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69 Cards in this Set
- Front
- Back
- 3rd side (hint)
Impetigo is not as serious of a condition as those that require oral agents, so you may want to try topical. What topical drug should you give for impetigo?
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Mupirocin (Bactroban®)
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What are the 3 most common bugs that cause Cellulitis?
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S pyogenes, MSSA, or MRSA
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What bug causes Erysipelas?
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S pyogenes so you want gram positive coverage
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What is the IV drug of choice for Cellulitis caused by MSSA?
Which PO drug, if it is a minor infection? IV and PO Drugs of choice for PCN allergic? Can you use for Type I hypersensitivity rxn? |
IV DOC- Antistaph pcn - nafcillin, oxacillin if IV needed;
PO- DOC- dicloxacillin if it’s a minor infection and PO route acceptable PCN Allergic- 1st gen cephs - cefazolin IV (Ancef® or Kefzol®); cephalexin PO (Keflex®) if minor infection; may be used in less severe PCN allergy, but not type I (anaphylactic) reactions |
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What bacterioSTATIC drug can be used to treat resistant strains of MRSA?
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c. Doxycycline (Vibramyin®) - resistant strains of MRSA, coagulase negative staph are becoming more common. BacterioSTATIC
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What are the 3 main SE of Doxycycline (Tetracyclins in general)?
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i. Photosensitivity - all tetracyclines
ii. Polyvalent cations will inhibit oral absorption due to chelation iii. Outdated tcn’s = risk of renal tubular acidosis |
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Clindamycin covers many _______ (aerobes/anaerobes?) EXCEPT _________
BacterioSTATIC or CIDAL? |
ANAEROBES
C.DIFF- so CDAD is a bit more likely with this drug; resistant strains of MRSA are common. It will cover many strep species. BacterioSTATIC |
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What bacterioSTATIC drug covers MSSA, Community acquired MRSA, most strep (NOT group A!), and coliforms? Its SE profile includes:
i. SJS/TEN, other drug eruptions ii. Photosensitivity iii. G6PD deficiency hemolysis (rare) iv. Boards: Long-term use - folate deficiency(maybe?) |
Sulfamethoxazole/trimethoprim (Bactrim® or Septra®)
***EXAM- G6PD Deficiency Hemolysis!** |
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What does Vancomycin IV cover? (5)
BacterioSTATIC or CIDAL? |
Vancomycin intravenous - covers MSSA, MRSA, Coag neg staph, strep, Enterococci ?- (enterococcal resistance is emerging)
Cell wall active = bacteriCIDAL!!! |
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Why shouldn't you infuse Vancomycin too fast?
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Rapid infusion = degranulation of mast cell = Red Man syndrome
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Why shouldn't Vancomycin be combined with Loop Diuretics or Aminioglycosides?
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Vancomycin is Ototoxic & Nephrotoxic; Even more so when combined with other oto- nephro- toxic drugs (loop diuretics, aminoglycosides)
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What does Linezolid Cover? Bacterio- static or -cidal?
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Linezolid (Zyvox®) IV or PO - covers **aerobic gram positives**, some enterococcal resistance has emerged. BacterioSTATIC. Used more in patients with PCN allergy.
FYI Boards: MAO inhibitor - problem with SSRI (can cause seratonin syndrome), tramadol, dextromethorphan, meperidine (serotonin syndrome); problem with tyramine, decongestants = hypertensive crisis |
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What IV antibiotic covers gram + (but is not effective in pneumococcal pnuemonia), and is VERY TOXIC - causing myotoxicity including rhabdomyolysis (problem with statins), is hepatotoxic, and causes pulmonary toxicity?
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Daptomycin (Cubicin®) IV
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The flora of chronic wounds changes over time. Describe the flora of Chronic wounds at the following stages:
1) Early 2) After 4 weeks 3) Several months |
1) Early = gram + skin flora: S aureus, S epidermidis, beta-hemolytic Strep
2) After 4 weeks, see gram neg/coliforms: Proteus, E coli, Klebsiella spp 3) After several months, add anaerobes for a wound with 4-5 different organisms |
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Pressure & stasis ulcers in NON-DIABETIC patients are polymicrobial. What bugs do these often include?
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gm +
Coliforms Pseudomonas Anaerobes |
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Empiric therapy for pressure ulcers in Non-diabetic patients doesn't usually need to cover MRSA unless the risk for MRSA is high. When would the risk for MRSA be high?
