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51 Cards in this Set
- Front
- Back
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Topical Antibacterials MOA?
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prevent future lesions by decreasing sebaceous FA metabolism by-products
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AEs of topical antibacterials?
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local, systemic effects rare
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Clindamycin?
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1% solution,gel lotion topical antibacterial for mild-mod acne
(BENZACYCLIN) |
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erythromycin?
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1.5-2% solution/powder/gel for mild-mod acne (BENZAMYACIN)
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tetracyclin?
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2.2% topical solution for mild-mod acne
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Azelaic Acid MOA?
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topical treatment that blocks DNA synthesis of acne-assoc. bacteria
(AZELEX-20% cream) |
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How long is azelaic acid (AZELEX-20% cream) used to treat noninflammatory lesions? infammatory lesions?
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1 month non-inflamm
2 month inflamm |
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Is azelaic acid well-tolerated? more or less efficacious as other topical therapies?
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yes, less efficacious
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Tretinoin MOA?
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topical acne treatment that corrects abnormalities/blockages of the follicular keratinocyte
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Tretinoin brands & strengths?
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RETIN-A, RETIN-A MICRO, AVITA
0.05% solution (most irritating) 0.01 &0.025% gel 0.025, 0.05,0.1& cream |
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Is topical tretinoin cat-x?
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No, PC-C but docs treat it like X
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other uses for topical tretinoin besides acne?
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photodamaged skin, palliation of wrinkles, mottle hyperpigmentation
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Dosing of topical tretinion?
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once daily
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What should you tell pt to avoid if they are on topical tretinoin tx?
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sun, concomitant high dose vit A, concomitant use of vitamins, herbals, drugs that are photosensitizers
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What are adverse effects of topical tretinoin?
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localized redness & stininging, excessive skin dryness, pigment changes, may initally worsen acne flares
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Adalapene brand, use, MOA?
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Differin (0.1% solution or gel)
topical tmt for acne retinoid-like cmpd |
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PC and dosing of adalapene (DIFFERIN)?
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PC-C, applu 2-3 x daily
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Is adalapene better tolerated and more efficacious than 0.025% tretinoin gel?
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yes adalapene (differin) is both better tolerated & more efficaious than 0.025% tretinion gel
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What antimicrobials are used to systemically treat acne?
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tetracycline, doxcycline, minocycline, erythromycin (not well tolerated), & clindamycin
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dose of tetracycline for acne?
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1 g daily for 2-3 weeks, increase to 2-3 times a day if no response for sever acne
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what are the adrs specific to minocycline?
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DIL, vestibular tox
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Dose of minocycline for long term therapy for acne?
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100 mg BID
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Dose of doxcycline for acne?
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50-100 mg BID
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Which have better penetration into tissue-tetracycline, doxy, mino?
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doxycyline & minocyline b/c mreo lipid soluble
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counseling for all pts on systemic tetracyclines?
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avoid sun exposure (use sunscreen), don't use while preggers (Teeth), separate dairy and cations (antacids), GI ses D!!
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Why is systemic erythromycin not popular for acne tmt?
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terrible GI effects (used for gastroparesis), may D-D intrxs , can cause QT prolongation
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What systemic therapy is only for women to use for acne?
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OCs (Alesse, Yasmin, Estrostep, Ortho-tri cyclen)
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What's in the OCs used for acne?
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norgestimate & ethinyl estradiol
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Sebum production is proportional to ?
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androgen levels
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MOA of OCs for acne?
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combo of norgestimate and ethinyl estradiol decrease unbound biologically active free testosterone
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Isotretinoin is indicated for?
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severe recalcitrant nodular acne unresponsive to convention therapies
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MOA isotretinoin (ACCUTANE, SORTRET)?
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decrease sebum production, alters keratinazation, inhibits inflammation, inhibits P.acnes in follices
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Dose of isotretinoin?
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0.5-1 mg/kg/day in 2 divided doses max of 2 mg/kg/day
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ADRS of isotretinoin?
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SKIN: dryness, peeling, pruritis, photosensitivity
MUCOUS MEMBRANES: chelitis (dry mouth, nose, eyes, blepharoconjunctivitis |
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more ADRs of isotretinoin?
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HEPATOTOX: Ast, Alt incr
antralgias/ muscle stiffness, EYE: decreased night vision (irrev) HYPERLIPDEMIA: esp TGs (NL <180, goes to 600-1000 get pancreatitis by proxy) |
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Last big ADR of isotretinoin (think iPledege)?
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TERATOGENIC CAT X MUST GIVE PPI BY LAW
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How do you manage skin adrs w/ accutane?
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moisturizers, sunscreen, protecitve clothing
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how do you manage chelitis (dry mouth, nose, eyes, blepharoconjunctivitis) with accutane use?
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sugarless candy, lip balm, artificial tears, saline nasal spray, decrease dose
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How do you manage hepatotox with accutane use?
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monitor transaminases
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how do you manage hyperlipidemia with accutane use?
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avoid etoh, watch diet, may have to dose decrease or DEC
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What is the difference btw S.M.A.R.T. & iPledge?
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formalized, national registry
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who needs to be registered w/ iPledge?
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pts, presribers, pharmacies
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What are the qualification criteria for iplege?
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women of CBP that have not had a hysterectomy, bilateral oophorectomy, or doc ovarian failure
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are women that have had tubular sterilization considered to be of CBP according to ipledge?
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yes
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What do female pts of CBP have to do to get accutane?
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2 negative preg tests at CLia lab, sign IC, each refill needs new neg preg test, must use 2 forms of BC
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What are acceptable primary forms of BC?
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tubal sterilization, partner's vasectomy, IUD, hormonal (estrogen containing?
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What are acceptable secondary forms of BC?
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cervical cap, male latex condoms, diaphragm, vaginal sponge w/spermicide
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What are unacceptable forms of BC?
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progesterone only containing PO contraception ,female condom IUD containing progesterone, WD, cervical shield, natural family planning, abstinence w/out approp doc of contraception methods
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How soon after RX written for accutane must pt have it filled?
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w/in 7 days
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How many days supply of accutane can be dispensed at one time?
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30 days
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Is unit dosing, automatic refills allowed for accutane?
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no
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