Common Skin Conditions Flashcards
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
The ______________________________ has pictures of common skin conditions that help identify it.
Another helpful resource is ___
Handbook of Nonprescription Drugs “OTC handbook of drugs”
www.dermnet.com
Natural products used for skin conditions:
- Aloe
- Tea Tree Oil
- Lysine
- Biotin
- Topical Vitamin D
- Aloe: is a natural product produced from the aloe vera plant and is used for sunburn and psoriasis.
- Tea Tree Oil: is used for acne
- Lysine: taken as a tablet, capsule or applied topically, is used for Cold sore (herpes simplex labialis) prevention
- Biotin: is a vitamin used for hair loss and brittle nails
- Topical Vitamin D: diaper rash and psoriasis
Drugs that can discolor skin and secretions:
Brown color
Entacapone
Levodopa
Methyldopa
- all can make urine brown
Drugs that can discolor skin and secretions:
Black/Green/Brown
Iron (black tary stool)
Methocarbamol
Drugs that can discolor skin and secretions:
Brown/Yellow
Nitrofurantoin* - can turn urine brown
Metronidazole
Tinidazole
Riboflavin (B2)
Drugs that can discolor skin and secretions:
Orange/Yellow
Sulfasalazine
Drugs that can discolor skin and secretions:
Yellow-Green
Propofol*
Flutamide
Drugs that can discolor skin and secretions:
Red-Orange
phenazopyridine* (a urinary analgesic) can cause urine to be red- orange.
rifampin*- come IV as a red formulation. It can discolor both Skin and Secretions. This can stain contact lenses.
rifapentine
Drugs that can discolor skin and secretions:
Red
anthracyclines (for the treatment of cancers)
Drugs that can discolor skin and secretions:
Blue
“Smurf drugs”
methylene blue
mitoxantrone
- both of these drugs are actually blue.
Drugs that can discolor skin and secretions:
Blue-Gray
“Smurf drugs”
amiodarone*- can tint the skin a blueish gray color
chloroquine
Drugs that can discolor skin and secretions:
Purple/Orange/Red
chlorzoxazone
Types of Acne Pimples:
In general, we have different types of bacteria on the surface of our skin.
We also have sebaceous glands which have oils and these can become clogged from dead skin cells, or oil.
Types of Acne Pimples:
White head
Black head
- these are normal mild acne lesions
White head- Pore is sealed (white closed comedone)
Black head - (black open comedone)
Types of Acne Pimples:
Papules
- are seen in moderate to severe acne
- there’s inflammation
- WBCs attacking bacteria infection
Types of Acne Pimples:
Pustules
- are seen in moderate to severe acne
-sometimes referred to as Nodular or Cystic acne - WBCs and waste products from bacteria, this is where you see Puss production
- there’s inflammation
Acne is classified according to the severity of the lesions.
Mild-
Moderate-
Severe-
Treatment is determined by severity.
Salicylic acid- can be helpful for very mild acne but not as effective as other agents
Mild Acne Tx:
First line-
Alternative–
First line-
(BPO) Benzoyl Peroxide
or
Topical retinoids (tretinoin, adapalene, tazarotene, trifarotene)
or
*Topical Combination Therapy = 1 of the 3 options
1) BPO + retinoid
2) BPO + topical antibiotic (all prescription)
3) BPO + topical antibiotic + retinoid
Alternative–
- add topical retinoid or BPO if patient is not already on.
or
- switch to a different retinoid
or
- use Topical dapsone (Aczone)
Moderate Acne Tx:
First line-
Alternative–
First line- *Topical Combination Therapy = (1 of 3 following options)
1) BPO + retinoid
2) BPO + topical antibiotic (all prescription)
3) BPO + retinoid + topical antibiotic
OR
Oral antibiotic + BPO + topical retinoid (+/- topical antibiotic)
Alternative——————————————————————
- change oral antibiotic
OR
For Females: can add combined oral contraceptive.
OR
For Females: can add spironolactone.
OR
trial
Severe Acne Tx:
First line-
Alternative–
First line- *Topical Combination Therapy = (1 of 3 following options) + oral
1) BPO + retinoid
2) BPO + topical antibiotic (all prescription)
3) BPO + retinoid + topical antibiotic
PLUS an oral antibiotic
OR
oral isotretinoin (Oral retinoid)
Alternative–
(BPO) Benzoyl Peroxide is more effective than salicylic acid
(BPO) Benzoyl Peroxide Counseling Points:
- can bleach clothing and hair
- increase sensitivity to the sun. So limit sun exposure and it is best to apply these at bedtime.
Topical Retinoid Counseling Points:
- known Teratogens, need to be avoided in pregnancy and breastfeeding
- are also used to reduce wrinkles
- increase sensitivity to the sun. So limit sun exposure and it is best to apply these at bedtime. Using only a pea-sized amount.
- if product causes irritation, then patient can apply every other day instead of daily or switch to a lower strength.
- these products take time to work. usually 4-12 weeks to work and initially acne will worsen before it gets better.
How do Retinoids work?
- Work primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands
How does BPO work?
The only topical OTC retinoid available is ______
adapalene (Differin)
BPO + hydrocortisone =
Vanoxide-HC
BPO + adapalene =
Epiduo, Epiduo Forte
- these are gels
BPO + erythromycin =
Benzamycin
BPO + clindamycin =
BenzaClin, Acanya, Neuac, Onexton
oral isotretinoin has many safety concerns:
- known Teratogen
- Cholesterol and pregnancy tests are Required on a monthly basis
- women must be on 2 forms of birth control and CANNOT use a progestin only pill (POP)
- can only pick up a 30-day supply at a time
- patients must sign a consent form about the safety concerns of birth defects
Oral isotretinoin should NOT be used with:
- Vitamin A supplements
- Tetracyclines
- Steroids
- Progestin only Contraceptives (POC) (e.g. Mini pill)
- St. Johns wort
Spironolactone is an __________
aldosterone receptor antagonist with antiandrogen effects.
