Acne Flashcards
(91 cards)
1
Q
Types of topicals from most drying to most moisturizing
A
Solutions Gels Lotions Creams Ointments
2
Q
Percent involvement- head and neck
A
9%
3
Q
Percent involvement anterior thorax
A
18%
4
Q
Percent involvement posterior thorax
A
18%
5
Q
Percent involvement each arm
A
9%
6
Q
Percent involvement each leg
A
18%
7
Q
Percent involvement genital area
A
1%
8
Q
Percent involvement area of the palm of hand
A
1%
9
Q
Mild acne
A
Predominantly comedonal or mixed comedonal and inflammatory
Few to several papules or pustules
No nodules
10
Q
Moderate acne
A
Several to many papules or nodules
Few to several nodules
11
Q
Severe acne
A
Numerous or extensive papules or pustules
Many nodules
12
Q
1st line tx for mild acne
A
Benzoyl Peroxide (BP) or Topical retinoid or Topical combination therapy BP + antibiotic or Retinoid + BP or Retinoid + BP + antibiotic
13
Q
Alternative tx for mild acne
A
Add topical retinoid or BP (if not on already)
or consider alternate retinoid
or consider topical Dapsone
14
Q
1st line tx for moderate acne
A
Topical combination therapy
BP + antibiotic
or retinoid + BP
or retinoid + BP + antibiotic
or oral antibiotic + topical retinoid + BP
or oral antibiotic + topical retinoid + BP + topical antibiotic
15
Q
Alternative tx for moderate acne
A
Consider alternate combination therapy or
consider change in oral antibiotic or
add combined oral contraceptive or oral spironolactone (females) or
Consider isotretinoin
16
Q
1st line tx for severe acne
A
Oral antibiotic + topical combination therapy BP + antibiotic or Retinoid + BP or Retinoid + BP + antibiotic or Oral isotretinoin
17
Q
Alternative tx for severe acne
A
Consider change in oral antibiotic or
Add combined oral contraceptive or oral spironolactone (females) or
Consider oral isotretinoin
18
Q
Acne f/u
A
Sx should begin to improve in 6-8 wks
F/u with PCP if sx worsen or don’t improve in 6-8 wks with proper medication adherence
19
Q
Benzoyl peroxide contraindications
A
Should not be used in pts who have shown hypersensitivity to benzoyl peroxide or to any of the other ingredients in the products
20
Q
Benzoyl peroxide adverse effects/toxicities
A
Hypersensitivity rxns, contact sensitization rxns, excessive erythema, and peeling
21
Q
Benzoyl peroxide pediatric use
A
Safety and effectiveness have not been established in children <12 yoa
22
Q
Contraindications of salicylic acid
A
Known sensitivity to salicylic acid or any other ingredient in the formulation
23
Q
Adverse effects/toxicities of salicylic acid
A
Hypersensitivity rxns, salicylate toxicity, excessive erythema, and scaling
24
Q
Other issues with salicylic acid
A
Cumulative irritant or drying effect. If excessive dryness occurs, use only 1 topical medication unless directed by a clinician
25
Interactions with salicylic acid
Acidifying agents, anticoagulants, antidiabetic agents, ASA, corticosteroids, diuretics, methotrexate, pyrazinamide, sulfur, and uricosuric agents
26
Pediatric use- salicylic acid
6% cream, lotion, and gel and 15% plaster not recommended in children < 2 yoa. Increased risk of salicylate toxicity with prolonged, excessive use in children <12 yoa. Varicella and influenza-like illness is associated with risk of Reye syndrome
27
Adverse drug effects of topical retinoids
```
Local erythema
Peeling
Dryness
Pruritis
Burning
Scaling
Stinging
Xerosis
```
28
Adapalene
| Differin
```
Topical retinoids
Available as cream- 0.1%
Gel- 0.1%, 0.3%
Solution- 0.1%
Lotion- 0.1%
Category C
Available in combo with benzoyl peroxide
FDA-approved for those greater than or equal to 9 yoa
Best tolerated
Photo-stable
```
29
Tazarotene
Avage
Fabior
Tazorac
```
Topical retinoids
Cream-0.05%, 0.1%
Foam-0.1%
Gel- 0.05%, 0.1%
Category X
Photo-stable
May be the most effective
Most irritating
```
30
Tretinoin
Atralin
Avita
Retin-A
```
Topical retinoids
Cream-0.025%, 0.05%, 0.1%
Gel-0.01%, 0.025%
Gel (micronized)- 0.05%
Microsphere gel- 0.04%, 0.1%
Polymerized cream- 0.025%
Polymerized gel- 0.025%
Category C
FDA-approved for those greater than or equal to 10 yoa
```
31
Topical antibiotics for acne
Clindamycin and erythromycin
Monotherapy not recommended because risk of bacterial resistance, adding benzoyl peroxide will decreased risk of bacterial resistance
More effective in combination with topical retinoids
32
Adverse drug effects of topical abx
```
Local erythema
