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SG - Pharm 4 > Dermatology: Acne Vulgaris & Rosacea > Flashcards

Dermatology: Acne Vulgaris & Rosacea Flashcards

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1
Q

This is the pathogenesis of which disease?

  1. androgen influenced increase in sebum production
  2. Keratin and sebum plug the hair follice & accumulate, leading to hyperkeratosis with comedone formation.
  3. P.acnes bacteria proliferates in the sebaceous follice.
  4. Inflammatory response.
A

Acne Vulgaris

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2
Q

How does P. acnes bacteria cause an inflammatory response in acne vulgaris?

A

These bacteria release enzymes and stimulate release of pro-inflammatory cytokines.

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3
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Benzoyl Perozide

Topical/oral Abx

isotretinoin (Accutane)

A

P. acnes proliferation

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4
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Intralesional corticosteroids

oral corticosteroids

topical/oral abx

A

Inflammatory Response

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5
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Antiandrogens

isotretinoin

topical/oral abx

corticosteroids

estrogens

A

abnormal serum

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6
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Salicylic Acid

Benzoyl peroxide

Topical retinoids

Isotrtinoin (Accutane)

A

Abnormal keratinization of follice

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7
Q

What is the 1st line tx for mild acne vulgaris in ADULTS?

A

BP

or

Topical Retinoid

___________________________________________________

**Topical Combination Therapy**:

(BP + abx)

or

(BP + retinoid)

or

(BP + retinoid + abx)

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8
Q

What is the general alternative for the 1st line treatments for mild acne vulgaris?

A

Depending on whether it applies to the 1st line tx or not:

Add Topical Retinoid or BP

or

Consider Alternate Retinoid

or

Consider Topical Dapsone

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9
Q

What is the 1st line tx for moderate acne vulgaris in ADULTS?

A

Topical Combination Therapy**:

(BP + Abx)

or

(BP + Retinoid)

or

(BP + Retinoid + Abx)

___________________________________________________

oral abx + topical retinoid + BP

or

oral abx + topical retinoid + BP + topical abx

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10
Q

What is the general alternative for the 1st line treatments for mild acne vulgaris?

A

Consider alt combination therapy

or

consider diff oral abx

or

add combined oral contraceptive or oral spironolactone (females)

or

consider oral isotretinoin

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11
Q

What is the 1st line tx for severe acne vulgaris in ADULTS?

A

Oral abx

+

Topical Combination Therapy**

(BP + Abx)

or

(BP + Retinoid)

or

(BP + Retinoid + Abx)

___________________________________________

OR

oral isotretinoin

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12
Q

What is the general alternative for the 1st line treatments for severe acne vulgaris?

A

change oral abx

or

add combined oral contraceptive or oral spironolactone (females)

or

oral isotretinoin

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13
Q

What are the topical antibiotics used in acne?

A

Erythromycin

Clindamycin

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14
Q

T/F: Erythromycin MOA in inflammatory acne vulgaris is unknown.

A

TRUE

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15
Q

What are adverse local rxns to erythromycin solution?

A

burning sensation, drying & irritating of the skin.

** water-based gel has less drying associated with it**

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16
Q

Is there a risk of getting c-diff with clindamycin?

A

No, becasue we are using it on the face.

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17
Q

Both erythromycin and clindamycin must be combined with __________ when giving for tx.

A

benzoyl peroxide

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18
Q

What is the newest treatment for acne vulgaris called?

A

Sacrecycline

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19
Q

When would you use sarecycline?

A

to tx inflammatory lesions of non-nodular moderate to severe acne vulgaris in people 9 years or older.

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20
Q

What drug family is sarecycline part of?

A

Tetracycline

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21
Q

T/F: sarecycline has a narrower spectrum of activity and causes lower rates of bacterial resistance.

A

TRUE

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22
Q

What is the biggest reason providers do not rx sarecycline?

A

$$$ High cost!

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23
Q

Retinoic acid is the acid form of _________.

A

Vitamin A

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24
Q

​MOA of which drug?

  • decreased cohesion between epidermal cells & increased epidermal cell turnover.
  • Expulsion of open comedones
  • transforms closed comedone to open
A

