Module 9 Study Guide: Dermatology
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Questions and Answers

What is the correct method for instilling ear drops in adults?

  • Pull the auricle up (correct)
  • Tilt the head to the right
  • Pull the auricle down
  • Tilt the head to the left

Which of the following is an appropriate first-line treatment for lice?

  • Lindane
  • Permethrin 1% and nit combing (correct)
  • Malathion lotion
  • Benzoyl alcohol

What precaution should be taken when considering the use of Lindane?

  • It is flammable and should be kept away from heat
  • It is neurotoxic and should not be used with a history of seizures (correct)
  • It is recommended during pregnancy
  • It is safe for children under 5 years

What is essential to understand about non-ovicidal treatments for pediculosis?

<p>They must be applied twice, seven to 10 days apart (C)</p> Signup and view all the answers

Which category is permethrin classified as during pregnancy?

<p>Category B (C)</p> Signup and view all the answers

Which topical formulation is primarily water-based with minimal oil content?

<p>Lotions (A)</p> Signup and view all the answers

What is a potential adverse effect of long-term use of topical steroids?

<p>Striae (B)</p> Signup and view all the answers

Which statement accurately describes the appropriate use of high potency steroids?

<p>They are reserved for the torso and extremities. (B)</p> Signup and view all the answers

What is the maximum duration for children to use topical steroids?

<p>One week (D)</p> Signup and view all the answers

Which mechanism describes how systemic corticosteroids function?

<p>Suppress influx of inflammatory cells (D)</p> Signup and view all the answers

What are the indications for systemic corticosteroid use in dermatology?

<p>Severe conditions like pemphigus and psoriasis (C)</p> Signup and view all the answers

Which of the following is NOT an adverse effect of systemic corticosteroids?

<p>Skin atrophy (A)</p> Signup and view all the answers

What characterizes ointments compared to other topical formulations?

<p>They are thick and greasy. (A)</p> Signup and view all the answers

What is the primary action of isotretinoin in the treatment of severe nodulocystic acne vulgaris?

<p>Decreases sebum production (C)</p> Signup and view all the answers

What is the role of the contraceptive pill (COC) in managing acne?

<p>Decreases sebum production by reducing androgen availability (D)</p> Signup and view all the answers

Which patient group should exercise caution when using adapalene?

<p>Patients with asthma (C)</p> Signup and view all the answers

What is a known drug interaction with isotretinoin?

<p>Tetracyclines (C)</p> Signup and view all the answers

What is the mechanism of action of adapalene?

<p>Unplugs existing comedones and prevents new ones from developing (A)</p> Signup and view all the answers

What age and condition must a patient meet to be prescribed COCs for acne management?

<p>Must be at least 15, have had menarche, and seek contraception (C)</p> Signup and view all the answers

What condition is contraindicated for the use of COCs?

<p>Renal impairment (B)</p> Signup and view all the answers

What effect does cigarette smoking have on women using COCs?

<p>Increases the risk of cardiovascular events (A)</p> Signup and view all the answers

What is the primary management option for mild-to-moderate blepharitis?

<p>Warm compresses and lid washing (C)</p> Signup and view all the answers

Which of the following ointments is typically used for moderate to severe cases of blepharitis?

<p>Erythromycin ointment (C)</p> Signup and view all the answers

What is the recommended treatment for bacterial conjunctivitis in contact lens wearers?

<p>Fluoroquinolones (D)</p> Signup and view all the answers

Which class of medications is used to prevent the release of inflammatory mediators in allergic conjunctivitis?

<p>Mast cell stabilizers (D)</p> Signup and view all the answers

Which medication is known to provide immediate relief for allergic conjunctivitis?

<p>Topical antihistamines (B)</p> Signup and view all the answers

If a patient with blepharitis shows no improvement after several weeks, what is the next step?

<p>Refer to an ophthalmologist (C)</p> Signup and view all the answers

What is the primary action of oral antihistamines in allergic conjunctivitis?

<p>Block H1 receptors (B)</p> Signup and view all the answers

What is an important consideration for contact lens wearers who develop bacterial conjunctivitis?

<p>Stop wearing contact lenses until resolution (D)</p> Signup and view all the answers

Which bacteria are commonly responsible for skin infections?

<p>Staphylococcus aureus and streptococcus pyogenes (B)</p> Signup and view all the answers

When should a topical agent be used for a skin infection?

<p>For localized, mild infections (D)</p> Signup and view all the answers

What are the treatment recommendations for a MRSA abscess?

<p>Incision and drainage, followed by wound care education (D)</p> Signup and view all the answers

What is the mechanism of action of podophyllin in treating venereal warts?

