The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold
The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold
Slides are prepared as per INC Syllabus Unit IX Drugs used in nervous system and it is most benefited for B sc Nursing students and faculty of the subject
Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.
The urinary system, also known as the renal system or urinary tract, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH.
Pharmacology of commonly used antisep, disinfect, insecticideMr. Dipti sorte
Slides are prepared as per INC Syllabus Unit III Antiseptics & Disinfectants and it is most benefited for B sc Nursing students and faculty of the subject
Slides are prepared as per INC Syllabus Unit IX Drugs used in nervous system and it is most benefited for B sc Nursing students and faculty of the subject
Slides are prepared as per INC Syllabus Unit V Drugs used on Respiratory systems and it is most benefited for 2nd yr B sc Nursing students and faculty of the subject.
The urinary system, also known as the renal system or urinary tract, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH.
Pharmacology of commonly used antisep, disinfect, insecticideMr. Dipti sorte
Slides are prepared as per INC Syllabus Unit III Antiseptics & Disinfectants and it is most benefited for B sc Nursing students and faculty of the subject
Guidelines for the management of acne
French Guidelines for the management of acne
Acne treatment guidelines
Management of acne
Antibiotics in acne
hormone therapy for acne
The presentation gives an in-depth review of the Anti-fungal drugs used to treat various acute and chronic fungal infections along with their uses and MOA.
Topical corticosteroids are common medications prescribed for skin problems encountered in the primary care or dermatology clinic settings. As skin conditions comprise of around 20% of cases seen in primary care, this article written to guide readers, especially non-dermatologists on the appropriate potency of topical corticosteroids to be chosen for skin problems of patients and to list the side effects both local and systemic.
Many skin conditions are treated with topical corticosteroids. This includes eczema, psoriasis, lichen sclerosus, lichen planus, nodular prurigo, discoid lupus erythematosus and vitiligo; to name a few. There are variety of factors to consider when choosing a topical corticosteroid including the correct potency based on severity of clinical presentation, age group of patients, parts of the body affected, and the balance between benefits versus side effects.
More importantly, is the need for accurate clinical diagnosis to ensure the correct use for the indication of topical corticosteroid and the need to exclude primary or secondary skin infection prior to prescription. Microscopic examination of skin scraping with potassium hydroxide can help in identifying superficial fungal skin infection as the condition may be worsened by the use of topical corticosteroid. As skin conditions comprise of one fifth of the cases seen in primary care, this article will offer guidelines to readers on the proper choice of corticosteroid for dermatological conditions commonly seen by clinicians.
Introduction:
Understanding pharmacology related to skin and mucous membrane health is crucial for nursing students in providing comprehensive care to patients with dermatological and mucosal conditions. This guide offers essential knowledge on pharmacological interventions, including medications, treatments, and nursing considerations, to promote skin and mucous membrane wellness and manage various dermatological and mucosal disorders effectively.
Similar to Drug used on skin & mucous membrane (20)
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
5. Introduction
• The topical drugs are especially appropriate for diseases of the skin.
• Some dermatologic diseases respond as well or better to drugs administered systemically.
• Major variables that determine response to topical drugs include:
• Regional variation in drug penetration: the scrotum, face, axilla, and scalp are far
more permeable than the forearm.
• Concentration gradient: increasing the concentration increases the mass of drug
transferred per unit time.
• Dosing schedule: the skin acts as a reservoir, so the "local half-life" may be longer
than systemic half-lives and permit once-daily application of drugs.
• Vehicles: vehicles maximize the skin penetration of the drug and their moistening or
drying effects have therapeutic benefit.
• Occlusion: occlusion (application of a plastic wrap) is extremely effective in
maximizing efficacy.
8/23/2018
10. Dermatologic Vehicles
• Important considerations in selection of a vehicle include:
• The solubility of the active agent in the vehicle
• The rate of release of the agent from the vehicle
• The ability of the vehicle to hydrate the stratum corneum, thus enhancing penetration
• The stability of the therapeutic agent in the vehicle
• Interactions of the vehicle, stratum corneum, and active agent.
• Depending upon the vehicle, drugs are classified as: tinctures, wet
dressings, lotions, gels, aerosols, powders, pastes, creams, and ointments.
• The ability of the vehicle to retard evaporation from the skin is least in
tinctures and greatest in ointments.
8/23/2018
11. Dermatologic Vehicles Cont,d
• Acute inflammation with oozing, vesiculation, and crusting is treated
with drying preparations (tinctures, wet dressings, and lotions).
• Chronic inflammation with xerosis, scaling, and lichenification is treated
with lubricating preparations (creams and ointments).
• Tinctures, lotions, gels, and aerosols are convenient for application to
the scalp and hairy areas.
• Emulsified creams are used in intertriginous areas without causing
maceration.
8/23/2018
12. Antibacterial Agents
• Topical corticosteroids do not inhibit the effects of
co-administered antibiotics.
• In the treatment of secondarily infected dermatoses, combination therapy
is superior to corticosteroid therapy alone.
• Antibiotic-corticosteroid combinations are useful in diaper dermatitis,
otitis externa, and impetiginized eczema.
• The pathogens in surgical wounds are those resident in the environment so
information about regional drug resistance is important.
8/23/2018
14. Bacitracin & Gramicidin
• Bacitracin and gramicidin are peptide antibiotics, active against gram-
positive organisms such as streptococci, pneumococci, and
staphylococci.
• Most anaerobic cocci, neisseriae, tetanus bacilli, and diphtheria bacilli
are also sensitive.
• Bacitracin is compounded in an ointment base alone or in combination
with neomycin, polymyxin B, or both.
• Bacitracin is poorly absorbed through the skin, so systemic toxicity is
rare but allergic contact dermatitis is frequent.
8/23/2018
15. Polymyxin B, Neomycin and gentamicin
• Polymyxin B is a peptide antibiotic effective against gram-negative
organisms. All gram-positive organisms are resistant.
• Neomycin and gentamicin are active against gram-negative organisms.
• Gentamicin generally shows greater activity against P aeruginosa than
neomycin.
• Neomycin causes sensitization, particularly in eczematous dermatoses
or if compounded in an ointment vehicle.
8/23/2018
16. Topical Antibiotics in Acne
• Currently, four antibiotics are so utilized: clindamycin, erythromycin,
metronidazole, and sulfacetamide.
• The effectiveness of topical therapy is less than that achieved by
systemic administration of the same antibiotic.
• Topical therapy is suitable in mild to moderate cases of inflammatory
acne.
• Clindamycin has activity against Propionibacterium acnes.
• Erythromycin: the mechanism of action of topical erythromycin in
inflammatory acne vulgaris is unknown.
8/23/2018
17. Topical Antibiotics in Acne Cont,d
• Adverse local reactions to erythromycin solution include a burning
sensation at the time of application and drying and irritation of the skin.
• The topical water-based gel is less drying and may be better-tolerated.
• Metronidazole: Topical metronidazole is effective in the treatment of acne
rosacea. The mechanism of action is unknown.
• Topical use during pregnancy and by nursing mothers and children is not
recommended.
• Adverse local effects of the water-based gel formulation (MetroGel)
include dryness, burning, and stinging.
8/23/2018
18. Topical Antibiotics in Acne Cont,d
• Caution should be exercised when applying metronidazole near the
eyes to avoid excessive tearing.
• Sodium Sulfacetamide: The mechanism of action is thought to be
inhibition of P acnes by competitive inhibition of p-aminobenzoic acid
utilization.
• 4% of topically applied sulfacetamide is absorbed so its use is
contraindicated in patients having hypersensitivity to sulfonamides.
8/23/2018
20. Topical Imidazoles
• The topical imidazoles:
• They have a wide range of activity against dermatophytes,
Candida albicans and Pityrosporum orbiculare.
8/23/2018
Clotrimazole
Econazole
Ketoconazole
Miconazole
Oxiconazole
Sulconazole
21. Topical Imidazoles Cont,d
• Once- or twice-daily application will result in clearing of
dermatophyte infections in 2-3 weeks.
• The medication should be continued until eradication of the organism
is confirmed.
• Paronychial and intertriginous candidiasis can be treated by any of
these agents when applied three or four times daily.
• Seborrheic dermatitis should be treated with twice-daily applications
of ketoconazole until clinical clearing is obtained.
8/23/2018
22. Nystatin
• Topical nystatin is used in cutaneous and mucosal candida infections.
• It is not effective against dermatophytes.
• Oral candidiasis (thrush) is treated by holding 5 mL (infants, 2 mL) of
nystatin oral suspension in the mouth for several minutes four times
daily before swallowing.
• An alternative therapy for thrush is to retain a vaginal tablet in the
mouth until dissolved four times daily.
• Vulvovaginal candidiasis may be treated by insertion of 1 vaginal
tablet twice daily for 14 days, then nightly for an additional 14-21
days.
8/23/2018
23. Oral Azoles
• Tinea versicolor is very responsive to short courses of once-daily dose
of 200 mg Ketoconazole.
• Significant side effects of Ketoconazole include gynecomastia and
hepatitis.
• Caution is advised when using ketoconazole in patients with a history of
hepatitis.
• Routine evaluation of hepatic function is advisable for patients on
prolonged therapy.
8/23/2018
24. Oral Azoles Cont,d
• The newer azole derivatives for oral therapy include fluconazole and
itraconazole.
• Fluconazole has a half-life of 30 hours. daily doses of 100 mg are sufficient
for candidiasis; alternate-day doses are sufficient for dermatophytes.
• The half-life of itraconazole is similar to fluconazole, with therapeutic
concentrations remaining in the skin for 28 days.
• Itraconazole should not be given to patients with ventricular dysfunction (may
cause heart failure).
• Routine evaluation of hepatic function is recommended for patients receiving
itraconazole for onychomycosis.
8/23/2018
25. Oral Azoles Cont,d
• Administration of oral azoles with midazolam or
triazolam potentiate hypnotic effects of these agents.
• Administration with HMG-CoA reductase inhibitors
causes a significant risk of rhabdomyolysis.
• Administration of the oral azoles with midazolam,
triazolam, or HMG-CoA inhibitors is contraindicated.
8/23/2018
26. Griseofulvin
• Griseofulvin is effective orally against dermatophyte infections. It is
ineffective against candida and P orbiculare.
• The adult dosage of the micronized ("microsize") form of the drug is 500 mg
daily in single or divided doses with meals.
• Griseofulvin is most effective in treating tinea infections of the scalp and
glabrous skin.
• Infections of the scalp respond in 4-6 weeks, and infections of glabrous skin
respond in 3-4 weeks.
• Griseofulvin is derived from a penicillium mold, and cross-sensitivity with
penicillin may occur.
• In prolonged therapy, routine evaluation of the hematopoietic, hepatic and
renal systems is advisable.8/23/2018
27. Immunomodulators
• Tacrolimus and pimecrolimus are macrolide immunosuppressant's that have
significant benefit in atopic dermatitis.
• Both agents inhibit T-lymphocyte activation and prevent degranulation of mast
cells by antigen-IgE complexes.
• Both agents are indicated for mild to moderate atopic dermatitis.
• Neither medication should be used with occlusive dressings.
8/23/2018
29. Permethrin
• Permethrin is toxic to Pediculus humanus, Pthirus pubis, and Sarcoptes
scabiei.
• Residual drug persists up to 10 days following application.
• permethrin 1% cream rinse is applied undiluted to affected areas of
pediculosis for 10 minutes and then rinsed off with warm water.
• For the treatment of scabies, a single application of 5% cream is applied
to the body from the neck down, left on for 8-12 hours, and then washed
off.
8/23/2018
30. Lindane (Hexachlorocyclohexane)
• Lindane is available as a shampoo or lotion.
• 10% of a dose applied to the forearm is absorbed and concentrated in fatty tissues,
including the brain.
• For pediculosis capitis or pubis, 30 mL of shampoo is applied to dry hair on the
scalp or genital area for 4 minutes and then rinsed off.
• No additional application is indicated unless living lice are present 1 week after
treatment.
• In scabies a single application is applied to the entire body from the neck down,
left on for 8-12 hours, and then washed off.
• Patients should be retreated only if active mites can be demonstrated, and never
within 1 week of initial treatment.
8/23/2018
31. Crotamiton
• Crotamiton is available as a cream or lotion.
• Crotamiton, is a scabicide with some antipruritic properties.
• For scabies two applications are applied from the chin down at 24-
hour intervals, with a cleansing bath 48 hrs. after the last application.
• Crotamiton is can be used as an alternative to lindane.
8/23/2018
32. Sulphur & Malathion
• Sulfur remains a possible alternative drug for use in infants and pregnant
women.
• The usual formulation is 5% precipitated sulfur in petrolatum.
• Malathion is available as a 0.5% lotion that should be applied to the hair
when dry; 4-6 hours later, the hair is combed to remove nits and lice.
8/23/2018
33. Agents Affecting Pigmentation
• Hydroquinone, mequinol and monobenzone reduce hyperpigmentation of
the skin.
• these compounds inhibit tyrosinase, interfering with the biosynthesis of
melanin.
• Topical hydroquinone & mequinol result in temporary lightening, but
monobenzone causes irreversible depigmentation.
• Monobenzone may cause hypopigmentation at sites distant from the area
of application.
8/23/2018
34. Agents Affecting Pigmentation Cont,d
• Trioxsalen and methoxsalen are psoralens used for the
repigmentation of depigmented macules of vitiligo.
• Psoralens must be photoactivated by long-wave-length
ultraviolet light in the range of 320-400 nm (UVA) to
produce a beneficial effect.
• The risks of psoralen photochemotherapy are cataracts
and skin cancer.
