Deck 22: Drugs Affecting the Integumentary System

Question 1

A child presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. Their parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment?

A)Mupirocin (Bactroban)
B)Bacitracin and polymyxin B (generic double antibiotic ointment)
C)Retapamulin (Altabax)
D)Oral cephalexin (Keflex)

Answer 1

Bacitracin and polymyxin B (generic double antibiotic ointment)

Question 2

When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that:

A)Tacrolimus is most effective if it is used continuously for four to six months.
B)Tacrolimus should be spread generously over the affected area.
C)The U.S. Food and Drug Administration (FDA) has issued a black box warning about the use of tacrolimus and the development of cancer in animals and humans.
D)The FDA recommends that patients be screened for cancer before prescribing tacrolimus.

Answer 2

The U.S. Food and Drug Administration (FDA) has issued a black box warning about the use of tacrolimus and the development of cancer in animals and humans.

Question 3

Instructions for applying a topical antibiotic or antiviral ointment include:

A)Apply thickly to the infected area, spreading the medication well past the borders of the infection.
B)If the rash worsens, apply a thicker layer of medication to settle down the infection.
C)Wash hands before and after application of topical antimicrobials.
D)Crusted lesions can be scrubbed off with a clean nailbrush.

Answer 3

Wash hands before and after application of topical antimicrobials.

Question 4

Patients who are treated with more than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:

A)High vitamin D levels
B)Hyperkalemia
C)Hypercalcemia
D)Hyperuricemia

Question 5

When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to:

A)Mix the griseofulvin with ice cream before administering.
B)Take the griseofulvin until the tinea clears, in approximately four to five weeks.
C)Shampoo with baby shampoo daily while taking the griseofulvin.
D)Take the griseofulvin with a high-fat food.

Question 6

An adolescent female calls the clinic with concerns that her acne is worse one week after starting topical tretinoin. What would be the appropriate care for her?

A)Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin.
B)Switch her to an oral antibiotic to treat her acne.
C)Advise her to apply an oil-based lotion to her face to soothe the redness.
D)Reassure her that the worsening of acne is normal and it should improve with continued use.

Question 7

A patient who has had eczema for many years reports that their corticosteroid cream is not working as well as it was previously. They may be experiencing tolerance to the corticosteroid. Treatment options include:

A)Increase the potency of the corticosteroid cream.
B)Recommend an interrupted or cyclic schedule of application.
C)Increase the frequency of dosing of the corticosteroid.
D)Discontinue the corticosteroid because it isn't working any longer.

Question 8

A 17-year-old competitive runner presents with hip pain that began after falling while running. Their only medical problem is severe acne for which they take isotretinoin (Accutane). What should the provider be concerned about?

A)The patient may have pulled a muscle and needs to rest to recover.
B)They are at risk for bone injuries and need to be evaluated for fracture.
C)Isotretinoin interacts with ibuprofen, which is the pain medication of choice.
D)Teen athletes are at risk for repetitive stress injuries.

Question 9

Instructions for the use of selenium sulfide shampoo (Selsun) to treat scalp seborrhea include:

A)Shampoo daily and rinse well.
B)Worsening of seborrhea for the first week is normal.
C)Seborrhea usually clears up after a few weeks of treatment.
D)Shampoo twice a week for two weeks, then weekly.

Question 10

A patient is prescribed tazarotene for their psoriasis. Patient education regarding topical tazarotene includes:

A)That tazarotene is applied in a thin film to the psoriasis plaque lesions
B)To apply it liberally to all psoriatic lesions
C)To apply tazarotene to nonaffected areas to prevent breakout
D)That tazarotene may cause hypercalcemia if it is overused

Question 11

Instructions for the use of malathion (Ovide) for head lice include:

A)Use a blow dryer to dry the hair after applying.
B)Use malathion (Ovide) daily for a week until all lice are dead.
C)Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours.
D)Use gloves to apply the malathion (Ovide).

Question 12

When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include:

A)Spread penciclovir liberally all over lips and the area surrounding lips.
B)Penciclovir therapy is started at the first sign of a cold sore outbreak.
C)Skin irritation is normal with penciclovir and it should resolve.
D)Penciclovir should be used a minimum of two weeks to prevent recurrence.

Question 13

A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his leg. Normal adverse effects of silver sulfadiazine cream include:

A)Transient leukopenia on days two to four that should resolve
B)Worsening of burn symptoms briefly before resolution
C)A red, scaly rash that will resolve with continued use
D)Hypercalcemia

Question 14

A patient is a nasal methicillin-resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes:

A)Take the oral medication exactly as prescribed.
B)Insert one-half of the dose in each nostril twice a day.
C)Alternate treating one nare in the morning and the other in the evening.
D)Nasal MRSA eradication requires at least four weeks of therapy, with up to eight weeks needed in some patients.

Question 15

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete's foot) would be:

A)Over-the-counter (OTC) topical azole (clotrimazole, miconazole)
B)Oral terbinafine
C)Oral griseofulvin microsize
D)Nystatin cream or ointment

Question 16

A patient who used clotrimazole (Lotrimin AF) for athlete's foot developed a red, itchy rash consistent with a hypersensitivity reaction. They now have athlete's foot again. What would be a good choice of antifungal?

A)Miconazole (Micatin) powder
B)Ketoconazole (Nizoral) cream
C)Terbinafine (Lamisil) cream
D)Griseofulvin (Grifulvin V) suspension

Question 17

A 6-month-old infant with severe eczema would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include:

A)Apply liberally to all areas with eczema.
B)Double the frequency of application when the eczema is severe.
C)Apply sparingly to eczema areas.
D)Cover the eczema area with an occlusive dressing after applying a corticosteroid.

Question 18

When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include:

A) All members of the household and personal contacts should also be treated.
B) Infants should have permethrin applied from the neck down.
C) The permethrin is washed off after 10 to 20 minutes.
D) Permethrin is flammable and to avoid open flame while the medication is applied.

Question 19

An adolescent has been prescribed isotretinoin (Accutane) by their dermatologist and is presenting to their primary care provider with symptoms of sadness and depression. The Beck Depression Inventory results indicate they have mild to moderate depression. What would be the best option at this point?

A)Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant.
B)Refer them to a mental health therapist.
C)Contact their dermatologist about discontinuing the isotretinoin.
D)Reassure them that mood swings are normal and schedule follow up in a week.