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Acne CasePatient and Setting: CC:JG, a 19-year-old female, office visit (ambulatory care setting)¨”I’m so frustrated with my  acne, I want something that will finally clear up my skin!”HPI:JG arrives at her first visit to the dermatology office. She was first diagnosed 2 years ago with moderate non-inflammatory by her primary care provider. Her lesions were primarily on her face and back. She tried benzoyl peroxide both gel and wash with limited success. She picked up Differin gel (0.1%) over the counter because her friend used it worked for her friend. She started using it for a week and stopped it because it made everything worse! She is inquiring about a drug her friend has been taking called Accutane. It seems to really be helping her and wants to know if it is something she can be prescribed. Currently she has at least 2 – 3 dozen each of open and closed comedones on her face and upper back   PMH:Acne vulgaris PCOSFamily History: non-contributorySocial History: (-) smoke/tobaccoOccasionally drinks on the weekendsSexually active with one partner, uses condoms for contraceptionMedication History:Differin gel 0.1% (purchased over the counter, started but stopped within a week)Multivitamin 1 tablet every day Metformin 1000 mg once a day Allergies:NKDA Physical Examination:Gen: Well developed, well nourished VS: BP 124/90, HR 72, T 37◦ C, RR 21, Wt 80 kg, HT 66 inHEENT: WNLCV: WNLChest: WNLABD: obese, non-tenderGU: no assessmentEXT: unremarkableNEURO: A & O x 3Labs Questions Do a prioritized list of drug-related problems. Use the DRP terminology (see care planning lecture).Use the table below to assist you in addressing ALL of the patient’s health or medication-related problems, in priority order. Please use the information provided in the case, your references, and your knowledge of the material. For each problem identified, the headings and questions below will guide you to provide all necessary information. Prioritized list of drug-related problems: (use the DRP terminology, see care planning lecture); [not limited to 4 problems]1.     Ineffective drug – benzoyl peroxide  2.     Non-Adherence – differin gel 3.     Need for additional therapy – for treatment of her acne 4.      Pathology:1. What is a comedone?2. How are such comedomes formed in the skin?Pharmacology:1.     Describe the mechanism of action of retinoids.2.     Describe the mechanism of action of antibiotics used in acne (eg: erythromycin, clindamycin, minocycline).Medicinal Chemistry Question:1. What is the structural difference between Tretinoin and Isoretinoin? 2. What is mechanism of action of Benzoyl peroxide?  Collect Assessment PlanImplementation Follow-up:Monitoring & Evalu Biology Science Pharmacology PAS MISC