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: