Module 10: Skin & Mucous Membrane Agents Flashcards

Flashcards covering skin and mucous membrane agents including antibacterials, antifungals, antivirals, acne treatments, corticosteroids, calcineurin inhibitors, and scabicides.

Mupirocin (Bactroban)

A topical antibacterial agent primarily used to treat impetigo.

Impetigo Pathogen (S. aureus)

One of the primary bacteria responsible for causing impetigo infections.

Impetigo Pathogen (Str. pyogenes)

A common bacterial cause of impetigo alongside S. aureus.

Drug of Choice (DOC) for Impetigo

Topical mupirocin (Bactroban) when there are $1-5$ lesions present.

Treatment for Extensive Impetigo

Oral antibiotics are required when there are $> 5$ lesions.

Cephalexin (Keflex)

An oral antibiotic frequently used to treat extensive impetigo.

MRSA Coverage for Impetigo (Doxycycline)

An oral antibiotic option (Vibramycin) used if MRSA is suspected in impetigo.

MRSA Coverage for Impetigo (Clindamycin)

An oral antibiotic option (Cleocin) used if MRSA is suspected in impetigo.

MRSA Coverage for Impetigo (SMZ-TMP)

An oral antibiotic option (Bactrim) used if MRSA is suspected in impetigo.

Nasal MRSA Carrier Treatment

Colonization is eradicated using intranasal mupirocin (Bactroban).

Nasal Mupirocin Administration

Insert $\frac{1}{2}$ dose into each nostril.

Nasal Mupirocin Frequency

Application should occur $2 \times$/day.

Nasal Mupirocin Duration

The treatment course for nasal MRSA colonization is $5 \times/d$.

Furuncle

Also known as a boil or abscess, typically caused by S. aureus.

Abscess Size for Systemic Antibiotics

Systemic antibiotics are needed for abscesses $> 2\,cm$.

Abscess Cellulitis Indicator

Systemic antibiotics are required if symptoms of cellulitis or infection are present.

MRSA Coverage for Abscess (Vibramycin)

Doxycycline is a systemic option for MRSA-positive furuncles.

MRSA Coverage for Abscess (Cleocin)

Clindamycin is a systemic option for MRSA-positive furuncles.

MRSA Coverage for Abscess (Bactrim)

SMZ-TMP is a systemic option for MRSA-positive furuncles.

Cellulitis Pathogen (Str. pneumoniae)

One of the common causative agents of cellulitis.

Cellulitis Pathogen (S. aureus)

A frequent bacterial cause of skin cellulitis.

Cellulitis Pathogen (H. influenzae)

A less common but noted causative agent of cellulitis.

Cellulitis Management

Requires empiric treatment with broad-spectrum antibiotics.

Nystatin (Mycostatin)

A topical antifungal agent used for candidiasis.

Clotrimazole (Lotrimin)

A topical antifungal agent used for various tinea and candida infections.

Miconazole (Desenex)

A topical antifungal agent used for cutaneous fungal infections.

Ciclopirox (Penlac)

A topical antifungal lacquer used primarily for onychomycosis.

Oral Candidiasis Treatment (Nystatin)

Administered as a Swish and Swallow (S&S) preparation.

Nystatin Oral Frequency

Applied qid ($4 \times$/day).

Nystatin Oral Duration

Treatment should continue for $48\,h$ after clinical cure.

Clotrimazole Troches

An alternative treatment for oral candidiasis.

Clotrimazole Troche Regimen

Used five times daily for a duration of $14\,d$.

Cutaneous Candidiasis Treatment

Use of nystatin powder, clotrimazole cream, or miconazole cream.

Cutaneous Candidiasis Regimen

Topical application bid for $14\,d$.

Candidiasis Adjunct Therapy

A mild topical corticosteroid may be added to antifungal treatment if needed.

Tinea Corporis Treatment

Clotrimazole or miconazole cream applied bid for $14\,d$.

Tinea Cruris Treatment

Clotrimazole or miconazole cream applied bid for $14\,d$.

Tinea Pedis Duration

Clotrimazole or miconazole cream should be used for $2-4\,wks$.

Tinea Versicolor (Selenium Sulfide)

Selsun Blue shampoo used qd for $1\,wk$.

Tinea Versicolor (Topical Cream)

Clotrimazole or miconazole cream used bid for $2-4\,wks$.

Onychomycosis Topical Schedule

Ciclopirox application qd for $24-48\,wks$.

Griseofulvin (Grifulvin V)

Systemic first-line therapy for tinea capitis.

Tinea Capitis Griseofulvin Duration

Therapy may last up to $12\,wks$.

Tinea Capitis Adjunct

Biweekly shampooing with an antifungal shampoo is recommended during systemic treatment.

Griseofulvin Contraindication (Liver)

Should not be used in patients with hepatic disease.

Griseofulvin Contraindication (SLE)

Contraindicated in patients with systemic lupus erythematosus.

Griseofulvin Contraindication (Pregnancy)

Avoid use in pregnant patients.