Retin-A
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tretinoin
class: retinoid - Vitamin A derivative
Indications: Acne
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: gel, cream,
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Altreno
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Altreno sounds like Alveeno sooo its a ______
tretinoin
class: retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: lotion
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Atralin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tretinoin
class: retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: gel
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Renova
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tretinoin
class: retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: cream
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Differin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
adapalene
class: retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: gel
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Epiduo
Epiduo Forte
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
BPO + adapalene
class: retinoid +
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms:
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Tazorac
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tazarotene
class: retinoid
Indications: Acne
approved in individuals aged 9 and older
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: cream, gel
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
- Tazarotene often works better than tretinoin; it is used in difficult cases
Drug-Drug/Food interactions:
Fabior
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tazarotene
class: retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: foam
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Arazlo
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tazarotene
class: retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: lotion
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Duobrii
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
halobetasol + tazarotene
class: steroid + retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: lotion
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Amzeeq
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
minocycline foam
class: tetracycline antibiotic
Indications: Acne
MOA:
Dosage forms: topical foam 4%
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- the topical foam should be applied at approximately the same time each day at least 1 hour before bedtime.
- the patient should NOT bathe, shower or swim for at least 1 hour after application of the product.
- After shaking the can well, a small amount of the foam should then be rubbed into acne affected parts of the face.
- may stain clothing
Drug-Drug/Food interactions:
Aczone
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
dapsone gel
class: antibiotic
Indications:
-topical treatment of Acne vulgaris (alternative option)
MOA: drug is a competitive antagonist of para-aminobenzoic acid (PABA) and prevents normal bacterial utilization of PABA for the synthesis of folic acid.
Dosage forms: gel 5%
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
** Avoid in G6DP deficiency**
major CYP3A4 substrate
Drug-Drug/Food interactions:
Winlevi
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clascoterone cream
class:
Indications:
- for the topical treatment of acne vulgaris in patients 12 years of age and older
MOA: drug is an androgen receptor inhibitor.
Dosage forms: 1% cream
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- Apply a thin layer to the affected area twice daily (morning and evening).
- HPA axis suppression may occur during or after treatment; more likely with use over a large surface area, prolonged use, and use with occlusive dressings.
For Pharmacist:
- Keep product refrigerated before dispensing, patient can store at room temperature
Drug-Drug/Food interactions:
HPA axis suppression:
what is this?
How do we control or treat?
inadequate cortisol production
Absorbica
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
isotretinoin
class: retinoid
Indications: Only FDA-approved for severe, refractory nodular acne
MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: capsules
Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks
Max dose:
Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.
Contraindications:
Pregnancy
Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.
Side Effects:
Monitoring:
Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *
Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.
Drug-Drug/Food interactions:
Amnesteem
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
isotretinoin
class: retinoid
Indications: Only FDA-approved for severe, refractory nodular acne
MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: capsules
Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks
Max dose:
Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.
Contraindications:
Pregnancy
Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.
Side Effects:
Monitoring:
Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *
Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.
Drug-Drug/Food interactions:
Claravis
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
isotretinoin
class: retinoid
Indications: Only FDA-approved for severe, refractory nodular acne
MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: capsules
Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks
Max dose:
Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.
Contraindications:
Pregnancy
Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.
Side Effects:
Monitoring:
Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *
Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.
Drug-Drug/Food interactions:
Myorisan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
isotretinoin
class: retinoid
Indications: Only FDA-approved for severe, refractory nodular acne
MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: capsules
Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks
Max dose:
Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.
Contraindications:
Pregnancy
Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.
Side Effects:
Monitoring:
Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *
Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.
Drug-Drug/Food interactions:
Zenatane
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
isotretinoin
class: retinoid
Indications: Only FDA-approved for severe, refractory nodular acne
MOA: drug reduces sebaceous gland size and reduces sebum production. drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: capsules
Dosing:
0.5-1mg/kg/day, divided BID with food for 15-20 weeks
Max dose:
Boxed Warnings:
-* Birth defects have been documented; must not be used by patients who are pregnant or may become pregnant*.
- *Can only be dispensed by a pharmacy registered and activated with the pregnancy REMS (iPLEDGE) program. Only a 1-month prescription can be dispensed at a time. Fill within 7 days with yellow sticker attached**.
Contraindications:
Pregnancy
Warnings:
- Dry skin, chapped lips, dry eyes/eye irritation (may cause difficulty wearing contact lenses), decrease night vision (may be permanent), arthralgias, skeletal hyperostosis (calcification of ligaments that attach to the spine), osteoporosis, psychiatric issues (depression, psychosis, risk of suicide), increased cholesterol (TG) and BG.
Side Effects:
Monitoring:
Pearls/Notes:
-** the ONLY oral retinoid**
-REMS program
- Patients who can get pregnant must sign patient information/informed consent form about birth defects if the fetus is exposed to isotretinoin. Must have had 2 negative pregnancy tests prior to starting treatment. **
- ** Do NOT get pregnant for 1 month before, while taking the drug, or for 1 month after the drug is stopped. Do NOT breastfeed or donate blood until at least 1 month has passed after the drug is stopped.
-* Do NOT use with vitamin A supplements, tetracyclines, steroids, progestin-only contraceptives or St. John’s wort. **
- * Must swallow capsule whole, or puncture and sprinkle on apple sauce or ice cream - this may irritate esophagus. *
Counseling: **pregnancy testing must be repeated on a monthly basis. 2 forms of birth control are required (CANNOT use a POP-progestin-only-pill). **Carry bottled water, eye drops and lip balm.
Drug-Drug/Food interactions:
Minocin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
minocycline
class: tetracycline antibiotic
Indications: Acne
MOA: drug inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria; cell wall synthesis is not affected.
Dosage forms: capsule/topical foam/tablet/ ER capsule & ER tablet/solution
Dosing:
IR formulations: 50-100 mg PO BID; may be used for patients greater than or equal to 8 years of age*
XR formulations: 1mg/kg PO daily; ONLY approved for use in patients greater or equal to 12 years of age.**
Max dose:
Contraindications:
pregnancy
myasthenia gravis?
Warnings:
Side Effects:
-* can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
-* like other tetracyclines, can cause fetal harm if administered during pregnancy.
-* May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age).
