Drug used in skin and mucus membrane

Useful for Nursing and medical students

1. Drug used in skin and mucus membrane Mr. Dipti Y. Sorte, Associate Professor Himalayan College of Nursing, SRHU. Dehradun.

2. Drugs used in skin & mucous membrane are: Corticosteroids : Glucocorticoids. Mineralocorticoids. Antipruritics : Anti-inflammatory. Anti- Bacterials . Antivirals. Anti- fungals . Anti- paracitics . Antiacne. Keratolytics & Antipsoiatics . Drug used for Eye, Ear & Nose Enzymes used in Therapy

3. Corticosteroids

4. Introduction Corticosteroids are steroid hormones that are either produced by the body or are man – made. Naturally occurring corticosteroids, hydrocortisone and cortisone are produced by the outer portion of the adrenal gland known as cortex, so, corticosteroids are classified as: Glucocorticoids. Mineralocorticoids. Synthetic corticosteroids mimic the actions of naturally occurring corticosteroids and may be used to replace corticosteroids in people with adrenal gland insufficiency.

5. Mechanism of action Glucocorticoids produce various metabolic effects, suppress inflammation and alter the normal immune response, they also promote water and sodium retention and potassium excretion. Mineralocorticoids (Salt retaining) regulate the balance of salt and water in body.

6. Drug example and doses. S. NO. Drugs Doses Glucocorticoids 1 Betamethasone 0.5 – 9mg daily. 2 Dexamethasone 0.5 – 16mg daily. 3 Prednisone 2.5 – 60mg daily. 4 Prednisolone 5 – 60mg daily. 5 Triamcinolone 4 – 48mg daily. 6 Methylprednisolone 4 – 48mg daily. 7 Hydrocortisone 50 – 200mg daily Mineralocorticoids 8 Fludrocortisone 100 microgram

7. Indications/uses Glucocorticoids drugs are used as replacement therapy for adrenocortical insufficiency. To treat neoplastic diseases. Septic shock. Cerebral edema. Inflammatory conditions of joint, gastrointestinal tracts, respiratory tract and skin. Mineralocorticoids are used as replacement therapy in primary and secondary adrenal insufficiency.

8. Contraindications/ precautions Serious infections. Mineralocorticoids use cautiously with cardiovascular and hypertension disease patients.

9. Adverse effects Muscle wasting. Growth retardation. Hypertension. Increased blood glucose level. Sodium and fluid retention. Acute adrenal insufficiency after abrupt withdrawal. Osteoporosis. Peptic ulcer. Glaucoma. Altered fat distribution.

10. Drug interactions Hormonal contraceptives may block the metabolism of glucocorticoids. Phenobarbital, phenytoin and rifampicin may enhance the metabolism of glucocorticoids. Concurrent use with orally hypoglycemics or insulin may increase blood sugar levels, there by increasing insulin or oral hypoglycemic requirements.

11. Nursing responsibilities Administer drug daily doses in the morning time. Monitor adverse effects of drug therapy. Monitor regularly for weight changes and also monitor fluid and electrolyte imbalances. Teach the patient to avoid such foods as fresh fruits and raw vegetables because they tend to have higher levels of bacteria than cooked foods, therapy increasing the risk of infection in an already immunosuppressed patients. Nurse should warn the patient not to stop drug abruptly because this may cause life threatening adrenal insufficiency.

12. Antipruritics

13. Introduction Antipruritic agents used to preventing and relieving itching i.e. decreasing sensitivity of local nerve ending, reducing local edema, cooling skin and counteracting histamine release.

14. Mechanism of action They have anti-inflammatory, anti-allergies, anti-infective properties thus show. Their actions in two different ways: Anti-inflammatory decreases the inflammation and itching cause vasoconstriction. Anti-infective kills or inhibit the growth of micro-organism (Bacteria, virus, fungi, parasitic). Antipruritics relieve itching of the skin and mucous membrane. Antiacne clear and dry the skin, reduce bacteria and reduce the size of activity of sebaceous glands. Keratolytics breakdown protein in keratin causing the loss of the stratum corneum skin layer.

