Pharmacotherapy 2 Exam 4 (Obgyn + Derm)

Which antifungal has inhibits steroid biosynthesis and can therefore cause endocrine abnormalities such as mentrual irregularities, hair loss, and gynecomastia? A. nystatin B. ketoconazole C. itraconazole D. terbinafine E. grisefulvin

B

Which contraceptive steroid works by decreasing FSH and maintaining the endometrium to decrease breakthrough bleeding? A. progestin B. estrogen

B

Which formulation of topical steroid is best for psoriasis of the scalp? A. gel B. oil C. solution D. ointment E. cream

B

Which is NOT a systemic effect seen with use of topical steroids? A. HPA suppression B. Hypoglycemia C. Cataracts D. Hyperglycemia

B

Which is NOT one of the factors you use to choose topical steroid for a pt? A. Patient age B. Patient comorbid conditions C. Location of involvement D. Patient preference for vehicle E. Amount of inflammation involved

B

Which is NOT part of the MOA of Nexplanon subdermal implant? A. thicken cervical mucus B. cytotoxic/phagocytic to sperm C. inhibits ovulation

B

Which is NOT part of the MOA of combined hormonal contraception? A. thicken cervical mucus B. cytotoxic/phagocytic to sperm C. inhibits ovulation

B

Which is an appropriate treatment for an extensive or refractory tinea cruris infection? A. Oral amphotericin B. Oral terbinafine C. Topical ciclopirox D. Topical grisefulvin

B

Which is most preferred COC if pt complains of continued bleeding issues? A. Norethindrone 1mg/EE 20mcg B. Levonorgestrel 0.15mg/EE 30mcg C. Drospirenone 3mg/EE 20mcg

B

Which med for heartburn should be avoided in pregnancy due to risk of fetal death? A. Maalox B. Nizatidine C. Cimetidine D. Tums E. Pepcid

B

Which med used for scabies comes in oral form? A. permethrin (Elimite, Nix, RID) B. ivermectin (Stromectol, Sklice) C. lindane (Kwell)

B

Which non-hormonal therapy can be used for treatment of menopausal symptoms and works by being an active alpha-adrenergic agonist that reduces vascular reactivity? A. Gabapentin B. Clonidine C. Paroxetine D. Desvenlafaxine E. SERM

B

Which oral treatment for acne inhibits all 4 components of acne but can have severe drying effects, CV risk, IBD, and msk pain? A. spironolactone B. isotretinoin C. oral contraceptives D. oral doxycycline

B

Which systemic treatment for psoriasis can cause neutropenia, injection site rxns, demyelinating disease, and HF? A. methotrexate B. TNF-alpha inhibitors C. IL-17 inhibitors D. IL-23 Inhibitors

B

Which systemic treatment for psoriasis is teratogenic, should be taken orally with food, and pts who take it cannot donate blood for 3 yrs after being treated with it? A. methotrexate B. acitretin C. cyclosporine D. apremilast

B

Which systemic treatment for psoriasis is the best choice for immunosuppressed or HIV pts? A. methotrexate B. acitretin C. cyclosporine D. apremilast

B

Which systemic treatment for psoriasis requires Hep B and TB screening prior to beginning treatment? A. methotrexate B. TNF-alpha inhibitors C. IL-17 inhibitors D. IL-23 Inhibitors

B

Which vehicle of topical steroids involves semisolid emulsions of oil in water and may feel cool? A. ointment B. cream C. lotion D. solution E. gel F. foam G. oil

B

Which works by causing parasite paralysis and death through increasing nerve and muscle cell membrane permeability? A. pyrethoids (permethrin) B. ivermectin C. lindane D. malathion

B

Why should lithium be avoided in pregnancy? A. Risk of neural tube defects B. Risk of cardiac defects C. Risk of bone defects D. Risk of preterm birth

B

Which acne medication is pregnancy category X? A. spironolactone B. isotretinoin C. oral contraceptives D. oral doxycycline

B (also tazarotene - retinoid)

What generation of progestin is levonorgestrel? A. 1st B. 2nd C. 3rd D. 4th

B (less unscheduled bleeding and longer 1/2 life than 1st gen)

Which topical steroid would be best for the body? A. desonide B. triamcinolone C. clobetasol

B (mid-high pot)

Which is NOT a benefit of combined hormonal contraceptives? A. dec risk of endometrial cancer B. dec risk of breast cancer C. dec risk of ectopic pregnancy D. dec risk of PID E. prevents ovarian cysts

B (not shown to inc. or dec risk of this)

Which is NOT correct pt. education regarding topical steroids? A. apply a thin layer B. apply daily until the rash/condition is gone C. apply max of twice a day D. d/c if skin condition worsens

B (only apply for 2-4 weeks then take a break and restart after 1-2 weeks)

Which TNF-alpha inhibitor is administered as an infusion? A. Etanercept B. Infliximab C. Adalimumab

B (the 2 others are subQ)

You start a 15 yo female on an oral contraceptive. At 1 month f/u, she complains of cyclic wt gain, breast pain, nausea, bloating, constipation and depressive sx. What is the best way to alter her regimen? A. decrease estrogen B. decrease progestin/consider Drospiredone C. switch to less androgenic progestin and increase estrogen

B (these are all progestin related sx)

