CANS Pharmacology & Medications in Aesthetics 2 — Questions and Answers
Question 1: Which class of dermal filler is considered fully reversible and carries the lowest long-term complication risk profile?
- Calcium hydroxylapatite (CaHA)
- Poly-L-lactic acid (PLLA)
- Hyaluronic acid (HA) (Correct answer)
- Polymethylmethacrylate (PMMA)
Correct answer: Hyaluronic acid (HA)
Hyaluronic acid fillers are the only type reversible with hyaluronidase and are naturally biodegradable, making them the safest option when complications arise.
Question 2: A patient taking a non-selective beta-blocker presents for lip filler. Why does epinephrine-containing local anesthetic require caution?
- Beta-blockers cause excessive sedation when combined with epinephrine
- Beta-blockade leaves alpha-adrenergic effects of epinephrine unopposed, risking paradoxical hypertension (Correct answer)
- Beta-blockers inhibit ester hydrolysis, prolonging epinephrine's action unpredictably
- Beta-blockers reduce local tissue perfusion and increase infection risk
Correct answer: Beta-blockade leaves alpha-adrenergic effects of epinephrine unopposed, risking paradoxical hypertension
With beta-receptors blocked, epinephrine's alpha-adrenergic vasoconstrictive and vasopressive effects are unopposed, which can trigger severe hypertension and reflex bradycardia.
Question 3: Antiviral prophylaxis with valacyclovir or acyclovir is strongly recommended before which aesthetic procedures in susceptible patients?
- Patients with atopic dermatitis before chemical peels
- Patients with a history of oral herpes simplex virus (HSV-1) before lip injections or ablative laser (Correct answer)
- Patients with rosacea before IPL photofacial treatments
- Patients with seborrheic dermatitis before microneedling
Correct answer: Patients with a history of oral herpes simplex virus (HSV-1) before lip injections or ablative laser
Trauma from lip injections or ablative laser can reactivate latent HSV-1, causing a painful outbreak; prophylactic antivirals started 1-2 days before and continued for 3-5 days after treatment prevent reactivation.
Question 4: A patient is taking warfarin for atrial fibrillation and desires elective botulinum toxin injections. The most appropriate management is to:
- Proceed normally as warfarin does not affect bruising with superficial injections
- Switch the patient to low-dose aspirin one week before treatment
- Consult the prescribing physician before any anticoagulation modification, balancing bleeding vs. thromboembolic risk (Correct answer)
- Administer vitamin K 10 mg orally the evening before to reverse warfarin temporarily
Correct answer: Consult the prescribing physician before any anticoagulation modification, balancing bleeding vs. thromboembolic risk
Stopping anticoagulation without medical supervision poses serious thromboembolic risks; the prescribing physician must weigh this against the procedural bleeding risk and may approve proceeding on anticoagulation for low-risk injections.
Question 5: Aspirin and NSAIDs should ideally be discontinued how many days before aesthetic injectable treatments to minimize bruising risk?
- 1–2 days
- 3–5 days
- 7–10 days (Correct answer)
- 14 days
Correct answer: 7–10 days
Aspirin irreversibly inhibits platelet COX for the platelet's lifespan (~7–10 days), while NSAIDs reversibly inhibit COX; both should be stopped 7–10 days before procedures to allow platelet recovery.
Question 6: Which commonly taken dietary supplement has antiplatelet properties and should be discontinued 1–2 weeks before aesthetic injectable procedures to reduce bruising?
- Vitamin C (ascorbic acid)
- Vitamin D3 (cholecalciferol)
- Omega-3 fish oil (Correct answer)
- Vitamin B12 (cyanocobalamin)
Correct answer: Omega-3 fish oil
Omega-3 fatty acids inhibit thromboxane A2-mediated platelet aggregation and have mild anticoagulant effects, increasing bruising risk with needle-based procedures.
Question 7: Diphenhydramine (Benadryl) may serve which useful roles in the aesthetic clinical setting?
- Reversing botulinum toxin ptosis and dissolving hyaluronic acid fillers
- Treating mild allergic reactions and providing mild anesthetic/sedative effects as a procedure adjunct (Correct answer)
- Preventing post-inflammatory hyperpigmentation after laser procedures
- Reducing post-filler swelling through its direct anti-edema mechanism
Correct answer: Treating mild allergic reactions and providing mild anesthetic/sedative effects as a procedure adjunct
Diphenhydramine blocks H1 histamine receptors to treat mild allergic reactions, and its local anesthetic properties (sodium channel blockade) and sedative effect make it useful as a procedural adjunct.
CANS Pharmacology & Medications in Aesthetics 2
Which class of dermal filler is considered fully reversible and carries the lowest long-term complication risk profile?