UVB when applied at 2 mg/cm²?
Which SPF blocks ~97 % of UVB when applied at 2 mg/cm²?
Least likely to provoke photoallergic reaction:
Least likely to provoke photoallergic reaction:
The minimum reapplication interval for any sunscreen while outdoors is generally:
The minimum reapplication interval for any sunscreen while outdoors is generally:
L.A. is a 32-year-old woman with lupus on oral prednisone who presents with interdigital lesions resembling athlete’s foot and wants a faster OTC. Your recommendation?
L.A. is a 32-year-old woman with lupus on oral prednisone who presents with interdigital lesions resembling athlete’s foot and wants a faster OTC. Your recommendation?
Which vitamin/mineral claim is PERMITTED on a supplement label?
Which vitamin/mineral claim is PERMITTED on a supplement label?
For mild atopic dermatitis on flexor surfaces, first-line OTC therapy is:
For mild atopic dermatitis on flexor surfaces, first-line OTC therapy is:
A 20-year-old man with Fitzpatrick type I skin asks why he still burns using SPF 15. Best explanation:
A 20-year-old man with Fitzpatrick type I skin asks why he still burns using SPF 15. Best explanation:
Which OTC antifungal has BOTH fungicidal activity and the shortest labeled course for tinea cruris?
Which OTC antifungal has BOTH fungicidal activity and the shortest labeled course for tinea cruris?
In the DSHEA definition, a dietary supplement MUST be:
In the DSHEA definition, a dietary supplement MUST be:
C.C. (age 8) has scaling, circular lesions with central clearing on the forearm; no fever, no meds. Parent used clotrimazole bid for three days with slight improvement. Next step?
C.C. (age 8) has scaling, circular lesions with central clearing on the forearm; no fever, no meds. Parent used clotrimazole bid for three days with slight improvement. Next step?
Which statement about avobenzone is TRUE?
Which statement about avobenzone is TRUE?
The enzyme inhibited by terbinafine is:
The enzyme inhibited by terbinafine is:
Select ALL that apply. Appropriate non-pharmacologic counseling for recurrent athlete’s foot:
Select ALL that apply. Appropriate non-pharmacologic counseling for recurrent athlete’s foot:
M.M., a 3-week-old, has moderate diaper rash unresponsive after seven days of barrier cream. No broken skin. Next best step?
M.M., a 3-week-old, has moderate diaper rash unresponsive after seven days of barrier cream. No broken skin. Next best step?
Which component of natural moisturizing factor is derived from filaggrin breakdown?
Which component of natural moisturizing factor is derived from filaggrin breakdown?
Broad-spectrum designation on sunscreen requires a critical wavelength ≥:
Broad-spectrum designation on sunscreen requires a critical wavelength ≥:
A patient asks why benzoyl peroxide may bleach fabrics. You explain it is a:
A patient asks why benzoyl peroxide may bleach fabrics. You explain it is a:
Which OTC agent is MOST appropriate for mild comedonal acne on the face?
Which OTC agent is MOST appropriate for mild comedonal acne on the face?
During counseling, you emphasize that chemical sunscreens should be applied:
During counseling, you emphasize that chemical sunscreens should be applied:
K.B. is a 55-year-old gardener on lisinopril who has painful fissures and white scaling on both soles (moccasin type). Best initial OTC option?
K.B. is a 55-year-old gardener on lisinopril who has painful fissures and white scaling on both soles (moccasin type). Best initial OTC option?
Which supplement verification program publishes independent test results and seals products that pass its standards?
Which supplement verification program publishes independent test results and seals products that pass its standards?
Most common medication-related problem identified in self-care encounters is:
Most common medication-related problem identified in self-care encounters is:
Select the LEAST appropriate sunscreen for a 2-year-old child with atopic dermatitis:
Select the LEAST appropriate sunscreen for a 2-year-old child with atopic dermatitis:
S.H. applies 1 mL of SPF 30 sunscreen over both arms (total area ~1000 cm²). Why is this inadequate?
S.H. applies 1 mL of SPF 30 sunscreen over both arms (total area ~1000 cm²). Why is this inadequate?