Monitoring:
Pearls/Notes:
-does cross the placenta
- is present in breast milk
- more effective than tetracycline in eradicating C. acnes
Drug-Drug/Food interactions:
Solodyn
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
minocycline
class: tetracycline antibiotic
Indications: Acne
MOA: drug inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria; cell wall synthesis is not affected.
Dosage forms: capsule/topical foam/tablet/ ER capsule & ER tablet/solution
Dosing:
IR formulations: 50-100 mg PO BID; may be used for patients greater than or equal to 8 years of age*
XR formulations: 1mg/kg PO daily; ONLY approved for use in patients greater or equal to 12 years of age.**
Max dose:
Contraindications:
pregnancy
myasthenia gravis?
Warnings:
Side Effects:
-* can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
-* like other tetracyclines, can cause fetal harm if administered during pregnancy.
-* May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age).
Monitoring:
Pearls/Notes:
-does cross the placenta
- is present in breast milk
- more effective than tetracycline in eradicating C. acnes
Drug-Drug/Food interactions:
Ximino
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
minocycline
class: tetracycline antibiotic
Indications: Acne
MOA: drug inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria; cell wall synthesis is not affected.
Dosage forms: capsule/topical foam/tablet/ ER capsule & ER tablet/solution
Dosing:
IR formulations: 50-100 mg PO BID; may be used for patients greater than or equal to 8 years of age*
XR formulations: 1mg/kg PO daily; ONLY approved for use in patients greater or equal to 12 years of age.**
Max dose:
Contraindications:
pregnancy
myasthenia gravis?
Warnings:
Side Effects:
-* can cause photosensitivity, rash in susceptible patients, dizziness, diarrhea, somnolence
-* like other tetracyclines, can cause fetal harm if administered during pregnancy.
-* May cause permanent discoloration in teeth if used when teeth are forming (up to 8 years of age).
Monitoring:
Pearls/Notes:
-does cross the placenta
- is present in breast milk
- more effective than tetracycline in eradicating C. acnes
Drug-Drug/Food interactions:
Veltin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clindamycin + tretinoin
Ziana
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clindamycin + tretinoin
Aklief
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
trifarotene
class: retinoid
Indications:
MOA: drug works primarily by reducing adherence of the keratinocytes (outer skin cells) in the oil glands.
Dosage forms: lotion
Dosing:
Max dose:
Contraindications:
Retinoids are teratogenic. Must avoid in pregnancy and breastfeeding
Pregnancy
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-* Limit exposure to the sun*
-* Best applied daily, usually at bedtime, about 20 minutes after washing face. *
-* If irritation occurs, use a lower strength or decrease frequency to every other night*.
- Apply a pea-sized amount is sufficient (for facial application); it should be smoothed over entire surface of face, not just on the acne
- Takes 4-12 weeks to see response; and initially may worsen acne before getting better.
- wash only with mild soap twice daily
- a moisturizer, followed by sunscreen should be used each morning
- can also bleach clothing
Drug-Drug/Food interactions:
Clearasil
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
(BPO) Benzoyl peroxide
class:
Indications: Acne
MOA:
Dosage forms:
Dosing: Start with 2.5-5% BPO, generally adequate and less irritating than the higher strengths.
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- Can bleach clothing and hair
- ** Limit exposure to the sun*
Drug-Drug/Food interactions:
PanOxyl
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
BPO
class:
Indications: Acne
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Vanoxide-HC
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
BPO 5% + hydrocortisone 0.5%
class:
Indications: Acne
MOA:
Dosage forms: lotion
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
-** can bleach clothing and hair**
-** limit sun exposure**
For Pharmacist:
- prior to dispensing, add powder content of vial to lotion. Shake bottle thoroughly to disperse completely. After addition of powder, place expiration date of 3 months on the bottle.
Drug-Drug/Food interactions:
Benzac
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
BPO
class:
Indications: Acne
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Benzamycin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
erythromycin + BPO
class:
Indications: Acne
MOA:
Dosage forms: gel
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- 70% ethyl alcohol for reconstitution
- ** Should be stored under refrigeration, after reconstitution, DO NOT FREEZE**
-** Product is good for 3 months after it has been properly reconstituted**. So, place a 3-month expiration date on the label following mixing,
-
Drug-Drug/Food interactions:
BenzaClin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clindamycin + BPO
class:
Indications:
MOA:
Dosage forms: gel
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- Add indicated amount of purified water to the vial and immediately shake to completely dissolve medication. (Use additional purified water to bring level up to the mark if needed).
- Add the solution in the vial to the gel; stir until homogenous (1 to 1.5 minutes)
- Place a 3- month expiration date on the label following mixing
- product can be stored at room temperature
- Clean face, apply a thin layer once or twice daily. Avoid contact with eyes; if contact, rinse with cold water.
- Takes 2-6 weeks for effect and up to 12 weeks for full benefit.
Drug-Drug/Food interactions:
Alopecia:
hair loss
The most common cause of hair loss is _________
hereditary male-pattern baldness
Medical conditions that cause hair loss include:
- hypothyroidism
- alopecia areata (an autoimmune condition)
- scalp infections
- lupus
- Zinc and Vitamin D deficiency can contribute to hair loss
Drugs that can contribute to alopecia include:
- chemotherapeutics (primarily because hair cells are rapidly dividing and are affected by the treatment)
- and infrequently with the following:
- valproate
- spironolactone
- heparin
- warfarin, clomiphene, hydroxychloroquine, interferons, lithium, some types of oral contraceptives
OTC Treatment for alopecia:
Minoxidil topical 5% foam, 2% or 5% solution
- tablets are prescription and are used for hypertension
Rx Treatment for alopecia:
finasteride (Propecia) tablets
- ## hazardous drug
- ## Proscar—> Pros is for benign PROStatic hyperplasia
- Propecia—>opecia—-> for alopecia
Propecia
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
finasteride
class: 5-alpha reductase inhibitor
Indications: alopecia
MOA:
Dosage forms: tablet
Dosing:
1mg daily; can take greater or equal to 3 months to begin to see effect.
