Self Care- Acne Treatments (Antibiotics)

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Author:
mwill222
ID:
123240
Filename:
Self Care- Acne Treatments (Antibiotics)
Updated:
2011-12-12 21:19:11
Tags:
pharmacy acne
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Description:
Fall 2011 PT Module III: Acne
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  1. When should topical antibiotics be used?
    • 2nd line mild acne
    • may be used earlier for moderate
    • used in combo to prevet resistance
  2. What are the side effects of topical antibiotics?
    • dryness
    • erythema
    • itching
    • peeling
    • possible pseudomembranous colitis
  3. Which antibiotic most commonly causes pseudomembranous colotis?
    clindamycin
  4. Topical antibiotics is used in combo with __________________________ for moderate to severe acne.
    • benzoyl peroxide
    • retinoids
  5. What is the frequency of use for topical antibiotics?
    • BID
    • (Erythromycin& Clindamycin)
  6. What are the preg categories of topical antibiotics?
    B
  7. In what ages can topical antibiotics be used?
    >12 yrs
  8. When should systemic antibiotics be used?
    • moderate to severe acne
    • OR if topical treatments were ineffective
    • OR is there is backance
    • OR risk of scarring/pitting
  9. What is the risk of using systemic antibiotics?
    • Increased resistance
    • Caution with oral contraceptives
    • Other drug interactions
  10. When shoudl you see improvement with systemic antibiotics?
    • 6-10 weeks
    • full effects: 6 months
  11. What is the MOA of Erythromycin (Macrolide)?
    • Binds 50s subunit
    • Inhibits translocation step of translation of mRNA to protein
  12. What are the possible interactions of systemic Eryhtromycin?
    • Liver Enzyme Inhibitor: can cause an Inc. concentration of 3A4 substrates (diltiazem, digoxin, wafarin)
    • QTc prolongation (w/ antiarrythmias, geodon)
  13. What is the MOA of systemic Clindamycin?
    • Discrete binding site of 50s subunit from Eryth.
    • Inhibits protein synthesis
    • Inhibits translocation step
    • Inhibits peptidyl tranferase enzyme (inhibits peptide bond formation)
  14. What are the characteristics of resistance for macrolides?
    • Efflux of drug pump
    • Drug Induces methylase enzyme synthesis (drug cant bind to subunit)
    • Baacteria produces esterases (inactivate the drug)
  15. What are the characteristics of resistance for clindamycin?
    • Not sequestered by same pumps as Macrolides
    • Not a methylase inducer (are ineffective w/ bacteris where methylases are always "on")
  16. What is the MOA of Tetracylines?
    • inhibits translation of mRNA to protein
    • Binds to 30s subunit
    • Blocks binding of tRNA to "A" site (inhibits elongation)
  17. What are the side effects of the tetracycline class?
    • GI- alters normal flora
    • Binds Ca+2 ions (tooth/bone)
    • Photosensitization
    • Hepatic/Renal toxicity
  18. What is the dosing of Tetracycline?
    • 250-500mg BID (dec. when lesions begin to clear up)
    • 1-2hrs before meals OR 4-6hrs after meals
  19. What are the side effects for tetracycline?
    • GI
    • Photosensitization
    • tooth discolorization
    • vaginal infections
  20. What are the drug interactions of Tetracycline?
    • Avoid dairy, antacids, iron
    • Isotretinoin
    • use caution with 3A4 substrates
  21. What is recommended age and Preg category of the tetracycline class?
    • >8yrs
    • D
  22. Which drugs of the tetracycline class has a better potency for gram + bacteria?
    • Doxycycline ~2x
    • Minocycline ~2-4x
  23. What is the dosing for Doxycycline?
    100-200mg Qday, then 50mg once improved
  24. What are the side effects of doxycylcine?
    • GI upset-- more common than tetracycline
    • Gastric Irritation
    • Photosensitivity
    • (Increased Incidence)
  25. What are the drug interactions of doxycycline?
    • Antacids, iron
    • 3A4 substrates
    • Isotretinoin
    • (Not affected by food as much)
