Title: Administering Medications
1Administering Medications
- Chapter 9
- Drugs for the Skin
2Learning OutcomesAfter studying this chapter,
you should be able to
- Describe the structures and functions of the
integumentary system. - Describe the major skin disorders and give
examples of medications to treat them. - Explain the process of inflammation, and list and
define the common symptoms of skin disorders. - Describe ways to increase absorption of drugs
into the skin layers.
- State the actions and give examples of diseases
that would be treated by these medication
categories (topical, oral or both) keratolytics,
aseptics, protectives, astringents, topical
anesthetics, antipruritics, anti-inflammatories,
anti-infectives, antihistamines.
3Anatomy of the Skin
4Main Functions of the Integumentary System
- Integumentary System skin and its appendages
(hair, nails, and sweat and sebaceous glands) - Largest organ of the body
- Waterproof, protective covering
- Protects internal organs
- Barrier for microorganisms
- Regulates body temperature
- Senses heat, cold, pressure and pain
- Secretion and excretion of fluid and electrolytes
5Inflammation
- Inflammation is the bodys natural response to
injury.
- When cell damage occurs, the capillaries in the
surrounding area bring in leukocytes (white blood
cells of the immune system), which destroy
microorganisms and begin cell repair.
Leukocytes
6Symptoms of Skin Disorders
- Pruritus (itching)caused by histamine
- Erythema (reddening)expansion of the capillaries
at skin surface - Edema (swelling)build-up of fluid in the tissues
- Scalingan excess of a protein, keratin, in the
epidermis. When a layer of dead cells builds up
and becomes hard, the resulting condition is
called keratosis. - Lesionsa superficial growth or patch of the skin
that does not resemble the area surrounding it.
Scaling
7Question
- In the previous slide, there is an example of
scaling. - What other term also describes it?
- Pruritus
- Erythema
- Edema
- Lesion
8Symptoms of Skin Disorders, (cont.)
- Ulcerationsopen lesions that are the result of
tissue damage that starts below the skin and then
erupts onto the skin surface - Hives or welts (urticaria)raised, irregularly
shaped skin eruptions that have red margins and
pale centers. Many causes.
Hives
9Question
- What is the difference between a lesion and an
ulceration? - Can a single skin disorder have multiple
symptoms? Look at the Symptoms of Skin
Disorders slides and think of situations
Discuss examples.
10Types of Drugs for the Skin
- Before we discuss specific disorders and the
drugs used to treat them, we should familiarize
ourselves with types of drugs used for skin
disorders. - Often one type of medication is used to treat
many different skin disorders. - Well look mainly at topical medicines. In
almost all cases, if the disorder is severe
enough, drugs may be given orally.
11Topical Drugs for the Skin
- Keratolytics (e.g. salicylic acid)
- Soften and destroy the outer layer of skin so
that it is sloughed off (shed). - Astringents (e.g. Calamine lotion)
- Shrink local blood vessels and dry up weepy
lesions. - Protectives (e.g. zinc oxide, also an astringent)
- Form a lasting film on the skin that cools,
dries, and/or soothes inflamed skin. - Antipruritics
- Relieve itching (corticosteroids and
anti-histamines are antipruiticssee next slide)
12Topical Drugs for the Skin (cont.)
- Corticosteroids
- have three actions
- Anti-inflammatory
- Antipruitic (anti-itch)
- Vasoconstriction (tightens blood vessels and
decreases swelling) - Anti-histamines
- Lessen effects of histamine, which decreases
itching.
13Topical Drugs for the Skin (cont.)
- Antiseptics
- Inhibits or slows the growth of microorganisms
- Antibiotics
- Kills or stops the growth of microorganisms
- Anesthetics
- Pain relief
- Miticides
- Kill parasites that infest the skin (like
scabies, lice)
14What to Focus on
- In the following slides of this chapter, I want
you to focus on the TYPE or CLASS of medicines
used to treat the disorders. - EXAMPLES of specific drugs are only given as
examplesdont worry about learning specific
names of drugs.
15Skin Disorder Contact Dermatitis
- Inflammation from direct contact with a substance
to which the skin is sensitive (e.g. poison oak,
soaps, etc.)
- Symptoms include red, hive-like papules, itching,
pain, and oozing, scaly lesions.
16Skin Disorder Contact Dermatitis
- Treatment
- Avoid causative agent
- Use a protective/astringent/antihistamine lotion
- Calamine and diphenhydramine (Caladryl) lotion
- Topical steroids are the mainstay of treatment.
