Pharm7e-Ch05-Presentation

[Audio] Welcome to the Pharmacology for Technicians Seventh Edition Watch and Learn Lessons..

[Audio] Chapter 5, The Integumentary System and Drug Therapy.

[Audio] In the anatomy and physiology section of this chapter, you will learn about the skin as an organ and the physiology of the skin. Throughout this chapter, you will learn about the classes of topical drugs and the skin conditions they treat. You will learn about the action of topical treatments and their application. In the last section, you will develop an understanding of the actions of antiseptics and disinfectants..

[Audio] Chapter 5, Section 1, Anatomy and Physiology of the Integumentary System.

[Audio] The integumentary system is composed of the tissue that covers the body, including the skin, nails, and hair. It serves an important role in protecting the body from exposure to harmful pathogens and harsh substances. It is also the main organ that regulates body temperature. The skin is the largest organ in the body and deals with microbial, chemical, and physical assaults on the body. Even if skin defects do not pose a hazard to overall health, correction of skin defects may aid the psychological well-being of the affected person..

[Audio] Figure 5.1, shown here, illustrates the anatomy of the skin. The epidermis is the top layer of the skin. It continually forms new cells. The dermis is found below the epidermis. Two types of glands are widely distributed in the dermis: sebaceous glands and sweat glands. A sebaceous gland secretes sebum, a substance that oils the skin and hair, preventing them from drying. Most sebaceous glands develop from hair follicles and empty their secretions into the follicles. A sweat gland produces sweat, which is made up of mostly water and salts. The subcutaneous tissue is the innermost layer of the skin and connects the dermis to underlying organs and tissues. This layer is composed of elastic fibers and a layer of fat cells, called adipose tissue..

[Audio] Chapter 5, Section 2, Sun Exposure and Drug Treatments.

[Audio] Many people consider sun exposure and the resulting suntan attractive. Unfortunately, the rays of the sun that produce suntans are also very damaging to skin. The rays responsible are ultraviolet radiation and can cause skin cancer. Ultraviolet A is referred to as the suntan region while ultraviolet B is known as the sunburn region. The best ways to prevent sun-damaged skin are to avoid sun exposure and to protect the skin with sunscreen. An effective sunscreen must have a sun protection factor or SPF of at least 30 and protect against both UVA and UVB rays..

[Audio] Although cancer treatments are covered in Chapter 20, it is necessary to understand the relationship between sun exposure and skin cancer. For all people with skin cancer, tumor growth is more common in areas of the body that are regularly exposed to the sun than in areas that are normally covered or shaded. The following are several categories of skin cancer. Actinic keratosis is a precancerous condition resulting from overexposure to sunlight. Basal cell carcinoma is a slow-growing tumor that rarely metastasizes. Malignant melanoma is a highly malignant cancer that forms from melanocytes. Sunburn greatly increases the risk of this skin disorder. Squamous cell carcinoma is a type of cancer that grows more rapidly than basal cell carcinoma. The cells tend to keratinize, and metastasis is uncommon..

[Audio] Photosensitivity is an abnormal sensitivity to light that can be caused by certain drugs. Photosensitivity increases the risk of sunburn or blistering with sun exposure. Among the drug classes associated with it are ACE inhibitors, antibiotics, antidepressants, antihistamines, antipsychotics, cardiovascular drugs, chemotherapeutic agents, diuretics, diabetes agents, and NSAIDs. As a pharmacy technician, it will be important for you to watch for computer prompts to know whether a drug needs a photosensitivity warning sticker..

[Audio] Pharmacologic treatment can help improve the condition of skin that has been overexposed to the sun. Benzocaine provides temporary relief from sunburn pain. It is available in various topical dosage forms. Benzocaine is associated with methemoglobinemia, a disorder in which an abnormal form of hemoglobin is produced. For this reason, benzocaine is not recommended in patients less than two years old. Hydrocortisone is used for severe sunburn. It decreases inflammation, accelerates healing, and relieves pain. It comes in a variety of topical dosage forms. Topical hydrocortisone may result in allergic contact dermatitis and local sensitization..

