Common Skin Conditions Flashcards

1
Q

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

class:

Indications:

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

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2
Q

The ______________________________ has pictures of common skin conditions that help identify it.

Another helpful resource is ___

A

Handbook of Nonprescription Drugs “OTC handbook of drugs”

www.dermnet.com

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3
Q

Natural products used for skin conditions:

  • Aloe
  • Tea Tree Oil
  • Lysine
  • Biotin
  • Topical Vitamin D
A
  • Aloe: is a natural product produced from the aloe vera plant and is used for sunburn and psoriasis.
  • Tea Tree Oil: is used for acne
  • Lysine: taken as a tablet, capsule or applied topically, is used for Cold sore (herpes simplex labialis) prevention
  • Biotin: is a vitamin used for hair loss and brittle nails
  • Topical Vitamin D: diaper rash and psoriasis
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4
Q

Drugs that can discolor skin and secretions:

Brown color

A

Entacapone
Levodopa
Methyldopa

  • all can make urine brown
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5
Q

Drugs that can discolor skin and secretions:

Black/Green/Brown

A

Iron (black tary stool)

Methocarbamol

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6
Q

Drugs that can discolor skin and secretions:

Brown/Yellow

A

Nitrofurantoin* - can turn urine brown
Metronidazole
Tinidazole
Riboflavin (B2)

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7
Q

Drugs that can discolor skin and secretions:

Orange/Yellow

A

Sulfasalazine

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8
Q

Drugs that can discolor skin and secretions:

Yellow-Green

A

Propofol*
Flutamide

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9
Q

Drugs that can discolor skin and secretions:

Red-Orange

A

phenazopyridine* (a urinary analgesic) can cause urine to be red- orange.

rifampin*- come IV as a red formulation. It can discolor both Skin and Secretions. This can stain contact lenses.

rifapentine

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10
Q

Drugs that can discolor skin and secretions:

Red

A

anthracyclines (for the treatment of cancers)

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11
Q

Drugs that can discolor skin and secretions:

Blue
“Smurf drugs”

A

methylene blue
mitoxantrone

  • both of these drugs are actually blue.
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12
Q

Drugs that can discolor skin and secretions:

Blue-Gray
“Smurf drugs”

A

amiodarone*- can tint the skin a blueish gray color

chloroquine

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13
Q

Drugs that can discolor skin and secretions:

Purple/Orange/Red

A

chlorzoxazone

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14
Q

Types of Acne Pimples:

A

In general, we have different types of bacteria on the surface of our skin.

We also have sebaceous glands which have oils and these can become clogged from dead skin cells, or oil.

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15
Q

Types of Acne Pimples:

White head

Black head

A
  • these are normal mild acne lesions

White head- Pore is sealed (white closed comedone)

Black head - (black open comedone)

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16
Q

Types of Acne Pimples:

Papules

A
  • are seen in moderate to severe acne
  • there’s inflammation
  • WBCs attacking bacteria infection
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17
Q

Types of Acne Pimples:

Pustules

A
  • are seen in moderate to severe acne
    -sometimes referred to as Nodular or Cystic acne
  • WBCs and waste products from bacteria, this is where you see Puss production
  • there’s inflammation
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18
Q

Acne is classified according to the severity of the lesions.

Mild-
Moderate-
Severe-

Treatment is determined by severity.

A

Salicylic acid- can be helpful for very mild acne but not as effective as other agents

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19
Q

Mild Acne Tx:

First line-

Alternative–

A

First line-
(BPO) Benzoyl Peroxide
or
Topical retinoids (tretinoin, adapalene, tazarotene, trifarotene)
or
*Topical Combination Therapy = 1 of the 3 options
1) BPO + retinoid
2) BPO + topical antibiotic (all prescription)
3) BPO + topical antibiotic + retinoid

Alternative–
- add topical retinoid or BPO if patient is not already on.
or
- switch to a different retinoid
or
- use Topical dapsone (Aczone)

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20
Q

Moderate Acne Tx:

First line-

Alternative–

A

First line- *Topical Combination Therapy = (1 of 3 following options)
1) BPO + retinoid
2) BPO + topical antibiotic (all prescription)
3) BPO + retinoid + topical antibiotic

OR

Oral antibiotic + BPO + topical retinoid (+/- topical antibiotic)

Alternative——————————————————————

  • change oral antibiotic
    OR
    For Females: can add combined oral contraceptive.
    OR
    For Females: can add spironolactone.
    OR
    trial
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21
Q

Severe Acne Tx:

First line-

Alternative–

A

First line- *Topical Combination Therapy = (1 of 3 following options) + oral
1) BPO + retinoid
2) BPO + topical antibiotic (all prescription)
3) BPO + retinoid + topical antibiotic
PLUS an oral antibiotic

OR

oral isotretinoin (Oral retinoid)

Alternative–

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22
Q

(BPO) Benzoyl Peroxide is more effective than salicylic acid

A
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23
Q

(BPO) Benzoyl Peroxide Counseling Points:

A
  • can bleach clothing and hair
  • increase sensitivity to the sun. So limit sun exposure and it is best to apply these at bedtime.
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24
Q

Topical Retinoid Counseling Points:

A
  • known Teratogens, need to be avoided in pregnancy and breastfeeding
  • are also used to reduce wrinkles
  • increase sensitivity to the sun. So limit sun exposure and it is best to apply these at bedtime. Using only a pea-sized amount.
  • if product causes irritation, then patient can apply every other day instead of daily or switch to a lower strength.
  • these products take time to work. usually 4-12 weeks to work and initially acne will worsen before it gets better.
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25
Q

How do Retinoids work?

A
  • Work primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands
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26
Q

How does BPO work?

