Transcript Chapter 16 Cholinesterase Inhibitors

Chapter 104
Drugs for the Skin
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Fig. 104-1. Anatomy of the skin.
A, Major structures of the skin. B, Growth layers of the epidermis.
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Drugs for the Skin
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Topical glucocorticoids (cream, ointment, or gel)
Uses
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To relieve inflammation and itching
Drying agent
Adverse effects
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Stretch marks
Purpura
Telangiectasia
Hypertrichosis
Possible systemic toxicity
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Topical Glucocorticoids
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Adverse effects
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Local reactions
• Thinning of the skin
• Stretch marks
• Purpura
• Telangiectasia
• Hypertrichosis
• Possible systemic toxicity
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Topical Glucocorticoids
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Adverse effects
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Systemic toxicity
• More likely with higher doses and long-term therapy
• Growth retardation in children
• Adrenal suppression
Administration
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Apply in a thin film and gently rub into the skin
Do not use occlusive bandages (or tight-fitting
diapers and plastic pants)
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Keratolytic Agents
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Promote shedding of horny layer of the skin
Primary agents and uses
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Salicylic acid – warts, corns
Sulfur – acne, dandruff, psoriasis, seborrheic
dermatitis
Benzoyl peroxide
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Treatment for Acne
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Nondrug therapy
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Cleansing
Drug therapy
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Benzoyl peroxide
Antibiotics
• Topical – clindamycin
• Oral – tetracycline antibiotics, isotretinoin, hormonal
agents
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Retinoids
• Tretinoin (Retin-A)
• Adapalene (Differin)
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Topical Drugs for Acne
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Benzoyl peroxide
Retinoids
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Tretinoin
Adapalene
Tazarotene
Azelaic acid
Dapsone
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Oral Drugs for Acne
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Antibiotics
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Isotretinoin (Accutane)
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Agents of choice
• Doxycycline (Vibramycin), minocycline (Minocin)
Alternatives (resistance is common)
• Tetracycline (Sumycin), erythromycin (Ery-Tab)
Teratogenic
Triglyceride levels must be monitored
Hormonal agents
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Sunscreens
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Sun exposure
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Promote tanning
UV radiation can also cause burns, premature
aging of the skin, skin cancer, and
immunosuppression
Sunscreens impede the penetration of UV
radiation to viable cells of the skin
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Fig. 104-2. Range of UVB and UVA protection conferred by FDA-approved sunscreens.
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Sunscreens
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Organic screens
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Also known as chemical screens
Absorb UV radiation and then dissipate it as heat
15 of the approved sunscreens
Inorganic screens
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Also known as physical screens
Scatter UV radiation
Titanium oxide and zinc oxide
Now micronized and are clear for applying to skin
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Sun Protection Factor
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SPF is an index of protection against UVB
radiation
SPF does not address UVA protection
Methods for obtaining SPF are not precise
Relationship between SPF and protection
against sunburn is not linear (SPF 30 is not
twice as much protection as SPF 15)
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Sunscreens
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Water and sweat resistance
Adverse effects of sunscreens
Proposed changes regarding sunscreen
testing and labeling
UVB rating and labeling
Using a sunscreen effectively
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Treatment for Psoriasis
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Psoriasis – red patches with silver scales
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Common, chronic inflammatory disorder that
follows an erratic course
Initial episode usually develops in early adulthood
Subsequent attacks may occur spontaneously or
in response to triggers
Varying degrees of severity
Symptoms come from:
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Accelerated maturation of epidermal cells
Excessive activity of inflammatory cells
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Treatment for Psoriasis
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Topical drugs
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Glucocorticoids
Calcipotriene (Dovonex)
Tazarotene (Tazorac)
Anthralin
Tars
Biologic agents
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Alefacept (Amevive)
Efalizumab (Raptiva)
Tumor necrosis factor inhibitors (Enbrel)
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Treatment for Psoriasis
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Systemic drugs (conventional agents)
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Methotrexate
Acitretin (Soriatane)
Glucocorticoids
Cyclosporine (Neoral)
Procedures
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Phototherapy
Coal tar plus ultraviolet B irradiation
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Actinic Keratoses (AK)
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Rough, scaly, red or brown papules caused
by chronic exposure to sunlight
Half of all skin cancers in U.S. begin as AK
Drugs for AK
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Fluorouracil
Diclofenac sodium
Imiquimod
Aminolevulinic acid plus blue light
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Drugs for Atopic Dermatitis (Eczema)
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Glucocorticoids
Topical immunosuppressants
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May cause skin cancer or lymphoma
Tacrolimus
Pimecrolimus
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Agents Used to Remove
Venereal Warts
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Physical measures
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Topical drugs
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Cryotherapy, electrodesiccation, laser surgery,
and conventional surgery
Podophyllin (must be applied by physician)
Can be applied at home
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Imiquimod
Podofilox
Kunecatechins
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Miscellaneous Drugs for Skin
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Agents to remove common warts
Antiperspirants
Deodorants
Drugs for seborrheic dermatitis and dandruff
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Drugs for Hair
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Treat hair loss
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Topical minoxidil
Finasteride (Propecia)
Treat unwanted facial hair
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Eflornithine (Vaniqa)
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Impetigo
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Most common bacterial infection of the skin –
Staphylococcus aureus is most common
Usually seen in children 2 to 5 years of age
Two forms
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Bullous
Nonbullous
Drugs for impetigo (see Table 104-5)
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Local Anesthetics
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Can be applied topically to relieve pain and
itching associated with skin disorders
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Benzocaine
Lidocaine
Pramoxine
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