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Pharmacology > Unit 1 Acne Treatment > Flashcards

Unit 1 Acne Treatment Flashcards

1
Q

What is the most common skin disease?

A

Acne Vulgaris

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2
Q

Acne Vulgaris affects what age range most?

A

12-25yrs

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3
Q

Who is more prone to develop acne vulgaris? Males or Females?/

A

Both genders are equally prone as well as race and ethnicity

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4
Q

More the more androgens the less sebum is produced.

T or F

A

False; the more androgens = more sebum produced

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5
Q

How are comedomes formed?

A

Excess sebum + sloughing of keratinocytes

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6
Q

Acne vulgaris is caused by

a. virus
b. fungus
c. bacteria
d. all of the above
e. none of the above

A

c. Bacteria

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7
Q

What is the bacteria that causes acne vulgaris?

A

Propionibacterium acnes (P. acnes)

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8
Q

How does the inflammatory response begin in a patient with acne vulgaris?

A

P. acnes convert sebum to free fatty acids

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9
Q

Where are the most common locations one would develop acne vulgaris?

A

face, neck, back, shoulders

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10
Q 
Follicular plugging takes about \_\_\_ weeks to evolve into 
an inflammatory lesion.
a. 2 weeks
b. 3 weeks
c. 4 weeks
d. 6 weeks 
e. it happens instantaneously
A

c. 4 weeks

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11
Q

What takes longer to form? An inflammatory lesion or a closed comedone?

A

Inflammatory lesion

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12
Q

A closed comedone is also known as.

A

A whitehead

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13
Q

An open comedone is also known as.

A

A blackhead

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14
Q

What are the goals in prescribing an acne treatment?

A
  1. eliminate existing lesions & prevent new lesions from developing
  2. decrease discomfort
  3. prevent or minimize scarring
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15
Q

You tell a patient you want them to use mild, noncomedogenic facial soap bid, avoid oily skin products and acne lesion manipulation. What type of specific treatment is this called?

A

Nonpharmacologic Treatment

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16
Q

What are some predisposing factors that will help the provider make the best pharmacological treatment?

A

severity, lesion types, scarring, skin discoloration, previous treatment history, patient tolerance

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17
Q

How long does it take for a pt to see improvement with their acne treatment?

A

Can take up to 6 yo 8 weeks to see results (reduce or prevent new eruptions)

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18
Q

Once beginning a treatment for acne vulgaris, it is common a pt will see flare initially? T or F? Explain

A

True. The initial lesions may resolve more rapidly causing an increase in flare up.

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19
Q

Open and closed comedones would be considered inflammatory or noninflammatory lesions?

A

Noninflammatory lesions

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20
Q

Describe mild acne vulgaris.

A 
Noninflammatory lesions (open and closed comedones)
     or 
Noninflammatory lesions (backheads & whiteheads)
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21
Q

List the types of Topical Retinoids (both generic and there trade name).

A

Generic Trade

  • Tretinoin *Retinin - A
  • Adapalene *Differin
  • Tazarotene *Avage, Tazorac
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22
Q

List the Topical Retinoid that is a contraindication in pregnancy.

A

G -Tazarotene

T - Avage, Tazorac

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23
Q

What are the adverse effects for someone given Tretinoin or Retin-A?

A

erythema, dryness, burning, photosensitivity

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24
Q

What is the mechanism of action for Tretinoin or Retin-A?

A
  1. Vitamin A analog (retinoid)
  2. increases cell turnover in follicular wall resulting in resolution of existing comedones & inhibition of new comedones formation
  3. anti-inflammatory effects
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25
Q

When is the best time to tell your pt to use the topical cream Tretinoin or Retin-A?

A

qhs - qohs

after washing area with mild,noncomedone cleanser

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26
Q

Why is qhs the best time to use Tretinoin or Retin-A?

A

Because it is deactivated by sunlight

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27
Q

What do all these topical retinoids have in common?

Tretinoin, Adapalene, Tazarotene

A

They are all taken qhs

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28
Q

What is the MOA (mechanism of action) for Adapalene?

Trade - Differen.

A

MOA: Retinoid-mimetic, may have anti-inflammatory properites

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29
Q

What is another alternative topical retinoid cream that has better tolerability to Tretinoin? What are the cons?

A

G: Adapalene T: Differen

Cons- more expensive

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30
Q

What is another alternative topical retinoid cream that is more irritating than Tretinoin? What is it’s cost?

A

G: Tazaroten
T: Avage, Tazorac
$240

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31
Q

What is the MOA (mechanism of action) of Tazarotene?

A

MOA: New generation retinoid, anti-inflammatory effects

32
Q

Benzoyl Peroxide cream is what type of medication? Is this a Generic medication or Trade?

A

Topical Antimicrobial- Generic

33
Q

What is the Trade Name for Topical Benzoyl Peroxide?

A

Benzagel

34
Q

What is the dosage for someone Rx w/ Benzoyl Peroxide/Benzagel? And when should they take it

A

2.5-5% gel; qday - bid

35
Q

What is the MOA for Benzoyl Peroxide / Benzagel?

A

MOA: nonantibiotic antibacterial & exfolliant (comedolitic)

36
Q

This medication may bleach your fabric?

a. Tetracycline
b. Dapsone
c. Erythromycin
d. Benzoyl peroxide
e. Tretinoin

A

d. Benzoyl Peroxide

37
Q

What is the most frequent adverse affect for Benzoyl Peroxide?
T: Benzagel

A

AE: Local irritation & dryness

38
Q

List some mild acne topical antimicrobial medications we have studied in class. Generic and Trade Names.

A

Generic Trade
Benzoyl Peroxide Benzagel
Clindamycin Cleocin -T
Erythromycin Ery

39
Q

How often should mild acne vulgaris topical agents be given?