Which class of drug are secukinumab and ixekizumab and how are they administered? A. TNF-alpha inhibitors B. IL-17 inhibitors C. IL-23 Inhibitors

B - subQ injection

What is the MoA of vaginal rings? A. blocks sperm B. incapacitate sperm C. prevent ovulation

C

What is topical nystatin primarily used to treat? A. tinea B. onychomycosis C. candidiasis D. blastomycoses E. all of the above

C

What makes tetracyclines Cat D in pregnancy? A. risk of ototoxicity in fetus B. risk of hemolytic anemia in fetus C. risk of bone and teeth abnormalities in fetus D. risk of severe N/V in mother

C

What strength steroid is clobetasol? A. low potency B. mid potency C. high potency D. mid/high potency

C

What strength steroid is flucinonide? A. low potency B. mid potency C. high potency D. mid/high potency

C

What subtype of rosacea is topical metronidazole the first line agent? A. ET B. phymatous C. papulopustular D. ocular

C

What type of contraception requires a blood pressure check before starting? A. hormonal IUD B. copper IUD C. combined hormonal contraceptive D. progestin-only contraceptive pill

C

Which anti-hypertensive class is contraindicated in pregnancy? A. CCBs (Nifedipine/Amlodipine) B. B-blockers (Labetolol) C ACE/ARB (Lisinopril/Losartan) D. Diuretics (HCTZ/Lasix)

C

Which antibiotic is category C in early pregnancy and category D in late pregnancy due to risk of kernicterus? A. Tetracyclines B. Quinolones C. Sulfonamides D. Metronidazole E. Nitrofurantoin

C

Which antifungal is the drug of choice for blastomycoses but can cause QT prolongation and hypokalemia? A. nystatin B. ketoconazole C. itraconazole D. terbinafine E. grisefulvin

C

Which cold medicine is not routinely recommended in pregnancy due to possibility of oxytocin effects? A. chlorpheniramine B. loratadine C. diphenhydramine D. pseudoephedrine

C

Which form of CHC has the lowest levels of ethinyl estradiol consistently? A. pill B. patch C. vaginal ring

C

Which is NOT part of the MoA of LNG IUDs? A. thicken cervical mucus B. thinning endometrium C. cytotoxic/phagocytic to sperm D. inhibits ovulation sometimes

C

Which is most preferred COC if pt has severe acne/androgenic symptoms? A. Norethindrone 1mg/EE 20mcg B. Levonorgestrel 0.15mg/EE 30mcg C. Drospirenone 3mg/EE 20mcg

C

Which med used for scabies comes in form of a lotion or shampoo but is not first line? A. permethrin (Elimite, Nix, RID) B. ivermectin (Stromectol, Sklice) C. lindane (Kwell)

C

Which of the following abx is pregnancy category D? A. penicillins B. macrolides C. tetracyclines D. nitrofurantoins E. quinolones

C

Which systemic treatment for psoriasis can also be used to treat psoriatic arthritis but may cause renal impairment, nausea, wt. loss, depression, and short-term diarrhea? A. methotrexate B. acitretin C. cyclosporine D. apremilast

D

Which systemic treatment for psoriasis is administered as subQ injections, and can increase a pts risk for malignancy, skin cancer, and interstitial pneumonia? A. methotrexate B. TNF-alpha inhibitors C. IL-17 inhibitors D. IL-23 Inhibitor

D

Which topical acne treatment is best for sensitive skin as it is also indicated in the treatment of rosacea? A. benzoyl peroxide B. topical abx C. topical retinoids D. azelic acid E. dapsone

D

Which vehicle of topical steroids is made up of water, alcohol , or propylene glycol and evaporate from skin providing cooling and drying effect? A. ointment B. cream C. lotion D. solution E. gel F. foam G. oil

D

Which works by inhibiting cholinesterase in parasite? A. pyrethoids (permethrin) B. ivermectin C. lindane D. malathion

D

How long should Permethrin NIX/RID lotion or shampoo be left on for treatment of lice?

10 minutes

How long can a copper IUD stay in?

10-12 years

What is severely elevated BP?

160/110

How frequent should a pt with psoriasis undergo phototherapy?

2-3 times a week

How long can LNG IUDs be in place for?

3-8 years

Topical steroids should be tapered off if using > how long?

4 weeks

Which anti-epileptic should be avoided in pregnancy due to risk of fascial anomalies? A. Carbamazepine B. Lamotrigine C. Phenytoin D. Topiramate E. Valproic Acid

A

Which antifungal is toxic if taken orally? A. nystatin B. ketoconazole C. itraconazole D. terbinafine E. grisefulvin

A

Which contraceptive steroid works by blocking FSH and LH surge thus inhibiting ovulation, as well as thickens cervical mucus to decrease sperm transport? A. progestin B. estrogen

A

Which emergency contraceptive method would NOT be effected by BMI? A. copper IUD B. oral Levonorgestrel C. anti-progestin (ulipristal/Ella)

A

Which emergency contraceptive method would be effective after the LH surge and ovulation? A. copper IUD B. oral Levonorgestrel C. oral ulipristal D. COC

A

Which is worst choice of vehicle if you need to apply topical steroids to a hairy area? A. Ointment B. Lotion C. Solution D. Gel E. Foam

A

Which med is contraindicated for pts that are allergic to ragweed or chrysanthemums? A. Permethrin (NIX, RID) B. Ivermectin (Sklice) C. Lindane (Kwell) D. Malathion (Ovide)

A

Which med used for scabies comes in form of a cream? A. permethrin (Elimite, Nix, RID) B. ivermectin (Stromectol, Sklice) C. lindane (Kwell)

A

Which non-hormonal therapy can be used for treatment of menopausal symptoms and works by acting on the thermoregulatory mechanism in the hypothalamus? A. Gabapentin B. Clonidine C. Paroxetine D. Desvenlafaxine E. SERM

A

What is the best option of rapid BP control of a pregnant mother with a BP > 160/110?

