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BLOCK I: Pharmacotherapeutics > Exam 1 Acneiform Disorders > Flashcards

Exam 1 Acneiform Disorders Flashcards

1
Q

general concepts of acne treatment

A
  • There is no cure

- Don’t forget patient expectations (as with all diseases) and discuss preventive measures

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2
Q

things to address with acne

A
  • Discomfort
  • Appearance
  • Long-term scarring
  • Psychological stress
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3
Q

Acne is believed to result from a combination of:

A
  • Sebaceous gland hyperplasia
  • Follicular hyperkeratosis
  • Propionibacterium acnes colonization
  • Inflammation
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4
Q

What is drug therapy aimed at?

A

1 or more of the mechanisms:

  • Sebaceous gland hyperplasia
  • Follicular hyperkeratosis
  • Propionibacterium acnes colonization
  • Inflammation
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5
Q

Non-drug therapy

A
  • Avoid contributing factors when possible
  • Counsel pt that acne is NOT poor hygiene
  • Simple washing with water/mild cleanser BID is enough
  • Advise pt not to squeeze/pick
  • Avoid oil-based products
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6
Q

MOA of topical retinoids

A
  • Vitamin A analogs that work by stimulating epidermal cell turnover which unplugs follicles
  • Inhibit production of inflammatory mediators
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7
Q

Preferred first-line agents in mild-moderate acne either alone or in combination

A

topical retinoids

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8
Q

Should be used as part of combo therapy for moderate-severe acne

A

topical retinoids

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9
Q

First-line to maintain remission

A

topical retinoids

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10
Q

should use sunscreen because new skin burns easily, use moisturizer in combo

A

topical retinoids

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11
Q

use topical retinoids at night because drugs are _____

A

use topical retinoids at night because drugs are photolabile

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12
Q

Original tretinoin should avoid use with ______ _______

A

Original tretinoin should avoid use with benzoyl peroxide

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13
Q

skin irritation including stinging, redness, dryness

A

ADRs of topical retinoids

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14
Q

topical retinoid drugs

A
  • Tretinoin (Retin-A)
  • Tazarotene (Tazorac)
  • Adapalene (Differin)
  • Adapalene + benzoyl peroxide (Epiduo Forte Gel)
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15
Q

Possibly more effective but more irritation

A

tazarotene (Tazorac)

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16
Q

Contraindicated in pregnancy – don’t use in females 10-50

A

tazarotene (Tazorac)

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17
Q

Less irritation

A

adapalene (Differin)

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18
Q

July 2016: Approved for OTC 12+ years old

A

adapalene (Differin)

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19
Q

Come in a variety of dosage forms (gels, lotions, creams, swabs, cleansers, etc.)

A

topical retinoids

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20
Q

MOA of benzoyl peroxide

A

Antibacterial (releases oxygen free radicals that damage cell wall) and keratolytic (exfoliates and opens pores) properties

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21
Q

Often in combo with other antibiotics to reduce resistance (bacteria have no way to produce resistance to above mechanism of action)

A

benzoyl peroxide

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22
Q

Available OTC so often used first-line as monotherapy

A

benzoyl peroxide

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23
Q

Can cause bleaching of skin

A

benzoyl peroxide

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24
Q

Avoid overuse (mostly once daily)

A

benzoyl peroxide

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25
Q

Skin irritation

Dryness and peeling of skin

A

benzoyl peroxide

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26
Q

topical antibiotics for acne

A

*Erythromycin
*Clindamycin
Sulfacetamide
Sulfur & Sulfacetamide
Dapsone

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27
Q

other treatment failure of mild acne

A

topical antibiotics

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28
Q

Moderate acne (usually in combo with other topicals)

A

topical antibiotics

29
Q

MOA for Azelaic Acid (Azelex)

A
  • antimicrobial, comedolytic, anti-inflammatory properties

- Normalizes keratinization and suppresses P. acnes

30
Q

Touted to cause less irritation so you might chose first-line for very sensitive skin

A

azelaic acid (Azelex)

31
Q

Downside is that it is usually less effective than other topicals and expensive

A

azelaic acid (Azelex)

32
Q

Also indicated for Rosacea (specific product form)

A

azelaic acid (Azelex)

33
Q
  • Reported cases of hypopigmentation

- $$$

A

azelaic acid (Azelex)

34
Q

Local skin irritation

A

ADR of azelaic acid (Azelex)

35
Q

MOA of salicylic acid

A

Produces desquamation of hyperkeratotic epithelium

36
Q

Salicylic acid is ______ at concentrations of 3% to 6%; it becomes ______ to tissue at concentrations >6%.

