Biologics
Biologic commonly used for atopic dermatitis
Dupixent
Patient, Anna, is being in seen in clinic. 20 Y/O F. We already roomed her. George and Linda walk in and asks if they can go back in the room with Anna as they are friends. How do we proceed?
Knock on Anna's room asks if she knows him. "Hi Anna, George and Linda are in the lobby stating they know you and would like to go back with you. Unfortunately we only allow one person back with you. Prior to doing so we need an authorization sheet filled out. Is that okay?"
Vitiligo
A disease that causes the loss of skin color in blotches
S/E
Side effects
Please pull up K 40 mg/cc, 3.5CC.
Pull straight.
Which areas are patient's allowed to inject on themselves?
Abdomen and thighs
It is Tuesday afternoon. We are full in rooms.
Patient A is in a wheelchair, confused, with no caregiver yet. They are running behind.
Patient B is upset at patient A. Patient B is early by an hour. Wants water.
Patient C wants to be added on for suture removal.
Patient B can wait in the hallway if they would like and we will get them once we have a room open if other patient's scheduled before them do not show up. Or they may come back in 30 minutes since they are early. Offer water.
If possible patient A can wait in the office. If too busy. Try to orient patient A. Offer them water, chat with them.
Patient C can be seen by Sunshine if we are too busy or can be used by her room if empty.
Pruritus
Itching
H/O
History of
Patient is unsure of his medical history. What can we infer?
Atenolol
Insulin pen KwikPen
Oral Tacrolimus
He is on a beta blocker, may have either hypertension, cardiac arrhythmias, and/or heart failure.
Insulin kwikpen- diabetic.
Oral Tacrolimus - Organ transplant. Needs to be seen for a skin ✓ ASAP. Risk of SCC.
A pill used for plaque psoriasis. No initial labs required.
Otezla
Patient is 30 minutes late for VV.
A) Let me check with Dr. Wong to see if we have time for you.
B) Hi unfortunately you are late for your appointment as we have a 15 minute window period. Let me check the schedule to see if we have any cancellations to fit you in today or would you like to reschedule?
C) Hi unfortunately you are late for your appointment as we have a 15 minute window period. Let me check with Dr. Wong to see if we have time for you.
D) So sad you had traffic. Aw... let's reschedule you buddy. Yeah I don't want to hear it! You will take this appointment whether you like it or not!
B Hi unfortunately you are late for your appointment as we have a 15 minute window period. Let me check the schedule to see if we have any cancellations to fit you in today or would you like to reschedule?
Contusion
Bruising
SOA
Schedule of appointments
What common Rx is prescribed for acne before Accutane?
BP 5 or 10%
Clindamycin Gel
Tretinoin
Minocycline
Doxycycline
Spironolactone
Azelaic acid
Adapalene
Salicylic acid
Formal name for Skyrizi
A) Risankizumab
B) Adalimumab
C) Rikanumalve
D) Padalumive
Risankizumab
Patient with a walker and can't see very well.
Guide patient. Guide them to sit down where the chair is. Hold the door open for them. Provide verbal cues.
Erythematous
Redness of skin.
SOB
Shortness of breath
Vitiligo & atopic dermatitis
Initial lab work for HS/Psoriasis to start them on biologics.
QuantiFERON(R)-TB Gold
CBC (includes Differential and Platelets)
CMP
Hepatitis B Core Antibody, Total
Hepatitis B Surface Antibody, Qualitative
Hepatitis B Surface Antigen with Reflex Confirmation
Hepatitis C Antibody with Reflex to HCV, RNA, Quantitative, Real-Time PCR
HIV-1/2 Antigen and Antibodies
Patient is uncomfortable laying flat for their biopsy on their abdomen.
Offer a pillow under their head. Raise HOB is applicable. If in room 3 change the room to 1 or 2.
Ichthyosis
Dry, scaly, thickened skin that can be rough and red
Fish scales
Labs are WNL. D/C HC 1%. Optional to use Clobetasol cr 0.05% QD-QOD. Resume with Dupixent subq inj q2weeks. Since dysphagia present, please order cetirizine 1 mg/mL oral syrup. Take PO 1tbsp QHS.
Please ask patient is any S/E such as NVD to Keflex.
Labs are within normal limits. Discontinue Hydrocortisone 1%. Optional to use Clobetasol cream 0.05% every day to every other day. Resume with Dupixent subcutaneous injection every 2 weeks. Since dysphagia (difficulty swallowing) present, please order cetirizine 1 mg/mL oral syrup. Take by mouth. 1 tablespoon every night.
Please ask patient is any side effects such as nausea, vomiting and diarrhea to Keflex.
K 2.5 cc 3.5 cc
Three separate syringes in a 1 CC
0.25 ml K 10 + 0.75 cc Saline = 1 cc x3
0.2 ml K 10 + 0.6 cc Saline = 0.8 CC x1