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skin, eye and ear

advanced pharm

Topical where you want the drug to work-ie; eye and ear drops- inhaled for the bronchi or ointment/cream for the skin
Systemic transdermal ie; fentanyl patch is actually systemic
Preparation H is topical whereas Tylenol suppository is systemic
What you put in your skin gets absorbed systemically
Ointments are 80%/20% water fat and the most potent- typically messy and not good for large surfaces
Creams are 50%/50% fat and better applied- for hairy males
Creams and lotions cause lubrication and moisture
Solutions potency is poor- evaporates- leaves the skin dry- may irritate the skin- for oozing skin lesions- good for big surface areas- pediculosis/scabies
Lotions are more water-based- Less potent and effective than ointments and creams- Easy to apply to large areas- Easy to apply to hairy surfaces- Useful for cooling and drying oozing, inflamed lesions
Absorption Creams > Ointments > Lotions > Solutions
Do not use diphenhydramine for body itch all over- you can use calamine lotion instead (zinc)
Dermatitis tx for red itchy skin= steroids
Steroid s/s Atrophy, Striae, Telangiectasia, Acne, Steroid rosacea high potency not to be used on face
Moa of topical steroids about the same as systemic- inhibit synthesis of leukotrienes, inflammatory mediators that come out of arachidonic acid-inhibit mRNA responsible for interleukin-1 formation.
Steroid potency in 7 classes class 1 is most potent- only for dermatologist- class 7 is OTC. We prescribe class 3-5. Class 2 is as potent as systemic steroids- adrenal atrophy- lowest potency is class 6- for face/kids
Triamcinolone acetonide 0.5% (Kenalog) ointment steroid- to make it stonger, use as an ointment- make it a cream to weaken
class II triamcinolone 0.5 ointment…used sparingly by primary care
Class VI triamcinolone low potency 0.025% cream …for children, thin skin, big areas
Topical skin medication for when steroids don’t work and do not cause atrophy Pimecrolimus 0.1% (Elidel)- do not use w/kids or >6 weeks
Deeper lesions should use systemic antibiotics
Superficial lesions in a pt you will not see for f/u use systemic anbx for skin infection- safer
Most bacterial skin disorders:folliculitis, impetigo, furuncles, carbuncles, pustules, and cellulitis caused by strep or staph
Antibacterial topical ointment contain Bacitracin Zinc, Neomycin, Polymyxin B- cream only has neomycin and polymixin- for pain it +Pramoxine HCl
For prescription because Neosporin isn’t strong enough Mupirocin: (Bactroban) A prescription only drug used topically for treatment of impetigo, and also intranasally to treat nasal colonization with MRSA
Silver silvadene cream for burns
Pediculosis or scabies Permethrin (Elimite, Nix)- Sodium channel blocker on the nerve cell membrane of the parasite- Safe in infants- Single application- for both scabies and lice-Minimal systemic absorption (2%)
Acne is a combination of ________ d/o with ________infection hormonal d/o w/bacterial infx- androgens- anaerobic P. acnes bacteria – you want to give them oxygen
Benzoyl peroxide can bleach the skin/towels, liberates active oxygen- s/e; peeling, red, warm, blistering/swelling skin- dosing is an issue
Antibiotic-benzoyl peroxide combinations Benzaclin: with clindamycin and Benzamycin: with erythromycin
Tretinoin vitamin A derivitive- increase cell turn-over- regenerates
Accutane Isotretinoin- need LFT q month- need pregnancy test- teratogenic
Treatment Plan for acne Systemic anbx: Tetracycline (doxycycline) 3-6mo. OR Macrolides: 500 mg azithromycin once every 5 days for 3-6 months, Benzoyl peroxide, Acne-wash/clearacil (2.5% Salicyclic acid wash)- Retinoin:
Doxycycline causes permanent staining of baby’s teeth- beware of ripe females
Mild acne disease Topical Clindamycin/erythromycin/sulfacetamide, benzoyl peroxideand (+Topical retinoids if ineffective)
