Transcript Roach: Introductory Clinical Pharmacology

Introduction to Clinical
Pharmacology
Chapter 52Topical Drugs Used in the
Treatment of Skin Disorders
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Anti-infectives: Actions and Uses
• Topical antibiotic drugs:
– Exert direct local effect on specific
microorganisms
– Bactericidal; Bacteriostatic
– Uses:
 Treat primary and secondary skin
infections and acne vulgaris
 Prevent infection in minor cuts, wounds,
scrapes and minor burns
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Anti-infectives: Actions and Uses
(cont’d)
• Topical antifungal drugs:
– Inhibit growth of fungi
– Uses:
•Tinea pedis, tinea cruris, tinea corporis
 Cutaneous candidiasis
•Other superficial fungal infections of
skin
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Anti-infectives: Actions and Uses
(cont’d)
• Topical antiviral drugs:
– Inhibit viral replication
– Used to treat:
 Initial episodes of genital herpes
•Herpes simplex virus infections in
immunocompromised patients
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Anti-infectives: Contraindications,
Precautions, and Interactions
• Contraindicated in patients:
– With known hypersensitivity to drugs or
any components of drug
• Topical antibiotics: Used cautiously during
pregnancy and lactation
• Acyclovir and penciclovir: Used cautiously
during pregnancy and lactation
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Antiseptics and Germicides:
Actions
• *Chlorhexidine: Affects wide range of
microorganisms, including gram-positive and
gram-negative bacteria
• *Hexachlorophene: Acts against staphylococci
and other gram-positive bacteria
• *Iodine: Anti-infective action against bacteria,
fungi, viruses, yeasts, protozoa
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Antiseptics and Germicides:
Uses**
• To reduce number of bacteria on skin
surfaces
• As surgical scrub and as preoperative skin
cleanser
• Wash hands before and after caring for
patients
• Cleanse the skin at home
• Prevent infection on minor cuts and abrasions
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Antiseptics and Germicides:
Contraindications, Precautions, and
Interactions
• Contraindicated in patients:
– With known hypersensitivity to individual
drug or any component of the preparation
• No significant precautions or interactions
when drugs are used as directed
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Corticosteroids: Actions and Uses
• Exert localized anti-inflammatory activity
• **Reduce itching, redness, swelling when
applied to inflamed skin
• **Use to treat skin disorders:
 Psoriasis; Dermatitis; Rashes; Eczema
 Insect bites; First- and second-degree
burns; Including sunburns
 *Example: fluocinonide/Lidex
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Corticosteroids: Adverse Reactions**
• Localized reactions:
– Burning, itching, irritation, redness, dryness of the
skin, allergic contact dermatitis and secondary
infections
• Systemic reactions:
– May occur with hypothalamic-pituitary-adrenal axis
suppression, Cushing’s syndrome, hyperglycemia and
glycosuria
– Widespread plaque psoriasis
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Antipsoriatics: Actions and Uses
• *Used to treat:
– Psoriasis by helping to remove the
plaques associated with disorder
• Adverse Reactions
– Skin irritation, temporary discoloration of
the fingers and hair
• Examples of antipsoriatics:
– Anthralin and calcipotriene
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Enzymes: Actions and Uses
• Used to help remove necrotic tissue from:
– Chronic dermal ulcers
– Severely burned areas
• Aid in removal of dead soft tissues by
hastening reduction of proteins into simpler
substances
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Enzymes: Contraindications,
Precautions, and Interactions
• Contraindicated in patients:
– With known hypersensitivity to drugs
– **In wounds in contact with major body
cavities or where nerves are exposed
– In fungating neoplastic ulcers
Enzymatic activity may be impaired by
certain detergents and heavy metal ions
like mercury and silver
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Keratolytics: Actions and Uses
• Removes excess growth of epidermis in disorders
such as warts
• **Used to remove:
– Warts
– Calluses
– Corns
– Seborrheic keratoses
**Adverse Reactions-flu-like syndrome
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Local Anesthetics: Actions and
Uses (end in –caine)
• Temporarily inhibit conduction of impulses
from sensory nerve fibers
• Relieve itching and pain due to skin
conditions
– Minor burns; Fungus infections; Insect
bites; Rashes; Sunburn; Plant poisoning
*Adverse Reactions: local irritation,
dermatitis, rash, burning, stinging and
tenderness may be noted
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Topical Local Anesthetics:
Contraindications, Precautions, and
Interactions
• Contraindicated in patients:
– With known hypersensitivity to any
component of preparation
• Used cautiously in patients:
– Receiving Class I antiarrhythmic drugs toxic effects are additive and potentially
synergistic
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Preadministration assessment:
– Visual inspection and palpation of the
involved area
– Record areas of involvement, including
size, color, and appearance
– Note presence of scales, crusting,
drainage, complaint of itching
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment (cont’d)
• Ongoing assessment:
– Inspect affected area for changes, and
adverse reactions
•Do not apply drug: Changes noted;
patient reports new problems
– Check treatment sites 1 day or more after
application
– Report signs: Extreme redness or infection
at application site
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Promoting an optimal response to therapy:
– Topical anti-infectives: Cleanse skin with
soap and warm water unless different
method ordered before each application
– Apply anti-infective; Area is either
covered or left exposed
– Topical antiseptics and germicides: Use,
instill, apply antiseptics and germicides as
directed by primary health care provider
or by label on product
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
(cont’d)
• Educating the patient and family:
– General teaching points
– Antinfectives: Protect skin from ultraviolet
rays
– Report severe diarrhea, stomach cramps
or bloody stools
– Antiviral agent: Use finger cot or glove to
prevent auto-inoculation of other body
sites when applying ointment
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Educating the patient and family (cont’d):
– Topical corticosteroid: Apply ointments,
creams or gels sparingly in light film; Rub
in gently
•Do not use bandages, dressings,
cosmetics, or other skin products over
treated area unless directed
•Enzyme preparations: Necessary to
inactivate collagenase- wash area with
providone iodine
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Evaluation
• Therapeutic drug response is achieved
• Patient or family member demonstrates an
understanding of the use and application of
the prescribed or recommended drug
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins