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Pharmacology Exam #4 > Dermatology: Acne Vulgaris & Rosacea > Flashcards

Dermatology: Acne Vulgaris & Rosacea Flashcards

1
Q

This is the pathogenesis of which disease?

  1. androgen influenced increase in sebum production
  2. Keratin and sebum plug the hair follice & accumulate, leading to hyperkeratosis with comedone formation.
  3. P.acnes bacteria proliferates in the sebaceous follice.
  4. Inflammatory response.
A

Acne Vulgaris

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2
Q

How does P. acnes bacteria cause an inflammatory response in acne vulgaris?

A

These bacteria release enzymes and stimulate release of pro-inflammatory cytokines.

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3
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Benzoyl Perozide

Topical/oral Abx

isotretinoin (Accutane)

A

P. acnes proliferation

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4
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Intralesional corticosteroids

oral corticosteroids

topical/oral abx

A

Inflammatory Response

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5
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Antiandrogens

isotretinoin

topical/oral abx

corticosteroids

estrogens

A

abnormal serum

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6
Q

What are the following meds used to treat specifically in Acne Vulgaris?

Salicylic Acid

Benzoyl peroxide

Topical retinoids

Isotrtinoin (Accutane)

A

Abnormal keratinization of follice

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7
Q

What is the 1st line tx for mild acne vulgaris in ADULTS?

A

BP

or

Topical Retinoid

___________________________________________________

**Topical Combination Therapy**:

(BP + abx)

or

(BP + retinoid)

or

(BP + retinoid + abx)

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8
Q

What is the general alternative for the 1st line treatments for mild acne vulgaris?

A

Depending on whether it applies to the 1st line tx or not:

Add Topical Retinoid or BP

or

Consider Alternate Retinoid

or

Consider Topical Dapsone

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9
Q

What is the 1st line tx for moderate acne vulgaris in ADULTS?

A

Topical Combination Therapy**:

(BP + Abx)

or

(BP + Retinoid)

or

(BP + Retinoid + Abx)

___________________________________________________

oral abx + topical retinoid + BP

or

oral abx + topical retinoid + BP + topical abx

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10
Q

What is the general alternative for the 1st line treatments for mild acne vulgaris?

A

Consider alt combination therapy

or

consider diff oral abx

or

add combined oral contraceptive or oral spironolactone (females)

or

consider oral isotretinoin

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11
Q

What is the 1st line tx for severe acne vulgaris in ADULTS?

A

Oral abx

+

Topical Combination Therapy**

(BP + Abx)

or

(BP + Retinoid)

or

(BP + Retinoid + Abx)

___________________________________________

OR

oral isotretinoin

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12
Q

What is the general alternative for the 1st line treatments for severe acne vulgaris?

A

change oral abx

or

add combined oral contraceptive or oral spironolactone (females)

or

oral isotretinoin

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13
Q

What are the topical antibiotics used in acne?

A

Erythromycin

Clindamycin

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14
Q

T/F: Erythromycin MOA in inflammatory acne vulgaris is unknown.

A

TRUE

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15
Q

What are adverse local rxns to erythromycin solution?

A

burning sensation, drying & irritating of the skin.

** water-based gel has less drying associated with it**

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16
Q

Is there a risk of getting c-diff with clindamycin?

A

No, becasue we are using it on the face.

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17
Q

Both erythromycin and clindamycin must be combined with __________ when giving for tx.

A

benzoyl peroxide

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18
Q

What is the newest treatment for acne vulgaris called?

A

Sacrecycline

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19
Q

When would you use sarecycline?

A

to tx inflammatory lesions of non-nodular moderate to severe acne vulgaris in people 9 years or older.

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20
Q

What drug family is sarecycline part of?

A

Tetracycline

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21
Q

T/F: sarecycline has a narrower spectrum of activity and causes lower rates of bacterial resistance.

A

TRUE

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22
Q

What is the biggest reason providers do not rx sarecycline?

A

$$$ High cost!

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23
Q

Retinoic acid is the acid form of _________.

A

Vitamin A

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24
Q

​MOA of which drug?

  • decreased cohesion between epidermal cells & increased epidermal cell turnover.
  • Expulsion of open comedones
  • transforms closed comedone to open
A

Retinoic Acid

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25
Q

Which drug should be applied initially in a concentration sufficient to induce slight erythema with mild peeling?

A

Retinoic Acid

26
Q

T/F: It is okay to apply tretinoin to the corners of the nose, eyes, mouth and mucous membanes.

A

False, DO NOT apply to the corners of the nose, eyes, mouth and mucous membranes.

27
Q

How long of therapy does Tretinoin require?

&

How long will it take before lesions clear?

A

Therapy: 4-6 wks

Clearance: 8-12 wks

28
Q

Prolonged use of this agent increases collagen synthesis & thickness of the epidermis.

