Module 9 Study Guide PDF

Module 9 Study Guide Become familiar with the **drug classes from the Module 9 drug tables on the Module 9 overview page.** Understand the mechanisms of action, Indications, potential side effects, adverse effects, potential drug-to-drug interactions, contraindications, patient education, and use i...

Module 9 Study Guide Become familiar with the **drug classes from the Module 9 drug tables on the Module 9 overview page.** Understand the mechanisms of action, Indications, potential side effects, adverse effects, potential drug-to-drug interactions, contraindications, patient education, and use in pregnancy, lactation, children, and elderly for each class. Note any monitoring or follow-up indicated. **Module 9 Unit A - Dermatologic: Skin Conditions** 1. What are the common pathogens that cause skin infections? Staphylococcus aureus & Streptococcus pyrogens (Gram +) 2. When is a topical agent appropriate for a skin infection? When would you use a systemic? (How do we base treatment)? a. Topicals appropriate for localized, mild infection b. Bacterial infections may be treated with topical or systemic agents. 3. What are the current treatment recommendations for a MRSA abscess? 1^st^ Line: incision, drainage, culture/sensitivity, education wound care/hygiene, follow-up in absence of systemic infection. Systemic Abx: Tetracyclines, Clindamycin, Erythromycin In the presence of systemic sx ***or***: c. severe local symptoms d. immune suppression e. extremes of patient age f. infections in a difficult to drain area or lack of response to incision and drainage alone. 4. What are the pharmacological treatments for venereal warts? Look at indications, MOA, safety, and patient education for each. g. Removal of the warts (cryotherapy (freezing) or topicals. i. *Prevention* w/ Gardasil (HPV) vaccine ii. *Condoms for prevention* h. **Provider applied Topicals**: iii. Podophyllin (podophyllum resin)(Podocon-25, Podofilm) highly caustic/wash off few hours after application with soap/water or alcohol. iv. Bichloroacetic acid (BCA) v. Trichloroacetic acid (TCA). high concentration 80-90% (destroys warts by chemical coagulation i. **Patient applied Topicals**: vi. Imiquimod (Aldara, Zyclara) local irritation-not antiviral, intensifies immune response. 12 and older/avoid in pregnancy. 1-3 x weekly for several weeks. vii. Podofilox (Conylox) Inhibits mitosis, cheaper/works faster than imiquimod/caustic, local irritation/avoid in pregnancy & lactation. viii. Kunecatechins (Sinecatechins/Veregen) (leaves make green tea). 15% ointment solution: 3x/day up to 16 weeks. Safety in pregnancy unknown. 5. Review topical antifungal medications. Look at indications, MOA, and safety. **Examples** (Clotrimazole Ketoconazole Fluconazole Miconazole Itraconazole) - Impair synthesis of ergosterol allowing for increased permeability & leakage of cellular components resulting in cell death. - Adverse Effects - Burning and itching (when used intravaginal) - Skin irritation, swelling, redness 6. Review systemic antifungal medications. Look at indications, MOA, duration of treatment, any monitoring needed, and drug-to-drug interactions. j. *Inhibiting* fungal CYP 450 ix. *Fluconazole:* 1. *least CYP 450 effect* 2. *prolongs the QT interval* k. *D2D interactions-lots* l. Adverse Effects: GI upset, headache, urticaria, pruritus, hepatic dysfunction, edema & hypokalemia **Note:** **Azoles** prolong QT & hepatotoxicity Systemic "azoles" cannot be used in pregnancy or lactation. Interfere with CYP450: increased levels of warfarin, theophylline, macrolides, statins. Oral agents like griseofulvin check liver function/avoid alcohol. **Vulvovaginal candidiasis**: educate on risk of pregnancy (ask about self-treatment yeast infections) 7. What is the effect of topical creams or ointments on condoms and diaphragms? m. Oil