<p>It inhibits DNA synthesis and mitosis (A)</p> Signup and view all the answers

Which of the following is true about bichloroacetic acid (BCA) and trichloroacetic acid (TCA)?

<p>They destroy warts by chemical coagulation (A)</p> Signup and view all the answers

What is the primary function of topical cyclosporine ophthalmic emulsion?

<p>To suppress the immune response and promote tear production (C)</p> Signup and view all the answers

Which of these drugs is NOT classified as an ocular decongestant?

<p>Sulfamethoxazole (B)</p> Signup and view all the answers

What precautions should be taken regarding the use of podophyllin?

<p>Soap and water should be used hours after application to reduce toxicity risk (D)</p> Signup and view all the answers

What adverse effects are associated with the use of ophthalmic beta-blockers?

<p>Heart block, bradycardia, and bronchospasm (D)</p> Signup and view all the answers

What is the primary action of Imiquimod in treating HPV-related warts?

<p>It induces the production of interferon-alpha and other immune responses (D)</p> Signup and view all the answers

Which statement regarding the use of Imiquimod is correct?

<p>It has minimal systemic absorption and primarily causes local irritation (C)</p> Signup and view all the answers

In which circumstance are glucocorticoids appropriate for prescribing?

<p>In cases of uveitis or iritis when infection is ruled out (C)</p> Signup and view all the answers

What serious risk is associated with administering ophthalmic beta-blockers alongside oral beta-blockers?

<p>Additive effects leading to severe bradycardia (D)</p> Signup and view all the answers

Who should avoid using ophthalmic beta-blockers?

<p>Patients with bradycardia or AV block (B)</p> Signup and view all the answers

What is the effect of preservative-free artificial tear substitutes when used daily?

<p>They are safe for continuous daily use (C)</p> Signup and view all the answers

What are the main classes of drugs used to treat open-angle glaucoma?

<p>Beta-blockers, prostaglandin analogs, and alpha-adrenergic agonists (C)</p> Signup and view all the answers

Flashcards

Topical Retinoids

A type of medication commonly used for acne treatment. It works by reducing inflammation and promoting the peeling of the top layer of skin, helping to clear acne.

P. acnes

A common type of bacteria that contributes to acne development. It releases active oxygen, leading to inflammation.

Isotretinoin (Accutane)

A strong acne medication used for severe nodulocystic acne. It reduces sebum production, inflammation, and keratinization, minimizing acne-causing bacteria.

Adapalene (Differin)

An acne treatment considered a cornerstone for mild to moderate acne. It acts by preventing comedones (blackheads and whiteheads) and reducing inflammation.

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COCs (YAZ, Estrostep, etc.)

Combined Oral Contraceptives (COCs) are approved for managing acne in women. They mainly work by decreasing androgen production and increasing the production of sex hormone-binding globulin, which limits the effects of androgens.

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Androgens

Hormones produced by the body, like testosterone, can stimulate sebum production, contributing to acne. They are also implicated in some cases of hair loss.

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Sex Hormone-Binding Globulin (SHBG)

A protein that binds to androgens (like testosterone) to reduce their effects. This can help improve acne by reducing sebum production.

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Sebum

The oil produced by your skin's sebaceous glands. It can become trapped in pores, contributing to acne development.

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What are the common pathogens that cause skin infections?

Gram-positive bacteria commonly found in skin infections. They can cause a variety of skin conditions, from mild acne to serious abscesses.

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When is a topical agent appropriate for a skin infection? When would you use a systemic?

Topical treatments are appropriate for localized, mild skin infections. Systemic treatments are necessary for severe infections or when topicals aren't effective. Treatment choices are based on the severity of symptoms.

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What are the current treatment recommendations for a MRSA abscess?

Incision and drainage, culture and sensitivity testing, patient education on wound care and hygiene, and follow-up are the recommended treatment approaches for MRSA abscesses. Systemic treatment is typically not necessary unless there are systemic or severe local symptoms, or the patient is immunosuppressed.

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What is the mechanism of action and safety considerations for Podophyllin (Podocon-25, Podofilm) in treating venereal warts?

Podophyllin is a resin mixture that inhibits DNA synthesis and mitosis, leading to wart destruction. Its use is limited due to its caustic nature and risk of systemic absorption leading to toxicity. It's not recommended during pregnancy or lactation.

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How do Bichloroacetic acid (BCA) and trichloroacetic acid (TCA) work to treat venereal warts?

Bichloroacetic acid (BCA) and trichloroacetic acid (TCA) destroy warts by chemical coagulation. They should be used carefully to avoid spreading to healthy tissue and can be repeated weekly.

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How does Imiquimod (Aldara, Zyclara) work to treat venereal warts?

