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Intro to D&D Final > Acne therapeutics part 2 > Flashcards

Acne therapeutics part 2 Flashcards

1
Q

true or false

benzoyl peroxide can be used as monotherapy in mild acne

A

true - but often used in combination

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2
Q

what strengths is benzoyl peroxide available

A

2.5-10%, but therapeutic efficacy has been shown to max out at 2.5%

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3
Q

what is the only benzoyl peroxide dosage form that is exclusively available as RX

A

gel

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4
Q

in what patients should benzoyl peroxide be avoided in

A

sensitive skin

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5
Q

true or false

benzoyl peroxide causes c. acnes resistance

A

FALSE - DOES NOT

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6
Q

If a patient experiences redness, burning, itching, peeling, or swelling from benzoyl peroxide, what should be done?

A

if mild, apply less frequently or reduce concentration

if severe, discontinue

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7
Q

how long does it take to observe results after using benzoyl peroxide

A

as soon as 5 days

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8
Q

concern with benzoyl peroxide

A

may bleach hair or fabrics

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9
Q

when using benzoyl peroxide, avoid contact with….

A

eyes, lips, mouth

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10
Q

name a topical hormone used for acne

A

clascoterone

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11
Q

what kind of acne is clascoterone used for

how does it work

A

HORMONAL ACNE

inhibits androgen receptors, which helps to reduce oil production and inflammation

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12
Q

true or false

clasterone is only indicated for men

what age?

A

FALSE

men and women 12 and older

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13
Q

explain how clasterone should NOT be applied

A

do not apply under occlusive things - risk of being systemically absorbed

so not apply over large surface areas of use for prolonged period of time

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14
Q

common vs more rare adverse events from using clascoterone

A

common - redness,dry, itchy

more rare – HPA suppression (hypothalmic-pituitary-adrenal)

LONG TERM SAFETY IS LACKING

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15
Q

since clascoterone has the potential to cause HPA suppression, what is an important consideration

A

have to taper down if stopping

do not stop abruptly (like steroids)

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16
Q

true or false

clascoterone is the only hormonal acne agent used in men (topically)

A

true

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17
Q

*****very important consideration when using antibiotics for acne - whether topical or systemic

A

DO NOT USE ALONE

use other agent with it

increased risk of resistance if you dont

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18
Q

which topical antibiotic is a SULFONE and what is the concern

A

DAPSONE

should not be used in pts with sulfa allergies

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19
Q

what is the newest topical antibiotic

A

minocycline

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20
Q

how does minocycline come?

what about dapsone?

A

minocycline - comes as FOAM

dapsone - comes as 5% and 7.5% gel

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21
Q

is minocycline topical foam expensive?

A

YES

more costly than erythromycin and clindamycin, but no evidence that it works better than clindamycib

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22
Q

dapsone is used in ______ acne….

A

inflammatory acne

and for comodomal (noninflammatory acne) in combination with a topical retinoid or benzoyl peroxide

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23
Q

name something that can happen when dapsone is applied

A

if used with benzoyl peroxide, it may be oxidized and turn an orange-brown, but it’s not a big deal because it can be brushed away

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24
Q

true or false

dapsone has been shown to benefit males more than females

A

FALSE

females more than males

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25
Q

what is a consideration if wanting to start a fixed-dose topical combination

A

if they’ve never used either before, may want to just start with 1 to see how their skin reacts and how they respond

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26
Q

concomitant BP use us recommended with combined ____ and _____ to prevent the development of antibiotic resistance

A

topical retinoid and topical antibiotic

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27
Q

place in therapy for oral (systemic) antibiotics

A

moderate-severe INFLAMMATORY acne

in conjunction with topical benzoyl peroxide and retinoid

28
Q

how long should someone be on oral antibiotics for acne?

explain

A

usually stopped in around 12 weeks

within 12 weeks, the appearance of new inflamm. lesions is reduced, and should start tapering down

if a flare up happens while tapering, increase the dose back up.

while all this is happening, TOPICAL THERAPY IS STILL BEING USED

29
Q

The goal with using oral antibiotics is to….

A

discontinue the oral antibiotics and be able to maintain control with topicla therapy

30
Q

true or false

topical antibiotics and oral antibiotics should not be used together

A

TRUE

BREEDS RESISTANCE

31
Q

there is no evidence to use oral antibiotics past….

