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Pharm - Skin and Soft Tissue Infections
Skin and Soft Tissue Infections
69
Pharmacology
Graduate
03/01/2010

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Cards

Term
Give 5 examples of primary infections.
Definition
superficial cellulitis, folliculitis, furunculosis, simple abscess, minor wound infection
Term
Name 4 examples of secondary infections.
Definition
complicated abscess, diabetic ulcers, infected burn wounds, deep space wound infections
Term
What is folliculitis?
Definition
inflammation of a hair follicle
Term
Name 2 causative agents of folliculitis?
Definition
Staph. aureus and Pseudomonas aeruginosa
Term
What is hot tub disease?
Definition
folliculitis caused by Pseudomonas aeruginosa
Term
What oral antibiotic will resolve folliculitis?
Definition
cephalexin (Keflex)
Term
What type of infection is a stye?
Definition
folliculitis of the eyelash follicle
Term
What OTC topical agents are used to treat folliculitis?
Definition
bacitracin/neomycin/polymyxin B (Neosporin) and bacitracin zinc/polymyxin B sulfate (Betadine Brand)
Term
What Rx topical agents are used to treat folliculitis?
Definition
acne preparations such as benzoyl peroxide (Benzac), doxycycline (Doryx), and clindamycin/benzoyl peroxide (Benzaclin); or mupirocin (Bactroban, Centany)
Term
How do you treat extensive folliculitis? (hot tubitis?)
Definition
systemic antibiotic - cephalexin (Keflex)
Term
What generation of cephalosporins is cephalexin?
Definition
1st generation
Term
What non-drug treatment is useful in folliculitis?
Definition
warm compresses
Term
What is benzoyl peroxide?
Definition
an antibacterial cleansing agent for acne
Term
How does benzoyl peroxide work to treat folliculitis?
Definition
it kills the bacteria and promotes the growth of new skin cells; it also dries the skin
Term
When should you use mupirocin (Bactroban, Bactroban nasal, Centany)?
Definition
Reserve for severe infections - has good MRSA coverage
Term
What is mupirocin (Bactroban nasal) used for?
Definition
decolonize nose (MRSA)
Term
What is the mechanism of action of mupirocin (Bactroban)?
Definition
selective binding to bacterial isoleucyl-tRNA synthetase, which halts the incorporation of isoleucine into bacterial proteins
Term
What is dissecting cellulitis of the scalp?
Definition
a simple folliculitis that begins as clusters of pustules and progresses to absces and sinus formation with scarring alopecia. Lesions are resistant to treatment and are progressive. This is rare and typically occurs in black men between 18-40. Referral.
Term
What is Grover's disease?
Definition
pruritic papules on trunk (typically white, older men who have been hospitalized). Possibly occlusion of sweat ducts? Exacerbated by sunlight, excessive heat, or sweating. Lesions may last weeks to years. Treatment is avoidance and symptomatic for pruritis.
Term
What is a furuncle?
Definition
An abscess, boil, walled-off mass of purulent material caused by a single pathogen; firm, red, and tender nodule - may drain spontaneously
Term
What is furuncle treatment for a closed lesion?
Definition
Broad spectrum abx for 7-10 days; RTC in 5-9 days for incision and drainage - remove the lesion as an intact mass
Term
How do you dress a incised and drained furuncle?
Definition
pack the wound with iodoform gauze as needed and perform daily dressing changes - use mupirocin ointment (to avoid MRSA infection) after opened, but oral abx before that (while closed); F/U in 1-3 days
Term
How do you treat an open furuncle?
Definition
Carefully remove all of the lesion - looking for a sac as well as caseated material. Pack with iodoform gauze, daily dressing changes, mupirocin (Bactroban), and maybe prescribe an oral abx; F/U in 1-3 days
Term
What is a carbuncle?
Definition
a broad, swollen, erythematous, deep, painful follicular mass
Term
What symptoms are usually associated with carbuncles?
Definition
fever, chills, malaise
Term
How do you treat a carbuncle?
Definition
clean the area daily with soap and water; sterile dressing if purulence; mupirocin to open wounds; wound culture; abx - fluoroquinolone, tetracycline, or amoxicillin/clavulanate
Term
What is erysipelas?
Definition
tender red edematous plaque; often found on the face along the jaw line
Term
What is bullous erysipelas?
Definition
tender red edematous plaque with bullous formation; legs and face are primary sites
Term
What typically causes bullous erysipelas?
Definition
GABHS
Term
What other symptoms are typically seen with bullous erysipelas?
Definition
lymphangitis, fever, chills
Term
What is the recurrence rate of bullous erysipelas and why?
Definition
30% because of lymphatic obstruction
Term
What is the treatment for bullous erysipelas?
Definition
rupture of bullae, debridement, and compression stockings

