Derm 3

Question 1

Topical antifungal treatments require __ to ___ weeks of therapy

Answer 1

4 - 6

Question 2

What are the 4 topical antifungals?

Answer 2

• Clotrimazole
• Miconazole
• Ketoconazole
• Nystatin

Question 4

What are the 3 Fungicides?

Answer 4

• Tolnaftate
• Naftifine
• Terbinafine

Question 5

What antifungal has a greater response but is expensive? $$$

Answer 5

Fungicides

• Tolnaftate
• Naftifine
• Terbinafine

Question 6

What are the 2 oral dissolving Oral Antifungals?

Answer 6

• Clotrimazole
• Miconazole

Question 7

What is the oral suspension Oral Antifungal?

Answer 7

Nystatin

Question 8

What are the 2 IV Antifungals?

Answer 8

• Amphotericin B
• Fluconazole

Question 9

Azoles that are available for systemic use can be classified into what 2 groups?

Answer 9

• Triazoles
  
  • fluconazole
  • itraconazole
• Imidazoles
  
  • clotrimazole
  • ketokonazole
  • miconazole

Question 10

What is the MOA of Azoles?

(Triazoles: fluconazole, itraconazole)

(Imidazoles: clotrimazole, ketoconazole, miconazole)

Answer 10

Interfere w/ fungal cytochrome P450 activity, decreasing ergosterol synthesis & inhibiting cell membrane formation

Question 12

MOA of what antifungal agent?

• Binds to sterols in fungal cell membrane, changing the cell wall permeability allowing for leakage of cellular contents

Answer 12

Nystatin

Question 13

Which antifungal?

• For stratum corneum, mucosa, cornea by dermatophytes & Candida sp. infections
• Not for subcutaneous, nail or hair infections
• Paronychial and intertriginous candidiasis applied three or four times daily
• Also treats seborrheic dermatitis (ketoconazole)
• Once- or twice-daily application
• clearing of dermatophyte infections in 2-3 weeks

Answer 13

Topical Imidazoles

• Clotrimazole
• Ketoconazole
• Miconazole

Question 14

Which antifungal?

• Topical ____ - cutaneous and mucosal candida
• Not effective against dermatophytes
• Oral candidiasis (thrush) - 5 mL (infants, 2 mL) oral suspension in the mouth (Swish and Swallow) four times daily for 7-10 days
• Oral troches four times daily for 7-10 days
• Vulvo-vaginal candidiasis - 1 vaginal tablet BID x 14 days, then Q HS for an additional 14-21 days

Answer 14

Nystatin

Question 15

Atopic Dermatitis / Pruritis is also called what?

Answer 15

Eczema

Question 16

What drugs?

• Inhibit T-lymphocyte activation and prevent degranulation of mast cells by antigen IgE complexes

Answer 16

Immunomodulators

• Calcineurin inhibitors
  
  • Tacrolimus
  • Pimecrolimus

Question 17

What is used to tx:

• Atopic dermatitis
• Off label for other autoimmune dermatologic disorders such as: Vitiligo & alopecia areata

*Neither medication should be used w/ ____.

Answer 17

Immunomodulators

• Calcineurin inhibitors
  
  • Tacrolimus
  • Pimecrolimus

*Occlusive dressings

Question 18

Which medication?

**Box Warning**

• Rare cases of malignancy (e.g., skin and lymphoma)
• Continuous long-term use in any age group should be avoided
• Application limited to areas of involvement with atopic dermatitis
• NOT indicated for use in children less than 2 years of age

Answer 18

Immunomodulators

• Calcineurin Inhibitors
  
  • Tacrolimus
  • Pimecrolimus

Question 19

General Tx of ____.

• If underlying cause known, treat that first
• Cool skin - light clothes on the body and bedding
• Air conditioning, humidifier
• Avoid topical products with fragrances, alcohol, wool, alkaline soap, and potential allergens
• Tepid shower before bed or cool compresses - Limit bathing to once per day with a non-soap, low pH cleanser (Cera-Ve, Cetaphil, Aveeno, Dove)
• NO orange or green soaps and NO Ivory

Answer 19

Pruritis

Question 20

General tx of Pruritis

• Within __ mins after bathing, apply ___ liberally and __ other times in the day
• Emollients can be _____ and compounded w/ 1% menthol, 10% urea to increase their effectiveness
• Topical steroids with inflammatory conditions
• Topical _____ 4x/day -causes burning sensation that decreases compliance
• Topical _____ 3-4x/day - can cause anticholinergic effects

Answer 20

• 3 / emollient cream ointment (Cetaphil) / 2
• Refrigerated
• Capsaicin
• Doxepin

Question 21

Which antipruritic agent?

