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Pharm I > Acne > Flashcards

Acne Flashcards

1
Q

Types of topicals from most drying to most moisturizing

A 
Solutions
Gels
Lotions
Creams
Ointments
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2
Q

Percent involvement- head and neck

A

9%

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3
Q

Percent involvement anterior thorax

A

18%

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4
Q

Percent involvement posterior thorax

A

18%

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5
Q

Percent involvement each arm

A

9%

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6
Q

Percent involvement each leg

A

18%

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7
Q

Percent involvement genital area

A

1%

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8
Q

Percent involvement area of the palm of hand

A

1%

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9
Q

Mild acne

A

Predominantly comedonal or mixed comedonal and inflammatory
Few to several papules or pustules
No nodules

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10
Q

Moderate acne

A

Several to many papules or nodules

Few to several nodules

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11
Q

Severe acne

A

Numerous or extensive papules or pustules

Many nodules

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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
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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

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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

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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

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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
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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

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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

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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

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20
Q

Benzoyl peroxide adverse effects/toxicities

A

Hypersensitivity rxns, contact sensitization rxns, excessive erythema, and peeling

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21
Q

Benzoyl peroxide pediatric use

A

Safety and effectiveness have not been established in children <12 yoa

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22
Q

Contraindications of salicylic acid

A

Known sensitivity to salicylic acid or any other ingredient in the formulation

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23
Q

Adverse effects/toxicities of salicylic acid

A

Hypersensitivity rxns, salicylate toxicity, excessive erythema, and scaling

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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

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25
Q

Interactions with salicylic acid

A

Acidifying agents, anticoagulants, antidiabetic agents, ASA, corticosteroids, diuretics, methotrexate, pyrazinamide, sulfur, and uricosuric agents

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26
Q

Pediatric use- salicylic acid

A

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

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27
Q

Adverse drug effects of topical retinoids

A 
Local erythema
Peeling
Dryness
Pruritis
Burning
Scaling
Stinging
Xerosis
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28
Q

Adapalene

Differin

A 
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
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29
Q

Tazarotene
Avage
Fabior
Tazorac

A 
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
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30
Q

Tretinoin
Atralin
Avita
Retin-A

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
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31
Q

Topical antibiotics for acne

A

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

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32
Q

Adverse drug effects of topical abx

A 
Local erythema
Dryness
Peeling
Burning
Oiliness
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33
Q

Dapsone contraindications

A

None

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34
Q

Adverse effects/toxicities of Dapsone

A

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

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35
Q

Interactions with Dapsone

A

TMP-SMX, topical benzoyl peroxide, rifampin, anticonvulsants, St. John’s wort, folic acid antagonists

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36
Q

Other issues with Dapsone

A

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

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37
Q

Pediatric use with Dapsone

A

Safety and efficacy was not studied in pediatric pts <12 yoa have not been established

38
Q

Active ingredients and strength- Acanya gel

A

Clindamycin phosphate 1.2% and benzoyl peroxide 2.5% (aqueous based)

39
Q

Active ingredients and strength- BenzaClin gel

A

Clindamycin phosphate 1% and benzoyl peroxide 5% (aqueous based)

40
Q

Active ingredients and strength- Benzamycin gel

A

Erythromycin 3% and benzoyl peroxide 5% (alcohol based)

41
Q

Active ingredients and strength- Duac gel

A

clindamycin phosphate 1% and benzoyl peroxide 5% (aqueous-based)

42
Q

Active ingredients and strength- Epiduo gel

A

Adapalene 0.1% and benzoyl peroxide 2.5%

43
Q

Active ingredients and strength- Veltin gel

A

Clindamycin phosphate 1.2% and tetinoin 0.025%

44
Q

Active ingredients and strength- Ziana gel

A

Clindamycin phosphate 1.2% and tretinoin 0.025%

45
Q

Oral abx adverse drug reactions

A

Vaginal candidiasis, increased risk of URTIs

Serious: benign intracranial htn with tetracyclines

46
Q

Doxycycline adverse drug effects

A

Pill esophagitis
GI upset
Photosensitivity
Staining of tooth enamel (less than or equal to 8 yo)

47
Q

Doxycyline notes

A

Pregnancy category D
Recommended over tetracycline bc increased efficacy, potential for once-daily dosing, better follicle penetration, less resistance

48
Q

Erythromycin adverse drug effects

A

GI upset

49
Q

Erythromycin notes

A

Pregnancy category B
High prevalence of resistance
Reserved for those who cannot use tetracycline

50
Q

Tetracycline adverse drug effects

A

Fixed drug eruption
GI sx
Staining of tooth enamel (less than or equal to 8 yo)

51
Q

Tetracycline notes

A

Pregnancy Category D

Recommended over erythromycin bc less resistance

52
Q

Minocycline adverse drug effects

A 
Pigment deposition in skin, mucous membranes, and teeth
Autoimmune hepatitis
System LLS
Serum sickness-like rxn
DHS
53
Q