A
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27
Q

The only topical OTC retinoid available is ______

A

adapalene (Differin)

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28
Q

BPO + hydrocortisone =

A

Vanoxide-HC

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29
Q

BPO + adapalene =

A

Epiduo, Epiduo Forte

  • these are gels
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30
Q

BPO + erythromycin =

A

Benzamycin

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31
Q

BPO + clindamycin =

A

BenzaClin, Acanya, Neuac, Onexton

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32
Q

oral isotretinoin has many safety concerns:

A
  • known Teratogen
  • Cholesterol and pregnancy tests are Required on a monthly basis
  • women must be on 2 forms of birth control and CANNOT use a progestin only pill (POP)
  • can only pick up a 30-day supply at a time
  • patients must sign a consent form about the safety concerns of birth defects
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33
Q

Oral isotretinoin should NOT be used with:

A
  • Vitamin A supplements
  • Tetracyclines
  • Steroids
  • Progestin only Contraceptives (POC) (e.g. Mini pill)
  • St. Johns wort
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34
Q

Spironolactone is an __________

A

aldosterone receptor antagonist with antiandrogen effects.

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35
Q

Retin-A

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tretinoin

class: retinoid - Vitamin A derivative

Indications: Acne

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: gel, cream,

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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36
Q

Altreno

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Altreno sounds like Alveeno sooo its a ______

A

tretinoin

class: retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: lotion

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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37
Q

Atralin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tretinoin

class: retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: gel

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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38
Q

Renova

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tretinoin

class: retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: cream

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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39
Q

Differin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

adapalene

class: retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: gel

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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40
Q

Epiduo
Epiduo Forte

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

BPO + adapalene

class: retinoid +

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms:

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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41
Q

Tazorac

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tazarotene

class: retinoid

Indications: Acne
approved in individuals aged 9 and older

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: cream, gel

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
- Tazarotene often works better than tretinoin; it is used in difficult cases

Drug-Drug/Food interactions:

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42
Q

Fabior

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tazarotene

class: retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: foam

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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43
Q

Arazlo

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tazarotene

class: retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: lotion

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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44
Q

Duobrii

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

halobetasol + tazarotene

class: steroid + retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: lotion

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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45
Q

Amzeeq

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

minocycline foam

class: tetracycline antibiotic

Indications: Acne

MOA:

Dosage forms: topical foam 4%

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- the topical foam should be applied at approximately the same time each day at least 1 hour before bedtime.
- the patient should NOT bathe, shower or swim for at least 1 hour after application of the product.
- After shaking the can well, a small amount of the foam should then be rubbed into acne affected parts of the face.
- may stain clothing

Drug-Drug/Food interactions:

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46
Q

Aczone

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

dapsone gel

class: antibiotic

Indications:
-topical treatment of Acne vulgaris (alternative option)

MOA: drug is a competitive antagonist of para-aminobenzoic acid (PABA) and prevents normal bacterial utilization of PABA for the synthesis of folic acid.

Dosage forms: gel 5%

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
** Avoid in G6DP deficiency**

major CYP3A4 substrate

Drug-Drug/Food interactions:

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47
Q

Winlevi

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clascoterone cream

class:

Indications:
- for the topical treatment of acne vulgaris in patients 12 years of age and older

MOA: drug is an androgen receptor inhibitor.

Dosage forms: 1% cream

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- Apply a thin layer to the affected area twice daily (morning and evening).
- HPA axis suppression may occur during or after treatment; more likely with use over a large surface area, prolonged use, and use with occlusive dressings.

For Pharmacist:
- Keep product refrigerated before dispensing, patient can store at room temperature

Drug-Drug/Food interactions:

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48
Q

HPA axis suppression:

what is this?
How do we control or treat?

A

inadequate cortisol production

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49
Q

Absorbica

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

isotretinoin

class: retinoid

Indications: Only FDA-approved for severe, refractory nodular acne

MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: capsules

Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks

Max dose:

Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.

Contraindications:
Pregnancy

Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.

Side Effects:

Monitoring:

Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped
.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *

Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.

Drug-Drug/Food interactions:

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50
Q

Amnesteem

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

isotretinoin

class: retinoid

Indications: Only FDA-approved for severe, refractory nodular acne

MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: capsules

Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks

Max dose:

Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.

Contraindications:
Pregnancy

Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.

Side Effects:

Monitoring:

Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped
.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *

Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.

Drug-Drug/Food interactions:

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51
Q

Claravis

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

isotretinoin

class: retinoid

Indications: Only FDA-approved for severe, refractory nodular acne

MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: capsules

Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks

Max dose:

Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.

Contraindications:
Pregnancy

Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.

Side Effects:

Monitoring:

Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped
.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *

Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.

Drug-Drug/Food interactions:

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52
Q

Myorisan

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

isotretinoin

class: retinoid

Indications: Only FDA-approved for severe, refractory nodular acne

MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: capsules

Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks

Max dose:

Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.

Contraindications:
Pregnancy

Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.

Side Effects:

Monitoring:

Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped
.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *

Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.

Drug-Drug/Food interactions:

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53
Q

Zenatane

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

isotretinoin

class: retinoid

Indications: Only FDA-approved for severe, refractory nodular acne

MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: capsules

Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks

Max dose:

Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.

Contraindications:
Pregnancy

Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.

Side Effects:

Monitoring:

Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped
.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *

Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.

Drug-Drug/Food interactions:

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54
Q

Minocin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

minocycline

class: tetracycline antibiotic

Indications: Acne

MOA: drug inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria; cell wall synthesis is not affected.

Dosage forms: capsule/topical foam/tablet/ ER capsule & ER tablet/solution

Dosing:
IR formulations: 50-100 mg PO BID; may be used for patients greater than or equal to 8 years of age*

XR formulations: 1mg/kg PO daily; ONLY approved for use in patients greater or equal to 12 years of age.**

Max dose:

Contraindications:
pregnancy
myasthenia gravis?

Warnings:

Side Effects:
-* can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
-* like other tetracyclines, can cause fetal harm if administered during pregnancy.
-* May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age)
.

Monitoring:

Pearls/Notes:
-does cross the placenta
- is present in breast milk

  • more effective than tetracycline in eradicating C. acnes

Drug-Drug/Food interactions:

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55
Q

Solodyn

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

minocycline

class: tetracycline antibiotic

Indications: Acne

MOA: drug inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria; cell wall synthesis is not affected.

