Question 1

Instructions for applying a topical antibiotic or antiviral ointment include:

Accepted Answer

Washing hands before and after applying topical antimicrobials is important to prevent the spread of infection and maintain hygiene. Option A and B are not necessarily required and may differ depending on the specific medication being used and the severity of the infection.

Question 2

Topical diphenhydramine (Benadryl) is available OTC to treat itching. Patients or parents should be instructed regarding the use of topical diphenhydramine that:

Accepted Answer

Topical diphenhydramine should not be used in children younger than age 2 years as absorption may be increased due to immaturity of the skin barrier. The other options are not correct.

Question 3

Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes instructing them:

Accepted Answer

Tazarotene should be applied in a thin layer to the psoriasis plaque lesions only. It should not be applied to nonaffected areas and should not be overused as it may cause side effects such as hypercalcemia. The instruction to apply it liberally to all psoriatic lesions is incorrect as it may increase the risk of side effects.

Question 4

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 5

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

Accepted Answer

Topical calcipotriene contains vitamin D analogs and can raise blood calcium levels, leading to hypercalcemia. Patients using greater than 100 grams per week are particularly at risk and should be monitored closely. Symptoms of hypercalcemia include increased thirst, frequent urination, constipation, abdominal pain, nausea, vomiting, fatigue, muscle weakness, and confusion.

Question 6

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

Accepted Answer

Bacitracin and polymixin B (generic double antibiotic ointment) is a cost-effective treatment option for impetigo and is often readily available over-the-counter without a prescription. Mupirocin and Retapamulin are more expensive and may require a prescription. Oral cephalexin is not typically indicated for localized impetigo and would be a more expensive and unnecessary choice.

Question 7

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 started at the first sign of a cold sore outbreak.

Answer: C 
 Skin irritation is a known side effect of topical penciclovir, but it should resolve. It is important for patients to be aware of this potential side effect and understand that it does not necessarily mean that the medication is not working.

Answer: D 
 Penciclovir should be used for a minimum of 2 weeks to prevent recurrence of cold sores. Educating patients on the importance of completing the full course of treatment is an important aspect of patient education when prescribing penciclovir.

Therefore, the best choices are B, C, and D.

Question 8

Jose has had eczema for many years and reports that he thinks his corticosteroid cream is not working as well as it was previously. He may be experiencing tolerance to the corticosteroid. Treatment options include:

Accepted Answer

Interrupted or cyclic application of corticosteroid creams can help reduce the risk of developing tolerance to the medication. This approach involves using the medication for a few weeks, followed by a period of rest where the medication is not used. This schedule helps to maintain the effectiveness of the medication while minimizing the risk of side effects or tolerance. Increasing the potency or frequency of dosing may not be the best choice as this could lead to increased side effects or dependence on the medication. Discontinuing the corticosteroid without exploring other treatment options may leave Jose without an effective treatment for his eczema.

Question 9

Drew is a 17-year-old competitive runner who presents with complaint of pain in his hip that occurred after he fell while running. His only medical problem is severe acne for which he takes isotretinoin (Accutane). With this history what would you be concerned for?

Accepted Answer

Isotretinoin is known to have effects on bone metabolism and can increase the risk of bone injuries. Given Drew's fall while running and his use of isotretinoin, the possibility of a fracture should be considered and evaluated appropriately.

Question 10

Juakeem 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

The correct way to treat nasal MRSA with mupirocin is to insert one-half of the dose in each nostril twice a day.

Question 11

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

Accepted Answer

The first-line therapy for treating topical fungal infections such as tinea corporis or tinea pedis would be OTC topical azole (clotrimazole, miconazole). These medications are effective against most dermatophyte fungi and are widely available without a prescription. Oral terbinafine and griseofulvin are reserved for more severe or refractory cases, while nystatin cream or ointment is used to treat fungal infections of the skin and mucous membranes caused by Candida species, not dermatophytes.

Question 12

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

Accepted Answer

According to the instructions for the use of malathion (Ovide) for head lice, the correct choice is to rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours. Using a blow dryer is not mentioned in the instructions, and malathion (Ovide) is typically used only once, not daily for a week. While using gloves is recommended, it is not the best choice, as it is not the most important instruction given.

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 decrease in white blood cells) is a normal adverse effect of silver sulfadiazine cream that occurs on days 2 to 4 of treatment and should resolve.

Option B is not a normal adverse effect of silver sulfadiazine cream. Option C is also not a normal adverse effect and may indicate an allergic reaction to the cream. Option D is not an adverse effect of silver sulfadiazine cream.

Question 14

When Sam used clotrimazole (Lotrimin AF) for athlete's foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete's foot again. What would be a good choice of antifungal for Sam?

Accepted Answer

Since Sam experienced a hypersensitivity reaction to clotrimazole, it would be best to avoid using azole antifungals like miconazole and ketoconazole. Griseofulvin is not typically used for athlete's foot. Terbinafine is a good option as it is a different class of antifungal that works by inhibiting fungal cell wall synthesis and has a lower risk of cross-reactivity with clotrimazole.

Question 15

Li is a 6-month-old infant with severe eczema. She 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 of eczema in infants, as their skin is thinner and more susceptible to absorption of the medication. Overuse can lead to side effects such as skin thinning and increased risk of infection. It is important to follow the instructions of a healthcare provider and not double the frequency of application without their guidance. The use of occlusive dressings is generally not recommended in infants, as it can further irritate the skin and increase the risk of infection.

Question 16

Erika has been prescribed isotretinoin (Accutane) by her dermatologist and is presenting to her primary care provider with symptoms of sadness and depression. A Beck's Depression Scale indicates she has mild to moderate depression. What would be the best care for her at this point?

Accepted Answer

The answer of Erika has been prescribed isotretinoin (Accutane) by...

Question 17

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

Accepted Answer

The instructions for the use of selenium sulfide shampoo (Selsun) to treat scalp seborrhea include shampooing twice a week for two weeks, then weekly. This is the recommended regimen for maintenance treatment. It is also important to rinse well after shampooing. While some people may experience worsening of seborrhea in the first week, it is not considered normal and should be discussed with a healthcare provider if it occurs. Seborrhea usually clears up after several weeks of treatment, but this can vary depending on individual factors.

Question 18

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

Accepted Answer

Scabies is highly contagious and can be easily transmitted from person to person, so it is important to treat all members of the household and close personal contacts to prevent reinfestation.

Answer: B 
 Permethrin should not be used on infants under 2 months of age, and should only be applied from the neck down to avoid accidental ingestion or exposure to sensitive areas.

Answer: C 
 Permethrin cream should be left on the skin for 8-14 hours before being washed off, according to the product instructions.

Answer: D 
 Permethrin is flammable and caution should be taken to avoid open flames or smoking while the cream is being applied.

Question 19

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 FDA due to concerns about the potential risk of cancer based on animal studies and some data in humans. This warning is intended to inform both prescribers and patients about the risks associated with its use.

Question 20

Catherine calls the clinic with concerns that her acne is worse 1 week after starting topical tretinoin. What would be the appropriate care for her?

Accepted Answer

It is common for topical tretinoin to initially worsen acne before improving it. This is known as the "retinization" period and can last up to 6-8 weeks. It is important to reassure the patient that this is normal and encourage them to continue using the medication as directed. Switching to another medication or adding an oral antibiotic is not necessary at this time. Applying oil-based lotion may exacerbate the acne and is not recommended.

Quiz 23: Drugs Affecting the Integumentary System