Common Skin Conditions (unfinished)

Counseling instructions for the use of a topical antifungal for athlete's foot (tinea pedis) should include all of the following except: A) Apply the medicine directly on the rash; do not extend the application beyond the visible rash. B) Use for at least 2-4 weeks, even if the rash appears to be healed. C) Do not walk barefoot to avoid spreading it. D) Wear sandals in public showers to avoid catching it. E) All of the above are correct statements.

A) Apply the medicine directly on the rash; do not extend the application beyond the visible rash.

Megan MacDonald will begin therapy with Retin-A Micro. Which of the following are correct counseling statements? (Select ALL that apply.) A) Begin with a reduced frequency of application (every second or third day) and shorter duration of contact (washing off the application after a period of time), to improve tolerance. B) A pea-sized amount is sufficient (for facial application); it should be divided into 4 equal parts and smoothed over the entire surface of the face. This medication should not be used as "spot" therapy. C) It will take 1-3 months to see the full response. Initially, the acne may actually worsen. D) The topical retinoid acne medications such as this one do not cause photosensitivity like the OTC products can; they are safer if going out in the sun. E) The topical retinoids are safe to use in pregnancy; the oral form is not.

A) Begin with a reduced frequency of application (every second or third day) and shorter duration of contact (washing off the application after a period of time), to improve tolerance. B) A pea-sized amount is sufficient (for facial application); it should be divided into 4 equal parts and smoothed over the entire surface of the face. This medication should not be used as "spot" therapy. C) It will take 1-3 months to see the full response. Initially, the acne may actually worsen. Rationale: It is best to limit sun exposure; the skin will burn more easily. Isotretinoin oral is much, much more dangerous in pregnancy, however even the topical retinoids are not recommended for use in pregnancy. Start with reduced frequency of application to help the patient get used to the medicine. These typically worsen acne initially.

A pharmacist is discussing oral isotretinoin with a prescriber. Which statements are correct? (Select ALL that apply.) A) Due to the birth defect risk, this is a REMS drug. It can only be dispensed by a pharmacy registered with the pregnancy risk management iPLEDGE program. B) The progestin-only "mini pill" is not adequate as a form of birth control in females using oral isotretinoin. C) This medication is Pregnancy Category X; use causes severe birth defects if pregnancy occurs while using this medication. D) Patients should be instructed that they will have dry skin; use a lip moisturizer and carry a water bottle to keep well-hydrated. E) The patient cannot get pregnant while taking this medication and for six months afterwards.

A) Due to the birth defect risk, this is a REMS drug. It can only be dispensed by a pharmacy registered with the pregnancy risk management iPLEDGE program. B) The progestin-only "mini pill" is not adequate as a form of birth control in females using oral isotretinoin. C) This medication is Pregnancy Category X; use causes severe birth defects if pregnancy occurs while using this medication. D) Patients should be instructed that they will have dry skin; use a lip moisturizer and carry a water bottle to keep well-hydrated. Rationale: Patients cannot become pregnant one month before taking this medication, while taking this medication and for one month afterwards.

Which of the following statements concerning sun exposure and sunscreens are correct? (Select ALL that apply.) A) It is advisable to stay out of the sun when it is strongest: between 10AM-4PM. Sun-protective clothing is also helpful. B) Agents that block UVA include avobenzone and ecamsule (and others); the American Academy of Dermatology states that a sunscreen with a recommended UVA-blocking agent should be chosen. C) On a cloudy, overcast day there is little risk of burning. D) "Broad-spectrum" sunscreens protect against both UVA and UVB. E) A sunscreen of an SPF of 50 or higher should be chosen for infants.

A) It is advisable to stay out of the sun when it is strongest: between 10AM-4PM. Sun-protective clothing is also helpful. B) Agents that block UVA include avobenzone and ecamsule (and others); the American Academy of Dermatology states that a sunscreen with a recommended UVA-blocking agent should be chosen. D) "Broad-spectrum" sunscreens protect against both UVA and UVB. Rationale: Some dermatologists recommend SPF of 15 and some recommend an SPF of 30; higher ratings than this are not useful. Infants should stay out of the sun.

Occasionally antifungal agents such as ketoconazole are given as intermittent "pulse" therapy when being used long-term. What is the purpose of pulse therapy? A) Less side effects and less costly B) Easier to remember to take the doses as prescribed. C) Increased hair growth. D) Higher risk of liver damage than with daily administration. E) It kills the organism more efficiently.

A) Less side effects and less costly

Which of the following prescription agents may be prescribed to a teenager with acne? A) Solodyn B) Ketoconazole C) Lamisil AT D) Nizoral E) Clearasil

A) Solodyn Rationale: Ketoconazole is an OTC shampoo used for dandruff (usually if less expensive options have failed). Lamisil AT contains terbenafine, and is for topical fungal infections. Minocycline (Solodyn) is a popular agent for acne. If used long-term it can discolor teeth. Use caution in the sun. Check case for tetracycline allergy.