Dosage forms: capsule/topical foam/tablet/ ER capsule & ER tablet/solution

Dosing:
IR formulations: 50-100 mg PO BID; may be used for patients greater than or equal to 8 years of age*

XR formulations: 1mg/kg PO daily; ONLY approved for use in patients greater or equal to 12 years of age.**

Max dose:

Contraindications:
pregnancy
myasthenia gravis?

Warnings:

Side Effects:
-* can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
-* like other tetracyclines, can cause fetal harm if administered during pregnancy.
-* May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age)
.

Monitoring:

Pearls/Notes:
-does cross the placenta
- is present in breast milk

  • more effective than tetracycline in eradicating C. acnes

Drug-Drug/Food interactions:

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56
Q

Ximino

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

minocycline

class: tetracycline antibiotic

Indications: Acne

MOA: drug inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria; cell wall synthesis is not affected.

Dosage forms: capsule/topical foam/tablet/ ER capsule & ER tablet/solution

Dosing:
IR formulations: 50-100 mg PO BID; may be used for patients greater than or equal to 8 years of age*

XR formulations: 1mg/kg PO daily; ONLY approved for use in patients greater or equal to 12 years of age.**

Max dose:

Contraindications:
pregnancy
myasthenia gravis?

Warnings:

Side Effects:
-* can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
-* like other tetracyclines, can cause fetal harm if administered during pregnancy.
-* May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age)
.

Monitoring:

Pearls/Notes:
-does cross the placenta
- is present in breast milk

  • more effective than tetracycline in eradicating C. acnes

Drug-Drug/Food interactions:

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57
Q

Veltin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clindamycin + tretinoin

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58
Q

Ziana

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clindamycin + tretinoin

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59
Q

Aklief

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

trifarotene

class: retinoid

Indications:

MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.

Dosage forms: lotion

Dosing:

Max dose:

Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing

Drug-Drug/Food interactions:

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60
Q

Clearasil

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

(BPO) Benzoyl peroxide

class:

Indications: Acne

MOA:

Dosage forms:

Dosing: Start with 2.5-5% BPO, generally adequate and less irritating than the higher strengths.

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- Can bleach clothing and hair
- ** Limit exposure to the sun*

Drug-Drug/Food interactions:

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61
Q

PanOxyl

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

BPO

class:

Indications: Acne

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

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62
Q

Vanoxide-HC

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

BPO 5% + hydrocortisone 0.5%

class:

Indications: Acne

MOA:

Dosage forms: lotion

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
-** can bleach clothing and hair**
-** limit sun exposure**

For Pharmacist:
- prior to dispensing, add powder content of vial to lotion. Shake bottle thoroughly to disperse completely. After addition of powder, place expiration date of 3 months on the bottle.

Drug-Drug/Food interactions:

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63
Q

Benzac

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

BPO

class:

Indications: Acne

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

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64
Q

Benzamycin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

erythromycin + BPO

class:

Indications: Acne

MOA:

Dosage forms: gel

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- 70% ethyl alcohol for reconstitution
- ** Should be stored under refrigeration, after reconstitution, DO NOT FREEZE**
-** Product is good for 3 months after it has been properly reconstituted**. So, place a 3-month expiration date on the label following mixing,
-

Drug-Drug/Food interactions:

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65
Q

BenzaClin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clindamycin + BPO

class:

Indications:

MOA:

Dosage forms: gel

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- Add indicated amount of purified water to the vial and immediately shake to completely dissolve medication. (Use additional purified water to bring level up to the mark if needed).
- Add the solution in the vial to the gel; stir until homogenous (1 to 1.5 minutes)
- Place a 3- month expiration date on the label following mixing
- product can be stored at room temperature
- Clean face, apply a thin layer once or twice daily. Avoid contact with eyes; if contact, rinse with cold water.
- Takes 2-6 weeks for effect and up to 12 weeks for full benefit.

Drug-Drug/Food interactions:

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66
Q

Alopecia:

A

hair loss

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67
Q

The most common cause of hair loss is _________

A

hereditary male-pattern baldness

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68
Q

Medical conditions that cause hair loss include:

A
  • hypothyroidism
  • alopecia areata (an autoimmune condition)
  • scalp infections
  • lupus
  • Zinc and Vitamin D deficiency can contribute to hair loss
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69
Q

Drugs that can contribute to alopecia include:

A
  • chemotherapeutics (primarily because hair cells are rapidly dividing and are affected by the treatment)
  • and infrequently with the following:
    • valproate
    • spironolactone
    • heparin
    • warfarin, clomiphene, hydroxychloroquine, interferons, lithium, some types of oral contraceptives
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70
Q

OTC Treatment for alopecia:

A

Minoxidil topical 5% foam, 2% or 5% solution

  • tablets are prescription and are used for hypertension
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71
Q

Rx Treatment for alopecia:

A

finasteride (Propecia) tablets

  • ## hazardous drug
  • ## Proscar—> Pros is for benign PROStatic hyperplasia
  • Propecia—>opecia—-> for alopecia
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72
Q

Propecia

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

finasteride

class: 5-alpha reductase inhibitor

Indications: alopecia

MOA:

Dosage forms: tablet

Dosing:
1mg daily; can take greater or equal to 3 months to begin to see effect.

Max dose:

Contraindications:
Pregnancy

Warnings:
Hazardous drug for females of childbearing potential, can harm a male fetus

Side Effects:

Monitoring:

Pearls/Notes:
- Must be used indefinitely or condition reappears
- * Do NOT dispense to patients taking finasteride (Proscar) for BPH*.
- * pregnant women should NOT handle the drug

Drug-Drug/Food interactions:

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73
Q

Proscar

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

finasteride

class: 5-alpha reductase inhibitor

Indications: BPH-benign prostatic hyperplasia

MOA: drug competitively inhibits type II 5-alpha reductase enzyme, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppresses serum dihydrotestosterone levels.

Dosage forms: tablet

Dosing:

Max dose:

Contraindications:
Pregnancy

Warnings:
Hazardous drug for females of childbearing potential, can harm a male fetus

Side Effects:

Monitoring:

Pearls/Notes:
- Must be used indefinitely or condition reappears
- * Do NOT dispense to patients taking finasteride (Proscar) for BPH*.