cephalexin
Term
What is impetigo?
Definition
red scaly patch with scattered crusted erosions; most common bacterial skin infection in children
Term
What season is impetigo most commonly seen in?
Definition
summer
Term
What is the treatment for impetigo?
Definition
clean the area daily - not with topical disinfectant; mupirocin, retapamulin - ointments or cephalexin, dicloxacillin - oral abx
Term
What is lymphangitis?
Definition
linear, lymphagatic red edematous plaque
Term
What is the treatment for lymphangitis?
Definition
immobilizaion and elevation of the infected area; parenteral abx - penicillin, then after fever abates switch to oral penicillin for 10 days
Term
When is cellulitis a medical emergency?
Definition
When it involves the periorbital area
Term
Describe cellulitis.
Definition
history of a minor wound that begins an infection
Term
How do you treat cellulitis?
Definition
cephalexin (Keflex), amoxicillin/clavulanate (Augmentin), or tirmethoprim/sulfamethoxazole (Bactrim)
Term
How do you treat serious cellulitis? (orbital cellulitis or large areas of infection)
Definition
IV antibiotics
Term
What is necrotizing fasciitis?
Definition
rapidly progressive painful erythema and edema of an area following history of a minor wound
Term
What factors are included in calculating the risk that an infection is necrotizing fasciitis?
Definition
C-reactive protein, WBC count, Hemoglobin, Sodium level, Creatinine level, and Glucose level
Term
What is a diabetic foot ulcer?
Definition
a well demarcated necrotic ulcer found on the foot of a diabetic patient; ulcerated plaques over weight bearing areas
Term
Are diabetic ulcers polymicrobial?
Definition
yes
Term
What is the % of diabetic patients that develop a foot ulcer during their lifetime?
Definition
15-25%
Term
How many diabetics are there in the U.S.?
Definition
23.6 million
Term
Give 2 reasons diabetics get diabetic foot ulcers.
Definition
1. Peripheral sensory neuropathy - prone to injury
2. Peripheral motor neuropathy - affects normal roll over process of joints leading to pressure points
Term
What is the treatment for diabetic foot ulcers?
Definition
PREVENTION
Rule out osteomyelitis
Oral broad specrum antibiotic - fluoroquinolone, amoxicillin/clavulanate
Debridement of the wound to bleeding margins
Daily care
Term
How can you prevent diabetic foot ulcers?
Definition
Keep sugars under control long term
Annual foot exams
Good socks and shoes - change shoes often
Inspect foot daily
Wash feet and dry between toes
Treat any break in the skin, rashes, or onychomychoses promptly
Term
How do you rule out osteomyelitis in a diabetic foot ulcer?
Definition
probe to bone or MRI
Term
How long do you dose an oral abx for a diabetic foot ulcer?
Definition
10-14 days, if no S/S of infection, discontinue
Term
How long does treatment of a diabetic foot ulcer last?
Definition
minimum of 6 weeks - they heal slowly
Term
When do you use IV abx for diabetic foot ulcers?
Definition
if extensive area or if osteomyelitis is suspected
Term
How far do you debride the diabetic foot ulcer?
Definition
to bleeding margins
Term
Why should you not use Hydrogen peroxide and antiseptic cleaners when trying to get a wound to heal?
Definition
they retard wound healing by killing the new cells trying to reform
Term
What should daily care of a diabetic foot ulcer include?
Definition
washing with soap and water, mupirocin (Bactroban) ointment, and clean sterile dressing
Term
What is a more intense treatment for diabetic foot ulcers?
Definition
becaplermin (Regranex) 0.1% gel
Term
What is in becaplermin (Regranex) 0.1% gel?
Definition
platelet-derived growth factors (PDGFs); these recruit cells around the ulcer and initiate the second phase of healing - proliferation
Term
What is important to note about becaplermin (Regranex)?
Definition
It is a 12-hour topical treatment. Apply it in the AM and remove in the PM. Use an abx cream/ointment at night.
Term
What non-drug treatment is used as part of more intense treatment of diabetic foot ulcers?
Definition
relieving pressure by casting or using half shoes, boots and other devices
Term
How often do diabetic foot ulcers need to be debrided?
Definition
weekly
Term
What is the average time for a healing of a diabetic foot ulcer?
Definition
42 days
Term
How do you treat foot ulcers in those with peripheral vascular disease? (PVD)
Definition
debride, place a sterile dressing, then apply an Unna boot
Term
What is an Unna boot?
Definition
a gauze bandage impregnated with a zinc ointment; it relieves edema and promotes healing
Term
How often does an Unna boot need to be replaced?
Definition
every 2-3 days
Term
What % of melanomas appear on the plantar surface?
Definition
7%
Term
In what ethnicity is the plantar surface of the foot the most common location of melanoma?
Definition
Japanese
Term
What is a decubitus ulcer?
Definition
a pressure sore; usually induced by lying in one position for too long - which compromises the blood supply to the skin
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