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Pharm - Topical Agnt

Pharmacology - Topical Agents

QuestionAnswer
Topical Corticosteroids - Uses Uses: inflammation, psoriasis, eczema, contact dermatitis
Topical Corticosteroids - Toxicity Toxicity is not common but can occur if over large areas Hypothalamic-pituitary-adrenal axis (HPA) suppression is most common
Topical Corticosteroids - Side Effects Atrophy, striae, acne, steroid rosaces Side effects can be increased if: used for prolonged periods of time, used under occlusion (covered - doesn't evaporate), on the face (skin is thinner)
Topical Corticosteroids - Group I Megapotent or very high potency Amount & duration need to be monitored Max use of 2 weeks then need to stop. Can wait 1 week and start again Inform pt not to use more than 50g per week Monitoring: Renal and HPA suppression
Topical Corticosteroids - Groups II – IV Application & duration vary Usually bid for 2 to 6 weeks Start more potent then decrease the potency If no results seen in 4 to 7 days, stop then resume with more potent drug
Group IV Topical Corticosteroids - examples Low potency Aclometasone 0.05% (Aclovate) Desonide 0.05% (Desowen) Hydrocortisone acetate 0.5%-2.5% (Hytone, Cortaid, Cortizone)
Group III Topical Corticosteroids - examples Medium potency Betamethasone valerate 0.1% (Valisone) Triamcinolone Acetonide 0.025-0.1% (Kenalog, Aristocort) Hydrocortisone Valerate 0.2% (Westcort)
Group II Topical Corticosteroids - examples High potency Amcinonide 0.1% (Cyclocort) Betamethasone Diproprinate 0.05% (Diprosone) Fluocinonide 0.05%(Lidex) Fluocinolone 0.2%(Synalar)
Group I Topical Corticosteroids - examples Very High potency Clobetasol propionate 0.05% (Temovate) Halbetasol 0.05% (Ultravate)
Mupriocin - Indications and MOA Bactroban Ind: Impetigo caused by staph aureus, beta hemolytic strep, strep pyogenes MOA: blocks protein synthesis of bacteria by binding with tRNA synthetase
Mupriocin - Adverse Reactions Pregnancy category B ADR: burning, stinging, pain, itching, dry skin, tenderness, rash
Bacitracin uses OTC for gram +
Erythromycin uses gram + and acne vulgaris
Neomycin sulfate and Gentamicin uses gram - (Monitor use in renal failure patients)
Polymyxin B sulfate uses anaerobic gram – (Psudomonas, E.coli, Enterobacter, Klebsiella) & gram +
Docosanol Abreva - Topical Antiviral Agent Apply 5 times a day OTC
Peniciclovir Denavir - Topical Antiviral Agent Apply q2h while awake used for cold sores - expensive
Acyclovir Zovirax - Topical Antiviral Agent Apply 5 times a day for 4 days for genital herpes
Antifungal agents - two commonly used classes 1. Imidazoles 2. Triazoles
Antifungal agents - Tx principles Must last long enough for complete turnover of skin after infection is resolved Oral agents used in tx of tinea capitis and usually for onychomycosis
Antifungal agents - with steroids Some are combined with steroids to relieve pruritus and inflammation. When sx improve stop combination and continue antifungal.
Nystatin Antifungal agent (note: not a Statin) Only antifungal known safe in infants
Clotrimazole Lotrimin, Mycelex - (Imidazoles) Ind: tinea pedis, cruris, corporis, versicolor ADR: erythema, stinging, blistering, peeling, pruritus, burning. Pregnancy category B
Ketoconazole Nizoral - (Imidazoles) Ind: pedis, cruris, corporis, versicolor, candida, sebhorrheic dermatitis ADR: severe pruritus, stinging. Pregnancy category C; Precaution: contains sulfites. Overdosage/ingestion: gastric lavage with sodium bicarbonate
Miconazole Monistat - (Imidazoles) Ind: tinea pedis, corporis (Rx and OTC), candidiasis and tinea versicolor (Rx) ADR: irritation, burning
Naftifine Naftin - (Triazoles) Ind: tinea pedis, corporis, cruris ADR: burning, stinging, dryness, itching, erythema. Pregnancy category B
Terbinafine Lamisil Ind: tinea pedis, cruris, corporis, Oral tx of onychomycosis
Nystatin Mycostatin Ind: Infections caused by candidiasis ADR: rash. Pregnancy category B
Created by: Marywood
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