Drug-Drug/Food interactions:

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74
Q

Rogaine

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

minoxidil

class:

Indications: alopecia
tablets for hypertension

MOA:

Dosage forms: foam/solution

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- flammable; do not use near a heat source
- can be used by males or females
- 5% strength is more effective but causes more facial hair growth
- must be used indefinitely or condition reappears

Drug-Drug/Food interactions:

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75
Q

Latisse

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Durysta - implant
Lumigan - eye drop - open angle glaucoma

A

bimatoprost

class: prostaglandin analog

Indications: hypotrichosis (thinning eyelashes)

MOA: drug is believed to reduce intraocular pressure by INCREASING the outflow of the aqueous humor.

Dosage forms: solution

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:
- may cause itchy eyes and/or eye redness. Eyelid skin darkening may occur, may be reversible.
- hair growth may occur in other areas that the solution frequently touches

Monitoring:

Pearls/Notes:
- Do NOT use with prostaglandin analogs used for glaucoma (IOP may increase)
-**Apply nightly, with applicator brush, to the skin at the base of the upper eyelashes only (Do NOT apply to the lower lid). Blot any excess. Repeat on other eye. Dispose of applicator after one use. If stopped, lashes will return to their previous appearance. **

Drug-Drug/Food interactions:

76
Q

Cold Sores:

Caused by:

Spread by:

A
  • herpes simplex labialis (aka HSV-1)
    “lay-be-alis”
  • ## can be caused by HSV-2 due to oral/genital sex.(triggers for sore eruption include stress, fatigue, dental work)
  • the virus spreads mostly with active lesions; kissing and sharing drinks can transmit the infection.
77
Q

Cold Sores:

Sore eruption

A

are common and highly contagious.

78
Q

OTC Tx for cold sores:

A
  • Lysine for “prevention”
  • Docosanol (Abreva)
79
Q

Rx Tx for cold sores:

A
  • acyclovir topical cream (Zovirax)
  • acyclovir buccal tablets (Sitavig)
  • penciclovir (Denavir)
80
Q

The ______1_____ period is the optimal time to start treatment for a cold sore in order to reduce blister duration.

-
-

A

1 & 2- prodromal (before seeing the sore)

  • tingling
  • itching
  • soreness
81
Q

Abreva

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

docosanol

class:

Indications:

MOA:

Dosage forms:

Dosing:
- Apply cream 5x daily at first sign of outbreak, continue until healed.

Max dose:

Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

82
Q

Zovirax

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

acyclovir

class:

Indications:

MOA:

Dosage forms: cream

Dosing:
- *Apply cream 5x daily for 4 days (can be used on genital sores_

Max dose:

Contraindications:

Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

83
Q

Sitavig

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

acyclovir

class:

Indications:

MOA:

Dosage forms: buccal tablets

Dosing:
Apply one 50mg tablet as a single dose to the upper gum region.

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- oral antivirals are more effective.

Drug-Drug/Food interactions:

84
Q

Denavir

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

penciclovir

class:

Indications:

MOA:

Dosage forms: topical cream

Dosing:
apply cream every 2 hours during waking hours for 4 days.

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
Drug-Drug/Food interactions:

85
Q

Often times we don’t know what the cause of dandruff is:

In can be caused by:

A
  • eczema (aka seborrheic dermatitis)
  • fungal infection
  • dermatitis
86
Q

The best approach for dandruff initially is to start with an OTC option.

Options include:

A
  • (Selsun) selenium sulfide
  • (Head & Shoulders) pyrithione zinc
  • Coal tar
  • (Nizoral A-D) ketoconazole 1% shampoo
    • apply twice a week
    • do not use if open sores on scalp
    • can cause skin irritation
    • ## rub shampoo in well and leave in for 5 minutes. Needs to be in contact with the scalp. Then rinse out.
87
Q

Rx options for dandruff:

A

(Nizoral) ketoconazole 2% shampoo

88
Q

Desitin: For diaper rash
- is a desicant–> meaning it helps draw water out of the skin.
This can be helpful to pull moisture out of the skin.

A
89
Q
A
90
Q

Eczema:

A
  • is a general term for many types of skin inflammation and is used interchangeably with the term atopic dermatitis.
  • is most common in young children and infants, but can occur at any age.
  • presents as skin rashes which become crusty and scaly; blisters can develop. The rash is itchy, red, dry and sore.
  • common sites affected include the elbows, behind the knees/ears, face (often the cheeks), buttocks, hands and feet.
  • patients should avoid triggers such as environmental irritants, allergens, (soaps, perfumes), pollution, stress or weather changes.
91
Q

-
-
-
-

A

The number one treatment: “moisturizers”
- *Hydration is essential to reduce disease severity. Use moisturizers (e.g. petrolatum), lanolin, Aquaphor, Eucerin,
- antihistamines (for itching), remember 1st generation are very sedating. May be beneficial to choose a 2nd generation antihistamine if patient has to go to work.
-
- topical steroids (occasional oral courses, if needed)
-
- [if topical steroids with hydration are NOT adequate]
- immunosuppressants:
Topical calcineurin inhibitors OR Topical PDE-4 inhibitors.
-
- in severe refractory cases, oral immunosuppressants (cyclosporine, methotrexate) OR monoclonal antibody drugs (e.g. dupilumab “Dupixent”)

92
Q

Elidel

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

pimecrolimus

class: Calcineurin inhibitor/Immunosuppressant

Indications: eczema

MOA:
-penetrates inflamed epidermis to inhibit T cell activation by blocking transcription of proinflammatory cytokine genes such as IL-2, interferon gamma, IL-4, and IL-10.
- the drug binds to intracellular protein FKBP-12, inhibiting calcineurin, which blocks cytokine transcription and inhibits T-cell activation. Prevents release of inflammatory cytokines and mediators from mast cells in vitro after stimulation by antigen/IgE.

Dosage forms: topical cream

Dosing:

Max dose:

Boxed Warning:
**Do NOT Use in children < 2 years of age; associated with lymphoma and skin cancer; use only as second line treatment for short-term, intermittent treatment

Contraindications:

Warnings:

Side Effects:
headache, skin burning, itching, cough and flu-like symptoms.