based- Weakens them! 8. Review medications used in the treatment of acne. Look at indications, MOA, and safety. n. Treatment by Severity & classification step wise approach o. **1^st^ Line** non-pharm: wash the face gently two or three times daily with a mild soap p. Mild-topicals; Retinoids and Antibiotics Comedolytic agent (Retinoic Acid), Bactericidal agent (Benzoyl peroxide) Topical antibiotic (Clindamycin 2% or Erythromycin 2-3%). Topical Abx should be combined with Benzoyl to decrease resistance. q. Moderate to severe acne (Or unresponsive mild): Oral Abx and comedolytics, including retinoids and azelaic acid. Women who do not respond to other drugs can use hormonal agents such as spironolactone and COCs. Recommended: Moderate-long-term therapy (6 weeks) can be used with mild treatment options. **Oral antibiotics**-(Tetracyclines, clindamycin, and erythromycin) Use Erythromycin if pregnancy is possibility. Tetracyclines contraindicated in pregnancy (infant teeth discoloration) **COC**s (Yaz, Estrostep, Ortho Tri-cyclen) only for women \>15 with periods **Spironolactone**-Women with PCOS or past teenage yrs (antiandrogen effects) typically 4-8 weeks for results (Get baseline CMP & CBC, opt. monitor K+) **Comedolytics** (retinoids & azelaic acid) like Retin-A r. **Severe and unresponsive acne** or severe nodulocystic acne (acne vulgaris) Refer to a dermatologist. Cystic acne is treated with another **vitamin A derivative, Accutane (isotretinoin).** Severe teratogenic SE (Patient, Provider, Pharmacist, Wholesaler must enroll in **IPLEDGE**) = **2x birth control + 2x negative preg. tests** 9. What **acne** treatments are appropriate in pregnancy? What acne treatments are contraindicated in pregnancy? - Abx safe in order: PCNs, cephalosporins, erythromycin, then other macrolides i.e. azithromycin - Most topicals Abx are safe. - **Retinoids** are teratogens (topical & systemic) - **Systemic salicylates-**limited use of topical (limited info) - Salicylic Acid (SalAc, Dermal Zone) is an NSAID & found in many topical OTC products - **Tetracycline** Abx (doxycycline, minocycline) tooth discoloration/enamel dysplasia/bone deformation/growth restriction - **Tretinoins** (Rein A, Isotretinoin, Tazarotene, Adapalene) Also avoid in lactation. 10. Review patient education in regard to managing expectations for acne treatment. When should they expect results for acne treatments? s. **Oral Abx**: need at least 6 weeks for skin to turn over x. Don't start another tx until after this time t. **COCs**: takes 4-6 months to see improvements 11. How is acne rosacea treated? u. **1^st^ line:** topical *metronidazole *(Flagyl, Metro-Gel) v. **2^nd^ line**: other topicals or oral Abx xi. ***\***Alcohol use in contraindicated w/in 48-72 hours of PO metronidazole (disulfiram reaction: vomiting, dizziness, throbbing HA, etc.)* w. *Rosacea may not clear up* 12. What are the differences in medication delivery systems? Compare ointments, creams, lotions, and solutions. x. **Ointments** -- dry area (more occlusive = more potent) xii. Help w/ dry, scaly, thick lesions. y. **Creams** -- moist areas (less occlusive = less potent) xiii. oozing and intertriginous areas z. ** Occlusive dressings** xiv. Pair w/ ointment to enhance its results by improving absorption/penetration of drug. a. **Gels aerosols lotions** - good for hairy areas (lotions least potent) 13. Review topical steroid use. What are the adverse effects of long-term use of topical steroids? ***Steroids** = used for non-infectious inflammatory conditions* b. Atrophy of skin c. Ecchymosis (bruising) d. Striae (stretch marks) e. Telangiectasia (spider veins) f. Acne g. Hypertrichosis (excess hair growth) h. Cataract formation or glaucoma with prolonged use around eyes 14. How long should topical steroids be used with children? Adults? **Topical:** i. Adults: \