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Nursing home with ↑MRSA rate
Previous recent MRSA infection |
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What monotherapy can be used for treatment of Pressure or stasis ulcers in non diabetic pts, if MRSA coverage is NOT needed?
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1) Antipseudomonal pcns + β-lactamase inhibitor (piperacillin/tazobactam, ticarcillin/clavulanate)- can be used as monotherapy unless MRSA coverage required. (Ticarcillin contains significant sodium - might be a CHF - related board question)
2) Antipseudomonal carbapenems - imipenem/cilastatin (Primaxin®), meropenem (Merrem®) , doripenem (Doribax)- [ertapenem (Invanz®) has less reliable antipseudomonal activity]; cilastatin protects imipenem from degradation by renal brush border cells - it is NOT a beta-lactamase inhibitor 3) FQ (fluoroquinolone) + clinda or metronidazole - FQ covers everything except anaerobes. See side 3 for boards stuff |
Boards: Ciprofloxacin - gram + resistance has rapidly emerged - this is why levofloxacin and moxifloxacin are “respiratory” quinolones - they have better pneumococcal coverage; ciprofloxacin inhibits CYP1A2/3A4 - drug interactions aplenty; most likely to cause CNS problem, esp in elderly (confusion, seizures, etc) Moxi doesn’t have great anti-pseudomanal activity
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Some Board info on FQ
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Fluoroquinolones
a. Polyvalent cations inhibit oral absorption due to chelation b. Photosensitivity c. Tendonitis d. Rarely used in peds or pregnancy (used in peds/pregnancy for anthrax, Tx of pulmonary infections in cystic fibrosis, etc.) |
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What are the ONLY 2 things that Metronidazole covers?
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Covers ONLY protozoa and anaerobes
Boards: a. NO ethanol! Due to inhibition of aldehyde dehydrogenase b. Topically is choice for rosacea management (not a cure, though!) |
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What does Clindamycin Cover?
Does is cover C.Diff? |
covers gram + and anaerobes but NOT C difficile, may cover some strains of MRSA (community acquired MRSA)
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Which is more of a worry for simple diabetic ulcers of the foot: MRSA or Pseudomonas?
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Generally, pseudomonas is not a worry for simple diabetic foot ulcers
These are polymicrobial, and MRSA is often a problem |
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What is the treatment for Smaller Diabetic ulcers caused by community acquired MRSA?
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- SMX/TMP or minocycline will cover the less resistant MRSA strains
- PenVK, 2nd gen cephs, 3rd gen cephs will give more reliable Strep coverage including peptostreptococcus ; - FQ will give Strep coverage; - 2nd and 3rd gen ceph and FQ will also cover coliforms - probably not a problem in smaller lesions but not definitely excluded, more common in debilitated patients (nursing home) |
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What bugs do you DEFINITELY need to cover with larger deeper Diabetic ulcers?
How will you treat them? |
Definitely need coliform coverage, MRSA, enterococci, peptostreptococcus
1. Amox/clav plus SMX/TMP 2. FQ plus linezolid |
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If a Diabetic Ulcer turns into a systemic Illness, what bugs should you cover?
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cover *everything* empirically, try to id cause and narrow spectrum after etiology identified
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What antibiotics are used in the treatment of systemic illness caused by ulcers in diabetics if MRSA is a concern?
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MRSA with vanco, daptomycin, tigecycline or linezolid; pseudomonas and gram negs with antipseudomonal pcn/βlactamase inhibitor OR carbapenem
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What antibiotics are used in the treatment of systemic illness caused by ulcers in diabetics if MRSA is a NOT a great concern?
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FQ or aztreonam plus metronidazole (or carbacephem or antipseudomonal pcn + βlactamase inhibitor monotherapy)
Boards: Aztreonam (Azactam) - a β-lactam like drug that covers only gram negative and pseudomonas. IV only. SAFE in any type of penicillin/cephalosporin allergy |
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Is osteomyelitis contagious?
How do you know when to treat osteomyelitis empirically vs. waiting for the cultures to return? |
YES
If illness is not systemic, wait until bone tissue culture identifies specific organism. Empiric therapy is indicated in systemic illness |
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If a patient with osteomyelitis has developed systemic illness, you should treat them empirically. While you can treat them the same a systemically ill diabetic ulcer pateint, most evidence is with BACTERICIDAL DRUGS. What is the best treatment for Osteomyelitis caused by the following:
1. MRSA 2. MSSA 3. Gram Negative including pseudomonas Give MSSA likely vs MRSA likely. |
Vancomycin where MRSA is confirmed (or highly likely);
Antistaph pcns/cefazolin for MSSA; FQ, ceftazidime or cefepime for gram negs including pseudomonas |
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Boards: Osteomyelitis, Rifampin, and Biofilms...