Monitoring:

Pearls/Notes:
- avoid exposure to natural or artificial sunlight.

Drug-Drug/Food interactions:

93
Q

Protopic

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tacrolimus

class: Calcineurin inhibitor/Immunosuppressant

Indications: eczema

MOA:
- suppresses cellular immunity (inhibit T-cell activation) by binding to an intracellular protein, FKBP-12, and complexes with calcineurin dependent proteins to inhibit calcineurin phosphatase activity.

Dosage forms: topical ointment

Dosing:

Max dose:

Boxed Warning:
**Do NOT Use in children < 2 years of age; associated with lymphoma and skin cancer; use only as second line treatment for short-term, intermittent treatment

Contraindications:

Warnings:

Side Effects:
headache, skin burning, itching, cough and flu-like symptoms.

Monitoring:

Pearls/Notes:
- avoid exposure to natural or artificial sunlight.

Drug-Drug/Food interactions:

94
Q

Eucrisa

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

crisaborole

class: (PDE-4) phosphodiesterase-4 enzyme inhibitor

Indications: eczema

MOA: drug inhibits PDE-4 enzyme which results in increased intracellular cyclic adenosine monophosphate (cAMP) levels.

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

95
Q

Dupixent

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

dupilumab

class: human monoclonal antibody/ (IL-4) Interleukin-4 antagonist

Indications: moderate-severe eczema

MOA: drug inhibits IL-4 and IL-13 signaling by binding to the IL-4R-alpha subunit. Blocking IL-4R-alpha inhibits IL-4 and IL-13 cytokine-induced inflammatory responses, including release of proinflammatory cytokines, chemokines, nitric oxide and IgE.

Dosage forms: injection

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:
- Injection site reactions are the most common side effect.

Monitoring:

Pearls/Notes:
- Avoid use with LIVE vaccines*

Drug-Drug/Food interactions:

96
Q

?? Opzelura

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

ruxolitinib

97
Q

??Rinvoq

class: Janus kinase inhibitors
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

upadacitinib

98
Q

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A
99
Q
A
100
Q

Athlete’s Foot: also called (______1____)

  • a fungal infection of the foot caused by ____2___

Symptoms include:
- *feet itching, peeling, redness, mild burning and sometimes sores. This is a common infection particularly among those using public pools, showers and locker rooms. Often occurs between the toes.

Patients should NOT be applying ______3_______ between the toes or on the feet.

Treatment: _______

A

1)tinea pedis

2) trichophyton rubrum

3) moisturizers

  • topically with antifungals
101
Q

Jock itch: is also called (_________1_______). This is also a fungal infection.
It affects the:
- genitals
- inner thighs
- buttocks

The rash is red itchy and can be ring shaped. It is not very contagious but can be spread from person to person.

Treatment includes: _______2_____

A

1)Tinea Cruris

2) Keeping the skin dry (use a clean towel after showering) and treat with a topical antifungal. Cream works best.
Change underwear at least daily.

102
Q

Ring worm: also called (_____________)

  • not a worm! but a fungal skin infection.

Symptoms include:
- circular, red, flat sores (one or more, may overlap) usually with dry, scaly skin. Can occur anywhere on the body.
Occasionally the ring-like presentation is not present - just itchy red skin.
The outer part of the sore can be raised while the skin in the middle appears normal.

Ring worm on the scalp is also called (______2_______).

A

tinea corporis

2) tinea capitis “cap” you wear a cap on your head

103
Q

Lamisil AT

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

terbinafine

class: antifungal OTC

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA: drug is a synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell membrane and results in fungal cell death.

Dosage forms: 1% cream, 1% gel, 1% spray

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

104
Q

Lotrimin Ultra

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

butenafine

class: antifungal OTC

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA: drug is a synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell membrane and results in fungal cell death.

Dosage forms: 1% cream

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

105
Q

Mentax

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

butenafine

class: antifungal OTC

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA: drug is a synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell membrane and results in fungal cell death.

Dosage forms: 1% cream

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

106
Q

Lotrimin AF

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clotrimazole

class: antifungal OTC

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA:

Dosage forms: 1% cream

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

107
Q

Pro-Ex Antifungal

A

clotrimazole

108
Q

Shopko Athletes foot

A

clotrimazole

109
Q

Cruex

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

miconazole

class: antifungal OTC

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA:

Dosage forms: powder, spray

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

110
Q

Desenex Jock Itch

A

miconazole

111
Q

Tinactin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tolnaftate

class: antifungal OTC

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA:

Dosage forms: cream, powder, spray

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

112
Q

Toelieva

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

undecylenic acid

class: antifungal OTC

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA:

Dosage forms: 25% liquid,

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

113
Q

Lotrisone

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

betamethasone/clotrimazole

class: antifungal & steroid

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA:

Dosage forms: topical

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

114
Q

Extina

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

ketoconazole

class: antifungal

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA:

Dosage forms: cream, foam

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

115
Q

Luzu

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

luliconazole

class: antifungal

Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).

MOA:

Dosage forms: 1% cream

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.

Drug-Drug/Food interactions:

116
Q

Onychomycosis: is a fungal infection of the nail, often caused by ______________. It can cause pain, discomfort and disfigurement and lead to physical limitations (e.g. difficulty walking, standing).

Treatment:
- Topical drugs are LIMITED to mild cases and patients who cannot tolerate systemic therapies, in combination with systemic treatment or as prophylaxis. [They are NOT POTENT ENOUGH to cure most infections.].

  • ___________ and ____________ are APPROVED for this use and most commonly used;
  • _________ and ___________ are used Off-label.

It takes a long time for the nail bed to look better sometimes up to a year in toenails. Toenails take longer to treat than fingernails and are more commonly infected.