A

3-4 months

32
Q

how long to notice clinical improvement after starting oral antibiotics

A

6-8 weeks

very long time

if nothing happens at this point, consider stopping (TAPER)

33
Q

true or false

oral antibiotics should not be used long term for acne

A

true

if they do well on them but flare up after taking off and keep needing to be put back on — consider alternate therapy

34
Q

initial dose minocycline for acne

A

50mg BID

35
Q

TRUE OR FALSE

minocycline is clinically less efficacious than the other oral ABX for acne

A

FALSE - actually more effective

this is because it’s more lipophilic than tetracycline and doxycycline — more can accumulate in the hair follicles to produce effefcts

36
Q

dose of doxy for acne

A

50-200mg in divided doses

37
Q

pt education for minocycline

A

take with food for better absorption (it’s lipophilic!)

sit upright after taking for less side effects like vertigo

38
Q

which is more likely to cause nausea and photosensitivity - tetracycline or minocycline?

A

tetracycline more likely

39
Q

2 main side effects doxycycline

A

GI side effects (take w food and sit upright)

photosensitivity

40
Q

what is sarecyckine

A

an oral antibiotic that can be used for acne. extremely expensive and not 1st or 2nd line

41
Q

advantages and disadvantages of sarecyckine

A

has lower GI ADRs because it has less activity against normal GI flora (NARROWER SPECTRUM)

very expensive and no improved efficacy or decreased chance of resistance

42
Q

name 2 systemic hormone therapies for acne

A

estrogen
anti-androgens (androgen receptor blocker)

43
Q

place in therapy for estrogen therapy

A

teens and women with mild, moderate, or severe acne IF TOPICALS FAIL!!!!!

used as an adjunct with other therapy

treatment for women who also want to use as birth control

44
Q

place in therapy for anti androgens

A

women with hyperandrogenism bc of PCOS and adrenal hyperactivity (hirsutism and acne)

45
Q

ideal birth control product (estrogen therapy) for acne control

A

LOW ANDROGEN activity and LOW DOSE OF ESTROGENS

46
Q

what particular patients on oral contraceptives are at high risk of a clot

A

if they smoke/have family history

47
Q

common side effects of estrogen therapy

A

nausea, weight gain, spotting, amenorrhea, breast tenderness

48
Q

is spironolactone used for acne treatment in men

A

not really, due to undesirable effects of gynecomastia (inc breast tissue) and decreased libido (sex drive)

49
Q

true or false

spironolactone is fairly well tolerated in females

A

true

most side effects occur in men

50
Q

monitoring in spironolactone

A

monitor potassium and BP

also check androgen levels at baseline and then every 3 months to make sure androgens are being suppressed

51
Q

with what drugs should spironolactone be avoided

A

bactrim
ARBS
ace inhibitors
potassium substutues

52
Q

place in therapy isotretinoin

A

SEVERE INFLAMMATORY ACNE

last line

53
Q

briefly explain dosing isotretinoin

how long is therapy?

A

WEIGHT BASED

start at low dose and gradually increase as tolerated

16-20 weeks, and in rare cases 24-32 weeks

54
Q

side effects isotretinoin

A

hair loss (resolves)
depression, psychosis
suicidal thoughts
benign intracranial HTN
abnormal labs
mucocutaneous side effects (drying)

hyperlipidemia

55
Q

is isotretinoin taken with or without food

A

empty stomach for isotretinoin with lidose

with food for norm

56
Q

explain in further detail how isotretinoin dries you out

A

dry skin, eyes, nose, and mouth

57
Q

resolution for dry skin and eyes caused by isotretinoin

A

skin - moisturize

eyes - artificial tears (may not be able to tolerate contacts)

58
Q

resolution for dry nose and mouth caused by isotretinoin

A

nose - petrolatum (vaseline) possibly an antibiotic ointment like bacitractin for colonization of staph aureus

mouth - hard candies

59
Q

MAIN lab values that isotretinoin effects

A

hyperlipidemia and increased hepatic enzymes (ALT, AST)

60
Q

normal triglyceride value

A

less than 150

61
Q

as mentioned, isotretinoin causes hyperlipidemia - increased triglycerides

what is the biggest concern with this

A

can cause pancreatitis

therefore, dont give to someone who is already very high at baseline

62
Q

normal hepatic enzyme value

A

5-20

if they were at 5 and went all the way to 20, it’s still in range but it’s a concern bc they quadrupled the value

if was at 19 and now 26, not as big a concern

63
Q

RARE isotret side effects

A

decreased WBC

osteoporosis
skeletal abnormalities
hypercalicemia

64
Q

pts on isotretinoin should eat what kind of diet

A

LOW IN FAT

it’s gonna cause hyperlipidemia

65
Q

2 methods of contraception are necessary if on isotretinoin

how long

A

start at 1 month prior to therapy and continue until 1 month after

66
Q
A

Intro to D&D Final (22 decks)

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