Max dose:
Contraindications:
Pregnancy
Warnings:
Hazardous drug for females of childbearing potential, can harm a male fetus
Side Effects:
Monitoring:
Pearls/Notes:
- Must be used indefinitely or condition reappears
- * Do NOT dispense to patients taking finasteride (Proscar) for BPH*.
- * pregnant women should NOT handle the drug
Drug-Drug/Food interactions:
Proscar
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
finasteride
class: 5-alpha reductase inhibitor
Indications: BPH-benign prostatic hyperplasia
MOA: drug competitively inhibits type II 5-alpha reductase enzyme, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppresses serum dihydrotestosterone levels.
Dosage forms: tablet
Dosing:
Max dose:
Contraindications:
Pregnancy
Warnings:
Hazardous drug for females of childbearing potential, can harm a male fetus
Side Effects:
Monitoring:
Pearls/Notes:
- Must be used indefinitely or condition reappears
- * Do NOT dispense to patients taking finasteride (Proscar) for BPH*.
Drug-Drug/Food interactions:
Rogaine
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
minoxidil
class:
Indications: alopecia
tablets for hypertension
MOA:
Dosage forms: foam/solution
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- flammable; do not use near a heat source
- can be used by males or females
- 5% strength is more effective but causes more facial hair growth
- must be used indefinitely or condition reappears
Drug-Drug/Food interactions:
Latisse
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Durysta - implant
Lumigan - eye drop - open angle glaucoma
bimatoprost
class: prostaglandin analog
Indications: hypotrichosis (thinning eyelashes)
MOA: drug is believed to reduce intraocular pressure by INCREASING the outflow of the aqueous humor.
Dosage forms: solution
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
- may cause itchy eyes and/or eye redness. Eyelid skin darkening may occur, may be reversible.
- hair growth may occur in other areas that the solution frequently touches
Monitoring:
Pearls/Notes:
- Do NOT use with prostaglandin analogs used for glaucoma (IOP may increase)
-**Apply nightly, with applicator brush, to the skin at the base of the upper eyelashes only (Do NOT apply to the lower lid). Blot any excess. Repeat on other eye. Dispose of applicator after one use. If stopped, lashes will return to their previous appearance. **
Drug-Drug/Food interactions:
Cold Sores:
Caused by:
Spread by:
- herpes simplex labialis (aka HSV-1)
“lay-be-alis” - ## can be caused by HSV-2 due to oral/genital sex.(triggers for sore eruption include stress, fatigue, dental work)
- the virus spreads mostly with active lesions; kissing and sharing drinks can transmit the infection.
Cold Sores:
Sore eruption
are common and highly contagious.
OTC Tx for cold sores:
- Lysine for “prevention”
- Docosanol (Abreva)
Rx Tx for cold sores:
- acyclovir topical cream (Zovirax)
- acyclovir buccal tablets (Sitavig)
- penciclovir (Denavir)
The ______1_____ period is the optimal time to start treatment for a cold sore in order to reduce blister duration.
-
-
1 & 2- prodromal (before seeing the sore)
- tingling
- itching
- soreness
Abreva
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
docosanol
class:
Indications:
MOA:
Dosage forms:
Dosing:
- Apply cream 5x daily at first sign of outbreak, continue until healed.
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Zovirax
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
acyclovir
class:
Indications:
MOA:
Dosage forms: cream
Dosing:
- *Apply cream 5x daily for 4 days (can be used on genital sores_
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Sitavig
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
acyclovir
class:
Indications:
MOA:
Dosage forms: buccal tablets
Dosing:
Apply one 50mg tablet as a single dose to the upper gum region.
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- oral antivirals are more effective.
Drug-Drug/Food interactions:
Denavir
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
penciclovir
class:
Indications:
MOA:
Dosage forms: topical cream
Dosing:
apply cream every 2 hours during waking hours for 4 days.
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Often times we don’t know what the cause of dandruff is:
In can be caused by:
- eczema (aka seborrheic dermatitis)
- fungal infection
- dermatitis
The best approach for dandruff initially is to start with an OTC option.
Options include:
- (Selsun) selenium sulfide
- (Head & Shoulders) pyrithione zinc
- Coal tar
- (Nizoral A-D) ketoconazole 1% shampoo
- apply twice a week
- do not use if open sores on scalp
- can cause skin irritation
- ## rub shampoo in well and leave in for 5 minutes. Needs to be in contact with the scalp. Then rinse out.
Rx options for dandruff:
(Nizoral) ketoconazole 2% shampoo
Desitin: For diaper rash
- is a desicant–> meaning it helps draw water out of the skin.
This can be helpful to pull moisture out of the skin.
Eczema:
- is a general term for many types of skin inflammation and is used interchangeably with the term atopic dermatitis.
- is most common in young children and infants, but can occur at any age.
- presents as skin rashes which become crusty and scaly; blisters can develop. The rash is itchy, red, dry and sore.
- common sites affected include the elbows, behind the knees/ears, face (often the cheeks), buttocks, hands and feet.
- patients should avoid triggers such as environmental irritants, allergens, (soaps, perfumes), pollution, stress or weather changes.
-
-
-
-
The number one treatment: “moisturizers”
- *Hydration is essential to reduce disease severity. Use moisturizers (e.g. petrolatum), lanolin, Aquaphor, Eucerin,
- antihistamines (for itching), remember 1st generation are very sedating. May be beneficial to choose a 2nd generation antihistamine if patient has to go to work.
-
- topical steroids (occasional oral courses, if needed)
-
- [if topical steroids with hydration are NOT adequate]
- immunosuppressants:
Topical calcineurin inhibitors OR Topical PDE-4 inhibitors.
-
- in severe refractory cases, oral immunosuppressants (cyclosporine, methotrexate) OR monoclonal antibody drugs (e.g. dupilumab “Dupixent”)
Elidel
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
pimecrolimus
class: Calcineurin inhibitor/Immunosuppressant
Indications: eczema
MOA:
-penetrates inflamed epidermis to inhibit T cell activation by blocking transcription of proinflammatory cytokine genes such as IL-2, interferon gamma, IL-4, and IL-10.