A

qday -bid

40
Q

What is the MOA of Clindamycin and Erythromycin?

A
  1. Kill bacteria in follicles
  2. effective for pupulopusturlar lesions
  3. Anti-inflammatory Properties
41
Q

Why is Clindamycin and Erythromycin more beneficial than BPO?

A

Less irritating; less drying

42
Q

What type of vehicle is BPO?

A

Alcohol

43
Q

How often should a patient use Azelaic Acid cream for mild acne vulgaris?

A

20% cream bid

44
Q

What is the MOA of Azelaic acid?

A
  1. Interferes with bacterial DNA synthesis (kills bacteria)

2. Anti-inflammatory, not primary irritant

45
Q

List the side of affects to using Azelaic Acid.

A
  1. Local irritation
  2. pruritis
  3. possible burning
46
Q

What is the generic drug for Aczone (Trade Name)

A

Dapsone

47
Q

Is Dapsone a topical cream, ointment or gel?

A

Gel

48
Q

What is the dose for Dapsone?

A

5% gel bid

49
Q

What is the MOA for Aczone?

A
  1. believed to interfere w/ chemotactic migration of neutrophils and interrupt the inflammatory cascade
  2. Believed to help reduce the formation of neutrophil-generated destructive oxygen-bearing molecules which irritate the skin
50
Q

What is the Adverse Effect of using Daspsone?

A

oiliness/peeling (19%), dryness (16%), erythema (13%) at the application site

51
Q

Give an example of a TA drug and TR drug used together for mild acne vulgaris.

A

TA - BPO

TR - Tretinoin

52
Q

A pt diagnosed with inflammatory papules and pustules with some noninflammatory lesions. Would be described as what type of acne?

A

Moderate Acne

53
Q

What type of category drug(s) are used for moderate acne?

A

Topical Retnoids + Oral Antibiotics +/- BPO

54
Q

What are the 3 first line defense oral antibiotics that can be used for Moderate acne vulgaris? List the Generic and Trade Names.

A

Generic Trade

  • Doxycycline *Adoxa
  • Minocycline *Minocin
  • Tetracycline *Sumycin
55
Q

What medication is a second line for moderate acne vulgaris?

A

Generic: Erythromycin
Trade: Ery-Tab

56
Q

What is a 3rd line medication for moderate acne vulgaris?

A

Generic: Trimethoprim-sulfamethoxazole
Trade: Septra, Bactrim

57
Q

These medications are all Tetracycline medications?

A

Doxycycline, Minocycline, Tetracycline

58
Q

This medication should not be used in children

A

1st Line Medications - Tetracyclines

Moderate Acne Vulgaris - Oral Antibiotics

59
Q

If a child less than 8 years or a female who is pregnant or nursing is given Doxycycline, what will be the consequences?

A

Secondary permanent tooth discoloration; abnormalities in bone formation

60
Q

What are the Adverse Effects in a patient who may take a first line medication for moderate acne vulgaris?

A

photosensitivity, GI upset, pseudomotor cerebri (benign intracranial HTN)

61
Q

When should a patient take Tetracycline?

A

on an empty stomach (1 hr before or 2 hr after meals); interacts w/ dairy, Ca, Fe, Mg, Zn

62
Q

This medication causes abnormal pigmentation, vertigo, rarely a severe drug Rxn (lupus-like Rxn).

A

Minicycline - an OA for moderate acne vulgaris

63
Q

What medication will cause GI upset and cutaneous reactions?

A

Erythromycin

64
Q

When would a pt be given Trimethoprim-sulfamethoxazole ( Septra/ Bactrim). Be specific.

A

Pt- Dx w/ moderate acne vulgaris

For those who cannot tolerate TCNs or erythromycin in cases of resistance to TCNs and erythro

65
Q

Why would it be beneficial to give a patient Doxycycline over Minocycline?

A

Because Doxycycline:

  1. taken qday vs Mino as day-bid
  2. doesn’t cause abnormal pigmentation, vertigo, or severe drug rxn
  3. cheaper
66
Q

What is the MOA of oral contraceptives?

A

Androgen levels correlate w/ sebum production.

OC’s decrease unbound (free) biologically active androgens. (ie. free testosterone)

67
Q

What 3 Oral contraceptives are FDA approved?

A
  1. Ortho Tri-Clclen
  2. Estrostep
  3. Yaz
68
Q

Norgestimate (triphasic)/0.35 mg ethinyl estradiol) is the chemical make up of what medication?

A

Ortho Tri-Cyclen

69
Q

Norethindrone acetate (triphasic)/ ethinyl estradiol) is the chemical make up of what medication?

A

Estrostep

70
Q

3mg drospirenone/ 20 mcg ethinyl estradiol is the chemical make up of what medication?

A

Yaz

71
Q

When is it a good indication to give a patient an oral contraceptive medication for acne vulgaris?

A

When they are sexually active! It also helps treat moderate acne vulgaris.

72
Q

What are some adverse effects a patient prescribed might experience?

A

Nausea, wt. gain, breast tenderness, increased risk of thromboembolism, stroke, MI, HTN, DVT

73
Q

Oral contraceptives may have potential drug interactions with what type of medication given for acne vulgaris? What is the pathophysiology explanation behind this interaction?

A

OC may interact to OA’s.

OA’s will decrease active estrogen absorption

74
Q

When given a patient an oral contraceptive, how long would you tell them the therapy may take for them to see improvements in their acne?

A

2-4 months (therapy needed)

75
Q

Inflammatory lesions and scarring with some noninflammatory lesions is what type of acne vulgaris?

A

Severe Acne Vulgaris

76
Q

What is the difference between moderate acne vulgaris and severe acne vulgaris?

A

Scarring

Pharmacology (6 decks)

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