Imiquimod (Aldara, Zyclara) enhances the immune response to HPV by stimulating the production of interferon-alpha, TNF, and interleukins, leading to wart destruction. Local irritation is a common side effect but systemic effects are minimal due to limited absorption.

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What are the safety considerations for the treatment of venereal warts in pregnancy and lactation and for children?

Podophyllin, BCA, and TCA should be used with caution during pregnancy and lactation due to potential toxicity. Imiquimod is approved for patients 12 and older.

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What is important to include in patient education for the treatment of venereal warts?

Patient education should include information about proper application techniques, potential side effects, and follow-up instructions for each treatment. Emphasize the importance of proper hygiene to prevent the spread of infection.

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What is blepharitis?

An inflammation or infection affecting the edge of the eyelid.

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How is mild-to-moderate blepharitis managed?

Warm compresses, eyelid massage, and gentle cleansing with baby shampoo.

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What kind of medication is used for moderate-to-severe blepharitis?

Antibiotic ointments like bacitracin or erythromycin.

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What should you do if blepharitis doesn't improve?

Referring the patient to an ophthalmologist if the condition worsens or fails to improve after several weeks.

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What are the preferred antibiotics for bacterial conjunctivitis in contact lens wearers?

Fluoroquinolones are the preferred choice due to their effectiveness against Pseudomonas, a common bacteria in contact lens wearers.

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What medications are used to manage allergic conjunctivitis?

Mast cell stabilizers (like cromolyn sodium) and topical antihistamines.

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How quickly do mast cell stabilizers and antihistamines provide relief for allergic conjunctivitis?

Mast cell stabilizers take several weeks to show benefits, while antihistamines offer immediate relief.

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How are dry eyes managed?

Artificial tears are used to lubricate the eye and reduce dryness.

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What is an ointment?

A thick, greasy topical medication that is often oil-based and used for dry skin or areas with thicker skin.

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What is a cream?

A topical medication that is a mixture of water and oil, making it less thick than an ointment but thicker than a lotion.

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What is a lotion?

A topical medication that is mostly water-based and usually contains little to no oil. It's light and easily absorbed.

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What is a solution?

A topical medication that is mainly water-based and designed to dissolve quickly. It's good for dry lesions but less occlusive than ointments.

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What is a gel?

A topical medication that is a mixture of solution and a thickening agent, often containing alcohol. It disappears quickly and is preferred for acne treatment.

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What are the adverse effects of long-term topical steroid use?

Long-term topical steroid use can result in skin thinning, bruising, stretch marks, dilated blood vessels, acne, excessive hair growth, and potential damage to the eye if used around it.

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What are the recommended durations for topical steroid use in children and adults?

Children should use topical steroids for a maximum of one week, while adults should limit use to two weeks.

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What are the appropriate areas of use for low and high potency steroids?

Low-potency steroids are suitable for the face and areas where skin folds occur, like under the breasts, abdomen, and inner thighs. High-potency steroids are reserved for extremities and the torso.

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Artificial Tear Substitutes

Isotonic solutions that replace natural tears. Safe for daily continuous use without preservatives.

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Restasis (Cyclosporine Ophthalmic Emulsion)

Topical cyclosporine emulsion used to treat dry eyes due to inflammation. Suppresses the immune response, promoting tear production.

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Ocular Decongestants

Weak solutions of adrenergic agonists applied topically to constrict dilated blood vessels in the conjunctiva.

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Glucocorticoids for Eye Inflammation

Glucocorticoids are used to treat inflammatory eye disorders like uveitis, iritis, and conjunctivitis. Prescribing should be done in consultation with an ophthalmologist to rule out underlying infections.

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Drug Classes for Open-Angle Glaucoma

Beta-blockers, prostaglandin analogs, and alpha-adrenergic agonists are drug classes used to treat open-angle glaucoma.

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Adverse Effects of Ophthalmic Beta-blockers

Nonselective: heart block, bradycardia, bronchospasm. Beta-selective: heart block, bradycardia, hypotension, blurred vision, dry eyes.

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Contraindications for Ophthalmic Beta-blockers

Patients with bradycardia, AV block, or cardiogenic shock should not use ophthalmic beta-blockers.

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Ophthalmic Beta-blockers with Oral Beta-blockers

Ophthalmic beta-blockers have an additive effect when used with oral beta-blockers, potentially increasing risk of adverse events.

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What's the first line treatment for scabies?

Permethrin 5% cream is used for the entire body, from the neck down to the soles of the feet.

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How do you treat head lice?

Permethrin 1% is the first line treatment, followed by nit combing.

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What is a preventative measure against ear infections?

Acetic acid and alcohol in a 1:3 ratio are applied to the ears before and after swimming to prevent ear infections. Do not use in children under 3 years old.