IV hydralazine or labetolol PO nifedipine

Consensus is that benefit outweighs the risk for menopausal women to take HRT for their symptoms if they are NOT at excess risk of what 2 things?

breast cancer or CVD

Is calcipotriene or calcitriol less irritating to the skin?

calcitriol

What supplementation should menopausal women be taking to reduce risk for osteoporosis?

calcium and vitamin D

What is the treatment for gonorrhea?

ceftriaxone 500 mg (<150kg) or 1 g (>150 kg) IM

Is a whitehead an open or closed comedone?

closed

Can a copper or LNG-IUD be used as emergency contraception?

copper

Acyclovir, Valacyclvir, and Famciclovir are used in the treatment of what STI?

herpes

47yo with psoriasis limited to anterior thigh, treatment?

high potency topical (clobetasol)

20yo with allergic contact dermatitis on bilateral palms, treatment?

high potency topical (clobetasosl ointment)

Is systemic absorption better in infants or adults?

infants

Is systemic absorption better in intact or inflamed skin?

inflamed

What is primarily used for treatment of phymatous subtype of roasacea?

laser debridement

What does LARC stand for? (contraception)

long acting reversible contraception

7yo female with atopic dermatitis at bilateral popliteal fossae Treatment?

low potency topical steroid (desonide)

Which 2 medications can be given orally for treatment of trichomonas vaginalis?

metronidazole or tinidazole

60yo with allergic contact dermatitis on bilateral eyelids, treatment?

mid potency steroid topical (hydrocortisone)

Diffuse irritant contact dermatitis, treatment?

mid/high potency topical steroid (triamcimalone)

How often does a CHC vaginal ring have to be changed?

monthly

Is triamcimalone ointment or cream a higher potency?

ointment

Is a blackhead an open or closed comedone?

open

How long should Permethrin 5% cream be left on for treatment of scabies?

overnight (applied from the neck down)

Which SSRI is FDA approved to treat vasomotor sx associated with menopause?

paroxetine

Pregnant female with psoriasis should be treated with what?

phototherapy

Why does a menopausal woman with intact uterus need to have progestin in addition to estrogen therapy for menopausal sx?

prevent risk of endometrial hyperplasia/cancer

Treatment for recurrent episodes of herpes must be initiated when for patient to receive benefit from therapy?

prodrome or w/i 24 hrs of symptom onset

What class of med are Tretinoin, Adapalene, and Tazorotene?

retinoids

Permethrin, Ivermectin, and Lindane are used in the treatment of...

scabies

Are low potency topical steroids okay to use in children?

yes but for a short duration (< 2 weeks)

Are topical steroids safe to use in pregnancy?

yes but use mid- to low-potency

Is systemic absorption better in thin skin or thick skin?

thin

What class of med is Tazarotene?

topical retinoid

Calcipotriene and calcitriol are what class of medication used in the treatment of psoriasis?

vitamin D analogs

How often does a CHC patch have to be changed?

weekly

Which anti-diarrheal is safer in pregnancy? A. kaopectate B. bismuth subsalicylate

A

What trimester of pregnancy should Flagyl be avoided? A. 1st B. 2nd C. 3rd D. during labor/delivery

A

What is the MoA of implanted contraception? A. blocks sperm B. incapacitate sperm C. prevent ovulation

C

Pt has psoriatic plaques on > 20% of body surface area, what is the best treatment?

- systemic therapy (methotrexate) - phototherapy

Pt has psoriatic plaques on < 5% of body surface area, what is the best treatment?

- topical corticosteroids (high potency) - vitamin D analog - tazarotene

Pt has psoriatic plaques on ~10-15% of body surface area, what is the best treatment?

- vitamin D analog +/- phototherapy

One finger tip unit is equal to how many grams of topical steroid?

0.5 grams (this is enough to cover 2 hand surfaces)

What is the formulation of ivermectin used to treat lice?

0.5% lotion

Women taking HRT for menopause symptoms are at greater risk for what 3 things?

1. MI and thromboembolism (after 1 yr) 2. Stroke (after 3 yrs) 3. Breast cancer (after 5 yrs)

What is the max amount of time the Face, Intertriginous area, or genital dermatoses should be treated with topical steroids?

< 2 weeks at a time

Limited disease for psoriasis is defined as < ?% of body surface area?

< 5%

At what BP do we begin treatment in pregnancy?

> 140/90

When does pre-eclampsia usually begin in pregnancy (week)?

> 20 weeks

Moderate-severe disease for psoriasis is defined as > ?% of body surface area?