• Potent H1- and H2-receptor antagonist properties
• May result in significant drowsiness in patients
• Topical use is contraindicated in urinary retention or narrow angle glaucoma

Answer 21

Topical doxepin 5% cream (Zonalon)

Question 22

What drugs are these?

• Permethrin
• Lindane (Hexachlorocyclohexane)
• Crotamiton
• Sulfur
• Spinosad
• Malathion
• Ivermectin

Answer 22

Ectoparasiticides

Question 23

Most common ADEs of what therapy?

• conjunctivitis
• ocular hyperemia
• eye irritation
• dandruff
• dry skin
• skin burning sensation

Answer 23

Sklice (ivermectin 0.5% lotion)

(tx for head lice)

Question 24

What are the 5 prescription lice products?

Answer 24

• Benzyl alcohol
• Malathion
• Spinosad
• Ivermectin (Skilice)
• Lindane

(MILBS)

Question 25

**Which prescription lice product?** * **Age:** 6 months+ * **Dosage:** 4-48 oz * **Time of app:** 10 mins, repeat in 7 days

Answer 25

* Benzyl alcohol

Question 26

**Which prescription lice product?** **Age:** safety not shown \<6 yrs **Dosage:** 2 oz bottle: apply enough to wet hair & scalp **Time of app:** 8-12 hrs, repeat in 7-9 days if lice persist

Answer 26

Malathion

Question 27

**Which prescription lice product?** **Age:** 4 yrs+ **Dosage:** up to 120 mL (1 bottle) **Time of app:** 10 mins, repeat in 7 days if lice persist

Answer 27

Spinosad

Question 28

**Which prescription lice product?** **Age:** 6 months+ **Dosage**: Up to 120 mL (4 oz tube) **Time of app:** 10 mins, tube for single use, consult HCP prior to re-treatment

Answer 28

**Ivermectin** (Sklice Lotion)

Question 29

**Which prescription lice product?** **Age:** use w/ caution in those \<110 lbs **Dosage:** 1-2 oz **Time of app:** 4 mins, DO NOT re-treat

Answer 29

Lindane

Question 30

**Which Ectoparasiticide?** * Is toxic to Pediculus humanus, Pthirus pubis, and Sarcoptes scabiei •Residual drug persists up to 10 days following application * 1% cream rinse pediculosis * 5% cream for scabies •Single application applied to the body from the neck down, left on for 8-12 hours, and then washed off

Answer 30

Permethrin

Question 31

**Which Ectoparasiticide?** * is available as a shampoo or lotion * 10% of a dose is absorbed * Concentrated in fatty tissues, including the brain * Potentially neurotoxic and can lead to seizures * For pediculosis capitis or pubis

Answer 31

Lindane

Question 32

**Tx of which Ectoparasiticide?** **What is this treating?** •30 mL of shampoo applied to dry hair on the scalp or genital area for 4 minutes and then rinsed off

Answer 32

**Lindane:** to tx Pediculosis capitis or Pediculosis pubis

Question 33

**Tx of which Ectoparasiticide?** **What is this treating?** •Single application applied to the entire body from the neck down, left on for 8-12 hours, and then washed off

Answer 33

**Lindane:** tx of scabies

Question 34

**Which ectoparasiticide?** ## Footnote * available as a cream or lotion * Scabicide with some antipruritic properties * Two applications applied from the chin down at 24-hour intervals, with a cleansing bath 48 hrs. after the last application

Answer 34

Crotamiton

Question 35

**Which Ectoparasiticide?** ## Footnote _•remains a possible alternative drug for use in infants and pregnant women._ * 5% precipitated ____ in petrolatum (compounded) * Two applications applied from the chin down at 24-hour intervals, with a cleansing bath 48 hrs. after the last application

Answer 35

Sulfur