28 - 196 - OTHER TOPICAL MEDICATIONS Flashcards by Sharmaine Lozano

What is activated after initial topical application of capsaicin?

transient receptor potential vanilloid-1

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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

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What are the chief side effects of capsaicin?

irritation and an intense burning sensation

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what dows EMLA contain

lidocaine 2.5% and prilocaine 2.5%

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EMLA can provide local anesthesia that may persist for up to how many hours

2 hours

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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

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What is the pregnancy category of EMLA?

pregnancy category B drug

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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

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This cream may cause transient local blanching followed by transient local erythema.

EMLA

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What is the pregnancy category of lidocaine?

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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

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most commonly derived from** juniper (oil of cade)**

may be derived from beech, birch, and pine

Wood Tar

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Derived from a sulfur-rich sedimentary rock

Shale oil (also referred to as ammonium bituminosulfonate, ichthyol, ichthammol, or black salve)

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Shale oil decreases inflammation by inhibiting what?

leukotriene B4 lipoxygenase

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reduces skin inflammation by inhibiting** phosphodiesterase 4**

Crisaborole

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Chlorhexidine has residual activity for longer than how many hours, even when wiped from the field?

6 hours

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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

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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

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MOA

(1) Binds to negatively charged bacterial cell wall and cytoplasmic components leading to altered osmotic equilibrium

(2) Precipitation of cytoplasmic components

Chlorhexidine

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What are the major side effects or contraindications of chlorhexidine

Keratitis, ototoxicity

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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.

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Pregnancy category of chlorhexidine

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What are the side effects of gentian violet?

Potential skin necrosis at high concentrations or when occluded; stains skin and clothing; tattooing when applied over granulation tissue; mutagenic

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Avoid in abscesses; bleaches hair

Hydrogen peroxide

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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

Pregnancy category of povidone iodine

Pregnancy category of metronidazole

Pregnancy category of mupirocin

Pregnancy category of retapamulin

Pregnancy category of azelaic acid

Pregnancy category of benzoyl peroxide

Pregnancy category of silver nitrate

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 o**f 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

Pregnancy category of Ivermectin

Pregnancy category of Malathion

Pregnancy category of crotamiton

Pregnancy category of lindane

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 i**n 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