advanced pharm
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| Topical | where you want the drug to work-ie; eye and ear drops- inhaled for the bronchi or ointment/cream for the skin
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| Systemic | transdermal ie; fentanyl patch is actually systemic
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| Preparation H is topical whereas Tylenol suppository is | systemic
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| What you put in your skin gets absorbed | systemically
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| Ointments are | 80%/20% water fat and the most potent- typically messy and not good for large surfaces
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| Creams are | 50%/50% fat and better applied- for hairy males
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| Creams and lotions cause | lubrication and moisture
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| Solutions | potency is poor- evaporates- leaves the skin dry- may irritate the skin- for oozing skin lesions- good for big surface areas- pediculosis/scabies
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| 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
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| Absorption | Creams > Ointments > Lotions > Solutions
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| Do not use diphenhydramine for | body itch all over- you can use calamine lotion instead (zinc)
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| Dermatitis tx | for red itchy skin= steroids
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| Steroid s/s | Atrophy, Striae, Telangiectasia, Acne, Steroid rosacea high potency not to be used on face
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| 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.
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| 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
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| Triamcinolone acetonide 0.5% (Kenalog) ointment | steroid- to make it stonger, use as an ointment- make it a cream to weaken
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| class II triamcinolone | 0.5 ointment…used sparingly by primary care
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| Class VI triamcinolone | low potency 0.025% cream …for children, thin skin, big areas
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| 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
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| Deeper lesions should use | systemic antibiotics
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| Superficial lesions in a pt you will not see for f/u | use systemic anbx for skin infection- safer
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| Most bacterial skin disorders:folliculitis, impetigo, furuncles, carbuncles, pustules, and cellulitis caused by | strep or staph
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| Antibacterial topical ointment contain | Bacitracin Zinc, Neomycin, Polymyxin B- cream only has neomycin and polymixin- for pain it +Pramoxine HCl
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| 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
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| Silver silvadene cream | for burns
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| 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%)
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| 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
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| Benzoyl peroxide | can bleach the skin/towels, liberates active oxygen- s/e; peeling, red, warm, blistering/swelling skin- dosing is an issue
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| Antibiotic-benzoyl peroxide combinations | Benzaclin: with clindamycin and Benzamycin: with erythromycin
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| Tretinoin | vitamin A derivitive- increase cell turn-over- regenerates
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| Accutane | Isotretinoin- need LFT q month- need pregnancy test- teratogenic
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| 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:
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| Doxycycline | causes permanent staining of baby’s teeth- beware of ripe females
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| Mild acne disease | Topical Clindamycin/erythromycin/sulfacetamide, benzoyl peroxideand (+Topical retinoids if ineffective)
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| Moderate acne disease | Benzoyl peroxide-Combined with anyone of these retinoids: tazarotene (3rd generation), Adapalene (3rd generation), Tretinoin (1st generation)
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| Severe-Cystic Acne | Oral antibiotics: Clindamycin,minocycline, Oral isotretinoin/accutane
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| Candida albicans or Dermatophytes | use azoles- antagonize the ergosterol layer
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| If fungal infection NOT involving hair and nails | use topical –azoles- if it involves the hair and nails, use terbinafine tablets or intraconazole
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| Two topical antiviral herpes drugs | Acyclovir (Zovirax), Penciclovir (Denavir) s/e itching, stinging, rash
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| Eye drops absorb as well as | oral medications- (same as systemic)- may cause bradycardia (B-blocker- timolol)
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| 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
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| Glaucoma drugs work by 2 mechanisms | 1) ↑ drainage (miosis) or 2) ↓production of aqueous fluid so the drainage goes ↓
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| Cholinergic drugs cause | pupil constriction- pilocarpine ↑ drainage-
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| Prostaglandin analogs do what | ↑ drainage of the eye- Latanoprost
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| 2 classes that increase the drainage of the eye | prostaglandin analogs (latanoprost) and cholinergics bacterial, (pilocarpine)
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| Sympathomimetic cause | pupil dilation
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| 2 classes that ↓ production of aqueous fluid | B-blockers- timolol/Timoptic and Carbonic anhydrase inhibitors- brinzolamide/Azopt
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| Cholinergic agonists s/e | miosis, blurred vision and accommodative spasms; and vascular congestion
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| Prostaglandin-like drugs s/e | can change eye color- lantaprost or –prost drugs
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| 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
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| 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
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| 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
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| Anti-inflammatory for the eye | used with antifungal/viral meds- Flurbiprofen (Ocufen), ketorolac/Acular- may ↓wound healing/corneal epithelial break↓
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| 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.
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| Anti-allergic eye drops | Antihistamines:Olopatadine (Patanol) for allergic conjunctivitis (hay fever) and Mast cell stabilizer: Cromolyn sodium (Crolom)
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| Red Eye | decongestants- Tetrahydrozolidine (Murine Plus)- Oxymetazoline (Visin LR)- constrict the blood vessels in the eye- can be addicting- less nutrition for the eye
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| You can use eye drops for your ear but you can’t use___ | ear drops for your eye-
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| 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
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| Neomycin + Polymyxin B+ Hydrocortisone for the ear= | Corticosporin Otic
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| Ciprofloxacin +Hydrocortisone for the ear= | Cipro HT Otic
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| Ciprofloxacin + dexamethasone for the ear= | ciprodex
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| Ofloxacin + (no steroid) for the ear is called? | Floxin Otic
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| Floxin Otic (antifungal) + [Hydrocortisone (steroid) Pramoxine (local analgesic) + emulsifier + antiseptic preservative]= | antifungal for ear- Cortic, Otomar, Aero Otic HC
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| Acetic acid (antifungal) + Hydrocortisone (steroid)+ antiseptic preservatives= | antifungal for ear- Acetasol HC
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