The Fitzpatrick phototype MOST associated with 'usually burns, tans minimally' is:
The Fitzpatrick phototype MOST associated with 'usually burns, tans minimally' is:
In the OTC antifungal family, which agent is approved for BOTH treatment and prophylaxis of tinea pedis?
In the OTC antifungal family, which agent is approved for BOTH treatment and prophylaxis of tinea pedis?
Why are corticosteroids discouraged in untreated fungal infections?
Why are corticosteroids discouraged in untreated fungal infections?
D.F. is a 26-year-old marathon runner asking about caffeine-containing 'energy' supplements. Which counseling point is CORRECT?
D.F. is a 26-year-old marathon runner asking about caffeine-containing 'energy' supplements. Which counseling point is CORRECT?
Which ingredient in Natural Moisturizing Factor binds water via multiple hydroxyl groups?
Which ingredient in Natural Moisturizing Factor binds water via multiple hydroxyl groups?
A patient with dark brown skin (phototype VI) asks if sunscreen is necessary. Best response:
A patient with dark brown skin (phototype VI) asks if sunscreen is necessary. Best response:
Select ALL that apply. Appropriate advice for parents treating infant diaper dermatitis with zinc oxide:
Select ALL that apply. Appropriate advice for parents treating infant diaper dermatitis with zinc oxide:
The broad-spectrum sunscreen label claim requires protection against:
The broad-spectrum sunscreen label claim requires protection against:
G.S. is a 45-year-old man on prednisone who presents with widespread erythematous plaques, purulent drainage, and fever. He believes it started as athlete’s foot. Your triage decision?
G.S. is a 45-year-old man on prednisone who presents with widespread erythematous plaques, purulent drainage, and fever. He believes it started as athlete’s foot. Your triage decision?
Flashcards
Tolnaftate
Tolnaftate
OTC option with the fastest effect for athlete's foot; Apply twice daily for 4 weeks.
Plan step
Plan step
In PPCP, it follows identifying the medication-related problem.
Ginkgo-Warfarin
Ginkgo-Warfarin
Ginkgo increases bleeding risk with warfarin.
Skin's Acidic Mantle Factors
Skin's Acidic Mantle Factors
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Homeopathic 30C Dilution
Homeopathic 30C Dilution
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Infant Diaper Rash Advice
Infant Diaper Rash Advice
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SPF 30
SPF 30
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Photoallergic Reaction Risk
Photoallergic Reaction Risk
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Athlete's Foot
Athlete's Foot
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Permitted Supplement Claim
Permitted Supplement Claim
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First-Line Atopic Dermatitis Therapy
First-Line Atopic Dermatitis Therapy
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SPF 15 Inadequacy
SPF 15 Inadequacy
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Terbinafine 1% cream
Terbinafine 1% cream
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DSHEA Definition
DSHEA Definition
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Fungal Lesion
Fungal Lesion
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Avobenzone Truth
Avobenzone Truth
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Terbinafine Enzyme Target
Terbinafine Enzyme Target
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Athlete's Foot: Non-Pharm
Athlete's Foot: Non-Pharm
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Diaper rash
Diaper rash
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Sunscreen Critical Wavelength
Sunscreen Critical Wavelength
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Study Notes
Patient Scenario: Athlete's Foot
- A 19-year-old college swimmer has white, soggy skin, and fissures between the 4th and 5th toes, is not taking any medication and has no chronic illnesses, Terbinafine 1% cream bid x 1 week is the fastest OTC option
- A 32-year-old woman with lupus on oral prednisone presents with interdigital lesions resembling athlete's foot, referral to a physician is advised because of her lupus
- A 45-year-old man on prednisone has widespread erythematous plaques, purulent drainage, and fever; immediate referral for systemic evaluation is needed due to his symptoms and medication
PPCP (Pharmacist's Patient Care Process)
- The PPCP step that immediately follows the identification of medication-related problems is to plan
Patient Scenario: Ginkgo Biloba and Warfarin
- A 68-year-old man on warfarin wants to start ginkgo biloba for memory; avoid using them together because ginkgo can increase bleeding risk with warfarin
Skin Composition
- The lipid lamellae of the stratum corneum are composed of ceramides, free fatty acids, and cholesterol
- Sebaceous fatty acids, lactic acid in sweat, melanin oxidation products, and filaggrin degradation products all contribute to the skin's acidic mantle
- Urea is a component of natural moisturizing factor derived from filaggrin breakdown.
