Skin

Question 1

What are ointments

Answer 1

• greasy
• forms occlusive barrier over skin
• most hydrating

Question 2

What are creams

Answer 2

• less greasy
• cosmetically accepted
• drys quicker
• applied more frequently

Question 3

What are gels

Answer 3

• high water content
• scalp and face suited

Question 4

What are lotions

Answer 4

• cooling effect
• preferred for large/ hairy area
• alcoholic base which can sting broken skin

Question 5

What is the caution with salicylate containing preparations

Answer 5

can cause toxicity
- in neonates
- when applied over large areas

Question 6

When should you avoid benzyl alcohol and why

Answer 6

avoid in neonates as can cause fatal toxicity

Question 7

When to apply Emollients for eczema

Answer 7

• as often as required
• maintain moisture

Question 8

How to apply emollients

Answer 8

• apply in direction of hair growth
• to avoid folliculitis (inflamed hair follicles)

Question 9

How long should you soak with bath additives for improved hydration

Answer 9

at least 10 to 20 mins

Question 10

What is the MHRA caution with paraffin based skin emollients

Answer 10

• fire risk
• clothes, dressings are easily ignited
• do not smoke

Question 11

Topical corticosteroids mode of action

Answer 11

reduces inflammation in inflammatory skin conditions
e.g eczema, dermatitis

Question 12

When are Topical corticosteroids contra-indicated

Answer 12

• acne
• rosacea
• skin infections

Question 13

What is the most potent Topical corticosteroids

Answer 13

Clobetasol
(Dermovate)

Question 14

What are the second most potent Topical corticosteroids

Answer 14

• betamthasone 0.1 (betnovate)
• hydrocortisone butyrate
• mometasone

Question 15

What are moderate poteny Topical corticsteroids

Answer 15

• clobetasone (Eumovate)
• Betamethasone 0.025 (Betnovate RD)

Question 16

What are mild potency Topical corticosteroids

Answer 16

Hydrocortisone <2.5%

Question 17

How to apply Topical corticosteroids

Answer 17

• apply thinly to affected area, no more than twice daily
• apply emollient first and wait 30 mins before applying steroid for maximum absorption
• Keep away from eyes

Question 18

Why should you avoid prolonged use of Topical corticosteroids (especially on face)

Answer 18

as they can cause
- skin thinning
- hypo / hyper pigmentation

Question 19

How long is the treatment course for rosacea

Answer 19

6 to 12 weeks

Question 20

Treatment for Rosacea (facial erythema) (face redness)

Answer 20

Brimonidine gel

Question 21

What are the brimonidine

Answer 21

• risk of cv effects
  (bradycardia, hypotension, dizziness)
• risk of rosacea exacerbation

Question 22

How to avoid CV effects of brimonidine

Answer 22

avoid application to irritated or damaged skin

Question 23

How to avoid exacerbation of rosacea when using brimonidine

Answer 23

• do not exceed maximum daily dose
• stop and report if symptoms worsen

Question 24

What is Oral Isotretinoin

Answer 24

acne treatment only prescribed under supervision

Question 25

Tretinoids (Isotretinoin) and vitamin A and pregnancy

Answer 25

they are teratogenic (deformities in babies)

Question 26

Tretinoids and contraception

Answer 26

effective contraception 1 month before and after treatment

Question 27

Tretinoids and contraception part 2

Answer 27

- needs 2 types of contraception - pregnancy test needs to be negative (every months)

Question 28

At which day of the menstrual cycle should you start teratogenic drug treatment

Answer 28

2nd or 3rd day

Question 29

Side effects of Isotretinoin

Answer 29

- hypoglycaemia - high cholesterol - pancreatitis - hepatotoxicity - visual disturbances - redness - severe dryness - erectile dysfunction - decreased libido

Question 30

At which level of triglycerides is there a higher risk of pancreatitis when taking Isotretinoin for acne

Answer 30

9mmol/litre

Question 31

When should you discontinue Isotretinoin

Answer 31

- if >9mmol/litre triglycerides - pancreatitis - severe skin peeling - hemorrhagic diarrhoea - visual disturbances - psychiatric reactions

Question 32

Patient counselling for Isotretinoin

Answer 32

Photosensitivity - avoid UV light - use high SPF sunscreen