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| 1. Your patient presents with a skin rash that you diagnose as eczema. What are your treatment options? |
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Definition
| Your treatment options are a steroid cream or another agent such as Pimecrolimus. Remember to use the lowest dose possible when using a steroid cream. Also, if the patient has a sensitivity or drug reactions to the steroid cream, the others are a better choice. However, keep in mind the new black box warning on the immunmodulators. |
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| 2. What are the most common side effects with steroid creams? |
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Definition
| Skin dryness, burning, pruritus, skin atrophy and hypopigmentation are the most common side effects. Remember that ointments are thicker and may decrease some of the dryness. Use caution with using steroid agents on patients with darker skin tones and on the face. |
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| 3. When considering a dermatological agent and choosing a vehicle to use, what are the advantages and disadvantages of each? |
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Definition
| The ointments have a petroleum jelly base and may be greasy however; they may cause the least amount of dryness. The creams are also somewhat greasy but slightly more tolerable than ointments and can be used in most all areas. Lotions are mixed with alcohol and may cause stinging and burning with application. Despite the drying effect of the lotions, some patients cannot tolerate the greasy feeling of the ointments and creams, so this would be an adequate choice. Also, if applying BID, having a medication that can be put on day and night may be more acceptable. It is difficult to apply a greasy substance then have to go to work or school. The gel formulations are greasy as well. The gels and the aerosol solutions are useful on the scalp. However, they contain alcohol so may irritate the skin. Powders are very easy to apply to intertriginous areas however, should not be used on wet lesions or moist areas because they can cake up. |
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| 4. What are you first and second line treatment choices for psoriasis? |
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Definition
| First line treatment is topical corticosteroids. Be sure to look at the potency of medication. Typically psoriatic lesions require a mid to high potency topical agent. If this fails you can move to a combination of calcipotriene and topical corticosteroids. Additionally, you can also use tazarotene in combination with topical corticosteroids. More severe psoriasis can be treated with phototherapy and systemic agents. Use of systemic agents requires consult with dermatologist. |
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| 5. What should you consider regarding metabolism when prescribing calcipotriene for the treatment of psoriasis? |
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Definition
| Calcipotriene is a synthetic analog of Vitamin D and 6% of it is absorbed systemically. For this reason, if it is given with calcium supplements and/or vitamin D supplements, it can cause hypercalcemia. This is mainly evident when using doses that exceed 100g per week for a prolonged period of time. You should avoid this medication in those patients with hypercalcemia and hypercalciuria. You should also use caution in those patients with a history of nephrolithiasis as this may increase the formation of renal calculi. |
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| 6. What should you consider regarding tazarotene and its use in the treatment of psoriasis? |
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Definition
| Topical tazarotene is approved for use in the treatment of psoriasis. It only comes in a gel formulation. It is a retinoid product. It has a slower onset of action and is typically used in conjunction with topical steroids. It causes some skin irritation and causes an increase in photosensitivity of the skin. It is also pregnancy category X and not used in children or women of childbearing age. |
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| 7. Your patient, a 6-month-old child, presents with scabies. Which agent would be contraindicated and why? |
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Definition
| Lindane-possible increase in absorption, may cause neurotoxicity. |
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| 8. Your patient presents with tinea capitus. You decide to prescribe griseofulvin. What should you consider prior to prescribing this medication? What should you tell your patients regarding the absorption of this medication? |
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Definition
| Because of the more severe side effects of granulocytopenia and hepatotoxicity, you may consider obtaining a CBC and LFT’s if the therapy is going to be longer than 6 weeks. If your patient is already at risk for hepatotoxicity, you will need to obtain LFT’s prior to therapy. It is also important to instruct your patient to take this medication with fatty foods as this increases absorption. It is important to explain to your patient to continue this medication as prescribed. Because the fungus embeds the hair follicle and essentially kills the hair follicle, it is important to continue this medication until adequate hair growth is established. |
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| 9. What laboratory measure must you monitor when treating with oral terbinafine? |
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Definition
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| 10. What role do the topical antifungal agents play in the treatment of tinea capitus? |
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Definition
| When treating tinea capitus, you can also use a topical antifungal agent in addition to the oral to prevent spread to others. However, this is not to be used alone in treating tinea capitus. Oral agents are necessary to get to the hair root as the fungus lives in the hair root. |
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| 11. Your 8yo patient presents with tinea corporis. What are your treatment options? |
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Definition
| Any of the topical antifungal agents. |
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| 12. What is the primary use for mupirocin (Bactroban)? |
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Definition
| Treatment of mild impetigo. |
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| 13. Your adult patient is diagnosed with acne rosacea. What agent is the treatment of choice for this? |
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Definition
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| 14. What is your first line agent for treatment of mild inflammatory acne? |
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Definition
| Topical benzoyl peroxide and salicylic acid washes are first line treatment with mild inflammatory acne. |
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| 15. Your 18-year-old female patient presents for treatment of moderate acne. What are your first and second line treatment choices and considerations for this patient? |
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Definition
Which agent would be most appropriate for use in this patient?
Topical antibiotics in addition topical benzoyl peroxide. Topical retinoids or azelaic acid or adapalene (retinoid like drug), however, be sure she is not pregnant . Oral antibiotics if acne is cystic (caution as some may not be used in pregnancy). Other options are oral contraceptives particularly those that are less androgenic (Ortho Tri Cyclen) |
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| 16. What is the meaning of a prodrug? |
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Definition
| A drug that, after ingestion, is transformed into a more bioavailable formulation of the drug. These drugs, when ingested are converted to the active form of the drug, increasing their bioavailability. |
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| 17. What should you consider regarding elimination when prescribing antiviral agents? |
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Definition
| All of the agents are eliminated by the kidneys so you must use caution with prescribing for those patients with renal dysfunction. They will require dosage reduction. |
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| 18. Which agents are approved for suppression therapy of genital herpes and what is the schedule of suppression therapy for genital herpes? |
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Definition
Acyclovir BID
Famciclovir BID
Valacyclovir QD |
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