- the drug binds to intracellular protein FKBP-12, inhibiting calcineurin, which blocks cytokine transcription and inhibits T-cell activation. Prevents release of inflammatory cytokines and mediators from mast cells in vitro after stimulation by antigen/IgE.
Dosage forms: topical cream
Dosing:
Max dose:
Boxed Warning:
**Do NOT Use in children < 2 years of age; associated with lymphoma and skin cancer; use only as second line treatment for short-term, intermittent treatment
Contraindications:
Warnings:
Side Effects:
headache, skin burning, itching, cough and flu-like symptoms.
Monitoring:
Pearls/Notes:
- avoid exposure to natural or artificial sunlight.
Drug-Drug/Food interactions:
Protopic
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tacrolimus
class: Calcineurin inhibitor/Immunosuppressant
Indications: eczema
MOA:
- suppresses cellular immunity (inhibit T-cell activation) by binding to an intracellular protein, FKBP-12, and complexes with calcineurin dependent proteins to inhibit calcineurin phosphatase activity.
Dosage forms: topical ointment
Dosing:
Max dose:
Boxed Warning:
**Do NOT Use in children < 2 years of age; associated with lymphoma and skin cancer; use only as second line treatment for short-term, intermittent treatment
Contraindications:
Warnings:
Side Effects:
headache, skin burning, itching, cough and flu-like symptoms.
Monitoring:
Pearls/Notes:
- avoid exposure to natural or artificial sunlight.
Drug-Drug/Food interactions:
Eucrisa
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
crisaborole
class: (PDE-4) phosphodiesterase-4 enzyme inhibitor
Indications: eczema
MOA: drug inhibits PDE-4 enzyme which results in increased intracellular cyclic adenosine monophosphate (cAMP) levels.
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Dupixent
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
dupilumab
class: human monoclonal antibody/ (IL-4) Interleukin-4 antagonist
Indications: moderate-severe eczema
MOA: drug inhibits IL-4 and IL-13 signaling by binding to the IL-4R-alpha subunit. Blocking IL-4R-alpha inhibits IL-4 and IL-13 cytokine-induced inflammatory responses, including release of proinflammatory cytokines, chemokines, nitric oxide and IgE.
Dosage forms: injection
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
- Injection site reactions are the most common side effect.
Monitoring:
Pearls/Notes:
- Avoid use with LIVE vaccines*
Drug-Drug/Food interactions:
?? Opzelura
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
ruxolitinib
??Rinvoq
class: Janus kinase inhibitors
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
upadacitinib
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Athlete’s Foot: also called (______1____)
- a fungal infection of the foot caused by ____2___
Symptoms include:
- *feet itching, peeling, redness, mild burning and sometimes sores. This is a common infection particularly among those using public pools, showers and locker rooms. Often occurs between the toes.
Patients should NOT be applying ______3_______ between the toes or on the feet.
Treatment: _______
1)tinea pedis
2) trichophyton rubrum
3) moisturizers
- topically with antifungals
Jock itch: is also called (_________1_______). This is also a fungal infection.
It affects the:
- genitals
- inner thighs
- buttocks
The rash is red itchy and can be ring shaped. It is not very contagious but can be spread from person to person.
Treatment includes: _______2_____
1)Tinea Cruris
2) Keeping the skin dry (use a clean towel after showering) and treat with a topical antifungal. Cream works best.
Change underwear at least daily.
Ring worm: also called (_____________)
- not a worm! but a fungal skin infection.
Symptoms include:
- circular, red, flat sores (one or more, may overlap) usually with dry, scaly skin. Can occur anywhere on the body.
Occasionally the ring-like presentation is not present - just itchy red skin.
The outer part of the sore can be raised while the skin in the middle appears normal.
Ring worm on the scalp is also called (______2_______).
tinea corporis
2) tinea capitis “cap” you wear a cap on your head
Lamisil AT
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
terbinafine
class: antifungal OTC
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA: drug is a synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell membrane and results in fungal cell death.
Dosage forms: 1% cream, 1% gel, 1% spray
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Lotrimin Ultra
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
butenafine
class: antifungal OTC
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA: drug is a synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell membrane and results in fungal cell death.
Dosage forms: 1% cream
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Mentax
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
butenafine
class: antifungal OTC
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA: drug is a synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell membrane and results in fungal cell death.
Dosage forms: 1% cream
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Lotrimin AF
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clotrimazole
class: antifungal OTC
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA:
Dosage forms: 1% cream
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Pro-Ex Antifungal
clotrimazole
Shopko Athletes foot
clotrimazole
Cruex
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
miconazole
class: antifungal OTC
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA:
Dosage forms: powder, spray
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Desenex Jock Itch
miconazole
Tinactin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tolnaftate
class: antifungal OTC
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA:
Dosage forms: cream, powder, spray
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Toelieva
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
undecylenic acid
class: antifungal OTC
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA:
Dosage forms: 25% liquid,
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Lotrisone
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
betamethasone/clotrimazole
class: antifungal & steroid
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA:
Dosage forms: topical
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Extina
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
ketoconazole
class: antifungal
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA:
Dosage forms: cream, foam
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Luzu
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
luliconazole
class: antifungal
Indications:
fungal treatments for the skin:
- Tinea infections: (pedis, corporis, capitis, cruris), tinea versicolor- fungal infection of the skin.
- Onychomycosis: (toenail & fingernail fungal infections).
MOA:
Dosage forms: 1% cream
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Safety & Counseling
-If the infection is on the foot, do NOT walk barefoot (to avoid spreading it); wear sandals in public showers (to avoid catching it).
- Apply medicine 1-2 inches beyond the rash
- Use for at least 2-4 weeks, even if it appears healed.
- Reduce moisture to the infected area.
- Creams work best and are used in most cases.
- Solutions can be easier to apply to hairy areas.
- Powders do NOT work well for treatment but may be used for prevention, such as in shoes after a gym workout; use cotton socks.
Drug-Drug/Food interactions:
Onychomycosis: is a fungal infection of the nail, often caused by ______________. It can cause pain, discomfort and disfigurement and lead to physical limitations (e.g. difficulty walking, standing).