8/23/2018
35. Sunscreens
• Topical medications against sunlight include:
• Sunscreens:
• Sunshades:
• The three classes of compounds used in sunscreens
are:
• p-aminobenzoic acid (PABA) and its esters
• The benzophenones
• The dibenzoylmethanes
8/23/2018
Contain chemical compounds that
absorb ultraviolet light
Contain opaque materials such as
titanium dioxide that reflect light
36. Sunscreens Cont,d
• Sunscreens are designed to absorb ultraviolet B (UVB) wavelength
(from 280 to 320 nm).
• UVB is the range responsible for most of the erythema and tanning
associated with sun exposure.
• Chronic exposure to light in this range induces aging of the skin and
photocarcinogenesis.
• Para-aminobenzoic acid and its esters are the most effective available
absorbers in the B region.
8/23/2018
37. Sunscreens Cont,d
• The benzophenones include oxybenzone, dioxybenzone, and sulisobenzone.
• The benzophenones absorb from 250 to 360 nm, but their effectiveness in
the UVB erythema is less than that of PABA.
• The dibenzoylmethanes include Parasol and Eusolex.
• The dibenzoylmethanes absorb wavelengths throughout the ultraviolet A
range (320 to 400 nm), with maximum absorption at 360 nm.
• Patients sensitive to UVA include: those with cutaneous lupus erythematosus
and drug-induced photosensitivity.
• In these patients, dibenzoylmethane-containing sunscreen may provide
improved photoprotection.
8/23/2018
38. Sunscreens Cont,d
• The sun protection factor (SPF) of a given sunscreen is a measure of its
effectiveness in absorbing erythrogenic ultraviolet light.
• It is determined by measuring the minimal erythema dose with and without
the sunscreen in a group of normal people.
• The ratio of the minimal erythema dose with sunscreen to the minimal
erythema dose without sunscreen is the SPF.
• Fair-skinned individuals who sunburn easily are advised to use a product
with an SPF of 15 or greater.
8/23/2018
39. Acne Preparations
• Retinoic acid (tretinoin), is the acid form of vitamin A. It is an effective
topical treatment for acne vulgaris.
• Several analogs of vitamin A (eg, isotretinoin), are effective orally in
various dermatologic diseases.
• Its action in acne is due to decreased cohesion between epidermal cells
and increased epidermal cell turnover.
• This results in the expulsion of open comedones and the transformation
of closed comedones into open ones.
• Topical retinoic acid is applied initially in a concentration sufficient to
induce slight erythema with mild peeling.
8/23/2018
40. Acne Preparations Cont,d
• Topical retinoic acid should be applied to dry skin only, and care should
be taken to avoid contact with the corners of the nose, eyes, mouth, and
mucous membranes.
• During the first 4-6 weeks of therapy, hidden comedones appear and it
seems that the acne has been aggravated by the retinoic acid.
• With continued therapy, the lesions will clear, and in 8-12 weeks
optimal clinical improvement occurs.
• The effects of tretinoin on keratinization and desquamation offer
benefits for patients with photodamaged skin.
8/23/2018
41. Acne Preparations Cont,d
• Prolonged use of tretinoin increases collagen synthesis and thickness of
the epidermis, so diminishes fine lines and wrinkles.
• This drug may increase the tumorigenic potential of ultraviolet radiation.
• Patients using retinoic acid should avoid sun exposure and use a
protective sunscreen.
• Isotretinoin (Accutane) is used in the treatment of severe cystic acne that
is recalcitrant to standard therapies.
• Isotretinoin may act by inhibiting sebaceous gland size and function.
• Teratogenicity is a significant risk in patients taking isotretinoin.
8/23/2018
42. Acne Preparations Cont,d
• Women must use an effective form of contraception for 1 month
before, throughout therapy, and for one menstrual cycle following
discontinuance of treatment.
• A serum pregnancy test must be obtained within 2 weeks before
therapy, and therapy should be initiated on the second or third day of
the next menstrual period.
8/23/2018
43. Acne Preparations Cont,d
• Benzoyl peroxide is an effective topical agent in the treatment of acne
vulgaris.
• It is converted to benzoic acid within the epidermis and dermis.
• It is active against P acnes and has peeling and comedolytic effects.
• Care should be taken to avoid contact with the eyes and mucous
membranes.
8/23/2018
44. Corticosteroids
• The antimitotic effects of corticosteroids on epidermis accounts for
their action in diseases with increased cell turnover (psoriasis).
• Corticosteroids are only minimally absorbed following application to
normal skin.
• Only 1% of a dose of hydrocortisone applied to the ventral forearm is
absorbed.
