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?

Accepted Answer

Bacitracin and polymyxin B (generic double antibiotic ointment) is the least expensive option and is effective for treating localized impetigo.

Question 2

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

Accepted Answer

Tacrolimus (Protopic) has a black box warning issued by the U.S. Food and Drug Administration (FDA) regarding the potential risk of cancer development in animals and humans. This warning is based on animal studies and the mechanism of action of the drug, which involves immunosuppression.

Question 3

Instructions for applying a topical antibiotic or antiviral ointment include:

Accepted Answer

Washing hands before and after applying topical antimicrobials is crucial to prevent the spread of infection and ensure cleanliness.

Question 4

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

Accepted Answer

Hypercalcemia can occur because calcipotriene is a vitamin D analog, and excessive use can lead to increased calcium absorption.

Question 5

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

Accepted Answer

Griseofulvin is better absorbed when taken with a high-fat meal, which enhances its bioavailability and effectiveness in treating fungal infections such as tinea capitis.

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?

Accepted Answer

Tretinoin, a topical retinoid, is known to potentially worsen acne during the first few weeks of treatment as it speeds up the cycle of skin cell turnover. This initial worsening is often referred to as "purging" and is considered a normal part of the treatment process. Patients are usually advised to continue using the medication as the condition improves over time.

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:

Accepted Answer

Using an interrupted or cyclic schedule can help prevent tolerance by allowing the skin to recover and maintain responsiveness to the corticosteroid.

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?

Accepted Answer

Isotretinoin (Accutane) is associated with an increased risk of bone injuries, including fractures, especially in young, active individuals. Given the patient's fall and current medication, evaluating for a fracture is prudent.

Question 9

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

Accepted Answer

Selenium sulfide shampoo, such as Selsun, is typically recommended for use twice a week for the first two weeks and then once a week to treat scalp seborrhea. This regimen helps effectively manage the condition without overuse, which can lead to scalp irritation or other side effects.

Question 10

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

Accepted Answer

Tazarotene is a topical retinoid used for psoriasis and should be applied in a thin film to the affected areas only, not liberally or to nonaffected areas to prevent breakout. It does not cause hypercalcemia; that side effect is more commonly associated with systemic treatments.

Question 11

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

Accepted Answer

Malathion (Ovide) should be left on the hair for 8 to 12 hours before rinsing and shampooing to effectively kill lice.

Question 12

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

Accepted Answer

Penciclovir therapy is most effective when initiated at the first sign of a cold sore, such as tingling, itching, or burning, to reduce the duration and severity of the outbreak.

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:

Accepted Answer

Transient leukopenia (a temporary decrease in the white blood cell count) on days two to four of treatment with silver sulfadiazine cream is a known, but typically self-resolving, side effect. This medication does not commonly cause worsening of burn symptoms, a red scaly rash that resolves with continued use, or 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:

Accepted Answer

Mupirocin is a topical antibiotic ointment used to eradicate nasal MRSA colonization. The correct method of application involves inserting approximately one-half of the dose into each nostril twice a day, typically for a duration of 5-10 days, not the extended periods mentioned in other options.

Question 15

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

Accepted Answer

Topical azoles like clotrimazole and miconazole are first-line treatments for superficial fungal infections such as tinea corporis and tinea pedis due to their effectiveness and safety profile.

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?

Accepted Answer

Terbinafine (Lamisil) cream is a good choice because it is a different class of antifungal (allylamine) compared to clotrimazole (an azole antifungal), reducing the risk of a cross-reactive hypersensitivity reaction.

Question 17

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

Accepted Answer

Topical corticosteroids should be applied sparingly to the areas affected by eczema to minimize potential side effects, such as skin thinning, especially in children.

Question 18

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

Accepted Answer

All members of the household and personal contacts should be treated to prevent reinfestation and spread of scabies.

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?

Accepted Answer

Isotretinoin has been associated with mood changes, including depression. It is important to contact the dermatologist to discuss the possibility of discontinuing the medication to see if symptoms improve.

Quiz 22: Drugs Affecting the Integumentary System