PCOL Acne (Maize)

Question 1

Keratolytics

Answer 1

benzoyl peroxide
sulfur
salicylic acid

Question 2

Benzoyl peroxide products

Answer 2

Clearasil, Fostex, Oxy-10

Question 3

Benzoyl peroxide mechanism of action

Answer 3

converted to benzoic acid - a potent oxidizing agent in the skin

Question 4

Benzoyl peroxide pharmacological effect:

• ____ keratinocytes
• increases ____ rate of keratinocytes
• prevents ____ of follicles
• antibacterial activity against ____

Answer 4

• loosens
• turnover
• closure
• P. acnes

Question 5

Benzoyl peroxide side effects

Answer 5

• drying & peeling of skin
• burning, blistering, scaling, edema
• no systemic side effects

Question 6

Sulfur products

Answer 6

Fostril, Liquimat, combination products

Question 7

Sulfur mechanism of action

Answer 7

forms hydrogen sulfide when applied to skin

Question 8

Sulfur pharmacological effect H–S:

• causes inflammation which promotes ____ and ____ of plugs
• ____ properties due to inactivation of ____ enzymes

Answer 8

• peeling; unblocking

- antibacterial; bacterial

Question 9

Sulfur side effects

Answer 9

redness, irritation, peeling, odor, comedogenic (acne-producing)

Question 10

Salicylic acid mechanism of action

Answer 10

lowers skin pH, increasing the hydration of keratin, facilitating the loosening and removal of keratinized skin cells

Question 11

Salicylic acid pharmacological effect:

• promote shedding of ____ ____
• effects range from ____ to ____ (dependent on ____)

Answer 11

• stratum corneum

- peeling; desquamation; concentration

Question 12

Salicylic acid concentrations:

• for dandruff, acne and psoriasis?
• for wart and corn removal?

Answer 12

• 3-6% (6% may cause skin damage)

- up to 40%

Question 13

Salicylic acid side effects

Answer 13

• irritation and inflammation of normal skin

- salicylism

Question 14

Acne antibiotic drugs:

Answer 14

tetracycline, minocycline, doxycycline, clindamycin, erythromycin
metronidazole
azelaic acid

Question 15

Acne antibiotic mechanism of action (except metronidazole)

Answer 15

reduces P. acnes by inhibiting protein synthesis (bacteriostatic) and decreases the percentage of free fatty acids

Question 16

Tetracycline brand names

Answer 16

Achromycin, Sumycin, Topicycline

Question 17

Tetracycline unique mechanism

Answer 17

decreases keratin in the sebaceous pores

Question 18

Tetracycline side effects (oral)

Answer 18

GI: N/V/D

pseudomembraneous colitis

Question 19

Tetracycline:

• ____ and ____ are discolored and ____ is impaired in the young (binds to ____; can’t give with milk, antacids, aluminum…)
• ____ for fair-skinned people
• increased incidence of ____
• little use of ____ tetracycline

Answer 19

• bones; teeth; growth; calcium
• photosensitivity
• superinfections
• topical

Question 20

Monocycline brand name?
Doxycycline brand name?
They may be more efficacious than ____
Side effects?

Answer 20

• Minocin
• Vibramycin
• tetracycline
• ototoxicity and darkening of skin and teeth more than tetracycline

Question 21

Erythromycin brand names

Answer 21

E-mycin, Ery-tab, A/T/S, Erycette, T-Stat, Ery-Sol, Benzamycin

Question 22

Erythromycin side effects

• oral?
• topical?

Answer 22

• N/V/D, epigastric pain, CYP3A4 inhibition

- burning and drying, especially when combined with benzoyl peroxide

Question 23

Metronidazole brand names

Answer 23

Flagyl, Metrogel

Question 24

Metronidazole mechanism of action

Answer 24

unknown, but used for acne rosacea instead of acne vulgaris

inhibits growth of Demodex brevis

Question 25

Metronidazole side effects: - N/V/D - peripheral ____ with prolonged use - ____ reaction (headache, copious ____, ____tension, possible death) - ____ in animals - burning, stinging, drying

