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Continuing Education

Each topic is eligible for one credit, NZ College of Pharmacists.

Deadline: Friday, August 27, 2010, Any submissions received after deadline date will not be processed.

Article: Acne

For last month's answers click here.

Symptoms and DiagnosisPostpartum depression (PPD) is a separate entity from major depression.

DSM-IV-TR states that the onset of PPD must be within 4 weeks of giving birth.

Diagnostic criteria for a major depressive episode include: depressed mood, diminished interest/pleasure in activities, appetite and/or sleep disturbance, fatigue, reduced concentration and recurrent thoughts of suicidal ideation.

Risk FactorsIt is advisable to screen all women for PPD during both the antepartum and postpartum periods.

Environmental stressors, such as poor social or emotional support, appear to have little predictive value for PPD.

A family history of depression and depression during pregnancy are both major risk factors for PPD.

Screening ToolsThe Edinburgh Postnatal Depression Scale (EPDS) is a useful screening tool – 6-8 weeks postpartum – and can be repeatedly administered to track symptoms over several visits.

For the Postpartum Depression Screening Scale (PDSS), a lower score corresponds to an increased severity of symptoms.

Simple screening tools such as that developed by Whooley et al, are not as effective as the longer EPDS and PDSS instruments.

TreatmentPharmacotherapy is recommended in women with mild, moderate and severe PPD.

Generally, studies have not reported high rates of adverse events in infants exposed to antidepressants in breast milk.

In PPD, selective serotonin reuptake inhibitors are superior to tricyclic antidepressants.

Counseling PPD PatientsIn women with PPD, a key counseling point is demystifying antidepressants.

Pharmacists have a key role in answering patients concerns regarding antidepressants in pregnancy and breastfeeding.

It may be useful to recommend that mothers take the antidepressant immediately after breastfeeding and prior to the infant’s sleep time to minimize exposure to peak drug concentrations.

Close last month's answers

Name: Address: Phone: Pharmaceutical Society Registration Number:

Which of the following answers are TRUE?
- Please tick (there may be more than one correct answer per question)

Pathogenesis of acnePropionibacterium acnes colonization plays a key role in the pathogenesis of acne .

There is no genetic basis involved in the development of acne.

There are few data to support a link between diet and the development of acne.

Clinical presentationOpen and closed comedones are the hallmark of non-inflammatory acne.

Acne mechanica describes the formation of comedones resulting from repeated mechanical rubbing and occlusion.

While acne is a highly visible condition, its onset does not appear to have any impact on adolescents self esteem.

Topical therapiesTopical agents should be applied only to the individual spots or pimples.

Pharmacists should advise patients regarding minimizing the use of cosmetics.

Tretinoin is associated with fewer adverse effects than aldapalene.

Oral therapiesOral antibiotics are often used as first-line therapy for moderate-to-severe acne.

Oral retinoids are often administered in lower daily doses over a longer treatment period.

Pharmacists should be aware of the numerous side effects associated with the use of isotretinoin.

Key points for the pharmacistAdvice on skin care is important in individuals with acne.

Hormonal therapy is not considered as a first-line therapy in women with acne.

Clients may seek general advice on the management of dryness of the skin, lips, nasal mucosa and eyes.

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