  • a ____________________ is essential for diagnosis as other conditions can produce a similar presentation.
A

tinea unguium

itraconazole and terbinafine

fluconazole and posaconazole

  • 20% potassium hydroxide (KOH) smear
117
Q

Lamisil

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

terbinafine

class: antifungal

Indications: Onychomycosis (toenail & fingernail fungal infections)

MOA:

Dosage forms: tablet

Dosing:
250mg PO daily for 6 weeks (fingernails)

250mg PO daily for 12 weeks [toenails]

Max dose:

Contraindications:

Warnings:
risk of hepatotoxicity
QT-prolonging (Avoid in QT risk)

Side Effects:
-primarily headache, rash, nausea

Monitoring:
LFTs

Pearls/Notes:
- Reoccurrence is common. Practice proper foot care and keep the nails dry. Keep blood glucose controlled. Do not smoke.

Drug-Drug/Food interactions:

118
Q

Sporanox

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

itraconazole

class: azole antifungal

Indications: Onychomycosis (toenail & fingernail fungal infections)

MOA:

Dosage forms: capsule, oral solution

Dosing:
200mg PO daily for 12 weeks (fingernails)
200mg BID for 1 week, then 3 weeks off then repeat 1-week course.

Max dose:

Boxed Warning:
* Avoid Use in heart failure*.

Contraindications:
heart failure

Warnings:
hepatotoxicity, QT prolonging (Avoid in QT risk)

Side Effects:
nausea and diarrhea
QT prolongation

Monitoring:
LFTs,

Pearls/Notes:
- Reoccurrence is common. Practice proper foot care and keep the nails dry. Keep blood glucose controlled. Do not smoke.
- substrate of CYP3A4

Drug-Drug/Food interactions:

-Requires gastric acid for absorption; cannot use with strong acid-suppressing drugs

119
Q

Loprox

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

ciclopirox

class: antifungal

Indications: onychomycosis (toenail & fingernail fungal infections)

MOA:

Dosage forms: 8% nail lacquer/topical solution, 0.77% gel, 0.77% cream, 0.77% topical suspension, 1% shampoo

Dosing:
- topical used daily every day at bedtime. [Used in combination with oral antifungals]. -poor efficacy when used alone

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

120
Q

Kerydin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

tavaborole

class: oxaborole antifungal

Indications: onychomycosis (toenail & fingernail fungal infections)

MOA:

Dosage forms: 5% topical solution

Dosing:
- applied topically daily for 48 weeks

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

121
Q

Jublia

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

efinconazole

class: azole antifungal

Indications:

MOA:

Dosage forms: 10% topical solution

Dosing:
- applied topically daily for 48 weeks

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

122
Q

Vaginal Fungal Infections:

  • Fungal vaginal infections are uncommon before a female begins menstruating.

Causes:
- Hormones impact the pH of the vagina, making menstruating women more susceptible. Infections occur most commonly the week before menstruation, making treatment decisions around the menses important.
- high-dose estrogen or hormone replacement therapy, recent antibiotic use (can kill the normal flora and lead to fungal overgrowth), douching or use of lubricants.
- underlying conditions (e.g. pregnancy, diabetes, HIV, steroid use)

  • Symptoms:
  • primarily itching with possible soreness and pain (burning) during urination or sex. Some women have a cottage-cheese like discharge (white, thick, clumpy).

A pH ________1__________ is consistent with bacterial vaginosis or trichomoniasis infection. OTC test kits are available to test vaginal pH.

Treatment:
- Treatment can begin during menses or wait until the bleeding stops.
- Tampons should NOT be used when medication is applied.
OTC:
options include ________

Rx:
options include ________

A

1) pH greater than > 4.5

Treatment:

OTC:
(Monistat) miconazole, (Gyne-Lotrimin) clotrimazole

Rx:
(Diflucan) fluconazole- 150mg PO x 1 day

123
Q

Vaginal Fungal Infections:

Vaginal fungal infections are more common during pregnancy. Pregnant patients should consult their physician. Longer treatment is required for ________________.

A

7-10 days

124
Q

Vaginal Fungal Infections:

  • If there are more than 4 infections in a year OR if symptoms reoccur within 2 months, then ______________.
A

refer to the physician to rule out an underlying condition that could be causative.

125
Q

Vaginal Fungal Infections:

Lactobacillus or yogurt with active cultures is thought to reduce infection occurrence. However, this is rated as “possibly ineffective” by ____

A

the Natural Medicines Database

126
Q

Vaginal Fungal Infections:

If self-treating, counsel that condoms and diaphragms do NOT provide adequate pregnancy protection; the oil in OTC antifungals weakens the latex.

A
127
Q

Gyne-Lotrimin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clotrimazole

class: azole antifungal

Indications: fungal infection of vagina

MOA:

Dosage forms: vaginal cream

Dosing:

OTC-

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

**Counseling for OTC antifungal:
- Prior to using the product, wash the external genital area with mild soap and water, and pat dry with a towel.
- Insert applicator, suppository or vaginal tab at night before bed. Lying down immediately after insertion helps retain the medicine inside the vagina; a protective pad can be used.
- the creams and suppositories are oil-based medications that can weaken latex condoms and diaphragms; avoid sexual intercourse.
- If you get your menstrual cycle during treatment, you may continue treatment.
- do NOT use tampons during treatment
- complete entire course of treatment
- Medical care is warranted if symptoms persist/return within 2 months after using an OTC product, or if greater than > 4 occurrences/per year

Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).

Drug-Drug/Food interactions:

128
Q

Monistat 3

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

miconazole

class: azole antifungal

Indications: fungal infection of vagina

MOA:

Dosage forms: vaginal cream

Dosing:

OTC-

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Counseling for OTC antifungal:
- Prior to using the product, wash the external genital area with mild soap and water, and pat dry with a towel.
- Insert applicator, suppository or vaginal tab at night before bed. Lying down immediately after insertion helps retain the medicine inside the vagina; a protective pad can be used.
- The creams and suppositories are oil-based medications that can weaken latex condoms and diaphragms; avoid sexual intercourse.
- If you get your menstrual cycle during treatment, you may continue the treatment.
- Do not use tampons during treatment
- complete entire course of treatment
- medical care is warranted if symptoms persist/return within 2 months after using an OTC product, or if greater than > 4 occurrences / per year

Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).

Drug-Drug/Food interactions:

129
Q

Terazol 7

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

terconazole

class: azole antifungal

Indications: fungal infection of vagina

MOA:

Dosage forms: topical vaginal cream

Dosing:
RX-

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).

