TOPICAL MEDICATION

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TOPICAL MEDICATION

• SHARON HARVEY

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LEARNING OUTCOMESTHE STUDENT WILL BE ABLE TO

• UNDERSTAND INDICATIONS, AND PREPARATIONS USED,
  FOR THE TOPICAL ROUTE
• SHOW AN AWARENESS OF HOW TOPICAL MEDICATION IS
  ADMINISTERED AND THE PARTICULAR PRECAUTIONS THAT
  ARE NECESSARY

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WHAT IS THE TOPICAL ROUTE OF ADMINISTRATION

• IT IS THE ADMINISTRATION OF DRUGS VIA THE
  EPIDERMIS (OUTER LAYER OF THE SKIN) AND EXTERNAL
  MUCOUS MEMBRANES TO ACHIEVE LOCAL OR SYSTEMIC
  EFFECTS.

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IN PAIRS DISCUSS WHY WE USE THE TOPICAL ROUTE FOR
ADMINISTERING CERTAIN DRUGS?

• PERMITS LOCAL RATHER THAN SYSTEMIC ABSORPTION OF
  THE DRUG
• REDUCES SIDE EFFECTS
• SOME DRUGS ARE SLOW RELEASE OVER 24 HOURS
  THEREFORE CONTINUOUS ACTION

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WHAT ROUTES CAN BE USED FOR ADMINISTERING TOPICAL
MEDICATION

• EYE
• EAR
• NOSE
• TRANSDERMAL
• RECTAL
• VAGINAL

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WHAT PREPARATIONS DO TOPICAL MEDICATION COME IN?

• PASTES
• CREAMS
• OINTMENTS
• PATCHES
• DROPS
• SPRAYS

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GUIDELINES FOR THE TOPICAL ADMINISTRATION OF DRUGS

• WASH HANDS
• EXPLAIN THE PROCEDURE TO THE PATIENT
• PREPARE THE EQUIPMENT
• APPLY THE MEDICATION TO THE SITE
• COMPLETE DOCUMENTATION

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EYE MEDICATION

• Available in two forms ointments and drops
• Important to treat correct eye
• If both eyes affected treat least affected eye
  first
• Use aseptic technique
• Should be done with the patient lying flat (not
  always possible)

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EYE MEDICATION (CONTINUED)

• THE LOWER LID SHOULD BE PULL DOWN TO FORM A
  POUCH, THEN OINTMENT OR DROPS CAN BE ADMINISTERED
• EYE MEDICATION IS USUALLY ABSORBED INTO THE
  CORNEA, HOWEVER IT IS POSSIBLE FOR EYE DROPS TO
  BE ABSORBED INTO THE CONJUNCTIVAL VESSELS AND
  INTO GENERAL CIRCULATION.
• THE EXCESS CAN DRAIN THROUGH THE TEAR DUCTS INTO
  THE NASAL MUCOSA

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USING THE BNF FIND ONE TOPICAL EYE PREPARATION
WRITE THE DRUG NAME, TYPE OF PREPARATION E.G.
OINTMENT, DROPS, ETC AND SIDE EFFECTS AND
CONTRAINDICATIONS
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EAR MEDICATION

• EAR MEDICATION SHOULD BE AT ROOM TEMPERATURE
• THE PATIENT SHOULD LIE ON THEIR SIDE IF POSSIBLE
• IN ADULTS AND CHILDREN OVER 3 YEARS GENTLY PULL
  THE PINNA UPWARDS AND BACKWARDS AND INSTILL THE
  MEDICATION

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EAR MEDICATIONS (CONT)

• IN CHILDREN BELOW 3 THE PINNA SHOULD BE PULLED
  DOWNWARDS AND BACKWARDS TO INSTILL MEDICATION
• THE PATIENT SHOULD STAY IN THAT POSITION FOR 5
  MINUTES