[Audio] Lidocaine provides temporary relief from sunburn pain and is available in various topical dosage forms. Silver sulfadiazine is a topical antiseptic that can be used to prevent infection in serious burns. It is only available in cream form. Patients who are allergic to sulfonamides can have an allergic reaction to silver sulfadiazine, so careful consideration must be given before its use. Because of the risk of tissue necrosis in the area of application, careful wound care and monitoring are necessary. Silver sulfadiazine does not protect against fungal organisms, so wounds treated with it should be monitored for development of fungal infection..

[Audio] Chapter 5, Section 3, Acne, Wrinkles, Rosacea, and Drug Treatments.

[Audio] In the United States, acne is the most common skin condition for which drug therapy is sought. Acne is initiated by the overproduction of sebum, which is produced by sebaceous glands around hair follicles. Such overproduction is most often stimulated by the hormonal changes encountered during puberty. As pores and follicles become clogged with oily material, dead skin cells, and dirt from the skin's surface, pimples appear. A pimple can either be an open clogged pore, known as a blackhead, or a closed clogged pore, known as a whitehead. Scars and pockmarks result from deep cysts in nodular acne and acne vulgaris..

[Audio] A wrinkle is a line or crease in the skin. They usually occur on parts of the body that receive the most sun exposure. Other factors that can promote wrinkling include smoking, lighter skin, and genetics. Rosacea is a chronic inflammatory disorder seen in adults. It presents as redness, visible blood vessels at the skin's surface, and raised bumps or pustules on the face and cheeks. It is triggered by stress, temperature, hot drinks, exercise, spicy food, alcohol, and irritating topical products. Sunlight is a major exacerbating factor for rosacea..

[Audio] First-line treatment for mild to moderate acne is to cleanse the affected area twice daily. Although this cleansing will not eliminate acne, it can help prevent new pimples from forming. OTC products such as benzoyl peroxide are used to treat repeated acne lesions. For moderate to severe acne, treatment involves prescription topical agents progressing to oral agents, including antibiotics, when needed. Wrinkles are typically treated with retinoids. When starting treatment for rosacea, the patient's specific triggers should be identified and avoided. Antibiotics are used to treat the symptoms of rosacea..

[Audio] Azelaic acid and benzoyl peroxide are topical agents used alone for mild acne and in combination with oral agents for moderate to severe acne. Their side effects include dryness, redness, burning, and flaking or peeling of the skin. These products are for external use only and some products are flammable..

[Audio] Clindamycin, dapsone, and erythromycin are topical drug products used to treat acne. Similar to azelaic acid and benzoyl peroxide, these products are for external use only and some are flammable. Metronidazole is available as a topical antibiotic for the treatment of rosacea..

[Audio] A retinoid is a vitamin A derivative. It works by increasing cell turnover in follicles, which pushes clogged material out of the pores. In acne, retinoids alter cell development and inflammatory processes to reduce swelling and redness. Adapalene is a retinoid for acne treatment available in several topical dosage forms. Its side effects include burning, dry skin, itching, peeling, and redness. Important considerations for its use it that is not to be used on infected, red, or irritated skin or applied close to the eyes or mouth. Isotretinoin is a treatment of last resort for severe acne. It is given orally. Isotretinoin has several serious side effects including depression, psychosis, pancreatitis, high triglyceride levels, and hepatotoxicity. Isotretinoin is a known teratogen, which means it causes birth defects. The FDA mandates that patients may only use isotretinoin if they participate in a REMS program called iPLEDGE. Patients of all genders must sign an agreement to use birth control, and patients who have or might have the ability to become pregnant must undergo pregnancy testing while receiving isotretinoin..

