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1. EYES, GI, GOUT, AND DERMATOLOGY
CH 38,39,72-75
Presented by Stephanie Dang, PharmD Candidate 2021
Washington State University College of Pharmacy and
Pharmaceutical Sciences
3. EYE
FORMULATIONS
Formulations Reminders
Solutions 1 drop = 0.05 mL
Suspensions Shake well
Ointments • Apply to conjunctival sac or
over lid margins
• Can make vision blurry
• Do not use with contact
lenses
Gels With cap on, invert and shake
once to get the medication into
the tip before instilling into the
eye
4. GLAUCOMA
• Goal of treatment: Reduce intraocular
pressure (IOP)
• 2 forms of glaucoma
• Open-angle: eye drops or surgery
• Closed angle: medical emergency
that is treated surgically
Treatment Goals: Decrease IOP
• Reduce aqueous humor production (make less
fluid)
• Beta blockers
• Increase aqueous humor outflow (move fluid out)
• Prostaglandins analogs
• Or, do both: often achieved with add-on
treatment
• Alpha-2 agonists
Drugs that can Increase IOP
• Anticholinergics
• Cough, cold and motion sickness medications
• Chronic steroids, especially eye drops
• Topiramate
5. PROSTAGLANDIN ANALOGS
• Increase aqueous humor outflow
• Tip: -prost = prostaglandin analog
Drugs Side effect/Clinical Concerns
Bimatoprost (Lumigan, Latisse) • Darkening of the iris
• Eyelash length and number can
increase
• Blurred vision and stinging
Latanoprost (Xalatan, Xelpros)
Travoprost (Travatan Z)
6. BETA-BLOCKERS
• Reduce aqueous humor production
Drugs Side effect/Clinical Concerns
Timolol 0.25% and 0.5% (Timoptic,
Timoptic-XE, Istalol)
• Contraindications: sinus
bradycardia
• Side effects: burning, stinging,
bradycardia/fatigue,
bronchospasms
+dorzolamide (Cosopt, Cosopt
PF)
+brimonidine (Combigan)
7. CONJUNCTIVITIS
“PINK EYE”
Cause: virus, bacterial, allergen, or
some type of ocular irritant
Prevent the spread of infection
• Avoid touching their eyes
• Use proper hand hygiene and
wash their hands thoroughly and
frequently
• Change towels and washcloths
daily, and do not share towels with
others
• Discard eye cosmetics, particularly
mascara
8. TREATMENTS
Type Causes Treatment
Viral Adenovirus none
Bacterial Staph. aureus
Most severe: N. gonorrhoeae or
Chlamydia, which require systemic
treatment
Moxifloxacin
Neomycin/Polymyxin B/
Dexamethasone
Ofloxacin
Trimethoprim
Allergic Pollen, dust mites, animal dander,
molds
Mast cell stabilizers
Antihistamines
• Azelastine
• Olopatadine
Antihistamines/Mast Cell
Stabilizers
• Ketotifen
10. OTHER OCULAR
CONDITIONS
Symptoms Examples of
Treatment
Usage Notes
Inflammation Steroids
• Prednisolone
NSAIDS
• Ketorolac
Steroid eye
drops should be
used short-term
due to risk of
increase IOP
Dryness Refresh
Systane
AKA Artificial
tears
Chronic Eye
Syndrome
Cyclosporine
Emulsion Eye
Drops
Redness Naphazoline
Naphazoline/ph
eniramine
Tetrahydrozoline
11. KEY COUNSELING
POINTS
Can cause stinging/burning (except for
preservative free)
Wait 5 minutes in between two drops of
the same medications
Wait 5-10 minutes in between drops of
two medications
Apply gel last. Wait 10 minutes after the
last eye drop before use
Remove contact lenses prior to using eye
drops. Wait 15 minutes to reinsert
13. ACNE
• Androgens (male sex hormone) are the primary determinant of acne
• Along with Cutibacterium acnes and fatty acids sebum (present in oil glands)
• Treatments
• OTC benzoyl peroxide (BPO)
• Salicylic acid
• Retinoids
• Topical or systemic (oral) antibiotics
• Systemic isotretinoin
• Women – oral contraceptive pills, spironolactone
14. COLD SORES
• Usually caused by HSV-1, but can also be caused by HSV-2
• Treatments
• Lysine
• Docosanol (Abreva)
• Acyclovir topical cream/ointment (Zovirax)
15. DANDRUFF
• Caused by either eczema or fungal overgrowth
• Treatment
• Ketoconazole shampoo
• 1% - OTC
• 2% - Rx
16. ALOPECIA
• Hair loss due to hormonal factors, medication conditions and
medications
• Drugs: chemotherapeutics, valproate, spironolactone, heparin,
warfarin, and much more
• Treatments
• Finasteride (Propecia)
• Minoxidil
• Bimatoprost (Latisse)
17. ECZEMA
• Skin rashes that become crusty and scaly, blisters can develop
• Treatments
• Moisturizers with petrolatum – Aquaphor, Eucerin
• Topical Steroids
• Antihistamines
• Calcineurin inhibitors
• Topical Phosphodiesterase-4 Inhibitor
• Monoclonal Antibody (IL-4 antagonist)
