Module 6: Dermatologic Drugs

Mupirocin

used topically for Staphylococcus and Streptococcus impetigo, intranasal for MRSA

Silver sulfadiazine

topical anti-infective used to prevent/treat infection from second and third degree burns, can cause pain/burning/itching

Clotrimazole

vaginal suppository or cream for yeast infections, other forms used to fungal infections like athlete’s foot

Miconazole 

topical cream/vaginal suppository 

Acyclovir and Penciclovir

topical antivirals for HSV 1 and 2 or HPV

Key points of antivirals…

do not cure viral skin infections and may shorten healing time, can decrease pain

What is the best treatment for viral infections?

systemic therapy

Topical Anesthetics 

used to reduce pain/pruritis associated with insect bites, sunburn, and poison ivy, can also be used to numb the skin

Corticosteroids shouldn’t be used…

during pregnancy

Psoraisis biologics 

Methotrexate, Cyclosporine, Tofactinib/Xelijanz, Entanercept/Enbrel, Adalimumab/Humira

Minoxidil/Rogaine

most common topical hair growth drug that is vasodilating on the scalp to stimulate hair growth

Finasteride

systemic hair growth drug, pregnancy category X drug, women are not to handle this drug without gloves/crushing, thereby making it airborne

Spironolactone

anti-androgen used to treat a variety of conditions

Topical Antineoplastics

blocks growth of abnormal pre-cancerous skin cells

Fluorouracil (5-FU)

Topical Antineoplastic that helps prevent basal cell carcinoma and actinic keratosis

Vitamin C and Zinc

systemic wound care drugs

Adverse affects of Aloe

diarrhea, abdominal pain, dermatitis (topical)

What are the possible drug interactions if Aloe is taken PO?

digoxin, anti-dysrhythmics, diuretics

Why do infants and older adults have increased skin absorption?

because their skin is thinner and more permeable

Drugs that end in -vir are…

antivirals

Drugs that end in -zole are …

antifungals

Drugs that end in -cin are usually…

antibiotics

Miosis

decrease in pupil size

Mydriasis

increase in pupil size

Mydriatics do what?

dilate the pupil

Miotics do what? 

constrict the pupil 

Cycloplegics

paralyze the ciliary body for mydriatic purposes

Cycloplegia

paralysis of accommodation

Glaucoma

inhibition of the normal flow of the aqueous humor, results in increased IOP, which leads to impaired vision and eventual blindness from the pressure of the retina

Open-angle glaucoma

more common form, drainage angle of the eye remains open but is not functioning properly

Angle-closure glaucoma

absolute emergency!!! causes blindness if left untreated, develops gradually

3 P’s of Blindness from open-angle glaucoma

preventable, painless, permanent (blindness)

Risk factors of glaucoma

family history, over age 40, diabetes, hypertension

Cholinergic/Miotic Agents

cause pupillary construction (miosis), decrease IOP by increasing aqueous humor outflow

Direct-acting cholinergic drugs

acetylcholine, caracole, pilocarpine (promote outflow of aqueous humor)

Indirect-acting cholinergic drugs

bind to + break down the enzymes that break down acetylcholine, more likely to cause adverse effects

Sympathomimetics

mimic epinephrine and norepinephrine to stimulate dilation, results in mydriasis, enhances aqueous humor outflow and reduces IOP

Sympathomimetics only do what?

only dilate the pupil to lower IOP for glaucoma, will not give for closed-angle

Adverse effects of Sympathomimetics

ocular effects like burning, pain, lacrimination - and systemic effects like hypertension, tachycardia, palpitations, lightheadedness

Beta-Adrenergic Blockers

treats closed-angle glaucoma, reduces IOP by reducing aqueous humor formation and increasing outflow

Beta-Adrenergic Blockers do not affect what?

pupil size

Drugs that end in -olol are what?

beta blockers

Adverse effects of beta-blockers

ocular effects like burning, blurred vision, pain - and limited systemic effects like headache, dizziness, cardiac, spasm

Carbonic Anhydrase Inhibitors

inhibit carbonic anhydrase, which reduces aqueous humor outflow, result is decreased IOP

Drugs that end in -zolamide are what?

carbonic anhydrase inhibitors

Carbonic Anhydrase Inhibitors treats which type of glaucoma? 