Drug-Drug/Food interactions:

130
Q

Diflucan

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

fluconazole

class: azole antifungal

Indications: fungal infection of vagina

MOA:

Dosage forms: tablet

Dosing:
Rx: 150mg PO x 1 dose

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).

Drug-Drug/Food interactions:

131
Q

Brexafemme

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

ibrexafungerp

class:

Indications:

MOA:

Dosage forms:

Dosing:
Rx- 300mg PO BID x1 day

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

132
Q

Gynazole-1

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

butoconazole

class: azole antifungal

Indications: fungal infection of vagina

MOA:

Dosage forms: vaginal cream

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).

Drug-Drug/Food interactions:

133
Q

Genital warts:

Cause:

Prevention:

Treatment:

A

Cause: Human papillomavirus (HPV), sexually transmitted

Prevention: Gardasil vaccine prevents infection with HPV for most strains causing genital warts.

Treatment:
- is only required if the patient is symptomatic

Rx:
(Aldara, Zyclara)- imiquimod cream

134
Q

Hemorrhoids:

Cause:

Symptoms:

Treatment:

A
  • are swollen blood vessels in the lower rectum. They are often the result of constipation and straining to have a bowel movement. Rectal tissue is sensitive with rich blood vessel supply making it susceptible to engorgement. (The blood is usually Bright red), unlike with a GI bleed which would be black.

Cause: Constipation and straining to have a bowel movement

Symptoms: rectal bleeding, itching and bleeding (bright red blood)

Treatment:

Non-pharm:

OTC:
- phenylephrine (Preparation H)
- hydrocortisone (products names often contain “HC” in or after the name)
- Witch hazel (Tucks pads): a mild astringent that can relieve mild itching.
- combination products

135
Q

Preparation H

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

phenylephrine

class: vasoconstrictor

Indications: hemorrhoids

MOA: drug shrinks the hemorrhoid and reduces burning and itching.

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- Clean the skin first with mild soap and warm water. gently pat dry. Apply ointment externally up to 5 times daily.
- For suppository: hold wrapped suppository container with rounded end up, separate the foil tabs and slowly peel apart, remove from the wrapper, insert into the rectum up to 4 times daily, especially at night and after bowel movements.

Drug-Drug/Food interactions:

136
Q

Lice and Scabies:

  • Scabies (mites) and lice are spread mainly through close contact and treated with some of the same medications.
  • Lice (Pediculus humanus capitis), most commonly occurs in elementary school-age children.
A
137
Q

Lice
- affects primarily children
- attach to the hair shaft
- insects
————
- Treatment (OTC): [the drug of treatment for lice is OTC]
- a lice comb needs to be consistently used to remove lice eggs from hair
- permethrin (Nix)
- pyrethin/piperonyl butoxide (Rid)
- ALL require REPEAT treatment

A

Scabies
- affects primarily adults
- burrow under the skin
- mites
———
- Treatment (Rx): [scabies is prescription only]
- products are higher potency and applied to the skin
- permethrin (Elimite) cream
- ivermectin (Stromectol)

138
Q

If patients have an allergy to chrysanthemum or ragweed, then avoid ______________

A

pyrethrins and permethrin products

139
Q

  • ## (Nix) permethrin 1% / for ages 2 months and older
  • ## (Rid) [pyrethrin 0.33% / piperonyl butoxide 4%] - for ages 2 years and older
  • (Sklice) ivermectin 0.5% lotion now available without a prescription / for ages 6 months and older
A

  • (Natroba) spinosad 0.9% w/w topical suspension / ages 6 months and up
  • (Ovide) malathion 0.5% lotion / ages 6 years and up
  • (Ulesfia*) benzyl alcohol 5% lotion / ages 6months and up
  • (Xeglyze) abametapir 0.74% lotion / ages 6 months and up
140
Q

Scabies NOTHING OTC

A

  • (Elimite) permethrin cream
  • (Stromectol) ivermectin oral
141
Q

Lice Tx:
- Repeating the procedure and removing the nits from hair using fine comb, bedding and elsewhere is essential.
——————————————————————————————-
- Wash clothes and bedding in hot water, followed by a hot dryer.
- If something cannot be washed, seal it in an airproof bag for 2 weeks or dry clean. Vacuum the carpet well. Soak combs and brushes in hot water for 10 minutes. Make sure to check other family members in the household.
- Do not use conditioner (including combination shampoo and conditioner) before using the lice medicine.
- Do not rewash the hair for 1-2 days after treatment.
- Most products must be left on the hair for 10 minutes before rinsing to be effective; [malathion should be left on for 8-12 hours].
- After treatment, use a nit comb to remove nits and lice every 2-3 days. Continue to check for 2-3 weeks to be sure all lice and nits are gone.
-
- Re-treatment is needed for most products [exceptions ___________] on days 7-10 to kill any surviving hatched lice before they produce new eggs.

A

exceptions: Sklice and Xeglyze do not need to be repeated.

142
Q

Lice

OTC options include:

Rx prescription options include:

A
143
Q

Scabies:

OTC options include:

Rx prescription options include:

A

OTC options include: NONE

Rx prescription options include:

144
Q

Bites:
- all animal bites require _________
- treat with an oral antihistamine or topical steroid for itching. (insect bites)

A

evalution. (increased infection risk, some toxic).

145
Q

Pinworm: (aka _____________)
- most commonly occurs in children and presents as anal itching.

Causes:
- easily spread by children, contaminated fingers can transfer eggs to surfaces and are then ingested.
- current treatments are active against ___1______

Tx: anthelmintics (e.g. drugs used to kill parasitic worms)
When you treat, you treat the whole household, there very contagious.

OTC options include:

Rx prescription options include:

A

Vermicularis

1) Enterobius vermicularis

Diagnosis:
- tape test: stick a piece of tape around the anus in the morning prior to voiding/defecating. The tape is removed and brought to a healthcare provider, who examines it under a microscope to look for eggs. It can take up to 3 morning tape tests to identify the eggs.

