Apply twice a day do not exceed 200 gmweek for

 Apply twice a day.
 Do not exceed 200 gm/week.

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company
Psoriasis: Rational Drug
Selection (cont ’ d)
 Treatments prescribed by specialists
 Phototherapy
 Systemic medications
 Methotrexate
 Oral retinoids
 Immunosuppressants
 Tumor necrosis factor blockers

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company
Psoriasis (cont ’ d)
 Monitoring
 Monitor for effectiveness and adverse effects.
 Outcome evaluation
 Psoriasis lesions should clear.
 Patient education
 Proper application of medications
 Many medications stain clothes and skin.
 Some medications cause photosensitivity.

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company
Acne
 Pathophysiology
 Genetic susceptibility
 Increased sebum production
 Propionibacterium acnes colonize the follicles and convert
the triglycerides in the sebum into free fatty acids.
 Free fatty acids cause inflammation.
 Goals of treatment
 Control acne and keep visible lesions and medication
adverse effects to a minimum

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company
Acne: Rational Drug Selection (cont ’ d)
 Topical antibiotics
 Control acne by their bacteriostatic or bactericidal activity
against P. acnes
 Benzoyl peroxide is available OTC.
 Erythromycin
 Clindamycin
 Tetracycline
 Combination products with benzoyl peroxide and
erythromycin or clindamycin

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company
Acne: Rational Drug Selection (cont ’ d)
 Oral agents
 Oral antibiotics
 Treats the P. acnes colonization
 Tetracycline, doxycycline, minocycline, erythromycin
 Hormonal therapy: oral contraceptives
 Controls the inflammatory component of acne
 Retinoid: isotretinoin
 Reserved for severe recalcitrant cystic acne
 Prescribed by dermatologist
 Pregnancy category X, requires iPledge registration to confirm pregnancy
prevention plan
 Liver enzyme and lipid levels need to be monitored.

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company
Acne Rosacea
 Affects middle-aged patients
 Chronic inflammatory disorder of the blood
vessels and pilosebaceous glands of the face
 Treatment
 Topical metronidazole (Metro-Gel, Noritate)
 Treatment continues for life.

Pharmacotherapeutics
for Advanced Nurse Practitioner Prescribers,
4th Edition
Copyright © 2016 F.A. Davis Company