Exam I

Question 1

Acne Treatments based on Mechanism Of Action (MOA)- 4 Components:

Answer 1

1. Follicular hyperproliferation and abnormal desquamation
2. Increased sebum production
3. C. acnesproliferation
4. Inflammation

Question 2

MOA Follicular hyperproliferation and abnormal desquamation: Medications

Answer 2

• Topical retinoids
• Oral retinoids
• Azelaic acid
• Salicylic acid
• Hormonal therapies

Question 3

MOA Increased sebum production: Medications

Answer 3

• Oralisotretinoin

* Hormonal therapies

Question 4

MOA C. acnesproliferation: Medications

Answer 4

• Benzoyl peroxide
• Topical and oral antibiotics
• Azelaic acid

Question 5

MOA Inflammation: Medications

Answer 5

• Oralisotretinoin
• Oral tetracyclines
• Topical retinoids
• Azelaic acid

Question 6

What is Retinoic Acid

Answer 6

Morphogen derived from Vitamin A, it is insoluble in water but soluble in many organic solvents

Question 7

Retinoic Acid’s effect on epithelial tissues

Answer 7

Its action in acne has been attributed to decreased cohesion between epidermal cells and increased epidermal cell turnover

Question 8

How it is retinoic acid applied topically

Answer 8

Topical retinoic acid is applied initially in a concentration sufficient to induce slight erythema with mild peeling

Question 9

The effects oftretinoinon keratinization and desquamation

Answer 9

It offers benefits for patients with photo-damaged skin. Prolonged use oftretinoinpromotes dermalcollagensynthesis, new blood vessel formation, and thickening of the epidermis, which helps diminish fine lines and wrinkles. Specially formulated moisturizing 0.05% cream (Renova, Refissa) is marketed for this purpose.

Question 10

The most common adverse effects of topical retinoic acid

Answer 10

Erythema and dryness that occur in the first few weeks of use, but these can be expected to resolve with continued therapy

Question 11

Acne-Systemic Agents-Oral isotretinoin: Isotretinoin Medications

Answer 11

Claravis, Amnesteen, Myorisan, Zenatane, Absorica, Sotret

Question 12

Isotretinoin recommendations

Answer 12

Children: Not recommended.
Contraindications: Pregnancy (Cat.X)
Nursing mothers
Boxed Warning: High risk of severe birth defects will result if pregnancy occurs while taking Amnesteem

Question 13

How many elements does REM need to mitigate risks associated with use of drug

Answer 13

1 or more elements

Question 14

REMS goals:

Answer 14

1. To inform patients about the serious risks associated with drug X;
2. To minimize potential drug-drug and disease-drug interactions; and
3. To prevent the risk of fetal exposures to drug X

Question 15

What is Isotretinoin treatment for acne

Answer 15

vulgaris that is thought to improve acne through reducing sebum production, inhibiting the growth of Cutibacterium (formerly Propionibacterium) acnes, and inhibiting comedogenesis

Question 16

Isotretinoin side effects

Answer 16

teratogenicity, mucocutaneous disorders, myalgias, visual changes, idiopathic intracranial hypertension, hepatotoxicity, and hyperlipidemia

Question 17

Patients with severe inflammatory acne (eg, acne conglobata, acne fulminans)

Answer 17

May require a lower initial dose and/or concomitant treatment with systemic glucocorticoids starting before or at the initiation of oralisotretinointherapy

Question 18

Other Systemic Agents for Acne MOA: Oral Antibiotics- Tetracycline dosage

Answer 18

500 mg twice daily

Question 19

Other Systemic Agents for Acne MOA: Oral Antibiotics- Tetracycline: Side effects and Contraindications

Answer 19

Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children

Question 20

Other Systemic Agents for Acne MOA: Oral Antibiotics- Doxycycline dosage

Answer 20

50 to 100 mg twice daily or 100 mg once daily
or
Delayed release formulation: 100 mg every 12 hours for one day, then 100 mg per day

Subantimicrobial dosing: 20 mg twice dailyor
Delayed release formulation given as 40 mg once daily

Question 21

Other Systemic Agents for Acne MOA: Oral Antibiotics- Doxycycline: Side effects and Contraindications

Answer 21

Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children

Question 22

Other Systemic Agents for Acne MOA: Oral Antibiotics- Minocycline dosage

Answer 22

50 mgone to three timesdailyor

Extended release formulation: 1 mg/kg/day (round to nearest available strength)

Question 23

Other Systemic Agents for Acne MOA: Oral Antibiotics- Minocycline: Side effects and Contraindications

Answer 23

Dizziness, drug-induced lupus, skin discoloration; contraindicated in pregnancy and young children

Question 24

Other Systemic Agents for Acne MOA: Oral Antibiotics- Sarecycline
dosage

Answer 24

Weight-based dosing:
33 to 54 kg: 60 mg once daily
55 to 84 kg: 100 mg once daily
85 to 136 kg: 150 mg once daily

Question 25

Other Systemic Agents for Acne MOA: Oral Antibiotics- Sarecycline Side effects and Contraindications

Answer 25

Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children

Question 26

Other Systemic Agents for Acne MOA: Oral Antibiotics- Erythromycin dosage

Answer 26

500 mg twice daily (base)

Question 27

Other Systemic Agents for Acne MOA: Oral Antibiotics- Erythromycin: Side effects

Answer 27

Gastrointestinal distress

Question 28

Other Systemic Agents for Acne MOA: Oral Antibiotics- Trimethoprim-sulfamethoxazole dosage

Answer 28

160 mg/800 mg once to twice daily

Question 29

Other Systemic Agents for Acne MOA: Oral Antibiotics- Trimethoprim-sulfamethoxazole: Side effects

Answer 29

Stevens-Johnson syndrome, toxic epidermal necrolysis

Question 30

Other Systemic Agents for Acne MOA: Oral Antibiotics- Azithromycin
dosage

Answer 30

Intermittent dosing due to long drug half-life; optimum regimen unknown

Question 31

Other Systemic Agents for Acne MOA: Oral Antibiotics- Azithromycin: Side effects

Answer 31

Gastrointestinal distress

Question 32

Slide 16

Answer 32

16