Dylan Knox Dknox6@uthsc.edu Derm tutoring: acne Dylan Knox Dknox6@uthsc.edu

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A.S. presents to your pharmacy wanting to buy an OTC remedy for his acne. You look at his medication record, and he fills phenytoin, phenobarbital, lisinopril, ibuprofen, and prednisone at your pharmacy. Which of these medicines would not contribute to his acne? a. Phenytoin b. Phenobarbital c. Lisinopril d. Ibuprofen e. Prednisone C,d,e E- anabolic steroids not prednisone

Drugs that contribute to acne Phenytoin  Isoniazid  Moisturizers (HINT: these are OTC)  Phenobarbital C-IV  Lithium  Ethionamide Steroids (anabolic) 

b. Clearasil (benzoyl peroxide) c. SulfLo bar (sulfur) A.s. asks for your opinion on what medication otc he should use for his acne. He has <10 comedones spread across his face. He mentions that he does not want to apply something many times a day. Which would you not recommend?  a. Biore strips b. Clearasil (benzoyl peroxide) c. SulfLo bar (sulfur) d. AmLactin Lotion (beta-hydroxy acid) A- Would have to use a lot of strips to get whole face/shouldn't use strips on active pimples C- applying 2-3 times a day

DT asks for a recommendation for otc acne treatment DT asks for a recommendation for otc acne treatment. She has <10 blackheads and has t1DM. Which would you not recommend a. Biore strips b. Clearasil (benzoyl peroxide) c. SulfLo bar (sulfur) d. AmLactin Lotion (beta-hydroxy acid) D- C/I in diabetes

Which strength of medicine would need a prescription to be compounded? A. benzoyl peroxide 5% B. benzoyl peroxide 10% C. benzoyl peroxide 15% D. sulfur lotion 7% E. sulfur lotion 12% F. B,C,E G. C, D, E H. C, E H

Otc Benzoyl peroxide 2.5%-10% Sulfur products 3%-10% Alpha-Hydroxy Acid 4%-10% Beta-Hydroxy 0.5%-2%

SS is pregnant and has grade II acne SS is pregnant and has grade II acne. She talked to her doctor who told her to use something over the counter but she can’t remember what. What product was it likely to be? A. benzoyl peroxide B. sulfur lotion C. alpha-hydroxy acid D. beta-hydroxy acid C- doesn’t penetrate skin

Which rx product has the least peeling and burning associated with it? A. adapalene B. tretenoin C. tazarotene A

What product is labeled for any stage of acne? A. spironolactone B. Yaz, Beyaz C. clindamycin 1% foam D. clindamycin 1.2%/BPO 2.5% E. clindamycin 1.2%/tretinoin 0.1% F. A,B, D G. A,B,D,E F. E- wrong strength tretinoin (0.025%)

Erythromycin..? No thanks

RB is a 90 kg man and his doctor calls you to ask how to dose minocycline for acne treatment. What would your recommendation be? A. 90 mg tablet ER QD B. 100 mg tablet ER QD C. 90 mg capsule (IR) QD D. 45 mg capsule (IR) BID B- all other dosage forms do not exist

Which antibiotics for acne can cause tooth staining? A. SMZ/TMP B. erythromycin C. Minocycline D. Tetracycline D. Tetracycline (and Doxycycline) Really important in young kids

What is not a side effect of spironolactone? A. Hypokalemia B. Hypotension C. Menstrual irregularities D. Breast tenderness A. (hyperkalemia- it’s a K sparing diuretic, so it makes sense it would increase K levels)

CL is a 18 YO WF picking up her prescription for Claravis CL is a 18 YO WF picking up her prescription for Claravis. She had a negative pregnancy test on 9/2. Today is 9/10. Can she pick up her claravis? Yes No No- 7 days from negative pregnancy test in reproductive females

CL’s twin brother JL is also trying to pick up his claravis today (9/8) and his doctor’s appointment was the same day as CL’s (9/2). Can he pick up his medication? Yes No Yes- 30 days from appointment for males/non-reproductive females

JL returns one month later for his claravis and insists that his doctor meant to put a refill on the prescription. What can you do? A. Refill the medication B. Call the doctor for an oral refill. C. Recommend the patient set up an appointment with his doctor. D. Tell him to take CL’s medication. C- no refills on isotretinoin products

Questions? dknox6@uthsc.edu