A

Salicylic acid is keratolytic at concentrations of 3% to 6%; it becomes destructive to tissue at concentrations >6%.

37
Q

what are concentration of salicylic acid at concentrations of 6-60% used for?

A
  • remove corns and warts

- in the treatment of psoriasis and other hyperkeratotic disorders.

38
Q
  • Less effective v. benzoyl peroxide
  • May use second-line if other comedolytic agents haven’t worked
  • May be in combo with other agents
A

salicylic acid

39
Q

local skin irritation

A

ADR of salicylic acid

40
Q

what PO antibiotics should you usually start with

A

minocycline or doxycycline

41
Q

second-line options for PO antibiotics

A
  • TMP-SMX
  • Azithromycin
  • Erythromycin
  • Clindamycin
42
Q

usually for moderate-severe acne

A

PO antibiotics

43
Q

when do you check patient back for efficacy when using PO antibiotics

A

6-8 weeks

44
Q

How long do you try to limit duration of treatment for PO antibiotics?

A

12 to 18 weeks to limit resistance

45
Q

Dosed with topical retinoid and/or benzoyl peroxide to improve efficacy and reduce resistance

A

PO antibiotics

46
Q

Estrogen is an ____-_______ agent

A

Estrogen is an anti-androgen agent

47
Q

for moderate-severe acne

A

oral contraceptives

48
Q

Only indicated for severe, recalcitrant, nodular acne

A

isotretinoin

49
Q

Option for management of acne that is producing either physical or psychological scarring

A

isotretinoin

50
Q

Used in a variety of other skin diseases such as ichthyosis and some cancers

A

isotretinoin

51
Q

ORAL ISOTRETINOIN IS A POTENT _________

A

ORAL ISOTRETINOIN IS A POTENT TERATOGEN

52
Q

Female patients of ____-_____ potential must only be treated with oral isotretinoin if they are participating in the approved pregnancy prevention and management program (______).

A

Female patients of child-bearing potential must only be treated with oral isotretinoin if they are participating in the approved pregnancy prevention and management program (iPLEDGE).

53
Q

Male patients must enroll in ______ as well as some amount of drug is found in ______.

A

Male patients must enroll in iPLEDGE as well as some amount of drug is found in semen.

54
Q

Mood disorders, depression, suicidal ideation, and suicides have been reported in patients taking this drug. However, a causal relationship has not been established.

A

isotretinoin

55
Q

Chronic, relapsing inflammatory skin disorder with exact cause unknown

A

rosacea

56
Q

possible causes of rosacea

A
  • Innate immunology
  • Microorganisms (Demodex folliculorum, Bacillus oleronius, etc.)
  • UV radiation
  • Vascular hyperreactivity
  • Genetics
57
Q

clinical features of rosacea

A
  • Facial erythema
  • Telangiectasias
  • Inflammatory skin lesions
58
Q

No cure known so treatment focus is on symptom suppression

A

rosacea

59
Q

4 types of rosacea

A
  • Erythematotelangiectatic rosacea – red blood vessles
  • Papulopustular rosacea – pus filled papules
  • Phymatous rosacea - nose
  • Ocular rosacea - eye
60
Q

non-medical treatment of rosacea: avoid triggers of flushing

A
  • Extremes of temperature
  • Sunlight
  • Spicy foods
  • Alcohol
  • Exercise
  • Acute psychological stressors
  • Medications
  • Menopausal hot flashes
61
Q

non-medical treatment of rosacea: skin care

A
  • Frequent skin moisturization
  • Gentle skin cleansing
  • Avoidance of irritating topical products
62
Q

medical treatment for rosacea

A
  • light therapy

- drug therapy - topical or systemic

63
Q

Especially good for telangiectasias

A

laser therapy

64
Q

first line treatment treatment in rosacea

A 
Topical brimonidine (Mirvaso) - Topical alpha2-adrenergic agonist
*Causes direct vasoconstriction
65
Q

second line treatment in rosacea - topical

A
  • usually for mild-moderate disease or failed other therapies
  • Metronidazole, azelaic acid, doxycycline
66
Q

second line treatment in rosacea - systemic

A
  • for more severe/inflammatory lesions or for those where topicals fail
  • Doxycycline or minocycline
67
Q

for refractory cases of rosacea

A

isotretinoin

68
Q

if rosacea has ocular involvement…

A

refer to ophthalmology

BLOCK I: Pharmacotherapeutics (9 decks)

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