both open and closed angle

Adverse effects of Carbonic Anhydrase Inhibitors

oral forms can cause drowsiness, confusion, myopia, anorexia, vomiting, diarrhea

• patients with sulfa allergies may develop cross-sensitivities

Osmotic Diuretics

used for acute glaucoma episodes and before/after ocular surgeries to reduce IOP

Osmotic Diuretic drugs

glycerin is usually tried first, mannitol if glycerin is unsuccessful, isosorbide and urea may also be used

Adverse effects of Osmotic Diuretics 

nausea, vomiting, headache, may cause fluid and electrolyte imbalance 

Prostaglandin Agonists

newest class of drugs for glaucoma and are extremely common, reduce IOP by increasing outflow of aqueous humor

What is unique about the dose of Prostaglandin Agonists?

most drugs allow for a single daily dose because the effects last 20-24 hours

Drugs that end in -prost are what?

prostaglandin agonists

What is unique about the eye effect of Prostaglandin Agonists?

can permanently change the eye color to brown 

Strabismus

one eye is deviating

Amblyopia

reduced vision in affected eye (lazy eye), main cause is strabismus

Diplopia

double vision

Nystagmus 

involuntary rhythmic eye movement

Pendular nystagmus

back and forth movement

Jerk nystagmus

one phase of eye movement is faster

Why is Amblyopia important to identify at a young age?

It prevents normal development of the visual cortex, and becomes extremely difficult to treat

Scotoma

blind spot

Cataracts

cloudy area in lens

Papilledema

edema of optic nerve

Age-related macular degeneration

loss of central field of vision, occurs with aging, two different types are wet (leaky blood vessels) and dry (deterioration of the retina)

Retinal Detachment

emergency, the retina is pulling away from blood vessels, signs include floaters, flashing lights, shadows, and gray curtains in vision

Accommodation

the change in shape of the lens to change focus

Presbyopia

loss of accommodation with age

Myopia

nearsighted; can see objects close but not far away

Hyperopia

farsighted; can see objects far away but not close

Astigmatism

unequal curvature of cornea, may coexist with myopia, hyperopia, or presbyopia

Conjunctivitis

inflammation of the conjunctiva caused by viral or bacterial infection, and allergies

Acute bacterial Conjunctivitis

pinkeye

Blepharitis

inflammation of eyelid margin, causes irritation and redness from buildup

Hordeolum/Stye

bacterial infection of eyelids

Chalazion 

red bump on eye/cyst

Natamycin

used topically to treat blepharitis, conjunctivitis, and keratitis

Adverse effects of ocular antiviral agents

secondary glaucoma, corneal defects, edema

Ocular Antinflammatories

reduce production of inflammatory mediators and help reduce pain, and used after surgery to prevent scarring and inflammation

Ocular Anti-inflammatory drugs that are Corticosteroids often end in what? 

-one

Ocular Anti-inflammatory drugs that are NSAIDs often end in what?

-ac

Ophthalmic Antiallergic Drugs include what categories? 

antihistamines, mast cell stabilizers, decongestants

What types of drugs produce the greatest immunosuppressant effect?

corticosteroids

Drugs that end in -zoline are what?

decongestants

Topical Ophalamic Anesthetics

often end in -caine, used to prevent eye pain during surgery, exams, and procedures

Cycloplegic mydriatics 

used for eye exams as they cause dilation, result in mydriasis and cycloplegia

Cyclopentolate

causes mydriasis and cycloplegia, used for exams

Fluorescein (AK-Fluor)

diagnostic dye for corneal defects and foreign bodies. defects appear bright green/yellow-orange, or a green halo

Conductive Hearing Loss

impaired sound conduction from outer to inner ear

Causes of conductive hearing loss

allergies, fluid, foreign objects, ruptured eardrum, earwax

Sensorineural hearing loss

impairment of the organ of Corti and it’s central connections

Causes of Sensorineural hearing loss

aging, noise damage, drug side effects, tumors, blasts/explosions

Presbycusis

age-related hearing loss (sensorineural)

Functional/psychogenic hearing loss

individual appears to not hear or respond to voices 

Meniere disease

episodic disorder of the middle ear involving excessive pressure and cause dizziness

Otitis externa

swimmer’s ear, very painful ear infection

Otitis media

middle ear infections that mostly affects children and follows an upper respiratory tract infection, can cause hearing loss without treatment