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Rifampin- traditionally used where biofilms are a problem. Bactericidal, but resistance develops rapidly, so it is not used as monotherapy in treatment.
1. Stains everything orange (tears, saliva, etc.) 2. Enzyme inducer - on liver biopsy see ↑endoplasmic reticulum 3. TB treatment regimen (RIPE or RISE R = rifampin) 4. Prophylaxis for meningitis (Neiserria or Haemophilus) - used alone in prophylaxis |
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What causes Xerosis?
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dry air, things that dry skin
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How is Xerosis treated?
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i. Keratolytics - 12% ammonium lactate
ii. Moisturizers iii. Moderate to low potency steroids (classes III-VI) |
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What are the SE of moderate to low potency steroids, like those used in Xerosis?
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systemic (hyperglycemia), striae, purpura
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What type of steroids are allowed to put on the face?
What 3 meet this criteria? |
ONLY lower potency non-fluorinated steroids on face!!!
a. Hydrocortisone b. Alclometasone c. Desonide ***EXAM***!!!!! |
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What is the Drug of Choice for Scabies?
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permethrin or ivermectin are DOC (ivermectin is off-label for scabies)
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Know about Herpes Zoster from Byrd's Lecture and that we have a vaccine now.
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Know about Herpes Zoster from Byrd's Lecture and that we have a vaccine now.
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What non-pharmacologic basics should you remember about treating or preventing Decubiti (chronic would)?
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remember repositioning, skin care, and nutritional status are important
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What are arterial chronic wounds caused by?
How do you treat them? |
Reduced circulatory capacity
Tx: Cilostazol and pentoxyphylline |
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If a patient with osteomyelitis has developed systemic illness, you should treat them empirically. While you can treat them the same a systemically ill diabetic ulcer pateint, most evidence is with BACTERICIDAL DRUGS. What is the best treatment for Osteomyelitis caused by the following:
1. MRSA 2. MSSA 3. Gram Negative including pseudomonas Give MSSA likely vs MRSA likely. |
Vancomycin where MRSA is confirmed (or highly likely);
Antistaph pcns/cefazolin for MSSA; FQ, ceftazidime or cefepime for gram negs including pseudomonas |
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Boards: Osteomyelitis, Rifampin, and Biofilms...
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Rifampin- traditionally used where biofilms are a problem. Bactericidal, but resistance develops rapidly, so it is not used as monotherapy in treatment.
1. Stains everything orange (tears, saliva, etc.) 2. Enzyme inducer - on liver biopsy see ↑endoplasmic reticulum 3. TB treatment regimen (RIPE or RISE R = rifampin) 4. Prophylaxis for meningitis (Neiserria or Haemophilus) - used alone in prophylaxis |
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What causes Xerosis?
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dry air, things that dry skin
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How is Xerosis treated?
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i. Keratolytics - 12% ammonium lactate
ii. Moisturizers iii. Moderate to low potency steroids (classes III-VI) |
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What are the SE of moderate to low potency steroids, like those used in Xerosis?
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systemic (hyperglycemia), striae, purpura
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What type of steroids are allowed to put on the face?
What 3 meet this criteria? |
ONLY lower potency non-fluorinated steroids on face!!!
a. Hydrocortisone b. Alclometasone c. Desonide ***EXAM***!!!!! |
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What is the Drug of Choice for Scabies?
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permethrin or ivermectin are DOC (ivermectin is off-label for scabies)
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Know about Herpes Zoster from Byrd's Lecture and that we have a vaccine now.
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Know about Herpes Zoster from Byrd's Lecture and that we have a vaccine now.
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What non-pharmacologic basics should you remember about treating or preventing Decubiti (chronic would)?
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remember repositioning, skin care, and nutritional status are important
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What are arterial chronic wounds caused by?
How do you treat them? |
Reduced circulatory capacity
Tx: Cilostazol and pentoxyphylline |
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How do you approach chronic woulds due to venous problems?
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**Avoid things that cause edema**
Na restriction Stop edema- causing Meds 1. Vasodilators in absence of blocked sympathetic response 2. ***NSAIDs*** 3. Thiazolidinediones ***EXAM***!!! |
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What is the treatment for chronic Diabetic Ulcers?