• occlusion with a plastic wrap enhances penetration, yielding a tenfold
increase in absorption.
8/23/2018
45. Corticosteroids Cont,d
• Corticosteroid penetration varies and compared with the forearm
hydrocortisone is absorbed:
• 0.14 times as well through the plantar foot arch
• 0.83 times as well through the palm
• 3.5 times as well through the scalp
• 6 times as well through the forehead
• 9 times as well through vulvar skin
• 42 times as well through scrotal skin
• Penetration increases several fold in the inflamed skin (atopic
dermatitis) and exfoliative diseases.
8/23/2018
46. Corticosteroids Cont,d
• Ointment bases tend to give better activity to the corticosteroid than do
cream or lotion vehicles.
• A tenfold increase in hydrocortisone concentration causes only a fourfold
increase in the forearm absorption.
• Intralesional injection of insoluble corticosteroids (eg, triamcinolone
preparations) increases their penetration.
• When these agents are injected into the lesion, measurable amounts are
gradually released for 3-4 weeks.
8/23/2018
47. Corticosteroids Cont,d
• Adverse local effects of topical corticosteroids include:
• Atrophy
• Steroid rosacea
• Steroid acne
• Alterations of cutaneous infections
• Hypopigmentation
• Hypertrichosis
• Increased intraocular pressure
• Allergic contact dermatitis
8/23/2018
Depressed, shiny, wrinkled "cigarette paper"-
appearing skin with telangiectases and tendency
to develop purpura and ecchymosis
Persistent erythema, telangiectatic
vessels, pustules, and papules
49. Salicylic Acid
• Salicylic acid has been extensively used in as a keratolytic agent.
• Its mechanism of action is not understood.
• Salicylic acid is keratolytic in concentrations of 3-6%.
• In concentrations greater than 6%, it can be destructive to tissues.
• Particular care must be exercised when using the drug on the
extremities of diabetics or patients with peripheral vascular disease.
8/23/2018
50. Propylene glycol
• Propylene glycol is used alone as a keratolytic agent in 40-70%
concentrations, with plastic occlusion, or in gel with 6% salicylic acid.
• It is also an effective humectant and increases the water content of the
stratum corneum.
• It develops an osmotic gradient, increasing hydration of the outer layers
by drawing water out from the inner layers.
8/23/2018
51. Urea
• Urea in a compatible cream vehicle or ointment base has a softening and
moisturizing effect on the stratum corneum.
• It makes creams and lotions feel less greasy and decreases the oily feel of drugs.
• Urea is also keratolytic by altering prekeratin and keratin, leading to increased
solubilization.
• As a humectant, urea is used in concentrations of 2-20% in creams and lotions.
• As a keratolytic agent, it is used in 20% concentration in hyperkeratosis of palms
and soles.
• Concentrations of 30-50% applied to the nail plate have been useful in softening
the nail prior to avulsion.
8/23/2018
52. Podophyllum Resin & Podophyllotoxin
• The major use of podophyllum resin is in the treatment of condyloma
acuminatum.
• A 25% concentration of podophyllum resin in compound tincture of benzoin is
used for condyloma acuminatum.
• Application should be restricted to wart tissue only.
• Podophyllotoxin is a cytotoxic agent with specific affinity for the mitotic spindle.
• Normal assembly of the spindle is prevented, and epidermal mitoses are arrested.
• The patient should wash off the preparation 2-3 hours after the initial application.
8/23/2018
53. Podophyllum Resin & Podophyllotoxin ---Contd
• If up to five applications have not resulted in resolution, other
methods should be considered.
• Use during pregnancy is contraindicated in view of possible cytotoxic
effects.
• Pure 0.5% podophyllotoxin (podofilox) is used for genital
condylomas.
8/23/2018
54. Fluorouracil
• Fluorouracil is used topically for actinic keratoses.
• The response begins with erythema, vesiculation, erosion, superficial
ulceration, necrosis, and finally reepithelialization.
• Fluorouracil should be continued until the stage of ulceration and
necrosis (in 3-4 weeks) and then stopped.
• The healing process continues for 1-2 months after therapy is
discontinued.
• Excessive exposure to sunlight during treatment increases the intensity
of the reaction and should be avoided.
8/23/2018
55. Aminolevulinic Acid (ALA)
• Aminolevulinic acid (ALA) is an endogenous precursor of
photosensitizing porphyrin metabolites.
• When topical ALA is applied, protoporphyrin IX (PpIX) accumulates in
the cell.
• When exposed to light of appropriate wavelength and energy, the PpIX
produces a photodynamic reaction.
• This reaction results in the formation of cytotoxic superoxide and
hydroxyl radicals.