  26. What are the side effects of Minocycline?
    • Immediate: 100mg daily
    • Extended: weight based (70kg- 65mg/day)
  27. What are the side effects of Minocycline?
    • GI
    • Photosenistivity
    • Vestibular toxicity
    • Skin discoloration
    • Drug-induced auto-immune lupus
  28. What are the interactions of minocycline?
    separate from antacids, iron, dairy (1-2 hrs b4 OR 4-6 hrs after)
  29. When shoud you use caution with tetracylines? And which one needs dosing adjustments?
    • Renal & Hepatic impairment
    • Minocycline
  30. Which tetracycline causes pseudotumor cerebri? And what is it?
    • Intracranial hypertension
    • Tetracycline
  31. 3A4 inhibitors will ________________ drug levels of ______ substrates like warfarin, cyclosporine, siltiazem, and simvastatin.
    • Increase
    • 3A4 Substrates
  32. What is the dosing of systemic Erythromycin?
    500mg BID
  33. What are the side effects of Erythromycin?
    • GI
    • N/V/D
  34. What is the Preg Category of Erythromycin?
    B
  35. When should you use caution when using systemic Eryhtromycin?
    hepatic impairment
  36. What is the dosing of systemic Clindamycin?
    150mg BID
  37. What are the side effects of clindamycin?
    • Diarrhea
    • GI upset
    • Pseudomembranous colitis
  38. What is the Preg Category of clindamycin?
    B
  39. When should you use caution when using systemic Clindamycin?
    hepatic impairment
  40. What is the MOA of Sulfonamides?
    • Competitive inhibitor of DHPS
    • inhibit folic acid synthesis (hinders synth of DNA purine bases)
    • inhibitbition of DNA synthesis
  41. What is the MOA of Sulfametoxazole + Trimetoprim
    • SMZ: Competitive Inhibitor of DHPS
    • TMP: Competitive Inhibitor of DHFR
    • Combo: Bacteriocidal
  42. What are the (4) characteristics of resistance of SMZ + TMP?
    • Altered DHPS
    • Efflux OR dec. absorption of drug
    • alternatice folic acid synthesis pathway
    • Inc. PABA synthesis
  43. What is the normal dosing of SMZ + TMP?
    800mg/160mg (DS) BID
  44. What are the side effects of SMZ+TMP?
    • Rash
    • Kidney injury (crsytalluria)
    • Photosensitivity
    • Leukocytopenia/Agranulocytosis
  45. What are the interactions with SMZ+TMP?
    • 2C8/9 substrates (warfarin, phenytoin)
    • cyclosporine (inc. nephrotoxicity)
  46. What is the Preg Category of SMZ+TMP?
    C, D if at term
  47. When should you avoid using SMZ+TMP?
    • Glc-6-phosphate dehydrogenase deficiency
    • ---can cause hemolytic anemia
  48. What are the hormones used in hormonal therapy for treatment of acne?
    • Ethinyl Estradiol & Norgestimate
    • (Estrogen & Progesterone)
  49. What is the MOA for hormonal therapy of acne?
    • Inc. Sex Hormone Binding Globulin
    • Dec. Free Testosterone (Androgen)
    • ---Dec. Sebum Production
    • ---Dec. Hyperkeratinization
  50. What are the side effect of hormonal therapy?
    • estrogens promote clotting
    • risk of MI and stroke inc. in high-risk patients
    • breast cancer risk
  51. When are oral contraceptives used to treat acne?
    for moderate to severe acne in females
  52. What are the side effects of oral contraceptives?
    • weight gain
    • nausea
    • breast tenderness
    • breakthrough bleeding
    • inc. risk of thromboembolic disease
  53. When can you see full effects of OC's?
    2-4 months (musts take at same time Qday)
  54. What are the contraindiciations of OCs?
    • Thromboemblonic disease
    • Heavy Smoking
    • Endometrial or Breast Cancer
    • Pregnancy (X)
  55. What are the drug interactions of OCs?
    • Antibiotics
    • 3A4 inducers
  56. When do you use caution with OCs?
    hepatic impairment

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