Treatment:
- Topical drugs are LIMITED to mild cases and patients who cannot tolerate systemic therapies, in combination with systemic treatment or as prophylaxis. [They are NOT POTENT ENOUGH to cure most infections.].
- ___________ and ____________ are APPROVED for this use and most commonly used;
- _________ and ___________ are used Off-label.
It takes a long time for the nail bed to look better sometimes up to a year in toenails. Toenails take longer to treat than fingernails and are more commonly infected.
- a ____________________ is essential for diagnosis as other conditions can produce a similar presentation.
tinea unguium
itraconazole and terbinafine
fluconazole and posaconazole
- 20% potassium hydroxide (KOH) smear
Lamisil
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
terbinafine
class: antifungal
Indications: Onychomycosis (toenail & fingernail fungal infections)
MOA:
Dosage forms: tablet
Dosing:
250mg PO daily for 6 weeks (fingernails)
250mg PO daily for 12 weeks [toenails]
Max dose:
Contraindications:
Warnings:
risk of hepatotoxicity
QT-prolonging (Avoid in QT risk)
Side Effects:
-primarily headache, rash, nausea
Monitoring:
LFTs
Pearls/Notes:
- Reoccurrence is common. Practice proper foot care and keep the nails dry. Keep blood glucose controlled. Do not smoke.
Drug-Drug/Food interactions:
Sporanox
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
itraconazole
class: azole antifungal
Indications: Onychomycosis (toenail & fingernail fungal infections)
MOA:
Dosage forms: capsule, oral solution
Dosing:
200mg PO daily for 12 weeks (fingernails)
200mg BID for 1 week, then 3 weeks off then repeat 1-week course.
Max dose:
Boxed Warning:
* Avoid Use in heart failure*.
Contraindications:
heart failure
Warnings:
hepatotoxicity, QT prolonging (Avoid in QT risk)
Side Effects:
nausea and diarrhea
QT prolongation
Monitoring:
LFTs,
Pearls/Notes:
- Reoccurrence is common. Practice proper foot care and keep the nails dry. Keep blood glucose controlled. Do not smoke.
- substrate of CYP3A4
Drug-Drug/Food interactions:
-Requires gastric acid for absorption; cannot use with strong acid-suppressing drugs
Loprox
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
ciclopirox
class: antifungal
Indications: onychomycosis (toenail & fingernail fungal infections)
MOA:
Dosage forms: 8% nail lacquer/topical solution, 0.77% gel, 0.77% cream, 0.77% topical suspension, 1% shampoo
Dosing:
- topical used daily every day at bedtime. [Used in combination with oral antifungals]. -poor efficacy when used alone
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Kerydin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
tavaborole
class: oxaborole antifungal
Indications: onychomycosis (toenail & fingernail fungal infections)
MOA:
Dosage forms: 5% topical solution
Dosing:
- applied topically daily for 48 weeks
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Jublia
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
efinconazole
class: azole antifungal
Indications:
MOA:
Dosage forms: 10% topical solution
Dosing:
- applied topically daily for 48 weeks
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Vaginal Fungal Infections:
- Fungal vaginal infections are uncommon before a female begins menstruating.
Causes:
- Hormones impact the pH of the vagina, making menstruating women more susceptible. Infections occur most commonly the week before menstruation, making treatment decisions around the menses important.
- high-dose estrogen or hormone replacement therapy, recent antibiotic use (can kill the normal flora and lead to fungal overgrowth), douching or use of lubricants.
- underlying conditions (e.g. pregnancy, diabetes, HIV, steroid use)
- Symptoms:
- primarily itching with possible soreness and pain (burning) during urination or sex. Some women have a cottage-cheese like discharge (white, thick, clumpy).
A pH ________1__________ is consistent with bacterial vaginosis or trichomoniasis infection. OTC test kits are available to test vaginal pH.
Treatment:
- Treatment can begin during menses or wait until the bleeding stops.
- Tampons should NOT be used when medication is applied.
OTC:
options include ________
Rx:
options include ________
1) pH greater than > 4.5
Treatment:
OTC:
(Monistat) miconazole, (Gyne-Lotrimin) clotrimazole
Rx:
(Diflucan) fluconazole- 150mg PO x 1 day
Vaginal Fungal Infections:
Vaginal fungal infections are more common during pregnancy. Pregnant patients should consult their physician. Longer treatment is required for ________________.
7-10 days
Vaginal Fungal Infections:
- If there are more than 4 infections in a year OR if symptoms reoccur within 2 months, then ______________.
refer to the physician to rule out an underlying condition that could be causative.
Vaginal Fungal Infections:
Lactobacillus or yogurt with active cultures is thought to reduce infection occurrence. However, this is rated as “possibly ineffective” by ____
the Natural Medicines Database
Vaginal Fungal Infections:
If self-treating, counsel that condoms and diaphragms do NOT provide adequate pregnancy protection; the oil in OTC antifungals weakens the latex.
Gyne-Lotrimin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clotrimazole
class: azole antifungal
Indications: fungal infection of vagina
MOA:
Dosage forms: vaginal cream
Dosing:
OTC-
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
**Counseling for OTC antifungal:
- Prior to using the product, wash the external genital area with mild soap and water, and pat dry with a towel.
- Insert applicator, suppository or vaginal tab at night before bed. Lying down immediately after insertion helps retain the medicine inside the vagina; a protective pad can be used.
- the creams and suppositories are oil-based medications that can weaken latex condoms and diaphragms; avoid sexual intercourse.
- If you get your menstrual cycle during treatment, you may continue treatment.
- do NOT use tampons during treatment
- complete entire course of treatment
- Medical care is warranted if symptoms persist/return within 2 months after using an OTC product, or if greater than > 4 occurrences/per year
Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).
Drug-Drug/Food interactions:
Monistat 3
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
miconazole
class: azole antifungal
Indications: fungal infection of vagina
MOA:
Dosage forms: vaginal cream
Dosing:
OTC-
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Counseling for OTC antifungal:
- Prior to using the product, wash the external genital area with mild soap and water, and pat dry with a towel.
