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Therapeutics > 76: Acne > Flashcards

76: Acne Flashcards

1
Q

acne

A

-inflammatory diseasse of sebaceaous glands and hair follicles
-comedones, papules, pustules
-inc androgens in adolescents

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2
Q

Aggravating factors acne

A

-oil cosmetics
-emotional stress
-irritation
-drugs

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3
Q

Drugs that worsen acne

A

-androgenic steroids
-corticosteroids
-lithium
-anti-epileptics
-tuberculostatic drugs
-oral contraceptives

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4
Q

Acne patho

A

-keratin obstruction of sebaceous follicle
-traps sebum
-comedone
-bacteria colonize in trapped sebum

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5
Q

comedone

A

-hair follicle plugged w sebum, keratin, dead skin

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6
Q

propionibacterium ances

A

-naturally colonize in skin/sebaceous glands
-proliferates in sebum environment
-convert TG to FFA = irritate cell = inflammation

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7
Q

Types of acne

A

-non-inflammatory (white/black heads)
-inflammatory (papules, pustules, ruptured contents)

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8
Q

Secondary lesions from acne

A

-excoriations
-erythematous macules
-hyperpigmented macules
-scars

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9
Q

acne tx complications

A

-dermabrasion
-chemical eels
-laser resurfacing
-$$$

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10
Q

Goals of acne therapy

A

-long-term control
-relieve discomfort
-improve skin appearance
-minimize stress
-prevent scars

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11
Q

MOA of acne therapy

A

-antimicrobial
-anti-inflammatory
-dec sebum production
-keratolytic
-comedolytic

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12
Q

keratolytic

A

-break down outer layers of skin
-dec thickness
-sloughing
-slicylic acid, urea, a-hydroxy acids

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13
Q

comedolytic

A

-inhibits formation of comedones
-tretinoin, adapalene, azelaic acid

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14
Q

non pharma tx of acne

A

-mild face soap BID
-minimize use of irritating products (aftershave, alcohol bases)
-use TEPID water
-weeks to months to see improvement

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15
Q

tx of mild comedonal, noninflammatory acne

A

-topical retinoids
-esp adapalene
-alt: benzoyl peroxide or azelaic acid low strength

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16
Q

tx of mild papulopustular inflammatory acne

A

-adapalene + BP
-or Clindamycin + BP
-alt: other retinoids, adapalene + oral antibiotic for disease

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17
Q

Tx of severe papulopustular and moderate nodular acne

A

-oral isotrentinoin
-alt: OA + adapalene, azelaic acid, oral antiandrogens, or antiandrogens + topicals

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18
Q

tx of nodular/conglobate acne

A

-oral isotrentinoin
-alt: OA + azelaic acid or any other topical agents or oral antiandrogens

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19
Q

Maintenance tx of acne

A

-adapalene
-alt: tazarotene, trentinoin, azelaic acid, BP

20
Q

Retinoids

A

-Adapalene
-Tazorotene
-Tretinoin

-regulate epithelial growth

21
Q

Adapalene

A

-1st line for mild acne both types and maintenance therapy
-gel, cream, solution
-daily at hs

22
Q

Tazorotene (tazorac)

A

-retinoid
-maintenance and comedonal tx
-cream, gel
-qd
-start low
-very drying
-category X

23
Q

Tretinoin

A

-retinoid
-cream, gel, solution
-qd hs
-sting, burn
-dryness
-photosensitivity
-4-6 weeks for improvement

24
Q

Azelaic acid (azelex)

A

-cream
-antibacterial
-keratolytic
-adjunct
-well tolerated

25
Q

Benzoyl peroxide (Oxy-10)

A

-cream, gel, lotion
-antibacterial
-comedolytic/keratolytic
-anti-inflammatory
-BID
-dry skin/irritation
-can bleach
-start lower strength

26
Q

topical antibiotics

A

-clindamycin +/- BP
-erythromycin

27
Q

Clindamycin (Cleocin-T)

A

-gel, solution, lotion
-topical antibiotic
-daily or BID

-also can come with BP in cream form to limit resistance

28
Q

Erythromycin

A

-gel, solution
-BID
-expires 30 days

29
Q

Low cost acne tx

A

-topical retinoid (lots are in OTC stuff)

30
Q

Medium cost acne tx

A

-oral abx
-anti-androgens
-oral corticosteroids

31
Q

high cost acne tx

A

-isotrentinoin
-anti-androgens
-tazarotene

32
Q

Adverse effects of topical products

A

-erythema
-scaling
-burning
-flare
-resistance (abx)

-tretinoin kinda the worst of em

33
Q

Combo products for acne tx

A

-Clindamycin + BP
-Adapalene + BP
-most insurance wont cover combo but will cover individual ingredients

34
Q

Oral abx

A

-minocycline
-doxycycline
-erythromycin
-azithromycin
-TMP/SMX

35
Q

Oral abx tx for acne

A

-dec bacteria and inflammation
-give it a few weeks
-most effect for inflammation
-switch to maintenance after inflammtion under control

36
Q

Oral abx risks

A

-allergy
-photosensitivity
-GI upset
-thrush
-resistance (limit to 6-8 weeks)

37
Q

Oral anti-androgen tx for acne

A

-low dose contraceptives
-spironolactone

38
Q

Topical anti-androgen therapy

A

-hormone tx
-clascoterone 1% cream
-androgen receptor inhibitor
-applied BID
-local erythema most common side effect

39
Q

Clascoterone 1% cream

A

-androgen inhibitor
-M or F
-BID
-erythema most common SE

40
Q

tx of severe ance

A

-isotretinoin

41
Q

Isotretinoin

A

-severe acne tx or pt fail everything else
-vit A derivative
-v effective
-reduces sebum and shrinks sebaceous glands

42
Q

Isotretinoin dosing

A

-0.5-2 mg/kg/day in 2 doses wf
-15-20 weeks
-acne will worsen then get better
-if acne flares after 2 months off tx, do 2nd course
-effectiveness inc w dose

43
Q

Isotretinoin side effects

A

-dry skin, eyes, nose, lips
-hair shedding
-peeling of palms and soles
-photosensitivity
-back pain
-arthralgias/myalgia
-fatigue
-risk of osteoporosis/delayed bone healing
-high AST/ALT
-high cholesterol and triglycerides
-category X
-HA
-mood changes
-night blindness
-depression/suicide

44
Q

Isotretinoin counseling tips

A

-avoid preg
-use contraception
-side effects
-do NOT take vit A
-use moisturizer and sunscreen
-take w food

45
Q

iPledge program

A

-dispensing only occurs after pharmacist receives authorization code
-30 day no refills
-do not dispense 7 days after office visit
-negative preg test every month

46
Q

Acne tx follow up

A

-2-6 months to see success
-lengthening acne free periods is key

Therapeutics (78 decks)

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