Retinoic Acid

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25
Which drug should be applied initially in a concentration sufficient to **induce slight erythema with mild peeling**?
Retinoic Acid
26
**T/F:** It is okay to apply **tretinoin** to the **corners of the nose, eyes, mouth and mucous membanes**.
False, DO NOT apply to the corners of the nose, eyes, mouth and mucous membranes.
27
How long of therapy does Tretinoin require? & How long will it take before lesions clear?
Therapy: **4-6 wks** Clearance: **8-12 wks**
28
**Prolonged use** of this agent **increases collagen synthesis** & **thickness of the epidermis.**
Tretinoin
29
**Topical retinoids** offer benefit for patients with ________ skin, ________ **skin (psoriasis)**, and **atropic areas.**
**photo-damaged** **thickened**
30
Tretinoin: Avoid ___ exposure & use a protective \_\_\_\_\_\_\_\_
sun sunscreen
31
What receptors do each of the following topical retinoids act on? 1. Adapelene 2. Tazarotene 3. Tretinoin
1. Beta, gamma 2. Beta, gamma 3. alpha, beta, gamma
32
What pregnancy category are each of the following topical retinoids? 1. Adapelene 2. Tazarotene 3. Tretinoin
1. C 2. X 3. C MAIN POINT: STAY AWAY FROM ALL OF THESE DURING PREGNANCY
33
Benzoyl Peroxide MOA?
* Bacteriostatic against P. acnes * Peeling & comedolytic effects
34
ADE of benzoyl peroxide
avoid contact with the **eyes and mucous membranes** will **bleach clothing, bedding & towels.**
35
Which drug suppresses comedones most effectively?
Topical retinoids
36
Which drug suppresses sebum production most effectively?
Oral isotretinoin
37
Which drugs suppress P. acnes and inflammation most effectively?
oral isotretinoin & oral tetracyclines
38
What two drugs should you use from the start of therapy when **inflammatory lesions** are involved?
**topical retinoids + abx**
39
Discontinue abx when _________ resolve. If you cannot discontinue, use _______ or \_\_\_\_\_\_\_\_\_combination agents.
inflammatory lesions BPO or BPO-antibiotic
40
Use ____________ to maintain remission when abx therapy is discontinued.
topical retinoid
41
**ADE** of Tetracycline (oral abx) Ex: **doxycycline, minocycline**
**slate gray hyperpigmentation** of skin **drug induced lupus** **_cannot be used in preggos_** **_Minocycline: dizziness_**
42
ADE of Erythromycin
GI upset
43
ADE of **C**lindamycin
C-diff
44
You would use **Isotrtinoin** to treat what?
**severe cystic acne & hidradenitis suppurativa**
45
\_\_\_\_\_\_\_\_\_\_ is a SIGNIFICANT risk in pts who use isotretinoin.
teratogenicity
46
What are the **2 conditions** women MUST meet to be **rx isotretinoin?**
1. Women MUST use **2 effective forms of contraception** 1 mo before, throughout therapy, & 1 menstrual cycle after discontinuation of tx. 2. Women MUST take a **serum pregnancy test** within 2 weeks before therapy: Therapy is initiated on the 2nd or 3rd day of next menstrual period.
47
ADE of isotretinoin (oral retinoid)
* **dry mucous membranes,** xerosis(dry skin), cheilitis, conjunctivitis, epistaxis, pruritis. * joint pain * thinning hair * HA * nausea * **mood swings, suicidal ideation, sleep disturbance** * **hyperTGL, elevated LFTs, dec. WBC count**
48
What labs must you draw in pts you rx Isoretinoid?
* **Baseline:** CBC, LFT, fasting lipid profile, serum preggo test in women of childbearing potential * **1st mo only:** repeat **CBC, LFT** * **Every month:** fasting lipid profile, serum preggo test
49
What topical abx do you use in Rosacea?
* metronidzaole * sulfacetamide
50
**T/F:** MOA of metronidazole is unknown.
TRUE
51
Can you use metronidazole during pregnancy, in nursing mothers and children?
NO
52
ADE of water-based gel formulation of metronidazole.
dryness, burning, stinging.
53
**MOA** of Na+ sulfacetamide
competitive i**nhibition of p-aminobenzoic acid utilization of bacteria.**
54
4% of topically applied _______ is abosorbed.
sulfacetamide.
55
Which drug is contraindicated in tx rosacea with patients who have a sulfonamide sensitivity? I know this was a horribly worded question but i am too lazy to change it- sorry GK
Na+ sulfacetamide
56
Which **topical abx that treats Rosacea** also effectively treats **seborrheic dermatitis**?
Na+ sulfacetamide
57
How can pts tx rosacea on their own?
- reduce usage of products that flare the flushing of rosacea - use sunscreen daily to protect skin from chronic UV rays
58
Alternative tx for rosacea
**Clindamycin** 1% cream **Erythromycin** 2% solution **Topical imidazoles, ketoxonazole cream** **azelaic acid** cream
59
T/F: tetracyclines exhibit both abx and anti-inflammatory effects.
True
60
Which drug is most warranted in **stage III rosacea with rhinophyma & rosacea fulminans?**
Isoretinoin (Accutane)
61
Which drug is **not recommended for opthalmic rosacea b/c it may exacerbate keratitis & blepharitis?**
Isotretinoin (Accutane)
62

SG - Pharm 4 (16 decks)

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