19. FUNGAL INFECTION CONT.
• Fungal infections: Vaginal
• Treatment
• 1, 3, or 7 day treatment, with vaginal cream, ointment, or vaginal
suppository/tablet
• OTC
• Clotrimazole, Miconazole
• Rx topical
• Butoconazole, Terconazole
• Rx oral
• Fluconazole
20. HEMORRHOIDS
• Due to constipation and straining to have bowel movement
• Treatments
• Increasing fiber
• Psyllium
• Phenylephrine topical (Preparation H)
• Hydrocortisone
• Witch hazel
23. BURNS
Types of Burns
• First degree: red/painful, minor swelling
• Second degree: thicker, very painful, produce blisters
• Third degree: damage to all layers of skin, appears white and charred
Treatments
• OTC- Ointments with 80% oil and 20% water, Silver sulfadiazine,
Polymyxin/bacitracin/neomycin (Neosporin)
• Rx- Mupirocin or Bacitracin/neomycin/polymyxin B/ hydrocortisone
(Cortisporin)
25. GOUT
Caused by the buildup of uric acid
Drugs that increase uric acid
• Aspirin
• Calcineurin inhibitors- Tacrolimus and cyclosporine
• Diuretics- loops and thiazides
• Niacin
• Pyrazinamide
• Select Chemotherapies
• Select pancreatic enzyme products
Food to avoid: organ meat, high fructose
corn syrup and alcohol
29. GASTROESOPHAGE AL
REFLUX DISE ASE
(GERD)
Key drugs that can worsen GERD symptoms
• Aspirin/NSAIDS
• Bisphosphonates
• Dabigatran
• Estrogen products
• Fish oil products
• Iron supplements
• Nicotine replacement therapy
• Steroids
• Tetracyclines
30. GERD TREATMENT ALGORITHM
Lifestyle Modifications
• Weight loss
• Elevate the head of the bed
• Avoid high fat meals within
2-3 hours of bedtime
• Avoid food/beverages that
trigger reflux: caffeine,
chocolate, acidic/spicy food,
carbonated beverages
Initial Drug Treatment
• PPI once daily for 8 weeks
Maintenance
Treatment
• 1st line: PPI at the lowest
effective dose
32. KEY DRUGS THAT DECREASED
ABSORPTION
Drugs that require an acidic gut (absorption decreased by antacids,
H2RAs and PPIs)
• Antiretrovirals, antivirals, azole antifungals, cephalosporin, iron products,
mesalamine, risedronate delated released, and tyrosine kinase inhibitors
Oral drug/drugs classes that antacids bind
• Antiretrovirals (INSTIs), bisphosphonates, isoniazid, levothyroxine,
mycophenolate, quinolones, sotalol, steroids, and tetracyclines
33. PEPTIC ULCER
DISEASE (PUD)
Symptoms: dyspepsia, gastric pain
Causes: H. Pylori-positive ulcers, NSAIDS, and stress ulcers
•PPIs, bismuth and antibiotics should be discontinued for 2 weeks prior to
these test
Tests: urea breath test, fecal antigen test
•Bismuth subsalicylate, metronidazole, tetracycline, and PPI BID
Treatment: Quadruple therapy
34. CONSTIPATION
Medical conditions that can cause
constipation
• Irritable bowel syndrome
• Anal disorders
• Multiple sclerosis
• Cerebral vascular events
• Parkinson's disease
• Spinal cord tumors
• Diabetes
• Hypothyroidism
36. DIARRHEA
• cramps, nausea, vomiting, or fever
Symptoms
• Can be idiopathic caused by diseases, drugs, or
by consuming contaminated food or water
Causes
37. DRUGS THAT CAN CAUSE DIARRHEA
Antacids
containing
magnesium
Antibiotics Antidiabetics Antineoplastics Colchicine
Drugs used for
constipation
Misoprostol Mycophenolate Prokinetic drugs
Protease
inhibitors
Quinidine Rolflumilast
38. TREATMENTS
• Management: oral rehydration solutions
Non-drug Treatment
• Symptomatic relief: Bismuth subsalicylate or
loperamide
Drug Treatments
39. INFLAMMATORY
BOWEL DISEASE
• bloody diarrhea
• rectal urgency
• having a feeling to pass stools even if the
colon is empty
• abdominal pain
• fatigue
• weight loss
• night sweats
• N/V
• constipation
Symptoms
• IBS does not cause inflammation
IBD vs IBS?
40. ULCERATIVE
COLITIS
Mucosal inflammation confined to the rectum and
colon with superficial ulcerations
Classifications
• Mild
• Moderate: >4 stools per day with minimal signs of
toxicity
• Severe: >6 blood stools per day with evidence of
toxicity
• Fulminant: >10 stools per day and severe symptoms
42. TREATMENTS
Non-drug treatment
• smaller, more frequent meals
• low fat and dairy products
• drink plenty of water
• antidiarrheal or antispasmodic drugs
• vitamin supplements
• probiotics
43. CD VS UC
CLINICAL
FEATURES
CD UC
Diarrhea Bloody or non-bloody Bloody
Fistulas/Strictures Common Uncommon
Locations Entire GI tract Colon
Depth Transmural Superficial
Pattern Non-continuous Continuous
Smoking Risk factors Protective
44. MAINTENANCE OF REMISSION
Crohn’s Disease Ulcerative Colitis
Mild disease Oral budesonide for ≤3 months; after this
course, discontinue treatment or change to
thiopurine or methotrexate
Mesalamine (5-ASA) rectal and/or
oral preferred
Moderate-severe disease Anti-TNF agents
Thiopurine
Methotrexate
IL receptor antagonist
Anti-TNF agents
Thiopurine
Cyclosporine
IL receptor antagonist
Janus kinase inhibitors
Refractory to above treatments and/or
steroids dependent
Integrin receptor antagonists Integrin receptor antagonists