Dryness
Peeling
Burning
Oiliness
```
33
Dapsone contraindications
None
34
Adverse effects/toxicities of Dapsone
Oiliness, peeling, dryness, erythema, burning, pruritis, pyrexia, nospharyngitis, upper respiratory infection, sinusitis, influenza, pharyngitis, cough, joint sprain, HA, suicide attempt, depression, psychosis, tonic clonic movements, abd pain, severe vomiting, and pancreatitis
35
Interactions with Dapsone
TMP-SMX, topical benzoyl peroxide, rifampin, anticonvulsants, St. John's wort, folic acid antagonists
36
Other issues with Dapsone
Some subjects with glucose 6 phosphate dehydrogenase deficiency developed changes suggestive of mild hemolysis. Observe for s/sx of hemolysis, peripheral neuropathy, and skin rxns
37
Pediatric use with Dapsone
Safety and efficacy was not studied in pediatric pts <12 yoa have not been established
38
Active ingredients and strength- Acanya gel
Clindamycin phosphate 1.2% and benzoyl peroxide 2.5% (aqueous based)
39
Active ingredients and strength- BenzaClin gel
Clindamycin phosphate 1% and benzoyl peroxide 5% (aqueous based)
40
Active ingredients and strength- Benzamycin gel
Erythromycin 3% and benzoyl peroxide 5% (alcohol based)
41
Active ingredients and strength- Duac gel
clindamycin phosphate 1% and benzoyl peroxide 5% (aqueous-based)
42
Active ingredients and strength- Epiduo gel
Adapalene 0.1% and benzoyl peroxide 2.5%
43
Active ingredients and strength- Veltin gel
Clindamycin phosphate 1.2% and tetinoin 0.025%
44
Active ingredients and strength- Ziana gel
Clindamycin phosphate 1.2% and tretinoin 0.025%
45
Oral abx adverse drug reactions
Vaginal candidiasis, increased risk of URTIs
| Serious: benign intracranial htn with tetracyclines
46
Doxycycline adverse drug effects
Pill esophagitis
GI upset
Photosensitivity
Staining of tooth enamel (less than or equal to 8 yo)
47
Doxycyline notes
Pregnancy category D
Recommended over tetracycline bc increased efficacy, potential for once-daily dosing, better follicle penetration, less resistance
48
Erythromycin adverse drug effects
GI upset
49
Erythromycin notes
Pregnancy category B
High prevalence of resistance
Reserved for those who cannot use tetracycline
50
Tetracycline adverse drug effects
Fixed drug eruption
GI sx
Staining of tooth enamel (less than or equal to 8 yo)
51
Tetracycline notes
Pregnancy Category D
| Recommended over erythromycin bc less resistance
52
Minocycline adverse drug effects
```
Pigment deposition in skin, mucous membranes, and teeth
Autoimmune hepatitis
System LLS
Serum sickness-like rxn
DHS
```
53
Minocycline notes
Pregnancy category D
ER formulation apparently has lower risk of ADEs
Recommended over tetracycline bc increased efficacy, potential for once-daily dosing, better follicle penetration, less resistance
Recommended over doxycycline due to some increased efficacy
54
TMP-SMX adverse drug effects
```
TEN
SJS
Bone marrow suppression
Hypersensitivity rxns
Drug eruptions
Fixed drug eruption
```
55
TMP-SMX notes
Pregnancy category D
| Can be used if other oral abx cannot be tolerated
56
Ways to optimize oral antibiotic therapy
Use for moderate to severe acne in combo with BP
Avoid antibiotic monotherapy
Taper within 1-2 mos if no new inflammatory lesions
Use topical retinoid in combo with oral antibiotic to augment therapy and also to prepare for maintenance; may also maintain with a topical retinoid + BP
57
Azelaic acid (Azelex and Finacea) contraindications
Known hypersensitivity to azelaic acid or any of its components
58
Azelaic acid adverse effects/toxicities
Pruritis, burning, stinging, tingling, erythema, dryness, rash, peeling, irritation, dermatitis, and contact dermatitis
59
Azelaic acid pediatric use
Safety and effectiveness in pediatric pts <12 yoa have not been established
60
Contraindications for Isotretinoin
Hypersensitivity to isotretinoin or any of its components
Hypersensitivity to vit A
Pregnancy
61
Interactions of isotretinoin
Tetracycline, vitamin A, methotrexate, contraceptives, or alcohol
62
Baseline monitoring of isotretinoin
LFT, pregnancy test, lipid panel
63
Ongoing monitoring of isotretinoin
Pregnancy test every 30 days for females
64
Pediatric use for isotretinoin
Safety and effectiveness not established in children <12 yoa
65
BBW for isotretinoin
must not be used by those who are pregnant or who may become pregnant