15. Drug Classification Drugs Classification Drugs Classification Anti-inflammatory Antiparasitic Betamethasone Dexamethasone Malathion Permethrin Hydrocortisone Triamcinolone Lindane Antibacterial Antifungals Gentamicin Sulfate Neomycin sulfate Ketoconazole Clotrimazole Silver sulfadiazine Polymyxin B Miconazole nitrate Griseofulvin Bacitracin Nystatin Antivirals Keratolytics & Antipsoriasis Acyclovir Penciclovir Salicylic acid Resorcinol

16. Drugs Classification Antipruritics Cyproheptadine Calamine lotion Diphenhydramine Antiacne Clindamycin Erythromycin Tetracycline Benzoyl peroxide Isotretinoin Tretinoin Azelaic acid (Cleanses/Antiseptics)

17. Indications Dermatitis (Anti-inflammatory). Allergic skin reactions (Anti-inflammatory). Bacterial skin infection (Antibacterial). To treat fungal infections (Antifungal) To treat herpes simplex virus infections (Antiviral) To treat scabies pediculosis (lice) (Antiparasitic) To treat pruritic (Antipruritics) To treat acne vulgaris and acne rosacea (Antiacne) To treat superficial fungal functions Psoriasis, corns, cellulitis (Keratolytics).

18. Contraindications/ Precautions Hypersensitivity. Pregnancy. Breast feeding.

19. Adverse Effects Skin irritation. Bone marrow suppression. Behavioral changes. Suppressed immune response. Hemolytic anemia. Leukopenia. Fluid and electrolyte imbalances. Antiacne may cause burning, itching, redness of the eye & scaling pain of lips also may cause photosensitivity reactions.

20. Drug interactions Excessive use of antiacne products may increase skin reactions.

21. Nursing Responsibilities: Nurse should assess before applying topical drug, assess skin and remove any previous applied medications. Always use aseptic technique while applying medications to open lesions. Instruct to patient that topical drugs are for external use only and to avoid contact with the eyes. Teach the patient how to apply drugs. Remember that if we are giving anti parasitics to control spread of infestation to other fly members. And if, need to be treated.

22. Nursing Responsibilities: Follow these guidelines when applying acne products. Clean and asses the affected area before applying acne preparations. Teach the patient using tetracyclines to be careful to cover the entire affected area not to go in sunlight. Advise the patient isotretinoin and tretinoin to apply sunscreen and wear protective clothing to prevent photosensitivity reactions. Advise women using isotretinoin and tretinoin to use contraception.

23. Topical Drugs used for disease of Eye. Drug Preparations Uses Ciprofloxacin 0.3% Drops & ointment Bacterial conjunctivitis Gentamycin 0.3% Drops Bacterial conjunctivitis Acyclovir 0.3% ointment Herpes simplex keratitis Betamethasone 0.1% Drops & ointment Allergic and inflammatory conditions of the eye. Dexamethasone 0.01% Drops Allergic and inflammatory conditions of the eye. Diclofenac 0.1% Drops Post operative ocular inflammation Azelastine 0.05% Drops Allergic conjunctivitis Dorzolamide 2% Drops Glaucoma Timolol 0.25% Drops Glaucoma Pilocarpine 0.5% & 2% drops Glaucoma Tropicamide 1% drops Uveitis, as mydriatic for refraction testing. Atropine 1% Drops & ointment Uveitis, as mydriatic for refraction testing.

24. Topical Drugs used for disease of Nose Drug Preparations Uses Azelastine 0.1% Nasal spray Allergic rhinitis Beclomethasone 500 mcg/ puff nasal spray Allergic rhinitis Oxymetazoline 0.05% nasal drops Nasal Decongestant

25. Drug Preparations Uses for diseases of Ear. Drug Preparations Uses Ciprofloxacin 0.2% drops Bacterial infection. Clotrimazole 1% drops Fungal infection. Gentamicin 0.3% drops Bacterial infection Betamethasone 0.1% drops Eczema of Ear, as an anti-inflammatory agent Sodium Bicarbonate 5% Drops To soften ear wax.