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• USING THE BNF FIND ONE TOPICAL EAR MEDICATION
• WRITE THE NAME OF THE DRUG, TYPE OF PREPARATION,
  AND SIDE EFFECTS OF THE DRUG AND ITS
  CONTRAINDICATIONS

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NASAL MEDICATION

• NASAL MEDICATIONS MAY FLOOD THE SINUSES AND
  DRIBBLE DOWN THE THROAT AND BE INGESTED THEREFORE
  THE PATIENT SHOULD EXPECTORATE ANY DRUG THAT THEY
  FEEL GOING DOWN THEIR THROAT RATHER THAN SWALLOW

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NASAL MEDICATION (CONT)

• THE NASAL PASSAGES SHOULD BE CLEARED PRIOR TO
  ADMINISTRATION OF MEDICATION
• FOR NASAL SPRAY THE PATIENT SHOULD BE SITTING
  UPRIGHT
• FOR NASAL DROPS THE PATIENT SHOULD BE LYING DOWN

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• USING THE BNF FIND ONE TOPICAL NASAL MEDICATION.
  WRITE THE NAME OF THE DRUG, TYPE OF PREPARATION,
  CONTRAINDICATIONS AND SIDE EFFECTS OF THE DRUG.

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TRANSDERMAL MEDICATIONS

• FOLLOWING APPLICATION OF THE DRUG, IT IS ABSORBED
  THROUGH THE HAIR FOLLICLES AND SWEAT GLANDS,
  ENTERING THE BLOOD STREAM
• THE PATCH SHOULD BE APPLIED TO A NON HAIRY SKIN
  SURFACE
• THE SITES OF ADMINISTRATION SHOULD BE ROTATED TO
  PREVENT IRRITATION

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RECTAL MEDICATION

• THE ACTION OF THE DRUG MAY BE LOCAL OR SYSTEMIC
• THE PATIENT SHOULD LIE ON THEIR LEFT SIDE
• FOR SYSTEMIC ACTION RECTAL DRUGS THE SUPPOSITORY
  SHOULD BE INSERTED BLUNT END FIRST
• FOR LOCAL ACTION RECTAL DRUGS THE SUPPOSITORY
  SHOULD BE INSERTED POINTED END FIRST
• THE SUPPOSITORY SHOULD ALWAYS BE LUBRICATED WITH
  A WATER SOLUBLE LUBRICANT

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VAGINAL MEDICATION

• THE PATIENT SHOULD BE ENCOURAGED TO EMPTY HER
  BLADDER AS SHE HAS TO LIE DOWN FOR 20 MINUTES
• THE PATIENT CAN EITHER LIE SUPINE WITH KNEES UP
  OR LATERAL WITH KNEES UP
• ALWAYS LUBRICATE THE PESSARY OR APPLICATOR BEFORE
  INSERTING

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DISCUSS

• WHAT ARE THE BENEFITS OF ADMINISTERING DRUGS
  RECTALLY?
• WHAT WOULD YOU DO IF YOU SUSPECTED THAT A PATIENT
  WAS SUFFERING FROM A SIDE EFFECT OF A DRUG THAT
  YOU HAVE GIVEN TOPICALLY?
• HOW DO YOU MINIMISE THE RISK TO YOURSELF WHEN
  ADMINISTERING TOPICAL MEDICATION?

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SUMMARY

• TOPICAL DRUGS ARE PREPARED IN MANY DIFFERENT
  FORMATS, AND HAVE A NUMBER OF ADVANTAGES, SUCH AS
  DIRECT ACTION ON THE AFFECTED AREA AND SLOW
  ABSORPTION THROUGH THE SKIN
• SPECIFIC INSTRUCTIONS SHOULD BE FOLLOWED
  CAREFULLY
• MEASURES TO PREVENT CROSS INFECTION WHEN
  ADMINISTERING TOPICAL MEDICATION ARE PARTICULARLY
  IMPORTANT