Atopic Dermatitis (Eczema): - Patchy, plaque-like rash
Flexular surfaces
IgE mediated
Treatment:
Topical corticosteroids
Use lowest potency
Complications of long-term topical steroid use: Atrophy, striae, rosacea
TOPICAL STEROID WITHDRAWAL - debilitating (skin manifestations, depression, insomnia, pain)
Oral , intranasal steroids
Non-pharm - Bathing, no harsh soaps, wet-wrap therapy, prevent trauma, ointments
Atrial Fibrillation (A-Fib) - an irregular and often very fast heart rate originating from abnormal
conduction in the atria
A fib treatment - Treatment with beta blockers or non-dihydropyridines (CCB-diltiazem) or other
antidysrhythmics
Anticoagulate with warfarin
When starting warfarin, when should you get the first INR based off of half life? - 3 Days
· Peripheral Artery Disease:
,Defined by: - Resting ankle-brachial index (ABI) of < 0.90
· Peripheral Artery Disease:
o Caused by: - Atherosclerosis
· Peripheral Artery Disease:
o Assessment: - Intermittent claudication
Thickened toenails
Pale, cold, rubor lower extremities
Pain at rest or when sleeping (late sign)
Decreased pulses
Increased cap refill
Peripheral Artery Disease:
o DX Studies: - Angiography, doppler US
ABI > 0.90 = PAD
ABI >1.3 = Severe and need toe-brachial-index (TBI)
Peripheral Artery Disease:
o Treatment: - Antiplatelets (Petal, Plavix, ASA)
Pentoxifylline (decreases blood viscosity)
Transposition of the Great Vessles - a congenital heart defect in which the position of the two major
vessels that carry blood away from the heart, the aorta and the pulmonary artery, is switched
,o What is the MOA of prostaglandin in a patient with transposition of the great vessles? - To produce
vasodilation and provide adequate oxygenation
· Varicose Veins: assessment - o To assess varicose veins on a patient you put them in Trendelenburg.
· Heart Failure:
o Left: - Orthopnea, tachycardia, tachypnea exertional dyspnea, cyanosis, crackles, blood-tinged sputum
· Heart Failure:
o Right - Ascites, enlarged liver/spleen, JVD, Anorexia/GI distress, dependent edema, weight gain
NYHA Heart Failure Classification: - 1 = cardiac disease, but no symptoms or limitations
2 = mild symptoms and slight limitation
3 = significant limitation due to symptoms, comfortable at rest
4 = severe limitation, symptoms at rest
Heart Failure Med Classes: - HCTZ
Loop diuretics
ACE/ARBS
Beta Blockers
CCB's
ONLY Dihyrdropyridine CCB's are used in HF with preserved EF for BP management
Peripheral Edema: - Caused by right heart failure
, Coronary Artery Disease:
Caused by - dyslipedemia/hyperlipedemia
Coronary Artery Disease:
Big Guns: - Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
***All other statins are indicated for moderate LDL elevation***
Anyone with an LDL >160 with family history, stroke history, or MI history automatically get high-
intensity agents (BIG GUNS)
Hypertension: - HTN >130/80
Masked hypertension - normal in office, high during daily activities
Ambulatory/Home BP monitoring is important
hypertension treatment - CCB's (Diltiazem, Amlodipine)
ACE/ARB (Lisinopril, Losartan)
Thiazide Diuretics (HCTZ)
Watch for electrolyte imbalances/dehydration in elderly population
Black Population:
Do NOT start with ACE/ARB - their bodies do not respond well