• Photosensitization by ALA and illumination with a blue light
photodynamic therapy illuminator (BLU-U) is the basis for ALA
therapy.8/23/2018
56. Aminolevulinic Acid (ALA) Cont,d
• A 20% topical solution of ALA is used in the treatment of actinic
keratoses.
• It is followed by blue light photodynamic illumination 14-18 hours
later.
• Patients must avoid exposure to sunlight or bright indoor lights for at
least 40 hours after ALA application.
8/23/2018
57. Antipruritic Agents
• Topical doxepin 5% cream (Zonalon) may provide significant antipruritic
activity in atopic dermatitis.
• Its mechanism may relate to the potent H1- and H2-receptor antagonist
properties.
• Percutaneous absorption is variable and may result in significant drowsiness
in some patients.
• Because of its anticholinergic effect, topical use is contraindicated in urinary
retention or narrow angle glaucoma.
8/23/2018
58. Trichogenic & Antitrichogenic Agents
• Topical minoxidil (Rogaine) is effective in reversing the progressive miniaturization of scalp
hairs in androgenic alopecia.
• Vertex balding is more responsive to therapy than frontal balding.
• The mechanism of action of minoxidil on hair follicles is unknown.
• The effect of minoxidil is not permanent, and cessation of treatment will lead to hair loss in 4-6
months.
• Finasteride (Propecia) blocks the production of dihydrotestosterone which is responsible for
androgenic alopecia.
• Oral finasteride, 1 mg/d, promotes hair growth and prevents further hair loss in many men with
androgenic alopecia.
• Treatment for at least 3-6 months is necessary to see increased hair growth or prevent further
hair loss.8/23/2018
59. Trichogenic & Antitrichogenic Agents Cont,d
• Continued treatment with finasteride is necessary to sustain benefit.
• Adverse effects include: decreased libido, ejaculation disorders, and
erectile dysfunction.
• Pregnant women should avoid finasteride even by handling crushed
tablets.
8/23/2018
It resolve in most men who remain on therapy and in all men
who discontinue finasteride
There is risk of hypospadias in a male fetus
60. Trichogenic & Antitrichogenic Agents Cont,d
• Eflornithine is an irreversible inhibitor of ornithine decarboxylase that
catalyzes the biosynthesis of polyamines.
• Polyamines are required for cell division, and inhibition of ornithine
decarboxylase affects the rate of hair growth.
• Eflornithine is effective in reducing facial hair growth in 30% of women
when applied twice daily for 6 months.
• Hair growth was observed to return to pretreatment levels 8 weeks after
discontinuation.
8/23/2018
62. 62
Pharmacokinetics
• It is the absorption, distribution, metabolism, and excretion of the drug
• A drug can be delivered to ocular tissue as:
• Locally:
• Eye drop
• Ointment
• Periocular injection
• Intraocular injection
• Systemically:
• Orally
• IV
63. 63
Drug Delivery in Eyes
Topical Periocular Intraocular Systemic
drop
ointment
gel
Soft contact lens
Subconj.
Subtenon
Peribulbar
Retrobulbar
Intracameral
Intravitreal
oral
intravenous
Intramuscular
64. 64
Factors influencing local drug penetration into
ocular tissue
• Drug concentration and solubility: the higher the concentration the better the
penetration e.g pilocarpine 1-4% but limited by reflex tearing
• Viscosity: addition of methylcellulose and polyvinyl alcohol increases drug
penetration by increasing the contact time with the cornea and altering corneal
epithelium
• Lipid solubility: because of the lipid rich environment of the epithelial cell
membranes, the higher lipid solubility the more the penetration
Amphipathic- epithelium/endothelium----lipophilic
stroma---hydrophilic
65. 65
Factors influencing local drug penetration into
ocular tissue
• Surfactants: the preservatives used in ocular preparations alter cell membrane
in the cornea and increase drug permeability e.g. benzylkonium and
thiomersal
• pH: the normal tear pH is 7.4 and if the drug pH is much different, this will
cause reflex tearing
• Drug tonicity: when an alkaloid drug is put in relatively alkaloid medium, the
proportion of the uncharged form will increase, thus more penetration
• Molecular weight and size:
66. 66
TOPICAL
Method
hold the skin below the lower eye lid
pull it forward slightly
INSTALL 1 drop
• measures to increase drop absorption:
-wait 5-10 minutes between drops
-compress lacrimal sac
-keep lids closed for 5 minutes after
instillation
Drop (Gutta)- simplest and more
convenient mainly for day time use
1 drop=50 microlitre
Conjuctival sac capacity=7-13
micro liter
so, even 1 drop is more than enough
67. 67
Ointments
• Increase the contact time of ocular medication to ocular
surface thus better effect
• It has the disadvantage of vision blurring
• The drug has to be high lipid soluble with some water
solubility to have the maximum effect as ointment
68. 68
Peri-ocular injections
• They reach behind iris-lens
diaphragm better than topical
application
• E.g. subconjunctival, subtenon,
peribulbar, or retrobulbar
• This route bypass the conjunctival
and corneal epithelium which is
good for drugs with low lipid
solubility (e.g. penicillins)
• Also steroid and local anesthetics
can be applied this way
69. 69
Periocular
Retrobulbar-Optic neuritis
Papillitis
Posterior uveitis
Anesthesia
Peribulbar-- anesthesia
Subconjunctival - To achieve higher concentration
Drugs which can’t penetrate
cornea due to large size Penetrate via sclera
Subtenon— ant. Subtenon– disease ant to the Lens
Post Subtenon– disease posterior to the lens
Retrobulbar-Optic neuritis
Papillitis
Posterior uveitis
Anesthesia
Peribulbar-- anesthesia
70. 70
Intraocular injections
• Intracameral or intravitreal
• E.g.