The pharmacist must log into the iPLEDGE system to obtain an authorization and a "do not dispense after" date
No more than 30 day supply can be dispensed at a time
Refills require a new prescription and authorization
66
iPLEDGE`
Female pts commit to two forms of contraception
Each month:
Prescriber enters female pt's pregnancy test results and forms of contraception
Pharmacy must log into system to get authorization and "do not dispense after" date
All criteria must be met before authorization is granted to the pharmacy
Pt must pick up prescription within the closing of their prescription window
67
Contraindications of hormonal contraception
```
BP: systolic >160 mm Hg, diastolic >100 mm Hg, or severe HTN
Carcinoma of the breast or endometrium
Genital bleeding, undiagnosed
HAs with focal neurologic sx
Heptatic adenomas or carcinomas
Valvular heart disease or CAD
Surgery with prolonged immobilization
```
68
Adverse effects/toxicities of hormonal contraception: cardio
Edema, varicose veins aggravation
69
Adverse effects/toxicities of hormonal contraception: CNS
Depression, migraine, mood changes
70
Adverse effects/toxicities of hormonal contraception: skin
Cholasma, melasma, or erythema
71
Adverse effects/toxicities of hormonal contraception: endocrine
Amenorrhea, breakthrough bleeding, breast pain/tenderness, fluid retention, or infertility
72
Adverse effects/toxicities of hormonal contraception: GI
Abdominal bleeding, abdominal cramps, appetite changes, nausea, weight changes, or vomiting
73
Adverse effects/toxicities of hormonal contraception: GU
Cervical ectropion, cervical secretion, vaginal candidiasis or vaginitis
74
Adverse effects/toxicities of hormonal contraception: blood
Folate decreased, porphyria exacerbation
75
Drug interactions with hormonal contraceptives
Abx decrease the effectiveness of hormonal contraceptives
76
Baseline monitoring for hormonal contraception
Pregnancy status, blood pressure
77
Pediatric use of hormonal contraception
Use before menarche is not indicated
78
Contraindications of spironolactone
Acute renal failure, Addison disease, hyperkalemia, anuria, concomitant eplerenone or triamterene use and significant renal impairment
79
Adverse effects/toxicities of sprionolactone
Endocrine: gynecomastia, electrolyte disturbances, hyperkalemia, metabolic acidosis, or potential feminization male fetus if taken during pregnancy
Neuro: somnolence, confusion, HA
Blood: agranulocytosis
Renal: increased BUN, renal failure, or renal insuficiency
80
Ongoing monitoring for spironolactone
Serum potassium, sodium, and renal function
81
General measures for psoriasis
Skin cleansing and moisturizing regimen
Sunscreen (SPF 30 or more)
Yellow or green-tinted cosmetics
Avoid toners, fragrances, and abrasives
82
1st line therapy for psoriasis without papulopustual lesions
Topical metronidazole, azelaic acid or brimonidine
| Vascular laser therapy
83
1st line therapy for psoriasis with papulopustual lesions- mild to moderate
Topical metronidazole or azelaic acid
Topical brimonidine
Topical ivermectin
Vascular laser therapy
84
1st line therapy for psoriasis with papulopustual lesions- moderate to severe
Topical metronidazole OR
Azelaic acid + doxycycline
Topical brimonidine
Vascular laser therapy
85
2nd line therapy for psoriasis with papulopustual lesions- mild to moderate
Topical BP, erythromycin, clindamycine
| Doxycycline
86
2nd line therapy for psoriasis with papulopustual lesions- moderate to severe
Doxycycline
87
3rd line therapy for psoriasis with papulopustual lesions- mild to moderate
Doxycycline
| Topical retinoids
88
3rd line therapy for psoriasis with papulopustual lesions- moderate to severe
Oral abx (tetra, minocycline, metronidazole, azithromycin) + topical BP, erythromycin, clindamycin, or permethrin
89
Refractory tx for psoriasis with papulopustual lesions- mild to moderate
Start moderate-severe tx
90
Refractory tx for psoriasis with papulopustual lesions- moderate to severe
Consider oral isotretinoin
91
Toxicities of topical corticosteroids for psoriasis
Local- skin atrophy, telangiectasia, striae, purpura, contact dermatitis, rosacea
Systemic: hypothalmic-pituitary-adrenal axis suppression may occur with use of medium and high-potency topical steroids. This will be lessened by intermittent or localized use. Increased IOP, glaucoma nd cataracts have been reported with use around the eye.