> 5-10%

How long does it take to return to fertility after removal of copper or LNG-IUD? A. rapidly B. about 1 week C. at least one full menstrual cycle D. at least 2 full menstrual cycles

A

Kyleena, Liletta, Skyla, and Kyleena are what type of contraception? A. LNG IUD B. Copper IUD C. Implant D. Transdermal Patch

A

What antifungal class is nystatin? A. Polyene B. Imidazole C. Triazole D. Allyamine E. Naphthiomate

A

What are the main AEs of Permethrin 5% cream? A. skin burning/itching B. palpitations C. orthostatic hypotension/conjunctivitis/SJS D. neurologic toxicities

A

What is the MoA of hormonal IUD? A. blocks sperm B. incapacitate sperm C. prevent ovulation

A

What is the primary AE associated with tar preparations for psoriasis? A. stain the skin B. stinging/burning C. local edema D. acneiform rash

A

What is the risk of using gentamicin for pyelonephritis in a pregnant woman? A. ototoxicity in fetus B. hemolytic anemia in fetus C. bone and teeth abnormalities in fetus D. severe N/V in mother

A

What strength steroid is desonide? A. low potency B. mid potency C. high potency D. mid/high potency

A

What strength steroid is hydrocortisone hydrochloride? A. low potency B. mid potency C. high potency D. mid/high potency

A

What subtype of rosacea is topical brimonidine used for? A. ET B. phymatous C. papulopustular D. ocular

A

Which of these is required before initiating contraception? A. medical history B. breast exam C. pap smear D. hemoglobin E. STI testing F All are required

A

Which pain med is safest to use in pregnancy? A. Acetaminophen B. Aspirin C. NSAIDs D. Low dose opioids

A

Which systemic treatment for psoriasis can cause hepatoxicity, renal impairment, bone marrow suppression, aplastic anemia, and/or interstitial pneumonitis? A. methotrexate B. acitretin C. cyclosporine D. apremilast

A

Which systemic treatment for psoriasis is a folic acid antagonist? A. methotrexate B. acitretin C. cyclosporine D. apremilast

A

Which topical acne treatment may stain or bleach fabric? A. benzoyl peroxide B. topical abx C. topical retinoids D. azelic acid E. dapsone

A

Which vehicle of topical steroids involves water suspended in oil, and is the most potent? A. ointment B. cream C. lotion D. solution E. gel F. foam G. oil

A

Which works by blocking parasite nerve cell membrane function? A. pyrethoids (permethrin) B. ivermectin C. lindane D. malathion

A

Which would be the LEAST effective in treating a moderate tinea corporis infection? A. Topical nystatin B. Topical butenafine C. Topical terbinafine D. Oral ketoconazole E. Oral grisefulvin

A

Women who have had a hysterectomy can receive what type of HRT for menopausal symptoms? A. Estrogen alone (oral/topical/patch) B. Progestin alone (Medroxyprogesterone acetate - Provera) C. Estrogen + Progestin combo

A

Which topical steroid would be best for face or intringinous area? A. desonide B. triamcinolone C. clobetasol

A (low pot.)

You start a 15 yo female on an oral contracteptive. At 1 month f/u, she complains of wt gain in breasts, hips, and thighs, telangictasias on skin, breast pain, nausea, and headaches. What is the best way to alter her regimen? A. decrease estrogen B. decrease progestin/consider Drospiredone C. switch to less androgenic progestin and increase estrogen

A (these are all estrogen-related sx)

All of the following work by preventing ovulation except... A. Hormonal IUD B. Implant C. Vaginal Ring D. DEPO shot E. Oral pills

A (this works by blocking sperm)

Which contraceptive methods are combined hormonal methods? A. Vaginal ring B. Transdermal patch C. LNG IUD D. Copper IUD E. Implant

A and B

What class of med are Etanercept, infliximab, and adalimumab? A. TNF-alpha inhibitors B. IL-17 inhibitors C. IL-23 Inhibitors

A. TNF-alpha inhibitors

Which B-blocker is not recommended in pregnancy due to risk of FGR in 3rd trimester? A. Labetolol (combo of alpha and beta blocker) B. Atenolol (beta blocker only)

B

Which antiepileptic drug is safest in pregnancy? A. Carbamazepine B. Lamotrigine C. Phenytoin D. Topiramate E. Valproic Acid

B

What is the MoA of oral contraceptives? A. blocks sperm B. incapacitate sperm C. prevent ovulation

C

How long should course of abx be for pregnant woman with asymptomatic bacteriuria or cystitis? A. 3-5 days B. 5-7 days C. 7-10 days D. 10-14 days

B

Paragard is what type of contraception? A. LNG IUD B. Copper IUD C. Implant D. Transdermal Patch

B

Psoriasis has to do with the proliferation of what cell type? A. melanocytes B. keratinocytes C. collagen D. fibrin

B

What antifungal class is ketoconazole? A. Polyene B. Imidazole C. Triazole D. Allyamine E. Naphthiomate

B

What component of acne do benzoyl peroxide and topical antibiotics control? a. ductal hyperkeratosis b. colonization by p. acnes c. excessive sebum excretion d. release of inflammatory cytokines

B

What describes the main AEs of tazarotene? A. stains the skin B. skin irritation and photosensitivity C. allergic urticaria rxn D. telangictasias and purpura