• Intracameral acetylcholine
(miochol) during cataract surgery
• Intravitreal antibiotics in cases of
endophthalmitis
• Intravitreal steroid in macular
edema
• Intravitreal Anti-VEGF for DR
71. 71
Sustained-release devices
• These are devices that deliver an
adequate supply of medication at a
steady-state level
• E.g.
• Ocusert delivering pilocarpine
• Timoptic XE delivering timolol
• Ganciclovir sustained-release
intraocular device
• Collagen shields
74. 74
Antibiotics
• Used topically in prophylaxis (pre and
postoperatively) and treatment of ocular
bacterial infections.
• Used orally for the treatment of
preseptal cellulitis
e.g. amoxycillin with clavulonate,
cefaclor
• Used intravenously for the treatment of
orbital cellulitis
e.g. gentamicin, cephalosporin,
vancomycin, flagyl
• Can be injected intravitrally for the
treatment of endophthalmitis
75. 75
• Specific antibiotic for almost each organisms
• Sulfonamiodes- Chlamydial infections like TRACHOMA
INCLUSION CONJUNCTIVITIS
TOXOPLAMOSIS
Bacterial cell wall syntheis inhibitors-
Penicillin
Cephalosporins
I) first generation- gm + cocci eg cephazolone
ii) second generation —Gm – ve and antistaphylococcal—
cefuroxime
iii) Third generation– Gm –ve bacilli --ceftriaxones
76. 76
• Side effects- allergic reaction
neutropenia
thrombocytopenia
Amino glycosides
mainly against gm negative bacilli
Bacterial protein synthesis inhibitors
Gentamycin—0.3% eye drop
Tobramycin- Pseudomonas 1% eye drop
Neomycin—0.3-0.5% eye drop
77. 77
Tetracycline
• Inhibit protein synthesis
• active against both gm+ and gm -, some fungi and Chlamydia
Chloromphenicol
• Broad spectrum ,bacteriostatic, gm+/gm-, Chlamydia
• 0.5% Eye drop, ointment
COMMONLY KNOWN AS JUKE MALAM
78. 78
Antibiotics
• Trachoma can be treated by topical and
systemic tetracycline or erythromycin, or
systemic azithromycin.
• Bacterial keratitis (bacterial corneal ulcers)
can be treated by topical fortified penicillins,
cephalosporins, aminoglycosides, vancomycin,
or fluoroquinolones.