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Becaplermin gel = PDGF = increased risk of cancer
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This was in italics, and not on one of her "hint hint wink wink' slides, so I assume its FYI
What are some common drugs that increase the risk of falls in the elderly? |
a. Anticholinergics = delirium
b. Drugs that cause postural hypotension (alpha blockers, DHP CCB, alpha-blockers including phenothiazines and tricyclic antidepressants, antiarrhythmics, sedatives) |
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The remaining cards are from the Derm ID Chart.
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The remaining cards are from the Derm ID Chart
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Tips from Dr. Babos on how to answer bug and drug questions.
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1. What is the most likely bug based upon site/type of infection (if not stated in stem)
2. Consider the severity of the infection - Minor - oral or topical - Moderate - oral - More severe - severe - IV, bactericidal agent preferred; usually double cover Pseudomonas sepsis 3. Select agents that will cover the bug AND reach the site of infection (very important in meningitis!) |
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Look out for contraindications. When is it ok to use a cephalosporin for a patient with a PCN allergy?
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OK to use ceph in mild (Not type I) PCN allergy (e.g., OK in rash) - do not use another penicillin (e.g., amox) in any kind of PCN allergy
Watch for drug intractions, allergies, age, & hepatic and renal function. |
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Age and pregnancy should be taken into consideration when giving pateints FQs or tetracycline. When might it be ok to give a child or a pregnancy woman FQ or tetracycline?
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Bioterror
CF Severe Osteomyelitis |
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What 3 drugs can be used to treat Superficial Tineas?
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Topical azole creams
Undecylenic acid Clioquinol, iodine |
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Which of the following can Selenium Shampoo be used to treat?
A) Superficial Tineas B) Systemic tineas C) Tinea capitis D) Nail E) Diaper candida |
C) Tinea capitis
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True or False:
It is appropriate to use Clioquinol (Iodochlorhydroxyquin) in children under 2 for diaper rash. |
Do NOT use in children < 2 years old
Do NOT use for diaper rash |
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Athlete’s Foot= Tinea _______
What is the treatment? |
Tinea Pedis
Any of the following can be used for any of the Superficial Tineas: Topical azole creams Undecylenic acid Clioquinol, iodine |
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Jock Itch= Tinea _______
What is the treatment? |
Tinea Cruris
Any of the following can be used for any of the Superficial Tineas: Topical azole creams Undecylenic acid |
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Ringworm= Tinea _______
What is the treatment? |
Tinea Corpris
Any of the following can be used for any of the Superficial Tineas: Topical azole creams Undecylenic acid |
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How do you treat systemic Tineas?
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Oral -azoles other than Itraconazole (monitor LFT, CBC for all including itracon)
OR Oral terbinafine |
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What are the possible treatments for Tinea Capitis?
Which one is associated with ↑QTc and induces 3A4 metab? |
Any of the following:
Clioquinol, iodine Oral -azoles other than Itraconazole (monitor LFT, CBC for all including itracon) Oral terbinafine Oral griseofulvin Oral itraconazole (↑QTc, 3A4 metab) Selenium shampoo |
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What should you be sure to monitor in patients taking oral azoles?
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Monitor LFT & CBC for all including itraconazole
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What is 1st line treatment for a fungal infections of the nail?
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Oral terbinafine OR Oral itraconazole (↑QTc, 3A4 metab)
Can also use Ciclopirox lacquer x 48 wks, but compliance is low, NOT 1st line Maybe Oral griseofulvin ? |
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Would you choose Nystatin CREAM or Nystatin SUSPENSION for Diaper Candida?
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CREAM!
Suspension is for TOPICAL treatment of oral mucosa, not diaper area |
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Which of the following is NOT helpful in the treatment of Diaper Candida?
A) Ciclopirox Cream B) Clotrimazole Cream C) Miconazole Cream D) Miconazole Powder |
D) Miconazole Powder
Ciclopirox cream, clotrimazole, miconazole cream NOT POWDER |
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How do you treat Herpes Simplex (Cold Sore)?
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Misc OTC numbing agents
Docosanol (Abreva) Penciclovir, acyclovir topical |
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What is the treatment for Herpes Zoster?
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Acyclovir, famciclovir, valacyclovir PO/IV
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1st line treatment for ALL Verruca?
What else can you give to a patient with Verruca Plana? |
ALL: Salicylic acid
Plana: Salicylic acid & Imiquimod |
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