[Audio] Tazarotene is used topically for acne and psoriasis. Its side effects include burning, dry skin, itching, peeling, and redness. Tazarotene is not to be used on infected, red, or irritated skin or applied close to the eyes or mouth. Tretinoin is used topically for acne, photodamaged skin, and some skin cancers. Its side effects and considerations are the same as those of tazarotene..

[Audio] There are several miscellaneous products used for acne or rosacea. Brimonidine is applied as a gel for the treatment of rosacea. It decreases the redness by causing constriction of blood vessels. Considerations with the use of this product are its potential for worsening of erythema. In addition, it is associated with cardiac and respiratory problems if ingested. Salicylic acid is used for mild acne. It is a keratolytic agent, meaning that it breaks down and peels off dead skin cells, preventing them from clogging pores. Its main side effect is skin irritation..

[Audio] The combination of sodium sulfacetamide and sulfur is used topically for acne treatment. Similar to the other miscellaneous agents, skin irritation is its main side effect..

[Audio] Chapter 5, Section 4, Dermatitis, Eczema, Psoriasis, Dandruff, and Drug Treatments.

[Audio] Dermatitis is a pruritic skin inflammation that can be caused by a variety of factors. Symptoms range from areas of redness and dryness to severe cases involving blistering and oozing erosions. Types of dermatitis include contact dermatitis, seborrheic dermatitis, diaper rash, and atopic dermatitis..

[Audio] Contact dermatitis occurs in response to irritants or allergenic substances such as soaps, detergents, poison ivy, and poison oak. It presents as rash, redness, itching, and blisters. Seborrheic dermatitis or cradle cap usually occurs in infants. It presents as a greasy, scaly area that appears red, brown, or yellow on the scalp, ears, upper trunk, eyebrows, or nose. In adults who grow beards, seborrheic dermatitis can occur in the beard area. Diaper rash is an acute and easily treated condition that occurs most frequently in children who are not yet toilet trained. When skin remains wet, it breaks down allowing surface bacteria to enter deeper tissues. This results in skin irritation and redness. Atopic dermatitis or eczema is a chronic condition characterized by periods of severe symptoms alternating with period of remission. Triggers include stress, exposure to skin irritants, and food allergies. Eczema presents as dry, flaky, red, and itchy skin..

[Audio] Psoriasis is an immunologic condition of the skin. Its symptoms include raised, silvery or white, flaky, and pruritic patches that can appear anywhere on the body. Like eczema, psoriasis is characterized by periods of exacerbation cycled with periods of remission. Psoriasis can be triggered by stress and environmental factors. Dandruff is a malfunction of the oil-producing glands on the scalp accompanied by overproduction of epidermis cells. This results in layers of epidermis sticking together and flaking off as they dry. Dandruff appears as specks of skin in the hair and on the scalp..

[Audio] Corticosteroids are usually first-line therapy for dermatitis and eczema. Therapy starts with topical medications but may progress to oral corticosteroids if severe. Seborrheic dermatitis can be treated with attention to good hygiene and topical antihistamines, anti-inflammatory agents, and moisturizing creams. Eczema treatment involves constant maintenance of skin with moisturizers to prevent exacerbations, along with topical corticosteroids for flare-ups. If the affected skin becomes infected, topical antibiotics may be used. Psoriasis can be difficult to treat and does not always respond well to drug therapy. As is the case for dermatitis and eczema, corticosteroids are the first-line treatment for psoriasis. Immunosuppressants and immunomodulators are sometimes required..

[Audio] Corticosteroid products vary in potency. This graphic categorizes the topical corticosteroids in terms of their relative potency. See Table 5.5 for brand names, dosage forms, and dispensing status of all the medications in this graphic..