Homeopathic Dilution
- A homeopathic 30C dilution corresponds to a final concentration of approximately 10⁻⁶⁰
Patient Scenario: Diaper Dermatitis
- For a 4-month-old with mild diaper dermatitis using zinc oxide paste, continue the zinc oxide and avoid hydrocortisone unless prescribed
- When treating infant diaper dermatitis with zinc oxide, apply a thick layer at every diaper change and gently cleanse with warm water, avoiding harsh wipes
Sunscreen Information
- An SPF of 50 blocks ~97% of UVB when applied at 2 mg/cm²
- The minimum reapplication interval for any sunscreen while outdoors is generally 2 hours
- A 20-year-old man with Fitzpatrick type I skin asks why he still burns using SPF 15 because SPF 15 blocks only ~93% UVB and must be reapplied liberally; consider SPF 30+
- Chemical sunscreens should be applied 15–30 minutes before sun exposure
- Broad-spectrum designation on sunscreen requires a critical wavelength ≥ 370 nm
- Avobenzone provides broad UVA coverage but is photolabile without stabilizers
- The broad-spectrum sunscreen label claim requires protection against both UVA and UVB
- For a 2-year-old with atopic dermatitis, SPF 15 octinoxate/oxybenzone spray is the least appropriate sunscreen
Patient Scenario: Sunscreen Use
- A patient with dark brown skin (phototype VI) asks if sunscreen is necessary; response is Melanin offers some protection, but broad-spectrum SPF 30 still reduces cancer risk
- Applying 1 mL of SPF 30 sunscreen over both arms (total area ~1000 cm²) is inadequate because the recommended dose is 2 mg/cm² (~2 g for that area).
Skin Phototypes
- The Fitzpatrick phototype most associated with "usually burns, tans minimally" is Type I
Supplement Information
- In the DSHEA definition, a dietary supplement must be ingested orally to supplement the diet
- A vitamin/mineral claim that "supports bone health" is permitted on a supplement label
- NSF Certified for Sport is a supplement verification program that publishes independent test results and seals products that pass its standards
Patient Scenario: Supplements
- A 26-year-old marathon runner asks about caffeine-containing "energy" supplements; high doses of caffeine may cause tachycardia and GI upset
OTC Antifungals
- Terbinafine inhibits the enzyme squalene epoxidase
- Terbinafine 1% cream once daily × 1 week is an OTC antifungal agent which has both fungicidal activity and the shortest labeled course for tinea cruris
- Tolnaftate powder is an agent approved for both treatment and prophylaxis of tinea pedis
- For a 55-year-old gardener on lisinopril with painful fissures and white scaling on both soles (moccasin type), Terbinafine 1% cream bid x 2 weeks is the best initial OTC option
Corticosteroids and Fungal Infections
- Corticosteroids are discouraged in untreated fungal infections because they suppress macrophage function needed to clear dermatophytes
Patient Scenario: Atopic Dermatitis
- For mild atopic dermatitis on flexor surfaces, first-line OTC therapy is hydrocortisone 1 % ointment bid × 7 days
Patient Scenario: Acne
- For mild comedonal acne on the face, benzoyl peroxide 2.5 % gel daily is most appropriate
Benzoyl Peroxide
- Benzoyl peroxide may bleach fabrics because it is a strong oxidizer
Photoallergic Reactions
- Zinc oxide is least likely to provoke a photoallergic reaction
Patient Scenario: Scaling Lesions
- An 8-year-old has scaling, circular lesions with central clearing on the forearm; no fever, no meds after using clotrimazole bid for three days with slight improvement; continue clotrimazole for full 4 weeks
Athlete's Foot Non-pharmacologic Counseling
- For recurrent athlete's foot, wear moisture-wicking socks, change socks after exercise, and apply antifungal powder to shoes
Medication-Related Problems
- The most common medication-related problem identified in self-care encounters is wrong dose or duration
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