Final pharm exam (1).docx

Oral active against pacnes typically used for

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– Oral • Active against P.acnes • Typically used for moderate to severe acne • Prevent further lesions
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• Anti-inflammatory effect • Tetracycline – First line • Erythromycin – Good alternative to tetracycline – Pregnancy category B • Bactrim: TMP/SMX – Bacteriostatic Accutaine- monitor CBC, CMP 1 mo after starting- pregs, CBC CMP, TG, Lipid, LFT Oral Contraceptives • Acne indication—must contain ethinyl estradiol – Norgestimate – Drospirenone – Levonorgestrel • Antiandrogenic • Anti-inflammatory • Decrease numbers of comedones Rosacea 1. Topical metronidazole, sulfa, azeleic acid 2. Oral abx Topical—first line – Metronidazole0.75%gel, cream, or lotion bid – Sodium sulfacetamide with sulfur (Sulfacet-R) • Contraindicated in kidney disease • Pregnancy Cat C—avoid in breast feeding – Azelaic acid(Finacea:15%gel) • Used for treating papules • Systemic (4–6 weeks) – Used for anti-inflammatory properties – Tetracycline250–500mgpobid – Minocycline50–100mgpoqd – Erythromycin ANTIVIRAL Types: acyclovir (Zovirax), famciclovir (Famvir), valacyclovir (Valtrex) • Contraindications: patients with renal disease • Adverse events: headache vertigo depression, tremors • Interactions: effect increase in patients taking probenecid; patients taking zidovudine (Retrovir) may experience drowsiness • Pregnancy—Category B WARTS Extensively used as a keratolytic • Mechanism of action poorly understood: solubilizes cell surface proteins in stratum corneum à Desquamation? • 3–6% is keratolytic; >6% more destructive • Be wary of absorption! Salicylic acid levels of 30–50% is toxic, most a concern in children • Allergy to salicylates: urticaria, anaphylaxis, erythema multiforme • Side effects: local irritation, acute inflammation, ulceration • Caution with diabetics and peripheral vascular disease Therapy for Genital Warts • Patient applied – Podofilox solution or gel (Condylox): 0.5% bid for 3 days followed by 4 days of no therapy; repeat cycle as needed for a total of four cycles – Imiquimod cream (Aldara): 5% cream applied three times a week for up to 16 weeks Therapy for Genital Warts (cont.) • Practitioner applied – Cryotherapy – Podophyllin or resin in compound tincture of benzoin 10% to 25% (Podofin) – Trichloroacetic acid or bichloracetic acid 80%–90% Azole Clotrimazole, ketoconazole, miconazole, oxiconazole, Cause leakage of fungal cell wall membrane Tinea and candida Erythema, itching, stinging, burning No pregs/lactation, caution in liver dx Ketoconazole- no sulfa allylamin e Butenafine, naftafine, terbinafine Limited effectiveness against yeast Oral Griseofulvin, itraconazole, terbinafine, fluconazole Treat up to 3 mo, monitor LFT, azoles-no statins, allymine-no cimetidine, rifampin Itracon-no children Azoles-no pregs, quinidine, hypoglycemia, potentiate-warfarin, versed, halcion, space out antacids
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First line SSRIs Fluoxetine and sertraline for pts w/ somnolence Paroxetine for pts w/ insomnia Secon d line TCA (despiramine or nortriptyline) or atypical
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  • Summer '17
  • Selective serotonin reuptake inhibitor, Serotonin Syndrome, cimetidine, griseofulvin

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