[Audio] Topical corticosteroids are anti-inflammatory agents that inhibit redness, swelling, itching, and pain in the dermal layer of the skin. They are used in contact dermatitis, eczema, psoriasis, and allergic reactions. The side effects most commonly seen are burning, itching, dryness, excessive hair growth, dermatitis, acne, hypopigmentation, and thinning of the skin. There are several important considerations to keep in mind with the use of these drugs. Occlusive wound dressings should not be applied over these products. When using the very high potency products, the length of treatment or the amount used should be restricted. In addition, topical corticosteroids should not be applied near the eyes or mucous membranes..

[Audio] The calcineurin inhibitors, pimecrolimus and tacrolimus, inhibit T-cell activation which prevents release of chemical mediators that promote inflammation. They are applied topically for the treatment of eczema. Common side effects include burning, itching, tingling, acne, and redness at the application site. Systemic side effects include headache, muscle aches, sinusitis, and flu-like symptoms. Cautions with the use of calcineurin inhibitors are that these drugs have been associated with an increased occurrence of cancer. As well, there is the potential for alcohol intolerance when taking these products. This is manifested by facial flushing when drinking alcohol..

[Audio] Calcipotriene is a Vitamin D analog used in psoriasis to regulate the growth and development of skin cells. It is available is several topical dosage forms. Common side effects include burning, itching, and redness. Less common side effects include inflamed hair follicles, skin irritation, change in local skin color at site of application, and thinning of the skin. Calcipotriene can cause alterations in calcium metabolism. It should be used with caution in patients with a history of high calcium levels such those who have had kidney stones..

[Audio] Calamine provides a counterirritant action that involves evaporation and cooling. These sensations soothe itchy skin. It is applied as a lotion to relieve itching from insect bites, rashes, hives, and poison ivy or poison oak. If itching and rash are not relieved within a few days, the patient should seek attention from a healthcare practitioner..

[Audio] The most common ingredients in OTC dandruff products are selenium sulfide and pyrithione zinc. These products slow cell and oil production which results in reduced flaking. They also have antipruritic properties which reduce itching. Side effects associated with these products include contact dermatitis, photosensitivity, and aggravation of preexisting skin conditions such as acne or psoriasis. If dandruff and scalp itching continue despite repeated use, the patient should be advised to seek medical advice..

[Audio] Chapter 5, Section 5, Skin Infections and Drug Treatments.

[Audio] Skin infections are common and can be caused by a bacteria, fungus, or a virus. In many cases, skin infections can be treated topically. In rare circumstances and severe infection, oral drugs may be needed. Bacterial skin infections most frequently involve Staphylococcus aureus which becomes harmful if overgrown or if introduced internally. There are several bacterial skin infections to be aware of. Impetigo is a superficial, highly contagious infection common in early childhood. Erysipelas is a form of cellulitis which spreads rapidly through the skin. Folliculitis is the inflammation of a hair follicle in which the surrounding tissue is not affected. A furuncle or boil results from the inflammation of a sebaceous gland and hair follicle. It is more extensive and deep than folliculitis. A carbuncle is a coalescent mass of infected follicles. It is deeper than a furuncle..

[Audio] Bacterial infections can be treated with topical products and systemic therapies. The combination of bacitracin, neomycin, and polymyxin B is used as an ointment to prevent or treat minor skin infections. It can cause burning, itching, dryness, tenderness, and swelling of the affected area. Considerations with the use of this combination is that it is for external use only, should not be applied near eyes and other mucous membranes, and should not be applied over large areas of skin. Mupirocin and retapamulin are both used topically for treatment of impetigo. Their side effects and cautions are the same as those of the bacitracin, neomycin, and polymyxin B combination. Erythromycin and metronidazole, which were discussed in section 5.3, may also be used for bacterial skin infections..

[Audio] Skin, mucous membranes, and nails are susceptible to various fungal infections. One type of fungus infection is called candidiasis. It is caused by the fungus Candida albicans. Candida lesions in the vagina are called vaginal infections while lesions in the mouth are called thrush. Tinea infections are another type of fungal infection that can affect the skin and nails. Tinea causes ringworm, an infection that spreads outward as the center heals. Another name for ringworm is tinea corporis. Tinea pedis is known as athlete's foot while tinea cruris is known as jock itch..

