Chapter 196 - Other Topical Medications Flashcards by Caryl Lyca Dematawaran

TABLE 196-1
Topical Antimicrobials and Astringents

What group does Chlorhexidine belong to?

Bisbiguanide

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Gentian violet belong to?

Dye

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Brilliant green belong to?

Dye

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Hydrogen peroxide belong to?

Peroxide

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Povidone-iodine belong to?

Iodophor

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Clioquinol belong to?

Iodophor

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Metronidazole belong to?

Imidazole

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Mupirocin belong to?

Fermentation product of Pseudomonas fluorescens

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Retapamulin belong to?

Pleuromutilin

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Azelaic acid belong to?

Dicarboxylic acid

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Benzoyl
peroxide belong to?

Peroxide

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Aluminum salts belong to?

Astringent

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Potassium
permanganate belong to?

Astringent

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TABLE 196-1
Topical Antimicrobials and Astringents

What group does Silver nitrate belong to?

Astringent

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
(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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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Unknown

Gentian violet
Brilliant green

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Oxidizes microbial molecules

Hydrogen peroxide
Benzoyl peroxide
Potassium permanganate

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Oxidation and release of free iodine

Povidone-iodine

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Oxidation and release of free iodine; chelates bacterial surface and trace metals needed for bacterial growth

Clioquinol

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Creation of reduced intermediate compounds and free radicals

Metronidazole

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Inhibits bacterial isoleucyl-tRNA synthetase

Mupirocin

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Inhibits 50S subunit of prokaryotic ribosome

Retapamulin

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Possibly through inhibition of microbial respiratory chain

Azelaic acid

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TABLE 196-1
Topical Antimicrobials and Astringents

ANTIBACTERIAL MECHANISM
Coagulation of proteins

Aluminum salts

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TABLE 196-1 Topical Antimicrobials and Astringents ANTIBACTERIAL MECHANISM Precipitation of bacterial proteins by free silver ions

Silver nitrate

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Gram-positive, Gram-negative bacteria, enveloped viruses, and fungi

Chlorhexidine

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Some vegetative Gram-positive bacteria (eg, Staphylococcus sp.) and yeast

1. Gentian violet 2. Brilliant green

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Broad-spectrum antimicrobial

1. Hydrogen peroxide 2. Benzoyl peroxide 3. Aluminum salts 4. Potassium permanganate

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Gram-positive, Gram-negative, enveloped viruses, fungi, sporicidal, Mycobacterium tuberculosis

1. Povidone-iodine 2. Clioquinol

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Anaerobes, protozoa, and microaerophilic bacteria

Metronidazole

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Gram-positive, some Gram-negative, spares normal flora

Mupirocin

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Gram-positive

Retapamulin

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Propionibacterium acnes and Staphylococcus epidermidis

Azelaic acid

TABLE 196-1 Topical Antimicrobials and Astringents ANTIMICROBIAL SPECTRUM Gram-positive and Gram-negative bacteria

Silver nitrate

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Keratitis, ototoxicity

Chlorhexidine

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Potential skin necrosis at high concentrations or when occluded; stains skin and clothing; tattooing when applied over granulation tissue; mutagenic

Gentian violet

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Potential skin necrosis; stains skin and clothing

Brilliant green

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Avoid in abscesses; bleaches hair

Hydrogen peroxide

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Caution in patients with thyroid disorders; potential systemic toxicity in neonates or when applied to large body surface area; neutralized by blood, serum proteins, and sputum

Povidone-iodine

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS 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

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Contraindicated during first trimester of pregnancy

Metronidazole

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Potentially toxic amounts of polyethylene glycol contained in vehicle may be absorbed in patients with extensive burns or open wounds

Mupirocin

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Allergic contact dermatitis

Retapamulin

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Hypopigmentation

Azelaic acid

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Bleaches dark clothing

Benzoyl peroxide

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Do not use under impervious material to prevent evaporation

Aluminum salts

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Skin discoloration; caustic at high concentrations or with contact of undissolved crystals

Potassium permanganate

TABLE 196-1 Topical Antimicrobials and Astringents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Black skin discoloration, caustic at high concentrations; potential methemoglobinemia

Silver nitrate

TABLE 196-1 Topical Antimicrobials and Astringents USE Antiseptic surgical hand scrub and surgical site preparation

Chlorhexidine

TABLE 196-1 Topical Antimicrobials and Astringents USE Impetiginized eczema; mycotic skin infections; oral candidiasis; superficial skin infections

1. Gentian violet 2. Brilliant green

TABLE 196-1 Topical Antimicrobials and Astringents USE Cleansing of wounds, suppurating ulcers, and local infections

Hydrogen peroxide

TABLE 196-1 Topical Antimicrobials and Astringents USE Antiseptic surgical hand scrub, prevention or treatment of topical site infection associated with surgery, burns, minor cuts/scrapes