Which of the following brand-generic matches are correct? (Select ALL that apply.) A) Terbinafine-Lamisil AT B) Butenafine-Lotrimin Ultra C) Tolnaftate-Tinactin D) Clotrimazole-Lotrimin E) Undecylenic acid-Desenex

A) Terbinafine-Lamisil AT B) Butenafine-Lotrimin Ultra C) Tolnaftate-Tinactin D) Clotrimazole-Lotrimin E) Undecylenic acid-Desenex

A father is picking up a prescription of Elidel for his child. Counseling statements should include the following: (Select ALL that apply.) A) Use the smallest amount needed to control symptoms. Continue as long as signs and symptoms persist; discontinue if resolution occurs. B) Wash hands after application. Keep the skin well hydrated by using a good moisturizer. C) This medication cannot be used in children who are not at least 36 months of age; use is contraindicated in infants. D) Limit sun and ultraviolet ray exposure if using this medication. E) This drug may add to the child's chance of getting lymphoma or other cancers.

A) Use the smallest amount needed to control symptoms. Continue as long as signs and symptoms persist; discontinue if resolution occurs. B) Wash hands after application. Keep the skin well hydrated by using a good moisturizer. D) Limit sun and ultraviolet ray exposure if using this medication. E) This drug may add to the child's chance of getting lymphoma or other cancers. Rationale: This medication cannot be used in children who are not at least two years of age (boxed warning).

Which of the following steroid topical formulations are available over-the-counter? (Select ALL that apply.) A) Hydrocortisone 2.5% B) Hydrocortisone 0.5% C) Hydrocortisone 1% D) Betamethasone 0.25% E) Betamethasone 0.5%

B) Hydrocortisone 0.5% C) Hydrocortisone 1%

Select the correct statement concerning oral isotretinoin: A) This medication is for mild to moderate acne. B) This medication is only for male patients due to the high risk of birth defects; and, males typically get worse acne than females. C) If female, only patients who can remember to use two effective forms of birth control can use the drugs similar to Accutane. D) Isotretinoin is Pregnancy Category D. E) None of the above.

C) If female, only patients who can remember to use two effective forms of birth control can use the drugs similar to Accutane. Rationale: Isotretinoin requires two effective forms of birth control. The Accutane name has a bad association with birth defects so that manufacturer changed the name, but it's the same drug. Although males typically get acne worse, some females get severe inflammatory acne and may be using this product.

If systemic ketoconazole is used to treat onychomycosis, which of the following medications must be stopped during the ketoconazole therapy? A) Amlodipine B) Carvedilol C) Rabeprazole D) Multivitamin/mineral supplement E) Digoxin

C) Rabeprazole Rationale: Ketoconazole and itraconazole are used for onychomycosis. These agents require an acidic medium for adequate absorption. No acid-suppressive agents of any type concurrently.

Which of the following statements are correct? (Select ALL that apply.) A) Salicylic acid is a stronger agent than benzoyl peroxide. B) Androgens (male sex hormones) are the primary determinant of acne, which is why boys usually get acne worse than girls. In addition, the prescence of an organism called mycobacterium that lives in the skin and fatty acids in oil glands in the skin must be present; all three in combination produce a bad case of acne. C) Some women find benefit in treating acne using birth control pills. D) Common times to get acne are during puberty, in infants, and women around the time of the menstrual cycle. E) Benzoyl peroxide comes in combinations with the antibiotics clindamycin or erythromycin; these require a prescription.

C) Some women find benefit in treating acne using birth control pills. D) Common times to get acne are during puberty, in infants, and women around the time of the menstrual cycle. E) Benzoyl peroxide comes in combinations with the antibiotics clindamycin or erythromycin; these require a prescription. Rationale: Benzoyl peroxide is a stronger agent than salicylic acid. The organism is called P. acnes; the rest of the statement in the second choice is accurate. Women may be using oral contraception if there is another reason to be on the pill; it is not usually given for acne alone.

The topical retinoids such as tretinoin (Avita, Retin-A), adapalene (Differin) and tazarotene (Tazorac, Avage) are first line prescription agents for treating most cases of acne. Choose the correct statements concerning these agents: (Select ALL that apply.) A) They are safe to use in breastfeeding. B) They are safe to use in pregnancy. C) They are derivatives of vitamin A. D) They are applied on each acne pimple as "spot" therapy. E) They are applied in a pea sized amount, which is divided into 4 equal parts and applied.

C) They are derivatives of vitamin A. E) They are applied in a pea sized amount, which is divided into 4 equal parts and applied.

Correct application instructions for topical steroid products should include the following points except: A) Overuse of this product can cause thinning of skin, striae in the skin folds, and can worsen acne. B) Do not use more than directed. C) Higher potency steroids (prescription strengths) are usually applied once daily. D) Lower potency steroids (OTC strengths) are usually applied three or four times daily. E) All of the above are correct counseling statements.

D) Lower potency steroids (OTC strengths) are usually applied three or four times daily. Rationale: High potency prescription steroids are generally once daily. The OTC/lower potency products are generally once or twice daily.

What does SPF indicate on a sunscreen product? A) The amount of time the product will last if the patient gets wet. B) The amount of time the product will last if the patient stays in the sun, up to 5 hours duration. C) The product's moisturizing efficacy. D) The degree of protection from UVA. E) The degree of protection from UVB.

E) The degree of protection from UVB.