[Audio] Tinea infections respond well to butenafine and terbinafine because these antifungals are fungicidal. They kill the fungus. The other antifungal agents are fungistatic meaning that they slow or stop fungal growth but don't kill the fungus. Butenafine and terbinafine are used for tinea infections. Ciclopirox is an effective agent for nail infections. Clotrimazole can be used for either tinea or candida infections. The main side effects of these agents are local irritation and stinging. It is recommended to discontinue them if sensitivity or skin irritation occurs..

[Audio] Ketoconazole can be used for seborrheic dermatitis or for fungal infections of the scalp. Miconazole is used for candidiasis skin infections and vaginal infections. The main side effects of these agents are local irritation and stinging. They should be discontinued if sensitivity or skin irritation occurs..

[Audio] Sertoconazole can be used for tinea infections such as ringworm or athlete's foot. Similar to the other antifungal agents, its main side effects are local irritation and stinging. Tolnaftate is an OTC drug recommended for jock itch. It is available in a variety of dosage forms including a powder. The main side effects of tolnaftate are pruritis, contact dermatitis, irritation, and stinging. It should be discontinued if sensitivity or skin irritation occurs..

[Audio] Viral infections can cause several skin disorders, including herpes labialis, also known as cold sores, and warts. Herpes simplex virus is associated with painful dermatitis and blisters. HSV type 1 is associated with cold sores while HSV type 2 is associated with genital infection. A wart is an epidermal tumor caused by a virus. The virus may lie dormant and later cause reinfection..

[Audio] Topical treatment of HSV is palliative; it affords relief but does not cure the infection. Some antivirals such as oral acyclovir may prevent recurrent outbreaks. The key to this effect is that it must be initiated early enough. Warts can be removed by surgery or destroyed by local freezing. Some OTC products may be effective if the wart is small. Most agents contain salicylic acid as an active ingredient. Acyclovir is used for genital herpes, cold sores, and mucocutaneous HSV. When used for cold sores, it is most effective when administered at the fist sign of an outbreak. It is available in topical forms as well as a buccal tablet. The side effects of topical acyclovir include dryness and flaking of skin, burning, stinging, and itching. Docosanol is an OTC topical medication used to treat cold sores. Similar to acyclovir, it is most effective when administered at the first sign of an outbreak. Its side effect profile is similar to that of acyclovir..

[Audio] Chapter 5, Section 6, External Parasites and Drug Treatments.

[Audio] Two common types of external parasites use the human body as a host: scabies and lice. This table provides a side-by-side comparison of the two parasites. Scabies are classified as mites. They spend part of their life cycle on the skin surface and part burrowed within the skin. Scabies mites feed on skin and intracellular fluid. An infected patient experiences an intense itching that worsens at night. Scabies lesions appear as light-gray, threadlike burrows that are thin, wavy, and slightly elevated. Lice, on the other hand, are wingless insects. Their entire life cycle is spent on the skin's surface, and their only source of nourishment is blood. The only symptom of a lice infestation is itching. Lice are best seen by shining a bright light on scalp. This allows for better detection of the white nits or eggs..

[Audio] Three types of lice can infest humans: body lice, head lice, and pubic lice. Body lice live on clothing and moist areas of the body. They can be treated by removing clothing, bathing, and putting on clean bedding and clothes. Head lice live on the scalp and in the hair. The female louse has a life span of 40 days and lays about 10 nits per day. The nits stick to the hair close to the scalp taking advantage of body heat. They hatch in 8 days. Some OTC medications only treat adult lice and cannot kill the nits. Treatment with these medications must be repeated. Nits cannot be shaken off and must be removed with a de-lousing comb. Pubic lice live in the pubic area and are eliminated by applying a topical treatment..