- Insert applicator, suppository or vaginal tab at night before bed. Lying down immediately after insertion helps retain the medicine inside the vagina; a protective pad can be used.
- The creams and suppositories are oil-based medications that can weaken latex condoms and diaphragms; avoid sexual intercourse.
- If you get your menstrual cycle during treatment, you may continue the treatment.
- Do not use tampons during treatment
- complete entire course of treatment
- medical care is warranted if symptoms persist/return within 2 months after using an OTC product, or if greater than > 4 occurrences / per year
Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).
Drug-Drug/Food interactions:
Terazol 7
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
terconazole
class: azole antifungal
Indications: fungal infection of vagina
MOA:
Dosage forms: topical vaginal cream
Dosing:
RX-
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).
Drug-Drug/Food interactions:
Diflucan
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
fluconazole
class: azole antifungal
Indications: fungal infection of vagina
MOA:
Dosage forms: tablet
Dosing:
Rx: 150mg PO x 1 dose
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).
Drug-Drug/Food interactions:
Brexafemme
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
ibrexafungerp
class:
Indications:
MOA:
Dosage forms:
Dosing:
Rx- 300mg PO BID x1 day
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Gynazole-1
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
butoconazole
class: azole antifungal
Indications: fungal infection of vagina
MOA:
Dosage forms: vaginal cream
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- To avoid future infections, keep the vagina area clean, wipe from front to back after using restroom.
- Use cotton underwear and avoid tight fitting clothing (including panty hose).
- Change pads/tampons often.
- Change out of wet swimsuits or clothing quickly.
- Recommend against use of vaginal douches, sprays and deodorant tampons (these can alter the vaginal pH and contribute to infection).
Drug-Drug/Food interactions:
Genital warts:
Cause:
Prevention:
Treatment:
Cause: Human papillomavirus (HPV), sexually transmitted
Prevention: Gardasil vaccine prevents infection with HPV for most strains causing genital warts.
Treatment:
- is only required if the patient is symptomatic
Rx:
(Aldara, Zyclara)- imiquimod cream
Hemorrhoids:
Cause:
Symptoms:
Treatment:
- are swollen blood vessels in the lower rectum. They are often the result of constipation and straining to have a bowel movement. Rectal tissue is sensitive with rich blood vessel supply making it susceptible to engorgement. (The blood is usually Bright red), unlike with a GI bleed which would be black.
Cause: Constipation and straining to have a bowel movement
Symptoms: rectal bleeding, itching and bleeding (bright red blood)
Treatment:
Non-pharm:
OTC:
- phenylephrine (Preparation H)
- hydrocortisone (products names often contain “HC” in or after the name)
- Witch hazel (Tucks pads): a mild astringent that can relieve mild itching.
- combination products
Preparation H
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
phenylephrine
class: vasoconstrictor
Indications: hemorrhoids
MOA: drug shrinks the hemorrhoid and reduces burning and itching.
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- Clean the skin first with mild soap and warm water. gently pat dry. Apply ointment externally up to 5 times daily.
- For suppository: hold wrapped suppository container with rounded end up, separate the foil tabs and slowly peel apart, remove from the wrapper, insert into the rectum up to 4 times daily, especially at night and after bowel movements.
Drug-Drug/Food interactions:
Lice and Scabies:
- Scabies (mites) and lice are spread mainly through close contact and treated with some of the same medications.
- Lice (Pediculus humanus capitis), most commonly occurs in elementary school-age children.
Lice
- affects primarily children
- attach to the hair shaft
- insects
————
- Treatment (OTC): [the drug of treatment for lice is OTC]
- a lice comb needs to be consistently used to remove lice eggs from hair
- permethrin (Nix)
- pyrethin/piperonyl butoxide (Rid)
- ALL require REPEAT treatment
Scabies
- affects primarily adults
- burrow under the skin
- mites
———
- Treatment (Rx): [scabies is prescription only]
- products are higher potency and applied to the skin
- permethrin (Elimite) cream
- ivermectin (Stromectol)
If patients have an allergy to chrysanthemum or ragweed, then avoid ______________
pyrethrins and permethrin products
- ## (Nix) permethrin 1% / for ages 2 months and older
- ## (Rid) [pyrethrin 0.33% / piperonyl butoxide 4%] - for ages 2 years and older
- (Sklice) ivermectin 0.5% lotion now available without a prescription / for ages 6 months and older
- (Natroba) spinosad 0.9% w/w topical suspension / ages 6 months and up
- (Ovide) malathion 0.5% lotion / ages 6 years and up
- (Ulesfia*) benzyl alcohol 5% lotion / ages 6months and up
- (Xeglyze) abametapir 0.74% lotion / ages 6 months and up
Scabies NOTHING OTC
- (Elimite) permethrin cream
- (Stromectol) ivermectin oral
Lice Tx:
- Repeating the procedure and removing the nits from hair using fine comb, bedding and elsewhere is essential.
——————————————————————————————-
- Wash clothes and bedding in hot water, followed by a hot dryer.
- If something cannot be washed, seal it in an airproof bag for 2 weeks or dry clean. Vacuum the carpet well. Soak combs and brushes in hot water for 10 minutes. Make sure to check other family members in the household.
- Do not use conditioner (including combination shampoo and conditioner) before using the lice medicine.
- Do not rewash the hair for 1-2 days after treatment.
- Most products must be left on the hair for 10 minutes before rinsing to be effective; [malathion should be left on for 8-12 hours].
- After treatment, use a nit comb to remove nits and lice every 2-3 days. Continue to check for 2-3 weeks to be sure all lice and nits are gone.
-
- Re-treatment is needed for most products [exceptions ___________] on days 7-10 to kill any surviving hatched lice before they produce new eggs.
exceptions: Sklice and Xeglyze do not need to be repeated.
Lice
OTC options include:
Rx prescription options include:
Scabies:
OTC options include:
Rx prescription options include:
OTC options include: NONE
Rx prescription options include:
Bites:
- all animal bites require _________
- treat with an oral antihistamine or topical steroid for itching. (insect bites)
evalution. (increased infection risk, some toxic).