Povidone-iodine

TABLE 196-1 Topical Antimicrobials and Astringents USE Approved for fungal infections; also used for pyoderma, folliculitis, and impetigo

Clioquinol

TABLE 196-1 Topical Antimicrobials and Astringents USE Rosacea

Metronidazole

TABLE 196-1 Topical Antimicrobials and Astringents USE Nonbullous impetigo, eradication of nasal carriage of Staphylococcus aureus

Mupirocin

TABLE 196-1 Topical Antimicrobials and Astringents USE Nonbullous impetigo

Retapamulin

TABLE 196-1 Topical Antimicrobials and Astringents USE Acne

1. Azelaic acid 2. Benzoyl peroxide

TABLE 196-1 Topical Antimicrobials and Astringents USE Weeping, impetiginized skin disorders

1. Aluminum salts 2. Potassium permanganate

TABLE 196-1 Topical Antimicrobials and Astringents USE Weeping, impetiginized skin disorders, cauterization of wounds, removal of granulation tissue, aseptic prophylaxis of burns

Silver nitrate

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Chlorhexidine

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Gentian violet

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Brilliant green

Not used in Western medicine

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Povidone-iodine

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Metronidazole

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Mupirocin

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Retapamulin

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Azelaic acid

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Benzoyl peroxide

TABLE 196-1 Topical Antimicrobials and Astringents PREGNANCY CATEGORY Silver nitrate

TABLE 196-2 Topical Antiparasitic Agents GROUP OR COMPOSITION Permethrin

Synthetic pyrethroid

TABLE 196-2 Topical Antiparasitic Agents GROUP OR COMPOSITION Ivermectin

Avermectin

TABLE 196-2 Topical Antiparasitic Agents GROUP OR COMPOSITION Synergized pyrethrins

Natural botanical

TABLE 196-2 Topical Antiparasitic Agents GROUP OR COMPOSITION Malathion

Organophosphate

TABLE 196-2 Topical Antiparasitic Agents GROUP OR COMPOSITION Crotamiton

Crotonyl-N-ethyl-o-toluidine

TABLE 196-2 Topical Antiparasitic Agents GROUP OR COMPOSITION Lindane

Organochlorine

TABLE 196-2 Topical Antiparasitic Agents GROUP OR COMPOSITION Spinosad

Fermentation product

TABLE 196-2 Topical Antiparasitic Agents MECHANISM Inhibits nerve cell sodium ion influx

Permethrin

TABLE 196-2 Topical Antiparasitic Agents MECHANISM Binding to glutamate-and gamma-aminobutyric acid–gated chloride ion channels

Ivermectin

TABLE 196-2 Topical Antiparasitic Agents MECHANISM Pyrethrins inhibit nerve cell sodium ion influx; piperonyl butoxide inhibits cytochrome P450

Synergized pyrethrins

TABLE 196-2 Topical Antiparasitic Agents MECHANISM Cholinesterase inhibitor

Malathion

TABLE 196-2 Topical Antiparasitic Agents MECHANISM Unknown

Crotamiton

TABLE 196-2 Topical Antiparasitic Agents MECHANISM Cholinesterase inhibitor

Lindane

TABLE 196-2 Topical Antiparasitic Agents MECHANISM Generalized CNS excitation leading to paralysis

Spinosad

TABLE 196-2 Topical Antiparasitic Agents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Itching and stinging on application; contraindicated for infants <2 months of age

Permethrin

TABLE 196-2 Topical Antiparasitic Agents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Skin irritation upon application

Ivermectin

TABLE 196-2 Topical Antiparasitic Agents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Itching and stinging on application; ragweed or chrysanthemum allergy

Synergized pyrethrins

TABLE 196-2 Topical Antiparasitic Agents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS Flammable; not approved for children <6 years of age

Malathion

TABLE 196-2 Topical Antiparasitic Agents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS 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

TABLE 196-2 Topical Antiparasitic Agents MAJOR SIDE EFFECTS OR CONTRAINDICATIONS No major side effects in preclinical trials

Spinosad

TABLE 196-2 Topical Antiparasitic Agents USE Lice and scabies; used on clothing as an insect repellant

Permethrin

TABLE 196-2 Topical Antiparasitic Agents USE Scabies, head lice, rosacea

Ivermectin

TABLE 196-2 Topical Antiparasitic Agents USE Lice

1. Synergized pyrethrins 2. Malathion 3. Spinosad

TABLE 196-2 Topical Antiparasitic Agents USE Scabies

Crotamiton

TABLE 196-2 Topical Antiparasitic Agents USE Lice and scabies

Lindane

TABLE 196-2 Topical Antiparasitic Agents PREGNANCY CATEGORY Permethrin

TABLE 196-2 Topical Antiparasitic Agents PREGNANCY CATEGORY Ivermectin

TABLE 196-2 Topical Antiparasitic Agents PREGNANCY CATEGORY Synergized pyrethrins