[Audio] Ivermectin is a prescription-only topical product used for head lice. It can also be used for inflammatory lesions of rosacea. Its side effects include skin irritation, rash, dry skin, dandruff, and eye irritation. It is to be used on the scalp and hair only. Permethrin is available OTC and is applied topically to treat head lice and scabies. Its main side effect is skin irritation. It may cause headache, diarrhea, dizziness, and nausea or vomiting. Pyrethrin is available OTC and is applied topically for head lice treatment. Like the other agents in this class, it can cause skin or eye irritation. Pyrethrin is to be used cautiously in ragweed allergies and has the potential to cause serious allergic reactions..

[Audio] Instructions to the patient vary with the type of lice infestation. For body lice the patient should shower or bathe, and apply 20 to 30 grams of cream or lotion to the whole body from the neck down. The patient should wash it off in 24 hours and repeat in one week. For head lice the patient should massage 2 ounces or less of cream or lotion into premoistened hair for four minutes, and then rinse it out. The patient should repeat after one week to eliminate eggs. For pubic lice the patient should apply a thin layer of cream or lotion that extends to the thighs, trunk, pubic region, and armpits. The patient should wash it off within 24 hours and repeat in one week. For both head and pubic lice, it is important to comb the hair with a clean, fine-tooth comb for at least eight days to ensure that all nits and adult lice are removed..

[Audio] Chapter 5, Section 7, Antiseptics and Disinfectants.

[Audio] Antiseptics and disinfectants have two uses. They can be used to disinfect instruments and to treat accessible infections in the oral cavity and on body surfaces. Disinfectants kill bacteria. The most desirable property of a disinfectant is its ability to destroy microorganisms rapidly and completely. There is no single disinfectant effective against all types of organisms. Aesthetic factors such as odor, taste, and staining quality influence disinfectant selection. Antiseptics, on the other hand, prevent bacterial growth and do not kill bacteria..

[Audio] A variety of agents serve as antiseptics and disinfectants. Benzalkonium chloride is used as a preoperative skin disinfectant and for the storage of instruments and hospital utensils. Hydrogen peroxide is a disinfectant used to prepare dental surfaces before fillings and to clean wounds. Isopropyl alcohol kills some bacteria. It can be used on cuts, abrasions, and wounds but will produce a marked stinging action. To be effective, alcohol must dry and be left on the wound for at least two minutes. Povidone-iodine is an effective disinfectant and can be applied to open wounds causing little discomfort. Sodium hypochlorite disinfects and deodorizes by killing most germs and their odors. It is a common household cleaning and laundry product. Zinc oxide is a mild antiseptic used for skin disorders such as diaper rash. It is an ingredient in calamine lotion. It is combined with a petroleum jelly and a waxy lanolin base for use in treating diaper rash and other minor skin irritations..

[Audio] Unlike the disinfectants used on the skin outlined so far, the following antiseptics can be used in the mouth. The oral cavity is very difficult to disinfect. Very few drugs adhere to the mucosal lining long enough to overcome bacteria or ease pain. Benzocaine is a local anesthetic that forms a protective barrier over the mucous membrane in the mouth. The patient should not eat for an hour after benzocaine is applied. Carbamide peroxide inhibits odor-forming bacteria in the mouth and provides pain relief in periodontal pockets, oral ulcers, and dental sores. It is also used to emulsify and disperse earwax. Chlorhexidine gluconate is a skin cleanser used for surgical scrubbing, skin wounds, germicidal hand rinsing, and antibacterial dental rinsing..

[Audio] Chapter 5, Section 8, Complementary and Alternative Therapies.

[Audio] Aloe gel has soothing and wound-healing properties. It may speed the healing of burns and sun overexposure. Aloe gel has antibacterial and antifungal properties. It is especially soothing when combined with lidocaine. Clove oil is an antiseptic used in dentistry. It can be mixed with zinc oxide or zinc acetate and used for temporary fillings and cements..