Griseofulvin Adverse Effects

Includes hypersensitivity reactions and central nervous system (CNS) effects.

Griseofulvin Absorption Advice

Patient should take the medication with a high-fat meal to ensure adequate absorption.

Terbinafine (Lamisil) Indication

First-line systemic therapy for onychomycosis.

Terbinafine Onychomycosis Duration

Dosed daily for $6-12\,wks$.

Terbinafine Contraindication (Kidney)

Contraindicated in patients with renal impairment.

Terbinafine Contraindication (Liver)

Contraindicated in patients with liver impairment.

Terbinafine Common Side Effects

Includes GI upset, altered taste, and rash.

Terbinafine Serious Skin Reactions

Rare risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Terbinafine Blood Dyscrasias

A rare but serious adverse effect involving blood cell abnormalities.

Terbinafine Warning Sign (Anorexia)

Patients should report persistent loss of appetite.

Terbinafine Warning Sign (RUQ Pain)

Patients should report right upper quadrant pain indicating potential liver issues.

Terbinafine Warning Sign (Jaundice)

Patients must report yellowing of the skin or eyes.

Terbinafine Warning Sign (Urine/Stool)

Patients must report dark urine or pale stools.

Terbinafine Monitoring (LFTs)

Liver function tests should be monitored every $6\,wks$.

Terbinafine Monitoring (CBC)

Complete blood count should be monitored every $6\,wks$.

Acyclovir (Zovirax) Indication

Topical antiviral used for herpes simplex virus (HSV).

Acyclovir HSV Regimen

Applied five times per day for $4\,d$.

Penciclovir (Denavir) Indication

Topical antiviral used for herpes simplex virus (HSV).

Penciclovir HSV Regimen

Applied q2h while awake for $4\,d$.

HSV Therapy Timing

Treatments should start as early as possible after the onset of signs and symptoms.

Antiviral Application Safety

Patients should wear a glove or finger cot during application.

Autoinoculation Prevention

Gloves prevent the virus from spreading to other body sites or other people.

Topical Retinoids (Examples)

Tretinoin (Retin-A) and adapalene (Differin).

Topical Retinoid MOA (Keratinization)

They alter the abnormal keratinization process associated with acne.

Topical Retinoid MOA (Mitosis)

They stimulate mitotic activity in follicular epithelial cells.

Topical Retinoid MOA (Turnover)

They increase the turnover of follicular epithelial cells.

Topical Retinoid Expectations

Acne may initially worsen before improving.

Topical Retinoid Response Time

Clinical improvement is typically seen with $6-8\,wks$ of continued treatment.

Topical Retinoid Adverse Effects

Includes redness, peeling, and photosensitivity.

Acne Topical Antibiotics (Examples)

Benzoyl peroxide, erythromycin, and clindamycin.

Acne Oral Antibiotics (Examples)

Tetracycline, doxycycline, and minocycline.

Acne Hormonal Therapy

Combined Oral Contraceptives (COC) can be used as a treatment.

Isotretinoin (Accutane) Criteria

Reserved for severe or treatment-resistant acne.

Isotretinoin Prescriber Rule

Must be prescribed by a dermatologist.

Isotretinoin MOA (Sebum)

Works by decreasing sebum production.

Isotretinoin MOA (Keratinization)

Works by decreasing abnormal keratinization.

Isotretinoin Contraindication (Age)

Not for use in children $< 12$ years old.

Isotretinoin Contraindication (Mental Health)

Contraindicated in patients with psychotic disorders.

Isotretinoin Pregnancy Protocol

Women must have a negative pregnancy test before starting.

Isotretinoin Birth Control Requirement

Must start birth control at least $1\,mth$ before initiating therapy.

Isotretinoin Post-Therapy Pregnancy Rule

Avoid pregnancy for at least $1\,mth$ after discontinuing the drug.

Isotretinoin AE (Cheilitis)

Inflammation/cracking of the lips, a common adverse effect.

Isotretinoin AE (Dermatologic)

Common adverse effects include dry skin.

Isotretinoin AE (Ocular)

Can cause conjunctivitis.

Isotretinoin AE (Lipids)

Risk of developing hypertriglyceridemia.

Isotretinoin AE (Metabolic)

Potential for hyperglycemia.

Isotretinoin AE (Psychiatric)

Can cause depression, psychosis, and suicidal ideation (SI).

Isotretinoin AE (Skeletal)

Potential for decreased bone mineral density.

Topical Corticosteroids (Examples)

Hydrocortisone, triamcinolone, mometasone, and clobetasol.

Topical Corticosteroid Uses

Commonly used to treat dermatitis, eczema, and psoriasis.

Topical Corticosteroid MOA (Cells)

Inhibit migration of macrophages and leukocytes.

Topical Corticosteroid MOA (Vascular)

Reverse vascular dilation and permeability.

Topical Corticosteroid Outcomes

Results in decreased edema, erythema, and pruritus.