Minocycline notes

A

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
Q

TMP-SMX adverse drug effects

A 
TEN
SJS
Bone marrow suppression
Hypersensitivity rxns
Drug eruptions
Fixed drug eruption
55
Q

TMP-SMX notes

A

Pregnancy category D

Can be used if other oral abx cannot be tolerated

56
Q

Ways to optimize oral antibiotic therapy

A

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
Q

Azelaic acid (Azelex and Finacea) contraindications

A

Known hypersensitivity to azelaic acid or any of its components

58
Q

Azelaic acid adverse effects/toxicities

A

Pruritis, burning, stinging, tingling, erythema, dryness, rash, peeling, irritation, dermatitis, and contact dermatitis

59
Q

Azelaic acid pediatric use

A

Safety and effectiveness in pediatric pts <12 yoa have not been established

60
Q

Contraindications for Isotretinoin

A

Hypersensitivity to isotretinoin or any of its components
Hypersensitivity to vit A
Pregnancy

61
Q

Interactions of isotretinoin

A

Tetracycline, vitamin A, methotrexate, contraceptives, or alcohol

62
Q

Baseline monitoring of isotretinoin

A

LFT, pregnancy test, lipid panel

63
Q

Ongoing monitoring of isotretinoin

A

Pregnancy test every 30 days for females

64
Q

Pediatric use for isotretinoin

A

Safety and effectiveness not established in children <12 yoa

65
Q

BBW for isotretinoin

A

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
Q

iPLEDGE`

A

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
Q

Contraindications of hormonal contraception

A 
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
Q

Adverse effects/toxicities of hormonal contraception: cardio

A

Edema, varicose veins aggravation

69
Q

Adverse effects/toxicities of hormonal contraception: CNS

A

Depression, migraine, mood changes

70
Q

Adverse effects/toxicities of hormonal contraception: skin

A

Cholasma, melasma, or erythema

71
Q

Adverse effects/toxicities of hormonal contraception: endocrine

A

Amenorrhea, breakthrough bleeding, breast pain/tenderness, fluid retention, or infertility

72
Q

Adverse effects/toxicities of hormonal contraception: GI

A

Abdominal bleeding, abdominal cramps, appetite changes, nausea, weight changes, or vomiting

73
Q

Adverse effects/toxicities of hormonal contraception: GU

A

Cervical ectropion, cervical secretion, vaginal candidiasis or vaginitis

74
Q

Adverse effects/toxicities of hormonal contraception: blood

A

Folate decreased, porphyria exacerbation

75
Q

Drug interactions with hormonal contraceptives

A

Abx decrease the effectiveness of hormonal contraceptives

76
Q

Baseline monitoring for hormonal contraception

A

Pregnancy status, blood pressure

77
Q

Pediatric use of hormonal contraception

A

Use before menarche is not indicated

78
Q

Contraindications of spironolactone

A

Acute renal failure, Addison disease, hyperkalemia, anuria, concomitant eplerenone or triamterene use and significant renal impairment

79
Q

Adverse effects/toxicities of sprionolactone

A

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
Q

Ongoing monitoring for spironolactone

A

Serum potassium, sodium, and renal function

81
Q

General measures for psoriasis

A

Skin cleansing and moisturizing regimen
Sunscreen (SPF 30 or more)
Yellow or green-tinted cosmetics
Avoid toners, fragrances, and abrasives

82
Q

1st line therapy for psoriasis without papulopustual lesions

A

Topical metronidazole, azelaic acid or brimonidine

Vascular laser therapy

83
Q

1st line therapy for psoriasis with papulopustual lesions- mild to moderate

A

Topical metronidazole or azelaic acid
Topical brimonidine
Topical ivermectin
Vascular laser therapy

84
Q

1st line therapy for psoriasis with papulopustual lesions- moderate to severe

A

Topical metronidazole OR
Azelaic acid + doxycycline
Topical brimonidine
Vascular laser therapy

85
Q

2nd line therapy for psoriasis with papulopustual lesions- mild to moderate

A

Topical BP, erythromycin, clindamycine

Doxycycline

86
Q

2nd line therapy for psoriasis with papulopustual lesions- moderate to severe

A

Doxycycline

87
Q

3rd line therapy for psoriasis with papulopustual lesions- mild to moderate

A

Doxycycline

Topical retinoids

88
Q

3rd line therapy for psoriasis with papulopustual lesions- moderate to severe

A

Oral abx (tetra, minocycline, metronidazole, azithromycin) + topical BP, erythromycin, clindamycin, or permethrin

89
Q

Refractory tx for psoriasis with papulopustual lesions- mild to moderate

A

Start moderate-severe tx

90
Q

Refractory tx for psoriasis with papulopustual lesions- moderate to severe

A

Consider oral isotretinoin

91
Q

Toxicities of topical corticosteroids for psoriasis

A

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.

Pharm I (10 decks)

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