26. Drugs used in the treatment of scabies and pediculosis Drug Formulations Details Permethrin 1% & 5% Cream 5% lotion 5% Gel 1% soap. Most efficacious and most frequently used drug for scabies and pediculosis (head and pubic lice) For Scabies: 5% permethrin is applied to the skin over the body from neck to toes; thorough hot water bath after 10-12 hours to wash off the drug. For pediculosis : 1% Permethrin is applied to the scalp/pubis and washed off after 10 mins. Treatment may be repeated, if necessary after 1week. Side effects are skin rashes, redness, itching, burning etc. Gamma Benzene Hexachloride (Lindane) 1% emulsion 1% lotion 1% cream 1% ointment 1% soap Very effective drug for both pediculosis & scabies. For Scabies: 1% Lindane is applied to the skin from neck to toes; a thorough scrub bath is given is given after 12 hours to wash off drug from the body. Application can be repeated if necessary after 7 days. For pediculosis: 1% Lindane is applied over the scalp and hair carefully without touching the eyes. Side effects include skin rashes, headache, restlessness, convulsions and cardiac arrhythmias. Contraindicated in children, epileptics and pregnant women.

27. Continued Drug Formulations Details Benzyl Benzoate 25% emulsion 25% lotion 25% Emulsion/lotion is applied to the skin over the body from neck to toes twice at 12 hours interval after a scrub bath; wash off 12hours after the 2 nd application. Side effect are skin rash and dermatitis. Crotamiton 10% lotion. 10% cream It has scabicidal, pediculicidal and Antipruritics activities. It is applied to skin over body below the chin twice at 24hrs interval after a scrub bath. It is less efficacious, hence requires repeated administration. It can be used in children. Side effects include skin rashes, itching, dermatitis etc. Sulphur 10% ointment It is used for scabies, it is less efficacious, requires repeated applications, has bad odour, hence is rarely used at present. DDT (Dicophane) 1-2% lotion 1-2% ointment It is toxic, hence is rarely used for scabies and pediculosis. Ivermectin Tablet (Oral) 0.2mg/kg. Anti-filarial drug used orally for scabies and pediculosis. Single dose produces almost complete cure. It is contraindicated in children, pregnant and lactating women.

28. Enzymes used in therapy

29. Hyaluronidase Source: Mammalian testes. Availability & Routes: Topical SC/IM and intraarticular. Action: Depolymerizes hyaluronic acid and increases the permeability of the tissues. Uses: To promote the absorption of drug and fluids given SC /IM and intraarticularly. To aid the reabsorption of extravasated fluid or blood in hematoma or post operative edema. To facilitate the diffusion of local anesthetic in ophthalmology.

30. Chymotrypsin Source: OX pancreas. Availability & Routes: Tablet (PO) and topical ointment. Action: Proteolytic enzyme. Uses: To reduce post operative edema..

31. α -Chymotrypsin (Alfa – Chymotrypsin) Source: OX pancreas. Availability & Routes: Injection & Tablet (PO). Action: Mucolytic & Proteolytic action. Uses: During cataract surgery to facilitate removal of the lens. To reduce inflammatory edema due to trauma, injection, surgery etc.

32. Serratiopeptidase Source: Serratia species. Availability & Routes: Tablet (PO). Action: Anti-inflammatory activity. Uses: To relieve pain and inflammation due to surgery, trauma, injection and chronic condition like osteoarthritis, rheumatoid arthritis, etc.

33. Urokinase Source: Isolated from human fetal kidney cell culture. Availability & Routes: IV Action: Fibrinolytic (Dissolve clot) Uses: Acute MI, Deep vein thrombosis, Pulmonary embolism, etc.

34. Tissue plasminogen activator (t-PA) Source: Derived from recombinant DNA technology. Availability & Routes: IV Action: Fibrinolytic (Dissolve clot) Uses: Acute MI, Deep vein thrombosis, Pulmonary embolism, etc.

35. L – Asparaginase Source: Escherichia coli. Availability & Routes: IV Action: Catalyzes the hydrolysis of asparagine to aspartic acid Uses: Acute Lymphoblastic leukemia.

36. Reference: Dr. P.K. Panwar, Essentials of pharmacology for nurses, AITBS pub. 2017, India, Pg no. 85 – 79. Dr. Suresh k sharma , Textbook of pharmacology, pathology & genetics for nurses, Jaypee pub. 2016 India Pg no 253 – 255. Tara v. Shanbhag , Smita shenoy , Pharmacology preparation manual for undergraduate, Elsevier pub. 2014. Pg no. 490 – 492. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barlet pub 2010 India, Pg no 194-201. Govind s. mittal , Pharmacology at a glance, Paras medical book pub. 2009 India 51 – 56. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India 1 st edition, Pg no 240.

37. THANKS