Administering Medications

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Administering Medications

• Chapter 9
• Drugs for the Skin

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Learning 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.

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Anatomy of the Skin
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Main 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

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Inflammation

• 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
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Symptoms 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
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Question

• In the previous slide, there is an example of
  scaling.
• What other term also describes it?
• Pruritus
• Erythema
• Edema
• Lesion

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Symptoms 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
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Question

• 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.

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Types 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.

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Topical 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)

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Topical 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.

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Topical 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)

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What 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.

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Skin 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.

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Skin 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
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Skin 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)

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Skin 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)

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Skin 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

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Skin 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

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Skin 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

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Skin 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

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Skin 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)

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Skin 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

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Skin 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.

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Skin 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

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Transdermal 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)

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And 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).

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Increasing 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.