Exam I Flashcards
Acne Treatments based on Mechanism Of Action (MOA)- 4 Components:
- Follicular hyperproliferation and abnormal desquamation
- Increased sebum production
- C. acnesproliferation
- Inflammation
MOA Follicular hyperproliferation and abnormal desquamation: Medications
- Topical retinoids
- Oral retinoids
- Azelaic acid
- Salicylic acid
- Hormonal therapies
MOA Increased sebum production: Medications
- Oralisotretinoin
* Hormonal therapies
MOA C. acnesproliferation: Medications
- Benzoyl peroxide
- Topical and oral antibiotics
- Azelaic acid
MOA Inflammation: Medications
- Oralisotretinoin
- Oral tetracyclines
- Topical retinoids
- Azelaic acid
What is Retinoic Acid
Morphogen derived from Vitamin A, it is insoluble in water but soluble in many organic solvents
Retinoic Acid’s effect on epithelial tissues
Its action in acne has been attributed to decreased cohesion between epidermal cells and increased epidermal cell turnover
How it is retinoic acid applied topically
Topical retinoic acid is applied initially in a concentration sufficient to induce slight erythema with mild peeling
The effects oftretinoinon keratinization and desquamation
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.
The most common adverse effects of topical retinoic acid
Erythema and dryness that occur in the first few weeks of use, but these can be expected to resolve with continued therapy
Acne-Systemic Agents-Oral isotretinoin: Isotretinoin Medications
Claravis, Amnesteen, Myorisan, Zenatane, Absorica, Sotret
Isotretinoin recommendations
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
How many elements does REM need to mitigate risks associated with use of drug
1 or more elements
REMS goals:
- To inform patients about the serious risks associated with drug X;
- To minimize potential drug-drug and disease-drug interactions; and
- To prevent the risk of fetal exposures to drug X
What is Isotretinoin treatment for acne
vulgaris that is thought to improve acne through reducing sebum production, inhibiting the growth of Cutibacterium (formerly Propionibacterium) acnes, and inhibiting comedogenesis
Isotretinoin side effects
teratogenicity, mucocutaneous disorders, myalgias, visual changes, idiopathic intracranial hypertension, hepatotoxicity, and hyperlipidemia
Patients with severe inflammatory acne (eg, acne conglobata, acne fulminans)
May require a lower initial dose and/or concomitant treatment with systemic glucocorticoids starting before or at the initiation of oralisotretinointherapy
Other Systemic Agents for Acne MOA: Oral Antibiotics- Tetracycline dosage
500 mg twice daily
Other Systemic Agents for Acne MOA: Oral Antibiotics- Tetracycline: Side effects and Contraindications
Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children
Other Systemic Agents for Acne MOA: Oral Antibiotics- Doxycycline dosage
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
Other Systemic Agents for Acne MOA: Oral Antibiotics- Doxycycline: Side effects and Contraindications
Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children
Other Systemic Agents for Acne MOA: Oral Antibiotics- Minocycline dosage
50 mgone to three timesdailyor
Extended release formulation: 1 mg/kg/day (round to nearest available strength)
Other Systemic Agents for Acne MOA: Oral Antibiotics- Minocycline: Side effects and Contraindications
Dizziness, drug-induced lupus, skin discoloration; contraindicated in pregnancy and young children
Other Systemic Agents for Acne MOA: Oral Antibiotics- Sarecycline
dosage
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
Other Systemic Agents for Acne MOA: Oral Antibiotics- Sarecycline Side effects and Contraindications
Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children
Other Systemic Agents for Acne MOA: Oral Antibiotics- Erythromycin dosage
500 mg twice daily (base)
Other Systemic Agents for Acne MOA: Oral Antibiotics- Erythromycin: Side effects
Gastrointestinal distress
Other Systemic Agents for Acne MOA: Oral Antibiotics- Trimethoprim-sulfamethoxazole dosage
160 mg/800 mg once to twice daily
Other Systemic Agents for Acne MOA: Oral Antibiotics- Trimethoprim-sulfamethoxazole: Side effects
Stevens-Johnson syndrome, toxic epidermal necrolysis
Other Systemic Agents for Acne MOA: Oral Antibiotics- Azithromycin
dosage
Intermittent dosing due to long drug half-life; optimum regimen unknown
Other Systemic Agents for Acne MOA: Oral Antibiotics- Azithromycin: Side effects
Gastrointestinal distress
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