Answer 25

- neuropathy - disulfuram; vomiting; hypo - carcinogenic - burning, stinging, drying

Question 26

Azelaic acid brand name

Answer 26

Azelex

Question 27

Azelaic acid pharmacological effect

Answer 27

antimicrobial action, reduction in the thickness of the stratum corneum, anti-wrinkle

Question 28

Azelaic acid side effects

Answer 28

- pruritis, burning, stinging, tingling | - erythema, dryness, rash

Question 29

Retinoids

Answer 29

vitamin A tretinoin adapalene isotretinoin

Question 30

Vitamin A is necessary for cell ____, ____ and ____ of epithelial cells, the ____ system and vision. Deficiency results in ____ and keratotic skin. High and low ____ give the same effect on skin, eyes and birth defects.

Answer 30

growth; differentiation; homeostasis; reproduction hyperplastic doses

Question 31

Tretinoin brand names

Answer 31

Retin-A, Renova, Avita, Retin-A Micro

Question 32

Tretinoin and isotretinoin mechanism: - Direct? - Indirect?

Answer 32

- homo- or hetero-dimer retinoid-receptor complexes bind to RARE and either promote or inhibit protein transcription - one receptor complex binds a transcription factor preventing it from binding to TRE on the DNA

Question 33

Tretinoin and adapalene pharmacological effects: - Decreases ____, promotes ____, increases the ____ and reduces the ____ of keratinocytes - the change in protein transcription has ____ and ____ activity - Reduces the thickness of the ____ ____

Answer 33

- proliferation; differentiation; turnover; cohesiveness - anti-inflammatory; anti-proliferative - stratum corneum

Question 34

Tretinoin side effects

Answer 34

- blistering, peeling, crusting, burning, edema - photosensitizing - might get worse before it gets better - no known systemic side effects

Question 35

Adapalene brand name

Answer 35

Differin (topical)

Question 36

Adapalene mechanism of action

Answer 36

same as other retinoids except it binds to RAR beta and gamma (leading receptor in skin) receptors only

Question 37

Adapalene side effects

Answer 37

erythema, scaling, dryness, pruritis, burning

Question 38

Isotretinoin brand name

Answer 38

Accutane (oral)

Question 39

Isotretinoin pharmacological effect: - decreases ____ ____ size - decreases ____ production - reduces ____ by inhibiting ____ release from macrophages - reduces ____

Answer 39

- sebaceous gland - sebum - inflammation; prostaglandin - keratinization

Question 40

Isotretinoin common side effects

Answer 40

- Common: inflammation of lips, epitaxis, itching of skin and nose, xerosis, conjunctivitis, xerophthalmia - Less common: skin rash, peeling on palms and soles, photosensitization, alopecia, arthralgia

Question 41

Isotretinoin CNS side effects

Answer 41

- persistant headache | - lethargy, fatigue, depression, psychosis, suicidal ideation

Question 42

Isotretinoin ophthalmic effects

Answer 42

- conjunctivitis, blurred/tunnel vision, diplopia, - reduction of night vision (rare) - optic neuritis, cataracts, papiledema (rare)

Question 43

Isotretinoin effects of blood lipids: - increase ____ and plasma ____ levels - reduces ____ levels

Answer 43

- triglycerides; cholesterol | - HDL

Question 44

Retinoids are ____ which are signaling molecules that control the ____ pattern of differentiation, making it a ____.

Answer 44

morphogens; spatial; teratogenic

Question 45

Push for retinoid removal from market due to

Answer 45

birth defects, teen suicide and 50% greater risk of Crohn's disease

Question 46

Pseudomembranous colitis, a side effect of ____ and ____ (antibiotics), may lead to a ______ caused by C. ______.

Answer 46

tetracycline; clindamycin; superinfection; difficile

Question 47

Clindamycin brand names

Answer 47

Cleocin, Cleocin T, C/T/S

Question 48

Clindamycin oral side effects: - ____ colitis (____infection) - N/V/D - impaired ____ function - ____ (rare)

Answer 48

- pseudomembraneous colitis; super - liver - neutropenia

Question 49

Clindamycin topical side effects

Answer 49

- dryness or peeling of skin | - contact dermatitis