28 - 196 - OTHER TOPICAL MEDICATIONS Flashcards
What is activated after initial topical application of capsaicin?
transient receptor potential vanilloid-1
What is depleted after repeated topical application of capsaicin?
Repeated application depletes** substance P** from cutaneous nerve endings and leads to desensitization of epidermal nerve fibers, thereby producing hypoalgesia
What are the chief side effects of capsaicin?
irritation and an intense burning sensation
what dows EMLA contain
lidocaine 2.5% and prilocaine 2.5%
EMLA can provide local anesthesia that may persist for up to how many hours
2 hours
This component of EMLA has been linked to cases of methemoglobinemia in patients for whom applications exceeded the recommended dose, application area, or application time
Prilocaine
What is the pregnancy category of EMLA?
pregnancy category B drug
T/F. EMLA is ototoxic
True
it should not be used if there is a concern that it could penetrate or migrate beyond the tympanic membrane to the middle ear
This cream may cause transient local blanching followed by transient local erythema.
EMLA
What is the pregnancy category of lidocaine?
B
works by activating the aryl hydrocarbon receptor, which results in induction of epidermal differentiation
Coal tar
Coal tar also counteracts T-helper type-2 cytokine-mediated downregulation of skin barrier protein
most commonly derived from** juniper (oil of cade)**
may be derived from beech, birch, and pine
Wood Tar
Derived from a sulfur-rich sedimentary rock
Shale oil (also referred to as ammonium bituminosulfonate, ichthyol, ichthammol, or black salve)
Shale oil decreases inflammation by inhibiting what?
leukotriene B4 lipoxygenase
reduces skin inflammation by inhibiting** phosphodiesterase 4**
Crisaborole
Chlorhexidine has residual activity for longer than how many hours, even when wiped from the field?
6 hours
Because of ototoxicity and the risk of conjunctivitis and corneal ulceration, this antiinfective is not recommended for preoperative preparation of the face or head
chlorhexidine
This antiinfective is a known contact sensitizer and may cause skin necrosis in concentrations greater than 2% aqueous solution or when used undiluted in skin folds
Gentian violet
MOA
(1) Binds to negatively charged bacterial cell wall and cytoplasmic components leading to altered osmotic equilibrium
(2) Precipitation of cytoplasmic components
Chlorhexidine
What are the major side effects or contraindications of chlorhexidine
Keratitis, ototoxicity
antimicrobial spectrum of chlorhexidine
Gram-positive, Gram-negative bacteria, enveloped viruses, and fungi
Although it does NOT kill bacterial spores or mycobacteria, it does inhibit their growth.
Pregnancy category of chlorhexidine
B
What are the side effects of gential violet?
Potential skin necrosis at high concentrations or when occluded; stains skin and clothing; tattooing when applied over granulation tissue; mutagenic
Avoid in abscesses; bleaches hair
Hydrogen peroxide
antimicrobial coverage of povidone iodine
Gram-positive, Gram-negative, enveloped viruses, fungi, sporicidal, Mycobacterium tuberculosis
AE: Possible irreversible optic atrophy and peripheral neuropathy (oral); contraindicated in children <2 years of age; contraindicated for diaper rash; stains skin yellow; neutralized by blood, serum proteins, and sputum
Clioquinol
Metronidazole is contraindicated during what trimester of pregnancy?
1st trimester
Has coverage against anaerobes, protozoa and microaerophilic bacteria
Metronidazole
this antiinfective belongs to the Fermentation product of Pseudomonas fluorescens
Mupirocin
what is the MOA of mupirocin
Inhibits bacterial isoleucyl-tRNA synthetase
what is the antimicrobial spectrum of mupirocin
G (+), some G (-), SPARES the normal flora
Pregnancy category of gentian violet
C
Pregnancy category of povidone iodine
C
Pregnancy category of metronidazole
B
Pregnancy category of mupirocin
B
Pregnancy category of retapamulin
B
Pregnancy category of azelaic acid
B
Pregnancy category of benzoyl peroxide
C
Pregnancy category of silver nitrate
C
MOA of retapamulin
Inhibits 50S subunit of prokaryotic ribosome
coverage of retapamulin
Gram-positive
antimicrobial coverage of azelaic acid
Propionibacterium acnes and Staphylococcus epidermidis
can cause Black skin discoloration, caustic at high concentrations; potential methemoglobinemia
Silver nitrate
T/F. Iodophors (povidone iodine and clioquinol) must be applied to dry skin as they are inactivated by contact with blood and sputum.