- Triamcinolone acetate (Aristocort)
- Hydrocortisone valerate 0.2 (LactiCare HC,
DermaGel, Cortaid, Dermacort) - Oral corticosteroids may be used if reaction is
severe or covers large area of body.
Note the steroid names in this slide end in
-sone and -lone
17Skin Disorder Eczema (atopic dermatitis)
- Inflammation with eruptions of pimple-like bumps,
blisters, scales, or scabs. Symptoms include dry
or weepy lesions, redness, swelling, itching,
and a feeling of warmth to the touch - Cause is not clear, but it can be triggered
- Treatment relieves symptoms
- Corticosteroids (oral and topical)
- oral antihistaminescetirizine (Zyrtec)
- pimecrolimus cream 1 (Elidel) (suppresses immune
response)
18Skin Disorder Psoriasis
- Chronic (long-term) dermatitis no cure
- Identified by its red, raised lesions covered
with dry, silvery scales - Treatment
- topical corticosteroids
- oral antihistamines
- Biologicssubcutaneously self-injected drugs
made from animal or human proteins that work with
the immune system. - etanercept (Enbrel)
19Skin Disorder Acne
- Increased secretions of the oil (sebaceous)
glands. The open pores of the skin become plugged
with oil (sebum) and dead cells - Treatment
- topical application of keratolytics like benzoyl
peroxide, or tretinoin (Retin-A) - topical or systemic long-term
antibiotic therapy (often
tetracycline antibiotics) - isotretinoin (Accutane)
given orally
20Skin Disorders Seborrheic Dermatitis
- Inflammatory skin disorder of unknown cause that
begins on the scalp/at base of hair - Symptoms include yellow or brownish-grey greasy
scales - Treatment
- frequent shampooing
- mild keratolytic agents
- Anti-fungal shampoos
21Skin Disorders Dandruff
- Scaling of the scalp that produces dry, white
flakes - Generally considered to be a much less severe
form of seborrheic dermatitis. - Treatment
- Very similar to seborrheic dermatitis, although
not as concentrated medications - frequent shampooing
- mild keratolytic agents
- Anti-fungal shampoos
22Skin Disorder Infections
- Caused by microbes invading the skin tissues
- Examples impetigo, boils
- Signs of infection reddening, swelling, warmth
to the touch, and pain. Bacterial skin infections
usually exhibit pus, a thick, yellowish fluid
made up of dead white blood cells and debris,
and/or crusting. - Treatment
- topical or oral antibiotics
- Aseptic treatments
23Skin Disorders Burns
- Caused by fire, chemicals, smoke, electricity.
- Can vary greatly in severity from blisters to
complete tissue destruction. - Treatment
- Anti-infectives (antibiotic, antifungal)
- mafenide acetate (Sulfamylon)
- Anesthetic for pain
- benzocaine (Solarcaine)
24Skin Disorders Pressure Ulcers
- Pressure ulcers develop where a bony prominence
is in contact with the bed or chair for long
periods without moving. Skin is deprived of
oxygen and nutrients for too long, the skin dies,
and an ulcer develops. - Very difficult to healprevention is key.
- Keep clean and dry
25Skin Disorders Scabies
- Scabies is a parasitic infection in the skin
caused by mites. Very itchy, with blisters and
insect burrows.
- Treatment
- topical insecticides called scabicides applied
from the neck down (remember Elimite from our
Brand Name Guesser on the first day?) - Oral scabicides are available, but greater risk
of toxic side effects - Also antipruitics to relieve itching.
26Skin Disorders Pediculosis
- Pediculosis is lice. Not caused by poor hygiene,
and very common in elementary schools.
- Treatment
- Manually removing nits and lice with special
combs and fingernails - shampoos containing pediculicides
27Transdermal Patches
- Transdermal patches dont usually treat a skin
condition. - Can treat hypertension, smoking cessation,
hormone replacement, birth control, pain, etc. - The medicine is absorbed into the bloodstream
through the skin very slowly over time. - Patches are often left in place for a day (e.g.
nicotine patch) to a few weeks (e.g.
contraception)
28And finally
- The following slide lists ways to INCREASE a
topical drugs absorption into the body. - If you wanted to DECREASE it, generally you would
do the opposite (think of opposite ideas as you
look at the next slide).
29Increasing Absorption of Drugs into Skin Layers
- Apply wet dressings.
- Use a fat or lipid-soluble drug.
- Rub the preparation into the skin.
- Keep medicine in contact with skin for an
extended period of time. - Apply an occlusive dressing (does not allow air
in) if ordered by the physician. - Use a stronger concentration of the drug.