Topical medications

Question 1

What are the different formulations for topical medications?

Answer 1

1) lotions - good for large skin app
2) ointments (emollient/paraffin base) - barrier for skin protection
3) creams (oil/water with emulsifiers)
4) gels (alcohol base)
5) paste (powdered drug and ointment)
6) powders (active drug and starch)
7) patches (fixed time drug delivery)

Question 2

What are the topically applied drugs?

Answer 2

• Steroids/NSAIDS
• opioids
• local anaesthetic
• antimicrobials
• skin treatments
• hormone replacement
• nicotine replacement
• organic nitrate patches
• Parkinson treatment

Question 3

What are the advantages of topical medications?

Answer 3

• non-invasive
• avoid first pass effect
• can have extended delivery over days
• improves adverse effect profile (less systemic effects)
• can be localised

Question 4

What are the disadvantages of topical medication?

Answer 4

• variable dose on app
• variable delivery
• dependant on intact skin surfaces and subnormal BF
• skin reaction poss
• can have continued drug absorption after removed
• fire hazard if use paraffin

Question 5

When are topical opioids used?

Answer 5

• if swallowing, nausea, vomiting recurrent problem
• steady state of pain relief
• starts up to 12 hour after patch given and lasts up to 24 hours after removed

Question 6

What is the best opioid to use in renal impairment?

Answer 6

fentanyl

Question 7

What is the best opioid to use with cognitive impairment?

Answer 7

buprenorphine

Question 8

What is the benefit of NSAIDs topically?

Answer 8

concentration can be localised to target area

Question 9

What are the topical local anaesthetics?

Answer 9

Lidocaine (block voltage gated Na channels and nociceptive signals)

Question 10

When are topical corticosteroids used?

Answer 10

• inflammatory skin conditions (eczema, dermatitis, dermatoses) when emollients ineffective
• potent not used on face as reddens

Question 11

How should corticosteroids be used for skin conditions?

Answer 11

use mild corticosteroids over potent when possible

Question 12

What are the different forms of topical corticosteroid?

Answer 12

lotions
ointments
creams

Question 13

What are the mild/moderate corticosteroids?

Answer 13

mild = hydrocortisone
moderate = eumovate

Question 14

What are the potent corticosteroids?

Answer 14

potent 
- beclomethasone 
- mometasone
V potent 
- Clobetasol propionate