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Why is an ovicidal medication important for lice treatment?

Ovicidal medications kill both the lice and the eggs, while non-ovicidal medications only kill the lice, requiring multiple treatments to kill newly hatched lice.

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How do we treat lice/scabies during pregnancy?

Permethrin is considered safe for pregnant and lactating women because it has a low absorption rate and is quickly metabolized.

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Study Notes

Module 9 Study Guide: Dermatology, Skin Conditions, and Infections

  • Skin Infections: Common pathogens include Staphylococcus aureus and Streptococcus pyogenes (gram-positive bacteria).

  • Topical vs. Systemic Treatment: Topical agents are suitable for localized, mild infections; systemic treatment is needed for infections unresponsive to topical therapy.

  • MRSA Abscess Treatment: Incision and drainage, culture and sensitivity testing, wound care education, and follow-up are essential. Systemic symptoms, severe local symptoms, and immunosuppression guide treatment.

  • Venereal Warts (Genital Warts): Pharmacological treatment options include podophyllin, bichloroacetic acid/trichloroacetic acid, imiquimod, and podofilox, each with specific mechanisms of action and safety considerations. Patient education about application and potential side effects (irritation, burning) is vital. These treatments should be avoided in pregnancy and lactation.

  • Topical Antifungal Medications: Azoles, for example, are a first-line treatment for most skin infections, by impairing fungal ergosterol synthesis and increasing membrane permeability. The typical treatment duration is 2-4 weeks, with additional one week after lesions have resolved.

  • Acne Treatment: Benzoyl peroxide is a first-line treatment for mild to moderate acne, reducing P. acnes growth and promoting exfoliation. Isotretinoin (Accutane) is used for severe nodulocystic acne, regulating sebum production and inflammation. Adapalene (Differin) and topical antibiotics have similar roles. Oral antibiotics and birth control pills (COC) are also utilized . Safety considerations and potential side effects of each medication are crucial for patient education. COC and Aldactone are often contraindicated in pregnancy.

  • Acne Treatment in Pregnancy: Benzoyl peroxide is generally considered safe. However, topical Differin and systemic treatment are usually avoided during pregnancy, but antibiotics and other treatments can be prescribed by a medical professional.

  • Acne Treatment Expectations: Results typically appear after 4-6 weeks for topical treatments or 6+ weeks for oral treatments, and 4-6 months for COCs.Patient education about gradual improvement is important.

  • Rosacea Treatment: Topical metronidazole is often the initial treatment; other topical antibiotics may be used if this doesn't work.

Module 9 Unit B: Ophthalmic Drugs

  • Blepharitis: Mild to moderate cases are treated with warm compresses, lid hygiene, and mild topical antibiotics. Severe cases may require referral to an ophthalmologist.
  • Bacterial Conjunctivitis: Treatment is using topical antibacterial eye drops or ointments. Contact lens wearers should discontinue use until symptoms resolve to reduce the risk of corneal infection, particularly with Gram-negative bacteria.
  • Allergic Conjunctivitis: Treatment includes mast cell stabilizers (e.g., cromolyn sodium), topical antihistamines, or a combination of mast cell stabilizers and antihistamines. Oral antihistamines may also be used.
  • Dry Eyes: Artificial tears, ocular lubricants, and topical cyclosporine are treatments for dry eyes, focusing on providing lubrication and reducing inflammation.

Module 9 Unit C: Otic Drugs

  • Acute Otitis Media (AOM) Treatment: Amoxicillin is often the first-line treatment, with amoxicillin-clavulanate an alternative if amoxicillin fails. Cephalosporins may be used in penicillin-allergic patients. Treatment duration is critical to resolve infections swiftly.
  • Otitis Externa (OE) Treatment: Fluoroquinolone eardrops are typical, with or without a steroid. Specific classes, like Fluoroquinolones, are often preferable for ruptured eardrums. Pain management with oral medications like acetaminophen or ibuprofen is important.

Module 9 Unit D: Dermatologic Infestations

  • Pediculosis (Lice) and Scabies Treatment: Treatment often involves topical medications (e.g., permethrin, lindane, malathion) or oral ivermectin. In pregnancy or for young children, some medications are preferred to others.
  • Patient Education: Important instructions include treatment duration, application methods, and avoiding contact with eyes and mucous membranes. Repeated treatments may be necessary for topical treatments that are not ovicidal.

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Module 9 Study Guide PDF

Description

This study guide covers essential concepts related to dermatology, including common skin infections caused by pathogens such as Staphylococcus aureus and Streptococcus pyogenes. It discusses treatment options, including topical and systemic therapies, and emphasizes the importance of patient education regarding various treatments like venereal warts. Understanding these conditions is crucial for effective management in dermatological practice.

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