OTC options include:
- (Reese’s Pinworm, Pamix*) pyrantel pamoate suspension
- (Vermisol) pyrantel pamoate tablets

Rx prescription options include:

  • (Albenza) albendazole
  • (Emverm) mebendazole
146
Q

Pinworm:

Safety & Counseling:

Wash hands frequently and treat the entire household.

A

pyrantel causes headaches and dizziness. It is given as a single dose and repeated in 2 weeks to eliminate reinfection.

mebendazole and albendazole cause headache, nausea and are hepatotoxic.

Albendazole must be taken with a high fat meal (to increase absorption).

147
Q

Burns:
- small, minor burns can be treated OTC
- run burn under cold water
- apply ointment to hold in moisture (e.g. Aquaphor)
- apply a bandage if there is broken skin or popped blisters

A
148
Q

Silvadene, SSD

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

silver sulfadiazine

class:

Indications:

  • can be used topically to reduce infection risk and promote healing.
    MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- Do NOT use with Sulfa allergy or G6PD deficiency (due to hemolysis risk).

Drug-Drug/Food interactions:

149
Q

Bactroban nasal:

A
  • product is applied to the nars. Inside the nose.
  • used for decolonization of patients who carry MRSA before surgical procedures.
150
Q

Poison Ivy, Oak, and Sumac:

Cause:

A
  • poison ivy, poison oak, sumac poisoning is an allergic reaction that results from touching the sap of these plants, which contain the toxin *urushiol.
  • the sap may be on the plant, in the ashes of the burned plants, on an animal or on other objects that came in contact with the plant.
  • small amounts of *urushiol can remain under a person’s fingernails for days unless removed with good cleaning.
151
Q

Poison Ivy, Oak, and Sumac:

Treatment:
- wash any items that came into contact with the plant, including under the fingernails.

OTC:

Rx:

A

OTC:
- (Burow’s Boro-Packs, Domeboro) aluminum acetate solution
- Colloidal oatmeal (Aveeno)
- calamine lotion + pramoxine (Caladryl, IvaRest)
- Zanfel

Rx:
- topical or oral steroids for severe rash

152
Q

Poison Ivy, Oak, and Sumac:

aluminum acetate is an astringent (_________________)

A
  • drying agent
153
Q

Inflammation and Rash:

  • the primary treatment for skin irritation is topical steroids.
  • 2 strengths of Hydrocortisone (HC) are available OTC, 0.5% and 1%.
  • all other topical steroids are prescription only.
  • the steroid vehicle influences the strength of the medication.
  • -* Usual potency from Highest to Lowest:

______________________

A

Ointments > Creams > Lotions > Solutions > Gels > Sprays

OCLSGS

154
Q

Inflammation and Rash:

  • thin skin on the face, eyelids, and genitals is highly susceptible to topical steroid side effects; low potency steroids should be used on these areas and skin folds (armpits, groin, under the breasts) where the absorption is higher.
  • local (skin) steroid side effects, if used long term, include skin thinning, pigment changes (lighter or darker), telangiectasia (i.e. spider veins or small blood vessels visible through the skin), rosacea, perioral dermatitis and acne, increased risk of skin infections, delayed wound healing, irritation/burning/peeling and possibly contact dermatitis.
A
  • For urticaria (hives):

OTC— second generation antihistamines (e.g. cetirizine) are preferred over first-generation antihistamines (e.g. diphenhydramine) due to tolerability. Higher doses are used.

Rx— hydroxyzine (Vistaril)

155
Q

Inflammation and Rash:

A
156
Q

Inflammation and Rash:

A

Class:

Dosage form:

Potency:

157
Q

Clobex

class:
Indications:
MOA:
Dosage forms:
Potency:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clobetasol propionate

class: topical steroid

Indications:

MOA:

Dosage forms: 0.05% Lotion, 0.05% Shampoo, 0.05% Spray

Potency: Very High Potency

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

158
Q

Temovate

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clobetasol propionate

Class: topical steroid

Dosage forms: 0.05% cream, 0.05% ointment

Potency: Very High Potency

159
Q

Olux

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clobetasol propionate

Class: topical steroid

Dosage form: 0.05% foam

Potency: Very High Potency

160
Q

Vanos

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

fluocinonide

Class: topical steroid

Dosage form: 0.1% cream

Potency: Very High Potency

161
Q

Diprolene

A

betamethasone dipropionate

Class:

Dosage:

Potency:

162
Q

Ultravate

A

halobetasol propionate

Class:

Dosage:

Potency:

163
Q

Diprolene AF

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

betamethasone dipropionate

164
Q

Lidex

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

fluocinonide

165
Q

Elocon

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

mometasone furoate

166
Q

Topicort

A

desoximetasone

Class:

Dosage:

Potency:

167
Q

Psorcon

A

diflorasone diacetate

Class:

Dosage:

Potency:

168
Q

Halog

A

halcinonide

Class:

Dosage:

Potency:

169
Q

Lidex-E

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

fluocinonide

170
Q

Luxiq

A

betamethasone valerate

Class:

Dosage:

Potency:

171
Q

Triderm

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

triamcinolone acetonide

172
Q

Kenalog

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

triamcinolone acetonide

173
Q

Synalar

A

fluocinolone acetonide

Class:

Dosage:

Potency:

174
Q

Cordran

A

flurandrenolide

Class:

Dosage:

Potency:

175
Q

DesOwen

A

desonide

Class:

Dosage:

Potency:

176
Q

Caprex

A

fluocinolone acetonide

Class:

Dosage:

Potency:

177
Q

Cutivate

A

fluticasone propionate

Class:

Dosage:

Potency:

178
Q

Locoid

A

hydrocortisone butyrate

Class:

Dosage:

Potency:

179
Q

Pandel

A

hydrocortisone probutate

Class:

Dosage:

Potency:

180
Q

Verdeso

A

desonide

Class:

Dosage:

Potency:

181
Q

Tridesilon

A

desonide

Class:

Dosage:

Potency:

182
Q

Desonate

A

desonide

Class:

Dosage:

Potency:

183
Q

Cortaid

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

hydrocortisone

184
Q
A
185
Q
A
186
Q
A