Moderate acne disease Benzoyl peroxide-Combined with anyone of these retinoids: tazarotene (3rd generation), Adapalene (3rd generation), Tretinoin (1st generation)
Severe-Cystic Acne Oral antibiotics: Clindamycin,minocycline, Oral isotretinoin/accutane
Candida albicans or Dermatophytes use azoles- antagonize the ergosterol layer
If fungal infection NOT involving hair and nails use topical –azoles- if it involves the hair and nails, use terbinafine tablets or intraconazole
Two topical antiviral herpes drugs Acyclovir (Zovirax), Penciclovir (Denavir) s/e itching, stinging, rash
Eye drops absorb as well as oral medications- (same as systemic)- may cause bradycardia (B-blocker- timolol)
Glaucoma is too much pressure from glands of the ciliary body right next to the lens- happens when drainage is not efficient- narrow angle cannot drain this fluid- widening pupil makes it worse- mydriasis
Glaucoma drugs work by 2 mechanisms 1) ↑ drainage (miosis) or 2) ↓production of aqueous fluid so the drainage goes ↓
Cholinergic drugs cause pupil constriction- pilocarpine ↑ drainage-
Prostaglandin analogs do what ↑ drainage of the eye- Latanoprost
2 classes that increase the drainage of the eye prostaglandin analogs (latanoprost) and cholinergics bacterial, (pilocarpine)
Sympathomimetic cause pupil dilation
2 classes that ↓ production of aqueous fluid B-blockers- timolol/Timoptic and Carbonic anhydrase inhibitors- brinzolamide/Azopt
Cholinergic agonists s/e miosis, blurred vision and accommodative spasms; and vascular congestion
Prostaglandin-like drugs s/e can change eye color- lantaprost or –prost drugs
Bacterial/viral/fungal eye infection blepharitis, conjuctivis, or stye- local antibiotics- and anti-inflammatory- decadron/dexamethasone- but give with antibiotic b/c it inhibits the immune rx in your eye
Natamycin (Natacyn) It is a polyene antifungal eye drug- It disrupts the fungal cell membrane by attacking the erosterol component of it- caused by fungal blepharitis, conjunctivitis, and keratitis
Trifluridine (Viroptic) for viral eye infx- It is a pyrimidine nucleoside antiviral drug- It inhibits viral DNA polymerase for keratitis and keratoconjunctivitis caused by herpes
Anti-inflammatory for the eye used with antifungal/viral meds- Flurbiprofen (Ocufen), ketorolac/Acular- may ↓wound healing/corneal epithelial break↓
Dexamethasone (Decadron) steroid- for inflammation-Tx of uveitis, iridocyclitis, & inflammation of cornea and conjunctiva- s/e- transient burning or stinging-extended use of steroids= cataracts, ↑ intraocular pressure,optic nerve damage.
Anti-allergic eye drops Antihistamines:Olopatadine (Patanol) for allergic conjunctivitis (hay fever) and Mast cell stabilizer: Cromolyn sodium (Crolom)
Red Eye decongestants- Tetrahydrozolidine (Murine Plus)- Oxymetazoline (Visin LR)- constrict the blood vessels in the eye- can be addicting- less nutrition for the eye
You can use eye drops for your ear but you can’t use___ ear drops for your eye-
Otic medications stay in the ear- NOT SYSTEMIC- Steroids can be combined with the anti-infective agent to ↓ the inflammation and the pruritus (not used alone, ↑ infx)- Topical analgesics as (pramoxine) can be added
Neomycin + Polymyxin B+ Hydrocortisone for the ear= Corticosporin Otic
Ciprofloxacin +Hydrocortisone for the ear= Cipro HT Otic
Ciprofloxacin + dexamethasone for the ear= ciprodex
Ofloxacin + (no steroid) for the ear is called? Floxin Otic
Floxin Otic (antifungal) + [Hydrocortisone (steroid) Pramoxine (local analgesic) + emulsifier + antiseptic preservative]= antifungal for ear- Cortic, Otomar, Aero Otic HC
Acetic acid (antifungal) + Hydrocortisone (steroid)+ antiseptic preservatives= antifungal for ear- Acetasol HC
Created by: arsho453
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