PHRD5985 Pharmacotherapy Lecture 19 - Dermatology

  1. indications for topical retinoids
    mild-mod inflammatory & comedonal acne
  2. how to maximize efficacy of topical retinoids
    combine w/ BPO or topical abx
  3. MOA of tretinoin (topical retinoid)
    drives out/extrudes existing comedones, prohibits formation of new ones
  4. MOA of adapalene (topical retinoid)
    • selective affinity for retinoic acid R
    • less irritation/discoloration thatn tretinoin
  5. examples of topical retinoids
    • tretinoin
    • adapalene
    • tazarotene
  6. which topical retinoid is best tolerated?
  7. which topical retinoid is most irritating?
  8. counseling point of use of topical retinoids w/ BPO
    application should be spaced (AM & PM)
  9. examples of topical abx
    • erythromycin
    • clindamycin
    • azelaic acid
  10. dosing freq of topical retinoids
    once daily
  11. dosing freq of topical abx
    twice daily
  12. purpose of combining topical abx w/ BPO
    • inc efficacy
    • dec resistance
  13. benefit of using azelaic acid
    no likelihood of resistance, systemic effects of photosensitivity rxns
  14. 2nd line topical agents
    • CCS's (for ST)
    • Dapsone
    • keratolytics
    • sulfur
    • resorcinol
  15. 1st link systemic agents
    • isotretinoin
    • macrolide abx
    • lincosamide abx
    • tetracycline abx
  16. first line tx in severe nodular/conglobata acne
  17. typical tx course of isotretinoin
  18. optimal results achieved at what cumulative dose of isotretinoin?
    120-150mg/kg over course of ~5mos
  19. tetracycline CI's
    • pregnancy
    • kids Image Upload 18yo
  20. counseling point for using tetracyclines
    take 1hr before meals (drug-dairy interaction)
  21. examples of tetracyclines
    • tetracycline (TCN)
    • doxycycline (Vibramycin)
    • minocycline (Minocin)
  22. when to assess need for continued use of oral abx
  23. 2nd line systemic agents for acne
    • Bactrim 
    • hormonal agents (OCP, spironolactone)
  24. Pregnancy Cat B acne agent
    azelaic acid
  25. pt counseling on length of tx
    6-8 weeks
  26. 1st line topical agents for psoriasis
    • CCSs
    • Vit D analogues
    • tazarotene
    • keratolytics
  27. MOA of topical CCS's for psoriasis tx
    vasoconstriction inhibits dermal edema, capillary dilation
  28. examples of topical CCS's
    • halobetasol propionate (high potency)
    • mometasone furoate (med potency)
    • hydrocortisone (low potency)
  29. most effective dosage form of topical CCS for tx of psoriasis
    ointment (lipophillic, occlusive, hydrating)
  30. examples of vit D analogues
    • calcipotriene
    • calcitriol
  31. 2nd line topical agents for tx of psoriasis
    • coal tar
    • anthralin
    • immunomodulators
  32. examples of immunomodulating calcineurin inhibitors
    • tacrolimus
    • pimecrolimus
  33. MOA of calcineurin inhibitors
    dec proliferation of epidermis
  34. "PART"
    • pregnancy prevention actively required during/after treatment
    • program for acitretin (Soriatane) use
  35. biologic tx for psoriasis
    • infliximab (IV)
    • etanercept (SC)
    • ustekinumab (SC)
  36. counsel for use of tazarotene in psoriasis
    do not use on BSA >20%
  37. pharm tx of atopic dermatitis
    • topical CCS
    • AH (doxepin, diphenhydramine)
    • topical immunomodulators (tacrolimus)
  38. black box warning for topical immunomodulators
    possible link between use & cancer
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PHRD5985 Pharmacotherapy Lecture 19 - Dermatology