B

What is the MoA of copper IUD? A. blocks sperm B. incapacitate sperm C. prevent ovulation

B

What is the biggest concern about putting someone on estrogen-containing contraceptive method? A. Risk of loss of bone density B. Risk of thromboembolic events C. Risk of N/V D. Risk of SJS

B

What severe AE of Lindane makes it NOT first line for scabies treatment? A. Cardio toxicity B. Neurologic toxicity C. Liver toxicity D. GI toxicity

B

What describes the MOA of copper IUD? A. thicken cervical mucus B. thinning endometrium C. cytotoxic/phagocytic to sperm D. inhibits ovulation

C

Which can stay in longest? A. LNG IUD B. Copper IUD C. Subdermal Implant

B (10-12 yrs)

Which is the best option of pyelonephritis in pregnancy? A. PO amoxicillin B. IV ceftriaxone C. IV nitrofurantoin D. IV Fosfomycin

B (C + D will not work for pyelo) (dose 1gm IV Q 24hr for 10-14 days)

What form of estrogen is in most oral contraceptives? A. estradiol B. estetrol C. ethinyl estradiol D. mestranol E. estradiol esters

C

What generation of progestin is desogestrel? A. 1st B. 2nd C. 3rd D. 4th

C

What is the MoA of DEPO shots? A. blocks sperm B. incapacitate sperm C. prevent ovulation

C

What is the treatment for primary, secondary, or early latent syphilis (< 1 year)?

Benzathine Penicillin G (Bicillin LA®) 2.4 million units IM x 1

All are indicated in the treatment of bacterial vaginosis except... A. oral metronidazole B. metronidazole vaginial gel C. oral fluconazole D. clindamycin vaginal cream

C

In what pt population with psoriasis is phototherapy contraindicated? A. pregnancy B. HIV C. SLE D. CVD

C

Nexplanon is what type of contraception? A. LNG IUD B. Copper IUD C. Implant D. Transdermal Patch

C

What antifungal class are itraconazole and fluconazole? A. Polyene B. Imidazole C. Triazole D. Allyamine E. Naphthiomate

C

What are the main AEs of oral Ivermectin? A. skin burning/itching B. palpitations C. orthostatic hypotension/conjunctivitis/SJS D. neurologic toxicities

C

What component of acne do oral contraceptives and spironolactone control? a. ductal hyperkeratosis b. colonization by p. acnes c. excessive sebum excretion d. release of inflammatory cytokines

C

Which of the following works for psoriasis by inhibiting keratinocyte proliferation? A. Emollients B. Topical steroids C. Topical Vitamin D analogs D. Tar preparations E. Tazarotene

C

Which should be avoided if possible in the first trimester of pregnancy due to risk of hemolytic anemia? A. amoxicillin B. ceftriaxone C. nitrofurantoin D. Fosfomycin

C

Which systemic treatment for psoriasis are administered as subQ injections, can cause neutropenia, infection and flares of IBD, and should be stored in refrigeration and not to be shaken by the pt? A. methotrexate B. TNF-alpha inhibitors C. IL-17 inhibitors D. IL-23 Inhibitor

C

Which systemic treatment for psoriasis is a T-cell suppressor and can cause renal toxicity and hypertension, and is typically only used short-term for inflammatory flares of psoriasis? A. methotrexate B. acitretin C. cyclosporine D. apremilast

C

Which topical acne treatment should be applied in the evening due to photosensitivity risk? A. benzoyl peroxide B. topical abx C. topical retinoids D. azelic acid E. dapsone

C

Which vehicle of topical steroids involves powder in water so it must be shaken before use. Better for hairy area or large surface areas? A. ointment B. cream C. lotion D. solution E. gel F. foam G. oil

C

Which works by being directly absorbed into parasites and ova and inhibits neurotransmission? A. pyrethoids (permethrin) B. ivermectin C. lindane D. malathion

C

Women who have an intact uterus can receive what type of HRT for menopausal symptoms? A. Estrogen alone (oral/topical/patch) B. Progestin alone (Medroxyprogesterone acetate - Provera) C. Estrogen + Progestin combo

C

Which med used to treat lice must stay in hair the longest? A. Permethrin (Nix 1%; RID 0.33%) B. Ivermectin (Sklice) C. Malathion (ovide)

C (8-12 hrs; the others are 10 min)

What generation of progestin is norgestimate and etonogestrol? A. 1st B. 2nd C. 3rd D. 4th

C (good cycle control and less androgenic effects)

Which topical steroid would be best for scalp/soles/palms? A. desonide B. triamcinolone C. clobetasol

C (high pot)

You start a 15 yo female on an oral contraceptive. At 1 month f/u, she complains of slow, steady wt gain, and inc. in acne, oily skin, and hirsutism. What is the best way to alter her regimen? A. decrease estrogen B. decrease progestin/consider Drospiredone C. switch to less androgenic progestin and increase estrogen

C (these are all androgen related sx)

Which class of drug is ustekinumab and how is it administered? A. TNF-alpha inhibitors B. IL-17 inhibitors C. IL-23 Inhibitors

C - subQ injection

Which contraceptive methods are progestin only? A. Vaginal ring B. Transdermal patch C. LNG IUD D. Copper IUD E. Implant

C and E

A 35-year-old woman is experiencing infertility due to anovulation. Which agent is most appropriate for this patient? A. Clomiphene B. Ospemifene C. Raloxifene D. Ulipristal

Correct answer = A. Clomiphene is a SERM that interferes with negative feedback of estrogens on the hypothalamus, thereby increasing the secretion of gonadotropin-releasing hormone and gonadotropins, and leading to stimulation of ovulation. Ospemifene is a SERM indicated for the treatment of dyspareunia. Raloxifene is a SERM used in the prevention of breast cancer and osteoporosis. Ulipristal is a progesterone agonist/antagonist used as an emergency contraceptive.