True
product labeling still warns of possible irreversible optic atrophy and peripheral neuromuscular disease
CLIOQUINOL
T/F. Mupirocin also has some coverage against pseudomonas
False
It has activity against staphylococci, streptococci, and certain Gram-negative bacteria, but is not effective against Pseudomonas and is inactive against much of the normal skin flora. I
. It is effective against certain Gram-positive bacteria and is approved by the U.S. Food and Drug Administration (FDA) for the treatment of methicillin-sensitive S. aureus and Streptococcus pyogenes.
RETAPAMULIN
MOA of permethrin
Inhibits nerve cell sodium ion influx
permethrin is contraindicated in what age?
< 2 months
MOA: Binding to glutamate- and γ-aminobutyric acid–gated chloride ion channels
Ivermectin
Pregnancy category of permethrin
B
Pregnancy category of Ivermectin
C
Pregnancy category of Malathion
B
Pregnancy category of crotamiton
C
Pregnancy category of lindane
C
Itching and stinging on application;
ragweed or chrysanthemum allergy
Synergized pyrethrins
This topical antipirasitic is flammable and not approved for children < 6 years of age
Malathion
Malathion is not approved at what age?
<6 years of age
these topical antiparitic are cholinesterase inhibitors
Malathion and lindane
side effects or contraindications of lindane
May cause seizures, muscle spasms, aplastic anemia; not for use in children <3 years of age, pregnant or breastfeeding women, patients with underlying neurologic disorders, or over broken skin
lindane is not approved for children less than how many years old?
< 3 years of age
MOA: Generalized CNS excitation leading to paralysis
Spinosad
which topical antiparasitic is based on Chrysanthemum cinerariifolium
PERMETHRIN
Aluminum chloride solutions are typically used as a first-line therapy for hyperhidrosis in____ solutions in the axilla and up to ___% on the palms and soles.
15% to 20% - axilla
30% - palms and soles
MOA of aluminum chloride
Aluminum chloride is thought to work though obstructing the distal portion of eccrine sweat gland ducts.
How do you apply aluminum chloride
The solution is applied topically for 1 week at night, when eccrine glands are less active, and if tolerated up to twice daily.
After control is achieved, it can be applied every 1 to 3 weeks as maintenance therapy.
Doxepin is a tricyclic antidepressant that is a potent antagonist of what receptors
histamine H1and histamine H2 receptors
MOA: Counter irritant. Cooling sensation in the skin via transient receptor potential melastatin 8 (TRPM8) receptors in the skin
Menthol
agents that cause contraction or shrinking of the tissues, arrest of secretion, or control of bleeding
ASTRINGENTS
This agent may cause permanent staining of clothing and ceramics and temporary brown or bright purple staining of the skin, which may be removed with a weak solution of oxalic acid or sodium thiosulfate.
POTASSIUM PERMANGANATE
methemoglobinemia has been noted secondary to topical treatment of this astringent
SILVER NITRATE
causes irreversible depigmentation by causing melanocyte necrosis
MONOBENZYL ETHER OF HYDROQUINONE
a humectant, occlusive, and keratolytic agent
PROPYLENE GLYCOL
SSA concentrations of how many percent does it cause shedding of scales by softening the stratum corneum, dissolving the intracellular matrix, and loosening connections between corneocytes
3% to 6%
In concentrations higher than ____ salicylic acid is destructive to tissue.
6%,
Salicylism has been reported with widespread and prolonged use, especially in children, who should apply no more than ___ (___mL of a ___% solution) to their skin in a 24-hour period.
2 g (33 mL of a 6% solution)
Hypercalcemia may occur if more than how many grams of calcipotriene is used per week?
100g