Pinworm: (aka _____________)
- most commonly occurs in children and presents as anal itching.
Causes:
- easily spread by children, contaminated fingers can transfer eggs to surfaces and are then ingested.
- current treatments are active against ___1______
Tx: anthelmintics (e.g. drugs used to kill parasitic worms)
When you treat, you treat the whole household, there very contagious.
OTC options include:
Rx prescription options include:
Vermicularis
1) Enterobius vermicularis
Diagnosis:
- tape test: stick a piece of tape around the anus in the morning prior to voiding/defecating. The tape is removed and brought to a healthcare provider, who examines it under a microscope to look for eggs. It can take up to 3 morning tape tests to identify the eggs.
OTC options include:
- (Reese’s Pinworm, Pamix*) pyrantel pamoate suspension
- (Vermisol) pyrantel pamoate tablets
Rx prescription options include:
- (Albenza) albendazole
- (Emverm) mebendazole
Pinworm:
Safety & Counseling:
Wash hands frequently and treat the entire household.
pyrantel causes headaches and dizziness. It is given as a single dose and repeated in 2 weeks to eliminate reinfection.
mebendazole and albendazole cause headache, nausea and are hepatotoxic.
Albendazole must be taken with a high fat meal (to increase absorption).
Burns:
- small, minor burns can be treated OTC
- run burn under cold water
- apply ointment to hold in moisture (e.g. Aquaphor)
- apply a bandage if there is broken skin or popped blisters
Silvadene, SSD
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
silver sulfadiazine
class:
Indications:
- can be used topically to reduce infection risk and promote healing.
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- Do NOT use with Sulfa allergy or G6PD deficiency (due to hemolysis risk).
Drug-Drug/Food interactions:
Bactroban nasal:
- product is applied to the nars. Inside the nose.
- used for decolonization of patients who carry MRSA before surgical procedures.
Poison Ivy, Oak, and Sumac:
Cause:
- poison ivy, poison oak, sumac poisoning is an allergic reaction that results from touching the sap of these plants, which contain the toxin *urushiol.
- the sap may be on the plant, in the ashes of the burned plants, on an animal or on other objects that came in contact with the plant.
- small amounts of *urushiol can remain under a person’s fingernails for days unless removed with good cleaning.
Poison Ivy, Oak, and Sumac:
Treatment:
- wash any items that came into contact with the plant, including under the fingernails.
OTC:
Rx:
OTC:
- (Burow’s Boro-Packs, Domeboro) aluminum acetate solution
- Colloidal oatmeal (Aveeno)
- calamine lotion + pramoxine (Caladryl, IvaRest)
- Zanfel
Rx:
- topical or oral steroids for severe rash
Poison Ivy, Oak, and Sumac:
aluminum acetate is an astringent (_________________)
- drying agent
Inflammation and Rash:
- the primary treatment for skin irritation is topical steroids.
- 2 strengths of Hydrocortisone (HC) are available OTC, 0.5% and 1%.
- all other topical steroids are prescription only.
- the steroid vehicle influences the strength of the medication.
- -* Usual potency from Highest to Lowest:
______________________
Ointments > Creams > Lotions > Solutions > Gels > Sprays
OCLSGS
Inflammation and Rash:
- thin skin on the face, eyelids, and genitals is highly susceptible to topical steroid side effects; low potency steroids should be used on these areas and skin folds (armpits, groin, under the breasts) where the absorption is higher.
- local (skin) steroid side effects, if used long term, include skin thinning, pigment changes (lighter or darker), telangiectasia (i.e. spider veins or small blood vessels visible through the skin), rosacea, perioral dermatitis and acne, increased risk of skin infections, delayed wound healing, irritation/burning/peeling and possibly contact dermatitis.
- For urticaria (hives):
OTC— second generation antihistamines (e.g. cetirizine) are preferred over first-generation antihistamines (e.g. diphenhydramine) due to tolerability. Higher doses are used.
Rx— hydroxyzine (Vistaril)
Inflammation and Rash:
Inflammation and Rash:
Class:
Dosage form:
Potency:
Clobex
class:
Indications:
MOA:
Dosage forms:
Potency:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clobetasol propionate
class: topical steroid
Indications:
MOA:
Dosage forms: 0.05% Lotion, 0.05% Shampoo, 0.05% Spray
Potency: Very High Potency
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Temovate
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clobetasol propionate
Class: topical steroid
Dosage forms: 0.05% cream, 0.05% ointment
Potency: Very High Potency
Olux
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clobetasol propionate
Class: topical steroid
Dosage form: 0.05% foam
Potency: Very High Potency
Vanos
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
fluocinonide
Class: topical steroid
Dosage form: 0.1% cream
Potency: Very High Potency
Diprolene
betamethasone dipropionate
Class:
Dosage:
Potency:
Ultravate
halobetasol propionate
Class:
Dosage:
Potency:
Diprolene AF
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
betamethasone dipropionate
Lidex
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
fluocinonide
Elocon
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
mometasone furoate
Topicort
desoximetasone
Class:
Dosage:
Potency:
Psorcon
diflorasone diacetate
Class:
Dosage:
Potency:
Halog
halcinonide
Class:
Dosage:
Potency:
Lidex-E
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
fluocinonide
Luxiq
betamethasone valerate
Class:
Dosage:
Potency:
Triderm
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
triamcinolone acetonide
Kenalog
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
triamcinolone acetonide
Synalar
fluocinolone acetonide
Class:
Dosage:
Potency:
Cordran
flurandrenolide
Class:
Dosage:
Potency:
DesOwen
desonide
Class:
Dosage:
Potency:
Caprex
fluocinolone acetonide
Class:
Dosage:
Potency:
Cutivate
fluticasone propionate
Class:
Dosage:
Potency:
Locoid
hydrocortisone butyrate
Class:
Dosage:
Potency:
Pandel
hydrocortisone probutate
Class:
Dosage:
Potency:
Verdeso
desonide
Class:
Dosage:
Potency:
Tridesilon
desonide
Class:
Dosage:
Potency:
Desonate
desonide
Class:
Dosage:
Potency:
Cortaid
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
hydrocortisone
