N609

First line treatment - is avoidance if possible. May use topical cortical steroids and/or oral antihistamines for itching. (Ex. hydrocortisone 1% or 2.5% and OTC Zyrtec/Claritin or Benadryl)
Second line - increased potency of topical corticosteroid. (Ex. triamcinolone 0.1%, mometasone 0.1% - can go higher but not super common in primary care)
Third line - oral corticosteroids (Ex. prednisone (taper or burst up to 10 days), methylprednisolone (usually taper but can burst up to 10 days)

Diagnosed by culture and/or microscopic evaluation, and sometimes clinical presentation alone - symptoms burning, itching, stinging of the scalp or skin. Standard treatment is topical and sometime oral antifungal agent. Ex. of treatments below:
Tinea Capitis (scalp) - terbinafine 250 mg PO daily 4-8 wks. (systemic treatment is sometimes needed)
Tinea Corporis (body) - terbinafine topical 1% gel/cream/spray daily 1-4 weeks, clotrimazole topical 1% cream/solution bid for 2-4 weeks

Tinea Pedis (feet) - terbinafine topical 1% twice daily for 1-4 weeks, OR naftifine topical 1% cream qd, 1% gel bid for up to 4 weeks
Tinea Manuum (hands)- griseofulvin microsize 500- 1000 mg orally given in 1-4 divided doses 4-8 weeks, OR terbinafine 250 mg orally once daily for 6 weeks
Tinea Unguium (nails) -terbinafine 250 mg orally once daily for 12 weeks (toenails) or 6 weeks (fingernails)

VERY common with infants/toddlers. Usually a clinical diagnosis with red/flat/itching rash. In adults will have same presentation. Causes by yeast infection of the skin. Warm, wet, dark places are where this can happen (so not only in diapers) - ex. skin folds, under clothing that is keeping skin dark, wet, warm.
Typical treatment - topical barrier and good diaper practice. Along with topical antifungal therapy - nystatin 100,000 units/g apply to affected area 3 times daily continue use for 3 days after rash clears.

Very common concern, mild to moderate acne easily treated in primary care
Mild inflammatory acne - mainstay of tx is good skin care routine with gentle cleansers, toners and lotions that work well with acne prone skin
RX
Comedones only- Primary initial treatment topical: tretinoin, adapelene, tazarotene, trifarotene
Comedones only - Secondary initial treatment topical/comedones only: salicylic acid
Papules/pustular - Primary initial treatment topical: topical retinoid+topical antibiotic (ex. Tretinoin topical and Clindamycin foam topical)
Moderate inflammatory acne - good skin care as mentioned above
RX
Primary options for treatment: topical retinoid + oral antibiotic (ex. Tretinoin topical and doxycycline (ONLY 2-3 months for oral antibiotic - then step down to topical)
(see drug guides for exact ages and dosing considerations and more secondary options)
Refer to dermatologist if severe acne and/or if above treatment fails

Inner ear infection based on otoscopic exam and history. VERY common in toddlers, less common as we develop into adulthood. However, anatomy anomalies can increase risk.
Typical treatment is symptomatic care for pain/fever and oral antibiotics. Top examples below:
Amoxicillin 90 mg/kg bid for 10 days (note higher dose for inner ear coverage)
Cefdinir 14 mg/kg daily for 10 days
Azithromycin 10 mg/kg daily on day one, then 5 mg/kg on days 2-5

Usually bacterial infection of the ear canal. Also known as "swimmers ear". Canal is red/swollen/tender - sometime you are unable to see the TM.
Standard treatment is otic drops, ex. below
Ciprofloxacin/dexamethasone otic - 4 drops twice daily for 7-10 days
Ofloxacin otic = 5 drops once daily for 7 days (children), 10 drops once daily for 7 days (adult)

Very common issue that is seen in adult males that have gone through andropause (sometimes earlier and for other reasons). Do NOT take if taking nitrates as could drop BP. Treatment examples below:
Sildenafil 25-100 mg orally once daily - one hour before activity
Tadalafil 5-20 mg orally once daily 45 minutes before activity OR 2.5-5mg orally once a day

Remove stimuli that may be causing the headaches, review diet. Ensure not "worst headache of their life" OR trauma to the head. If emergent headache they need to go to ER ASAP. If OTC treatments are helping (acetaminophen or ibuprofen) then can go migraine specific medications. Ex. Triptan migraine medications below
Rizatriptan 5-10 mg orally as a single dose may repeat after 2 hours - max per day is 30 mg
Sumatriptan 25-100 mg orally as a single dose, may repeat after at least 2 hours - max in a day is 200 mg

VERY common and very effective when taken daily within the same 2 -hour window. Important to review what missed doses look like with patient (follow manufacturer directions). Contraindication - migraine with aura, blood clotting disorders, hypertension, smoking, certain cancers (note: progestin only can be done in migraine pts and hypertension pts)
Ex. of typical doses below
Monophasic (Yasmin) - drospirenone/ethinyl estradiol 3mg/30 (3 weeks active pill, 1 week inactive)
Triphasic (Ortho Novum 777)- norethindrone/ethinyl estradiol 0.5 mg/35 mcg, 0.75mg/35 mcg, 1 mg/35 mcg) (gradual increase 3 weeks of active pills, 1 week inactive)
Progesterone only - drospirenone 4mg (24 days active pills, 4 days inactive) MUST BE TAKEN SAME TIME OF DAY TO WORK

Mirena IUD (progestogen)- levonorgestrel intra-uterine device 52 mg, good for 5-7 years (note periods may stop or be very light - some spotting)
Paragard IUD (copper) - copper intra-uterine device releases copper into uterine cavity good for 10 years (note can cause heavy periods)
Nexplan (progestogen) - subdermal implant (upper inner arm) etonogestrel device 68 mg, good for 3 years (note can cause sporadic periods/spotting)

Common in children but can see in adults. Key is knowing there are 3 TYPES VIRAL, ATOPIC and BACTERIAL. Viral typically resolves on its own. Atopic is allergy related and OTC allergy eye drops are the mainstay of treatment. Bacterial is treated with optic antibiotics. Ex. below.
Polymyxin B/trimethoprim ophthalmic - 1 drop every 4 hours or up to 6 times daily 7-10 days
Erythromycin ophthalmic - ointment applied to water line on lid up to 6 times daily
IF CONTACT LENS wearer recommend Ofloxacin opthalmic - 1-2 drops every 2-4 hours for 2 days, then 1-2 drops 4 times a day for 5 days.

Arcangelo, V. (2022). Pharmacotherapeutics for Advanced Practice: A Practical Approach. 5th ed.
Wolters Kluwer. Philadelphia, PA
Epocrates. (2025). Epocrates medical references [Mobile app]
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