A 12-year-old child has extensive psoriatic lesions covering his back. Which topical therapy would, with continuous use, most likely prevent him from reaching his full adult height? A. Clobetasol propionate B. Salicylic acid C. Calcipotriene D. Calcitriol

Correct answer = A. Excessive use of potent corticosteroids applied to a large surface area can cause systemic toxicity, including growth retardation.

Which topical antibacterial agent targets gram-negative bacteria? A. Gentamicin B. Bacitracin C. Mupirocin D. Retapamulin

Correct answer = A. Gentamicin interferes with bacterial protein synthesis targeting gram- negative organisms and is often used in combination with other agents to treat skin infections caused by gram-negative organisms.

A 56-year-old woman with diabetes complains of thickening of the nail of the right big toe and a change in color (yellow). The podiatrist diagnoses the patient with onychomycosis of the toenails. Which is the most appropriate choice for treating this infection? A. Terbinane B. Micafungin C. Itraconazole D. Griseofulvin

Correct answer = A. Terbinane is better tolerated, requires a shorter duration of therapy, and is more effective than either itraconazole or griseofulvin. Micafungin is not active for this type of infection.

Which antifungal agent is MOST likely to cause renal insufciency? A. Fluconazole B. Amphotericin B C. Itraconazole D. Posaconazole

Correct answer = B. Amphotericin B is the best choice since nephrotoxicity is commonly associated with this medication. Although the dose of uconazole must be adjusted for renal insufciency, it is not associated with causing nephrotoxicity. Itraconazole and posaconazole are metabolized by the liver and are not associated with nephrotoxicity.

A 17-year-old female has darkened spots on her face following resolution of acne lesions. Which agent is the best choice to treat her acne, if one of the goals of therapy is to lighten these spots? A. Benzoyl peroxide B. Azelaic acid C. Clindamycin D. Dapsone

Correct answer = B. Azelaic acid exhibits a lightening effect on hyperpigmented skin, which makes it useful in patients who experience dyspigmentation as a consequence of inflammatory acne. The other agents do not lighten the skin.

A 44-year-old man presents to clinic with fevers and chills, headaches, and shortness of breath. He reports that he was exploring caves about 5 weeks ago. He is diagnosed with mild/moderate acute pulmonary histoplasmosis. Which is the most appropriate choice for treating this infection? A. Micafungin B. Itraconazole C. Terbinane D. Griseofulvin

Correct answer = B. Itraconazole is the treatment of choice in patients with mild/moderate acute pulmonary histoplasmosis who have had symptoms for more than 1 month. Micafungin, terbinane, and griseofulvin are not active for this type of infection.

Which contraceptive method provides long-acting reversible contraception (LARC)? A. Contraceptive vaginal ring B. Intrauterine device C. Extended-cycle oral contraceptives D. Transdermal contraceptive patch

Correct answer = B. The progestin-only intrauterine devices provide contraception for 3 to 5 years, depending on the device. The etonogestrel subdermal implant is another LARC that provides contraception for 3 years. The contraceptive vaginal ring is worn for 3 weeks at a time, and the transdermal patch for 1 week at a time. Extended cycle oral contraceptives must be administered daily.

Which antifungal agent should be avoided in patients with evidence of ventricular dysfunction? A. Micafungin B. Itraconazole C. Terbinane D. Posaconazole

Correct answer = B. There is a black box warning that warns against the use of itraconazole in patients with evidence of ventricular dysfunction, including patients with heart failure

A 22-year-old woman requests emergency contraception after unprotected intercourse that occurred 1 day ago. She has no medical conditions. Which agent is most appropriate? A. Ethinyl estradiol/norgestimate B. Etonogestrel C. Levonorgestrel D. Mifepristone

Correct answer = C. A single dose of levonorgestrel is preferred for emergency contraception and should be administered within 72 hours of unprotected intercourse for best efcacy. Estrogen/progestin regimens are less used for emergency contraception due to a higher incidence of adverse effects such as nausea/vomiting. Etonogestrel is a progestin used in the contraceptive ring and implant. Mifepristone is a progesterone antagonist used to terminate pregnancy once it has occurred.

A 53-year-old woman has severe vasomotor symptoms (hot flushes) associated with menopause. She has no pertinent past medical or surgical history. Which would be most appropriate for her symptoms? A. Conjugated estrogens vaginal cream B. Estradiol transdermal patch C. Oral estradiol and medroxyprogesterone acetate D. Injectable medroxyprogesterone acetate

Correct answer = C. Estrogen vaginal cream only treats vaginal symptoms of menopause such as vaginal atrophy and does not treat hot ushes. Since this patient has an intact uterus, a progestin such as medroxyprogesterone needs to be used along with the estrogen to prevent the development of endometrial hyperplasia. Unopposed estrogen (for example, the estradiol transdermal patch) should not be used. Injectable medroxyprogesterone acetate is used for contraception.

