Essentials of Pharmacology for Health Professions, 9th Edition - Chapter 12 PDF

Essentials of Pharmacology for Health Professions, 9th edition Chapter 12: Integumentary...

Essentials of Pharmacology for Health Professions, 9th edition Chapter 12: Integumentary System Medications Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Chapter Objectives Upon completion of this chapter, the learner should be able to: 1. Describe proper application procedures for various skin medications 2. Identify indications, side effects, and precautions or contraindications of the nine major categories of skin medications 3. Explain the factors that influence the absorption of skin medications 4. Classify drugs according to their action: antipruritic, emollient, keratolytic, enzymatic, antifungal, anti-infective, or agents to treat burns and acne 5. Identify appropriate indications of the nine major categories of skin medications Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Introduction Integumentary system is the body’s largest organ. It is the external covering of the body that serves to protect the inner organs from damages like abrasions, burns, dehydration, and ultraviolet (UV) rays. There are many conditions that can affect the skin, causing pain, annoyance, and discomfort. Skin ailments can range from itching to severe burns. Treatment is usually topical or local, but skin conditions are sometimes treated internally with oral medications or injections for systematic effects. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Categories of Medications The nine major medication categories for the integumentary system include: Antipruritics—relieve itching Corticosteroids—treat dermatological disorders Emollients and protectants—soothe irritation Keratolytic agents—loosen epithelial scales Enzyme preparations—promote the removal of necrotic tissue Scabicides and pediculicides—treat scabies or lice Local anti-infectives—prevent and treat fungal and bacterial infections Burn medications—prevent or treat burn infections Treatments for acne Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Absorption of Skin Medications The factors that influence the rate of absorption of topical medication include: Time for the medication to remain on the skin varies Type of topical used effect absorption Gels and creams: water-based, absorbed more quickly Ointments and pastes: oil-based, absorbed slower In addition, it is important to always review directions before administering. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-1 Which instruction should be given to a patient with psoriasis who is prescribed a corticosteroid topical cream? a. “The medication will be absorbed slowly.” b. “The medication will be absorbed quickly.” c. “Apply more cream if the skin starts to bleed.” d. “Wrap the area with a bandage after applying the cream.” Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-1: Answer Which instruction should be given to a patient with psoriasis who is prescribed a corticosteroid topical cream? Answer: b “The medication will be absorbed quickly.” Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Case Study Activity Barbara Smith seeks medical attention for plantar warts. During her appointment, she is prescribed a keratolytic. Which teaching should be given to Barbara about the medication? a. Use until the condition improves b. Avoid contact with surrounding tissue c. Cover the area after applying the medication d. Skin breakdown around the warts is expected Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Case Study Activity: Answer Which teaching should be given to Barbara about the medication? Answer: b Avoid contact with surrounding tissue Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Antipruritic (1 of 2) The following details the use, side effects, and precautions or contraindications of antipruritic medications: Use: Used short-term to relieve discomfort from dermatitis (rashes) associated with allergic reactions, poison ivy, hives, and insect bites Relieve itching by the use of products singly or in combination containing local anesthetics, drying agents, anti-inflammatory agents, and antihistamines Side effects: Stinging, burning, and allergic reactions Precautions/contraindications: Delayed healing, prolonged use, and hypersensitivity reaction Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Antipruritic (2 of 2) The following images illustrate an allergic contact dermatitis reaction (A) and poison ivy (B). Both would be treated using an antipruritic medication. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Corticosteroids (1 of 2) The following details the use, side effects, and precautions or contraindications of corticosteroid medications: Use: Used topically and systemically for allergic reaction conditions Side effects: Epidermal thinning Increased fragility of blood vessels Ulceration with occlusive dressings Activation of latent infections Slow healing Precautions/contraindications: Open wounds Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Corticosteroids (2 of 2) The following images show psoriasis (A) and seborrheic dermatitis of the face (B). Both conditions would be treated using a corticosteroid medication. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-2 For which reason would a corticosteroid topical medication be contraindicated? a. Allergic to iodine b. Patient is pregnant c. Open wound on the skin d. Taking a drug containing sulfa Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-2: Answer For which reason would a corticosteroid topical medication be contraindicated? Answer: c Open wound on the skin Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Emollients and Protectants The following details the use of emollients and protectants: Use: Used topically to soothe, soften, protect (via creation of a lipid barrier), and seal out wetness in minor dermatological conditions Examples: diaper rash, irritation, abrasions, and minor burns Used as first-line therapy in eczema and other conditions to reduce the need for corticosteroids or other medications Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Keratolytic Medications (1 of 2) The following details the use, side effects, and precautions or contraindications of keratolytic medications: Use: Used to control abnormal scaling such as dandruff, seborrhea, and psoriasis Used to promote peeling of skin such as acne, hard corns, calluses, and warts Side effects: Irritation to eyes or mucous membranes Photosensitivity Precautions/contraindications: Open areas of the skin Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Keratolytic Medications (2 of 2) The following pictures illustrate a common wart (A) and a plantar wart (B), which would commonly be treated with a keratolytic medication. