Retinoids Flashcards

Question

Biologic function of retinoids

Answer 1

1. only medication that effect (although not to the same degree) all the etiologic factors (sebum oroduction, comedeogenesis, colonization with P.acnes) 2. Initially restricted to nodulocystic acne - now also moderate acne with signs of scarring 3. Intially - optimal benefits at up to 1mg/kg per day (but dose dependent side effects) smiliar short term results obtained with less than 0.5mg/kg/day (can continue longer to total acc dose to prevent relapse) 4. Total acc dose: total amount of oral isotretinoin over course divided by body weight 5. Total accumulative dose for minimising rx post relapse = 120-150mg/kg (no further gain above 150) 6. A lag period of 1-3 months may occur before onset of response 7. 1/3 require 2nd course (persistence/relapse) 8. Exclude hyperandrogenemia d/t ovarian or adrenal dysfx with a hx in women with acne unresponsive to isotret 9. A flare of disease in first few weeks with acne cysts with pyogenic granuloma like lesions (can reduce risk by low dose in first few weeks) 10. Contraception in females = NB!!! (1 month prior until 1 month after) 11. Isotretinoin more limitied effect in Hs, dissecting cellulitis of scalp, (sometimes with acne in follicular occlusion tetrad$ 12. Some clinicians recommend isotretinoin before HS surgery, other avoid d/t increased scarring risk

Answer 2

1. isotretinoin and acitretin are somewhat effective and are considered to be of equal potencg in the treatment of Mf 2. Retinoids can be used in combination with PUVA, interferin or systemic chemotherapy 3. It is often impossible to maintain remission with these retinoids as monotherapy 4. Oral and topical CTCL produce clinical response in CTCL 5. Combination therapies utilizing bexarotene together with PUVA, NB-UVB, Mtx, interferon alpha or denileukin diftitox have also been evaluated

Answer 3

Avoid/use cautiously 1. Tetracycline, doxycycline, minocycline (increase intracranial pressure) 2. Alcohol (increased conversion of acitretin to etretinate and hepatotoxicity) 3. Methotraxate (synergistic liber toxicity with retinoids, hiwever sometimes used with close monitoring in PRP, severe psoriasis) - caution - ETOH, tetracyclines, vitamin A supplements 4. Vitamin A supplements (risk of hypervitaminosis A) - toxicity risk may increase with CYP3A4 inhibitors such as azoles and macrolides, cyp stimulators such as rifampicin, phenytoin, carbamazapine may decrease level of retinouds 5. May increase cyclosporine level via competing for CYP3A4 6. Can have poor hgt control in DM and retinoid (rare SE) 7. Acitretin decrease efficacy of POPs 8. Avoid UV/photosensitizing meds 9. Interaction between RXR and Viramin D receptor positively affect action of Vit D3

Answer 4

1. Icthyosis - Acitretin for nonsyndromic AR congenital icthyosis (consider intermittend) as disease is lifelong 2. Darier disease - start low to prevent exacerbation (acitretin 10mg po 3x weekly) 3. PRP - Acitretin preferred above iso 4. Rosacea - treatment resistant (works better on inflammatory lesions) 5. Premalignant and malignant skin lesions - acitretin effective, also works for HPV induced neoplasia and actinic keratosis (in pts with basal cell nevus syndrome and XP if may reduce development of skin Ca), renal transplant precipitants 6. Lupus erythematosus - Both iso and Aci used succesfully in pts with various forms of lupus

Answer 5

absolute - pregnancy, women contemplating pregnancy, non-compliance with contraception, breastfeeding and hypersensitivity relative contra-indication - leukopenia, moderate to severe hypercholesterolemia or hypertriglyceridemia, significant hepatic (esp for bexarotene) or renal dysfx, hypothyroidism (eso for bexarotene and alitretinoin), suicidal ideation, and pseudotumor cerebri. Patients should not tale vit A supplements in excess

Answer 6

1. Dyslipidemia 2. Liver toxicity 3. Hematologic toxicities

Answer 7

1. Skin irritation (most common) - erythema and peeling (retinoid dermatitis) - perioral most sensitive

Answer 8

1. Skin irritation (most common) - erythema and peeling (retinoid dermatitis) - perioral most sensitive 2. No proven photoallergic/phototoxic toxic to topical retinoids (but decreased tolerance to UVR) 3. No evidence that topical retinoid causes congenital abnormalities 3. Temporary worsening of acne may occur within the first few weeks of rx 4. Uncommon side effects include transient hypo- or hyperpigmentation, koebnerization of psoriasis (esp tezarotene), allergic contact dermatitis and ectropion

Answer 9

1. Teratogenicity 2. Skin and mucous adverse affects 3. Systemic toxic effects - Bone toxicity - Muscle effects - CNS and psychiatric effects - Opthalmologic side effects - hypothyroidism -Gastro-intestinal side effects -renal effects

Answer 10

1. potent teratogens 2. No retinoid embryopathy /malformation have been reported in pregancies where only the male partner in p/c was taking iso/acitretin at time of conceptuon HOWEVER usually recommended that ken who actively trying to father children avoid retinoid therapy 3. Also NO blood donation OR sharing meds

Answer 11

narrowing of disc space

Answer 12

1. Raised intra cranial pressure (N/V/headache) 2. Complete pseudotumor cerebri syndrome with papilledema + blurred vision = rare 3. Examine for papilledema if persistent headache/vision/n/v 4. No clear evidence for increased in psychosis/depression/suicide in fact decreased depression but counsel pt about if

Retinoids Flashcards

(55 cards)