A 25-year-old woman is using injectable medroxyprogesterone acetate as a method of contraception. Which adverse effect is a concern if she wishes to use this therapy long-term? A. Hyperkalemia B. Male pattern baldness C. Osteoporosis D. Weight loss

Correct answer = C. Medroxyprogesterone acetate may contribute to bone loss and predispose patients to osteoporosis and/or fractures. Therefore, the drug should not be continued for more than 2 years if possible. The drug often causes weight gain, not weight loss. The other adverse effects are not associated with medroxyprogesterone.

Which drug is a topically applied antibiotic that is thought to work through anti- inammatory effects to treat rosacea? A. Brimonidine B. Doxycycline C. Metronidazole D. Benzoyl peroxide

Correct answer = C. Metronidazole is an antibacterial agent used topically for rosacea. It is believed to work in rosacea through anti-inammatory or immunosuppressive effects. Doxycycline is also used for its anti-inammatory effects, but is used orally rather than topically.

16-year-old female has mild acne on her face. Which agent is the least appropriate choice for treating her acne? A. Benzoyl peroxide B. Topical clindamycin C. Oral doxycycline D. Adapalene

Correct answer = C. Oral antibiotics, such as doxycycline, are reserved for moderate to severe acne.

A 36-year-old woman requests birth control. She has no medical conditions, and she smokes one pack of cigarettes per day. Which would be the most appropriate to recommend? A. Vaginal contraceptive ring B. Transdermal contraceptive patch C. Progestin-only "mini-pill" D. Combination oral contraceptive pill

Correct answer = C. Progestin-only products are preferred in older women who are smokers, due to a lower risk of severe adverse effects, such as myocardial infarction and stroke. Estrogen-containing contraceptives are not recommended in women over the age of 35 who are smokers. The vaginal contraceptive ring, transdermal contraceptive patch, and combination oral contraceptive pills all contain estrogen

Which is the most appropriate oral contraceptive for a patient with moderate acne? A. Ethinyl estradiol/levonorgestrel B. Ethinyl estradiol/norethindrone acetate C. Ethinyl estradiol/norgestimate D. Ulipristal

Correct answer = C. The progestins levonorgestrel and norethindrone acetate may have androgenic activity and contribute to acne. Norgestimate has less androgenic activity and is preferred for this patient. Ulipristal is an emergency contraceptive and should not be used as a regular method of contraception.

A 26-year-old woman is diagnosed with pustular psoriasis. She is getting married in 1 year and she would like to become pregnant and start a family within a year of her marriage. Which agent should be avoided for treatment of her psoriasis because the duration of its teratogenic potential may affect her plans for pregnancy? A. Methotrexate B. Triamcinolone acetonide C. Iniximab D. Acitretin

Correct answer = D. Acitretin is teratogenic and women must avoid pregnancy for at least 3 years after the use of this drug (due to the long duration of teratogenic potential).

Which is the most effective form of contraception with typical use? A. Combined oral contraceptives B. Progestin-only "mini-pill" C. Depot medroxyprogesterone acetate injection D. Subdermal progestin implant

Correct answer = D. See Figure 25.9. The subdermal implant has a very low failure rate, since it does not require adherence of the patient after implantation. Progestin-only pills are less effective than combined oral contraceptives and the depot medroxyprogesterone acetate injection.

All are possible treatments for onycomycosis except... A. Oral terbinafine B. Oral Itraconazole C. Topical ciclopirox D. Topical nystatin

D

How long after vasectomy can pregnancy be prevented? A. Immediately after B. ~ 1 week after C. 1-2 months after D. 3-6 months after

D

Lindane should NOT be used in any of the following for scabies tx except... A. Pt with seizure disorder B. Infants/children C. pregnant women D. Lindane should be avoided in all of these

D

What antifungal class are terbinafine/naftifine/butenafine? A. Polyene B. Imidazole C. Triazole D. Allyamine E. Naphthiomate

D

What component of acne do oral antibiotics and topical retinoids control? a. ductal hyperkeratosis b. colonization by p. acnes c. excessive sebum excretion d. release of inflammatory cytokines

D

What strength steroid is triamcinolone? A. low potency B. mid potency C. high potency D. mid/high potency

D

Which anti-depressant class as a whole should be avoided in pregnancy due to risk of birth defects? A. SSRIs B. SNRIs C. TCAs D. Benzos E. Antipsychotics

D

Which antifungal has a prolonged half life of 200-400 hours and clearance is decreased in renal or hepatic impairment? A. nystatin B. ketoconazole C. itraconazole D. terbinafine E. grisefulvin

D

Which cold medicine is not routinely recommended in pregnancy prior to 14 weeks due to possibility of gastroschisis? A. chlorpheniramine B. loratadine C. diphenhydramine D. pseudoephedrine

D

Which contraceptive method is non-hormonal? A. Vaginal ring B. Transdermal patch C. LNG IUD D. Copper IUD E. Implant

D

Which drug is taken orally for more severe forms of psoriasis? A. Etanercept B. Calcipotriene C. Tazarotene D. Methotrexate