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Enzyme Preparations Bedridden patients are prone to decubitus ulcers (pressure sores) and diabetic patients are prone to develop foot ulcers. The following is important to ensure proper treatment and healing. Necrotic skin must be removed in order to promote proper healing Collagenase (Santyl) is a topical enzyme ointment used for the chemical debridement (removal of dead or damaged tissue) of dermal ulcers and burns. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Scabicides and Pediculicides (1 of 2) The following details the use and treatments of scabicide and pediculicide medications: Scabies Caused by an itch mite that burrows under the skin Pediculosis (lice) Caused by infestation of lice on the hairs of the scalp, pubic area, and trunk Treatments Laundering or dry cleaning all clothing and bedding, scabicides, and pediculicides Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Scabicides and Pediculicides (2 of 2) The following images show a scabies skin infection (A), the scabies mite (B), and lice infested in hair (C). These are common conditions treated with scabicides and pediculicides. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-3 In which way would a topical gel medication be absorbed? a. Slowly because it is an oil-based preparation b. Quickly because it is a water-based preparation c. Slowly because the site needs to be kept open to air d. Quickly because it is being applied to an area of callused skin Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-3: Answer In which way would a topical gel medication be absorbed? Answer: b Quickly because it is a water-based preparation Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Local Anti-Infectives (1 of 2) The following details the use and treatments of local anti-infective medications: Used to treat diseases caused by microorganisms Antifungals: treat ringworm or tinea (pedis, corporis, cruris) and yeast (candidiasis), such as thrush, diaper rash, and vaginitis Antivirals: treat herpes simplex, herpes zoster, and varicella zoster Antibacterial agents: treat impetigo caused by Staphylococcus aureus, some species of Streptococci and MRSA, and infected traumatic skin lesions Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Local Anti-Infectives (2 of 2) The images below show athlete’s foot (A), body ringworm (B), and thrush of the tongue (C). These conditions would typically be treated with a local anti- infective medication. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Antiseptics The following details the use and treatments of antiseptic medications: Substances that inhibit the growth of bacteria Frequently used to describe chemicals applied to body tissues, especially the skin Major antiseptics in use today are chlorhexidine and povidone–iodine (Betadine), used for surgical scrubs and as bacteriostatic skin cleansers Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-4 Which topical agent is used to promote peeling of the skin? a. Antiseptic b. Antifungal c. Keratolytic d. Pediculicide Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-4: Answer Which topical agent is used to promote peeling of the skin? Answer: c Keratolytic Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Burn Medications (1 of 2) Burns are injuries to the skin and tissue below the skin that are caused by heat from flames, hot liquids, steam, heated objects, chemicals, friction, electricity, radiation, or the sun. There are different levels of severity including: ⮚ First degree—superficial ⮚ Second degree—partial thickness ⮚ Third degree—full thickness The images illustrate the various degrees. (A) First degree (B) Second degree (C) and (D) Third degree Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Burn Medications (2 of 2) The following details the use and treatments of burn medications: Burns Injuries to the skin and tissues below the skin caused by heat from flames, hot liquids, steam, heated objects, chemicals, friction, electricity, radiation, or the sun Usually classified as first-, second-, or third-degree burns, depending upon their severity and the depth to which tissues have been damaged Treatments include topical application of medications to prevent or treat infections Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Sunscreens The following details the use and treatments of sunscreen medications: Overexposure to the sun is considered to be the primary cause of skin cancer. Most common form of all cancers in the United States UV radiation is a type of invisible light emitted by the sun. Divided into two types: UVA and UVB Sun Protection Factor Measure of the protection a sunscreen offers Greater than 30 reduces the risk of skin cancer Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Agents Used to Treat Acne The following details the use and treatments of acne medications: Acne is a common condition of the skin. It affects almost everyone to some degree. It is most commonly seen on the face, scalp, neck, chest, back, and shoulders. Mild acne may be treated with nonprescription topical medications. Severe acne may be treated with a combination of a retinoid and topical antibiotics or oral antibiotics. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-5 For which skin condition would a topical enzyme preparation be prescribed? a. Remove necrotic tissue b. Soften minor skin irritations c. Treat herpes simplex lesion d. Kill bacteria in an infected skin wound Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Knowledge Check Activity 12-5: Answer For which skin condition would a topical enzyme preparation be prescribed? Answer: a Remove necrotic tissue Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Mechanism of Action and Indications for Use (1 of 2) Type of Medication Use Antipruritics Relieve itching caused by topical allergic reactions and insect bites Corticosteroids Treat allergic reactions, psoriasis, and seborrheic dermatitis Emollients and protectants Treat diaper rash, irritation, abrasions, and minor burns Keratolytic agents Control abnormal skin scaling or promote skin peeling Enzymes Debride dead tissue from ulcers and burns Scabicides and pediculicides Scabicides to treat scabies; pediculicides to treat lice Anti-infectives Treat fungal, viral, or bacterial skin infections Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Mechanism of Action and Indications for Use (2 of 2) Type of Medication Use Antiseptics Inhibit bacterial growth on the skin Burn medication Prevent or treat infections from the damaged skin Sunscreen Prevent damage from UVA and UVB Acne medication Treat blemishes on the face, scalp, neck, chest, back, and shoulders Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.  Self-Assessment 1. For which conditions would a topical anesthetic be used? 2. What factors influence the absorption of skin medications? 3. Describe the proper application procedures for various skin medications. Colbert, James & Katrancha, Essentials of Pharmacology for Health Professions, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.