29
Q

Topical retinoids offer benefit for patients with ________ skin, ________ skin (psoriasis), and atropic areas.

A

photo-damaged

thickened

30
Q

Tretinoin:

Avoid ___ exposure & use a protective ________

A

sun

sunscreen

31
Q

What receptors do each of the following topical retinoids act on?

  1. Adapelene
  2. Tazarotene
  3. Tretinoin
A
  1. Beta, gamma
  2. Beta, gamma
  3. alpha, beta, gamma
32
Q

What pregnancy category are each of the following topical retinoids?

  1. Adapelene
  2. Tazarotene
  3. Tretinoin
A
  1. C
  2. X
  3. C

MAIN POINT: STAY AWAY FROM ALL OF THESE DURING PREGNANCY

33
Q

Benzoyl Peroxide MOA?

A
  • Bacteriostatic against P. acnes
  • Peeling & comedolytic effects
34
Q

ADE of benzoyl peroxide

A

avoid contact with the eyes and mucous membranes

will bleach clothing, bedding & towels.

35
Q

Which drug suppresses comedones most effectively?

A

Topical retinoids

36
Q

Which drug suppresses sebum production most effectively?

A

Oral isotretinoin

37
Q

Which drugs suppress P. acnes and inflammation most effectively?

A

oral isotretinoin & oral tetracyclines

38
Q

What two drugs should you use from the start of therapy when inflammatory lesions are involved?

A

topical retinoids + abx

39
Q

Discontinue abx when _________ resolve.

If you cannot discontinue, use _______ or _________combination agents.

A

inflammatory lesions

BPO or BPO-antibiotic

40
Q

Use ____________ to maintain remission when abx therapy is discontinued.

A

topical retinoid

41
Q

ADE of Tetracycline (oral abx)

Ex: doxycycline, minocycline

A

slate gray hyperpigmentation of skin

drug induced lupus

cannot be used in preggos

Minocycline: dizziness

42
Q

ADE of Erythromycin

43
Q

ADE of Clindamycin

44
Q

You would use Isotrtinoin to treat what?

A

severe cystic acne & hidradenitis suppurativa

45
Q

__________ is a SIGNIFICANT risk in pts who use isotretinoin.

A

teratogenicity

46
Q

What are the 2 conditions women MUST meet to be rx isotretinoin?

A
  1. Women MUST use 2 effective forms of contraception 1 mo before, throughout therapy, & 1 menstrual cycle after discontinuation of tx.
  2. Women MUST take a serum pregnancy test within 2 weeks before therapy: Therapy is initiated on the 2nd or 3rd day of next menstrual period.
47
Q

ADE of isotretinoin (oral retinoid)

A
  • dry mucous membranes, xerosis(dry skin), cheilitis, conjunctivitis, epistaxis, pruritis.
  • joint pain
  • thinning hair
  • HA
  • nausea
  • mood swings, suicidal ideation, sleep disturbance
  • hyperTGL, elevated LFTs, dec. WBC count
48
Q

What labs must you draw in pts you rx Isoretinoid?

A
  • Baseline: CBC, LFT, fasting lipid profile, serum preggo test in women of childbearing potential
  • 1st mo only: repeat CBC, LFT
  • Every month: fasting lipid profile, serum preggo test
49
Q

What topical abx do you use in Rosacea?

A
  • metronidzaole
  • sulfacetamide
50
Q

T/F: MOA of metronidazole is unknown.

51
Q

Can you use metronidazole during pregnancy, in nursing mothers and children?

52
Q

ADE of water-based gel formulation of metronidazole.

A

dryness, burning, stinging.

53
Q

MOA of Na+ sulfacetamide

A

competitive inhibition of p-aminobenzoic acid utilization of bacteria.

54
Q

4% of topically applied _______ is abosorbed.

A

sulfacetamide.

55
Q

Which drug is contraindicated in tx rosacea with patients who have a sulfonamide sensitivity?

I know this was a horribly worded question but i am too lazy to change it- sorry

GK

A

Na+ sulfacetamide

56
Q

Which topical abx that treats Rosacea also effectively treats seborrheic dermatitis?

A

Na+ sulfacetamide

57
Q

How can pts tx rosacea on their own?

A
  • reduce usage of products that flare the flushing of rosacea
  • use sunscreen daily to protect skin from chronic UV rays
58
Q

Alternative tx for rosacea

A

Clindamycin 1% cream

Erythromycin 2% solution

Topical imidazoles, ketoxonazole cream

azelaic acid cream

59
Q

T/F: tetracyclines exhibit both abx and anti-inflammatory effects.

60
Q

Which drug is most warranted in stage III rosacea with rhinophyma & rosacea fulminans?

A

Isoretinoin (Accutane)

61
Q

Which drug is not recommended for opthalmic rosacea b/c it may exacerbate keratitis & blepharitis?

A

Isotretinoin (Accutane)

Pharmacology Exam #4 (4 decks)

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