• Bacterial conjunctivitis is usually self limited
but topical erythromycin, aminoglycosides,
fluoroquinolones, or chloramphenicol can be
used
79. 79
Antivirals • Acyclovir
3% oinment 5 times-10-14 days
800mg oral 5 times 10-14 days
intravenous for Herpes zoster retinitis
• Others
Idoxuridine
Vidarabine
Cytarabine
Triflurothymidine
Gancyclovir
INDICATIONS
HZ keratitis
Viral uveitis
80. 80
ANTIFUNGAL
INDICATIONS
Fungal corneal ulcer
Fungal retinitis/ Endophthalmitis
Commonly used drugs are
• Polyenes
• Damage cell membrane of susceptible fungi
• e.g. amphotericin B, natamycin, nystatin
• side effect: nephrotoxicity
• Imidazoles
• Increase fungal cell membrane permeability
• e.g. miconazole, ketoconazole,fluconazile
• Flucytocine
• Act by inhibiting DNA synthesis
81. 81
Mydriatics and cycloplegics
• Dilate the pupil, ciliary muscle paralysis
• CLASSIFICATION
Short acting- Tropicamide (4-6 hours)
Intermediate- Homatropine ( 24 hours)
Long acting- Atropine (2 weeks)
Indications
corneal ulcer
uveitis
cycloplegic refraction
83. 83
Carbonic anhydrase inhibitors
Systemic Topical
Acetazoamide Dorzolamide
Brinzolamide
Mechanism of action---- Reduce aqueous humor formation
Side effect
Paresthesiae
Frequent urination
GI disturbances
Hypokalamia
84. 84
Hyperosmotic agent--- iv mannitol
when IOP is very high 60-70
Prostaglandins
Latanoprost (0.005% eye drop) increased aqueous out flow
Reduced IOP
Side effect– conjunctival redness, iris and periocular pigmentation
hypertrichosis, darkening of iris
87. 87
Indications
Topical
allergic conjunctivitis,
scleritis,
uveitis,
allergic keratitis
after intraocular and extra ocular surgeries
Systemic (pathology behind the LENS)
Posterior uveitis
Optic neuritis
corneal graft rejection
NEVER GIVE STEROID IF YOU ARE SUSPECTING ACTIVE INFECTION
Side effects
OCULAR
Glaucoma
Cataract
Activation of infection
Delayed wound healing
SYSTEMIC
Peptic ulcer
Hypertension
Increased blood sugar
Osteoporosis
Mental changes
Activation of tuberculosis and
other infections
90. 90
Ocular Lubricants
• Indication
ocular irritations in various diseases
Dry eyes
Commonly available commercial tear substitutes
REFRESH TEARS
TEAR PLUS
MOISOL
OCCUWET
DUDROP
91. 91
Ocular diagnostic drugs
• Fluorescein dye
• Available as drops or strips
• Uses: stain corneal abrasions,
applanation tonometry, detecting
wound leak, NLD obstruction,
fluorescein angiography
• Caution:
• stains soft contact lens
• Fluorescein drops can be
contaminated by Pseudomonas sp.
92. 92
Ocular diagnostic drugs
• Rose bengal stain
• Stains devitalized epithelium
• Uses: severe dry eye, herpetic keratitis
93. 93
Local anesthetics
• Topical
• E.g. propacaine, tetracaine
• Uses: applanation tonometry, goniscopy, removal of corneal
foreign bodies, removal of sutures, examination of patients who
cannot open eyes because of pain
• Adverse effects: toxic to corneal epithelium, allergic reaction rarely
94. 94
Local anesthetics
• Orbital infiltration
• Peribulbar or retrobulbar
• Cause anesthesia and akinesia for
intraocular surgery
• e.g. lidocaine, bupivacaine
96. 96
Complications of topical administration
• Mechanical injury from the bottle
e.g. corneal abrasion
• Pigmentation: epinephrine-
adrenochrome
• Ocular damage: e.g. topical
anesthetics, benzylkonium
• Hypersensitivity: e.g. atropine,
neomycin, gentamicin
• Systemic effect: topical
phenylephrine can increase BP
97. 97
Amiodarone
• A cardiac arrhythmia drug
• Causes optic neuropathy (mild decreased vision, visual field defects,
bilateral optic disc swelling)
• Also causes corneal vortex keratopathy (corneal verticillata) which is
whorl-shaped pigmented deposits in the corneal epithelium
98. 98
Digitalis
• A cardiac failure drug
• Causes chromatopsia (objects appear yellow) with overdose
99. 99
Chloroquines
• E.g. chloroquine,
hydroxychloroquine
• Used in malaria, rheumatoid
arthritis, SLE
• Cause vortex keratopathy (corneal
verticillata) which is usually
asymptomatic but can present with
glare and photophobia
• Also cause retinopathy (bull’s eye
maculopathy)
100. 100
Chorpromazine
• A psychiatric drug
• Causes corneal punctate epithelial opacities, lens surface opacities
• Rarely symptomatic
• Reversible with drug discontinuation
102. 102
Ethambutol
• An anti-TB drug
• Causes a dose-related optic neuropathy
• Usually reversible but occasionally permanent visual damage
might occur
103. References
1. Dr. P.K. Panwar, Essentials of pharmacology for nurses, AITBS pub. 2017,
India, Pg no. 85 – 79.
2. Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics for
nurses, Jaypee pub. 2016 India Pg no 253 – 255.
3. Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for
undergraduate, Elsevier pub. 2014. Pg no. 490 – 492.
4. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barlet
pub 2010 India, Pg no 194-201.
5. Govind s. mittal, Pharmacology at a glance, Paras medical book pub. 2009
India 51 – 56.
6. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India
1st edition, Pg no 240.