TABLE 196-2 Topical Antiparasitic Agents PREGNANCY CATEGORY Malathion

TABLE 196-2 Topical Antiparasitic Agents PREGNANCY CATEGORY Crotamiton

TABLE 196-2 Topical Antiparasitic Agents PREGNANCY CATEGORY Lindane

TABLE 196-2 Topical Antiparasitic Agents PREGNANCY CATEGORY Spinosad

Not rated

TABLE 196-3 Topical Antipruritics GROUP Diphenhydramine

Antihistamine

TABLE 196-3 Topical Antipruritics GROUP Doxepin

Tricyclic antidepressant

TABLE 196-3 Topical Antipruritics GROUP Menthol

Cyclic terpene alcohol

TABLE 196-3 Topical Antipruritics GROUP Pramoxine hydrochloride

Surface anesthetic

TABLE 196-3 Topical Antipruritics MECHANISM Local anesthesia; histamine antagonism

Diphenhydramine

TABLE 196-3 Topical Antipruritics MECHANISM Histamine antagonism, interference with neuronal synaptic communication; decreased awareness through production of drowsiness

Doxepin

TABLE 196-3 Topical Antipruritics MECHANISM Counter irritant. Cooling sensation in the skin via transient receptor potential melastatin 8 (TRPM8) receptors in the skin

Menthol

TABLE 196-3 Topical Antipruritics MECHANISM Local anesthesia

1. Phenol 2. Pramoxine hydrochloride

TABLE 196-3 Topical Antipruritics PRECAUTIONS Significant percutaneous absorption; potential sensitization with cross-sensitization to oral form and related compounds

Diphenhydramine

TABLE 196-3 Topical Antipruritics PRECAUTIONS Potential contact sensitization; significant systemic absorption resulting in drowsiness and drug interactions; contraindicated in patients taking monoamine oxidase inhibitors

Doxepin

TABLE 196-3 Topical Antipruritics PRECAUTIONS Avoid in pregnant women and infants; irritant in diaper area and skin folds

Phenol

TABLE 196-3 Topical Antipruritics PREGNANCY CATEGORY Diphenhydramine

TABLE 196-3 Topical Antipruritics PREGNANCY CATEGORY Doxepin

TABLE 196-3 Topical Antipruritics PREGNANCY CATEGORY Menthol

C when combined with camphor (ie, Sarna)

TABLE 196-3 Topical Antipruritics PREGNANCY CATEGORY Phenol

Should be avoided

TABLE 196-3 Topical Antipruritics PREGNANCY CATEGORY Pramoxine hydrochloride

TABLE 196-4 Topical Keratolytic Agents DOSAGE Alpha-Hydroxy acids

2% to 20% as nonpeeling agent, >20% as peeling agent

TABLE 196-4 Topical Keratolytic Agents DOSAGE Propylene glycol

40% to 60% under occlusion at bedtime; may be combined with salicylic acid (Keralyt gel) or lactic acid (Epilyt); 2% vehicle in many preparations

TABLE 196-4 Topical Keratolytic Agents DOSAGE Salicylic acid

Scaly dermatoses: FDA approved twice daily to 4 times daily at 1.8% to 3%; calluses, corns, and warts: FDA-approved at 12% to 40% for plaster vehicles, 12% to 17.6% in collodion-like vehicles

TABLE 196-4 Topical Keratolytic Agents DOSAGE Urea

Twice daily to 4 times daily in 10% to 40% creams and lotions

TABLE 196-4 Topical Keratolytic Agents DOSAGE Lactic acid

Twice daily to 4 times daily in 5% to 12% preparations

TABLE 196-4 Topical Keratolytic Agents INDICATIONS Photoaging, scaling, hyperkeratosis, acne, hyperpigmentation

Alpha-Hydroxy acids

TABLE 196-4 Topical Keratolytic Agents INDICATIONS Ichthyosis, hyperkeratosis, psoriasis

Propylene glycol

TABLE 196-4 Topical Keratolytic Agents INDICATIONS Hyperkeratosis, scaling

Salicylic acid

TABLE 196-4 Topical Keratolytic Agents INDICATIONS Xerosis, pruritus, hyperkeratosis, eczema, ichthyosis, psoriasis, nail avulsion

Urea

TABLE 196-4 Topical Keratolytic Agents INDICATIONS Ichthyosis, xerosis, eczema, photoaging

Lactic acid

TABLE 196-4 Topical Keratolytic Agents PREGNANCY CATEGORY Alpha-Hydroxy acids

Not contraindicated in pregnancy

TABLE 196-4 Topical Keratolytic Agents PREGNANCY CATEGORY Salicylic acid

TABLE 196-4 Topical Keratolytic Agents PREGNANCY CATEGORY Urea

TABLE 196-4 Topical Keratolytic Agents PREGNANCY CATEGORY Lactic acid

Not contraindicated in pregnancy