D

Which is the least best option to treat SEVERE hyperemesis gravidarum? A. IV Phenergan B. Zofran SQ pump C. IV Compazine D. IV Diphenhydramine E. Reglan SQ pump

D

Which SSRI should be avoided in pregnancy? A. Citalopram(Celexa) B. Escitalopram(Lexapro) C. Fluoxetine(Prozac) D. Paroxetine(Paxil) E. Sertraline(Zoloft)

D Paroxetine (Paxil) - due to cardiac defects

How long should course of IV ceftriaxone be for pregnant woman with pyelonephritis? A. 3-5 days B. 5-7 days C. 7-10 days D. 10-14 days

D (1 gm IV Q24 hrs)

What generation of progestin is drospirenone? A. 1st B. 2nd C. 3rd D. 4th

D (also approved to treat acne)

Which generation of progestin has a hyperkalemia risk? A. 1st B. 2nd C. 3rd D. 4th

D (drospirenone - derived from spirnolactone)

TNF-alpha inhibitors are contraindicated in all of the following except... A. Pt with CHF B. Pt with MS C. Pt with active Hep B infection D. Pt with IBD

D (these are actually used in treatment of IBD)

All are topical antifungals for use in vulvovaginal candidiasis except... A. Butoconazole B. Clotrimazole C. Miconazole D. Fluconazole E. Teraconazole

D (this is oral)

What antifungal class is tolnaftate? A. Polyene B. Imidazole C. Triazole D. Allyamine E. Naphthiomate

E

Which anti-epileptic should be avoided in pregnancy due to risk of neural tube defects? A. Carbamazepine B. Lamotrigine C. Phenytoin D. Topiramate E. Valproic Acid

E

Which antiepileptic drug has the highest risk in pregnancy? A. Carbamazepine B. Lamotrigine C. Phenytoin D. Topiramate E. Valproic Acid

E

Which antifungal is available as a gel, shampoo, or nail polish and can cause skin burning and contact dermatitis? A. nystatin B. ketoconazole C. itraconazole D. terbinafine E. ciclopirox

E

Which antifungal is typically administered orally for tinea and onychomycosis but can cause severe AEs of Hepatoxicity, granulocytopenia, leukopenia, SJS, TEN, rash, headache, and `confusion? A. nystatin B. ketoconazole C. itraconazole D. terbinafine E. grisefulvin

E

Which med when given with estrogen can be used to treat vasomotor symptoms and prevent osteoporosis in menopause? A. Gabapentin B. Clonidine C. Paroxetine D. Desvenlafaxine E. SERM

E

Which of the following works for psoriasis by being a keratolytic agent? A. Emollients B. Topical steroids C. Topical Vitamin D analogs D. Tar preparations E. Tazarotene

E

Which topical acne treatment may cause orange discoloration of hair and sinusitis? A. benzoyl peroxide B. topical abx C. topical retinoids D. azelic acid E. dapsone

E

Which topical treatment for psoriasis is Category X for pregnancy? A. Emollients B. Topical steroids C. Topical Vitamin D analogs D. Tar preparations E. Tazarotene

E

Which vehicle of topical steroids is made up oil in water emulsion in alcohol and has a drying effect and can penetrate well? A. ointment B. cream C. lotion D. solution E. gel F. foam G. oil

E

What is the MC cause of bacterial vaginosis?

gardnerella vaginalis

All are indicated for use in vulvovaginal candidiasis except... A. Butoconazole B. Clotrimazole C. Miconazole D. Teraconazole E. Fluconazole F. Metronidazole

F

Which antifungal is the drug of choice for cryptococcal meningitis but can cause hepatitis? A. nystatin B. ketoconazole C. itraconazole D. terbinafine E. grisefulvin F. fluconazole

F

Which vehicle of topical steroids is made up a gas suspended in a liquid under pressure that is good for inflamed skin and scalp? A. ointment B. cream C. lotion D. solution E. gel F. foam G. oil

F

Which 2 vehicles of topical steroids are best choices for use on the scalp? A. ointment B. cream C. lotion D. solution E. gel F. foam G. oil

F and G

Fatigue, wt loss, N/V, joint pain, skin hyperpigmentation, and salt cravings are do to what systemic AE of topical steroids?

HPA suppression

What is the gold standard for treating menopausal sx?

HRT

Is a copper or LNG-IUD more likely to cause amenorrhea?

LNG-IUD

Which CCB is the drug of choice in pregnancy?

Nifedipine ER

Pt with HIV and hepatitis with psoriasis should be treated with what?

acitretin

Which SNRI is typically used for tx of menopause sx?

desvenlafaxine

What is the treatment for chlamydia?

doxy 100 mg BID x 7 days (azithromycin in pregnancy)

26 yo who complains of hair growth and acne on her face that really bothers her. Also complains of weight gain and longer intervals between menses. Her BMI is 30. She desires fertility in 1 year. • What is her most likely diagnosis? • What is/are the best options for her?

dx: PCOS, which can be verified by labs, US if necessary. best option: CHC

26 yo who complains of severe pelvic pain around the time of her menses. She has had painful periods since menarche however it is getting worse. She has diarrhea and dyspareunia during this time as well. She is not using anything for contraception. • What is her most likely diagnosis? What is/are the best options for her?

dx: endometriosis best option: anything that inhibits ovulation (LNG IUD, implant, COC)