Drug used in skin and mucus

membrane
.
Drugs used in skin & mucous membrane are:
• Corticosteroids:
1. Glucocorticoids. Drug used for Eye, Ear &
2. Mineralocorticoids. Nose
• Antipruritics:
1. Anti-inflammatory.
2. Anti-Bacterials. Enzymes used in
3. Antivirals. Therapy
4. Anti-fungals.
5. Anti-paracitics.
6. Antiacne.
7. Keratolytics & Antipsoiatics.
Corticosteroid
s
 Introduction
• Corticosteroids are steroid hormones that are either produced by the body or
are man – made. Naturally occurring corticosteroids, hydrocortisone and
cortisone are produced by the outer portion of the adrenal gland known as
cortex, so, corticosteroids are classified as:
• Glucocorticoids.
• Mineralocorticoids.
• Synthetic corticosteroids mimic the actions of naturally occurring
corticosteroids and may be used to replace corticosteroids in people with
adrenal gland insufficiency.
Mechanism of action
• Glucocorticoids produce various metabolic effects,
suppress inflammation and alter the normal immune
response, they also promote water and sodium
retention and potassium excretion.
• Mineralocorticoids (Salt retaining) regulate the
balance of salt and water in body.
 Drug example and doses.
S. NO. Drugs Doses

Glucocorticoids
1 Betamethasone 0.5 – 9mg daily.
2 Dexamethasone 0.5 – 16mg daily.
3 Prednisone 2.5 – 60mg daily.
4 Prednisolone 5 – 60mg daily.
5 Triamcinolone 4 – 48mg daily.
6 Methylprednisolone 4 – 48mg daily.
7 Hydrocortisone 50 – 200mg daily
Mineralocorticoids
8 Fludrocortisone 100 microgram
Indications/uses
• Glucocorticoids drugs are used as replacement therapy
for adrenocortical insufficiency.
• To treat neoplastic diseases.
• Septic shock.
• Cerebral edema.
• Inflammatory conditions of joint, gastrointestinal
tracts, respiratory tract and skin.
• Mineralocorticoids are used as replacement therapy
in primary and secondary adrenal insufficiency.
Contraindications/ precautions

•Serious infections.
•Mineralocorticoids use cautiously with
cardiovascular and hypertension
disease patients.
Adverse effects
• Muscle wasting.
• Growth retardation.
• Hypertension.
• Increased blood glucose level.
• Sodium and fluid retention.
• Acute adrenal insufficiency after abrupt withdrawal.
• Osteoporosis.
• Peptic ulcer.
• Glaucoma.
• Altered fat distribution.
Drug interactions
• Hormonal contraceptives may block the
metabolism of glucocorticoids.
• Phenobarbital, phenytoin and rifampicin may
enhance the metabolism of glucocorticoids.
• Concurrent use with orally hypoglycemics or
insulin may increase blood sugar levels, there by
increasing insulin or oral hypoglycemic
requirements.
 Nursing responsibilities
• Administer drug daily doses in the morning time.
• Monitor adverse effects of drug therapy.
• Monitor regularly for weight changes and also monitor fluid and electrolyte
imbalances.
• Teach the patient to avoid such foods as fresh fruits and raw vegetables
because they tend to have higher levels of bacteria than cooked foods,
therapy increasing the risk of infection in an already immunosuppressed
patients.
• Nurse should warn the patient not to stop drug abruptly because this may
cause life threatening adrenal insufficiency.
Antipruritics
Introduction
• Antipruritic agents used to preventing and
relieving itching i.e. decreasing sensitivity
of local nerve ending, reducing local
edema, cooling skin and counteracting
histamine release.
 Mechanism of action
• They have anti-inflammatory, anti-allergies, anti-infective properties thus
show. Their actions in two different ways:
1) Anti-inflammatory decreases the inflammation and itching cause
vasoconstriction.
2) Anti-infective kills or inhibit the growth of micro-organism (Bacteria,
virus, fungi, parasitic).
3) Antipruritics relieve itching of the skin and mucous membrane.
4) Antiacne clear and dry the skin, reduce bacteria and reduce the size of
activity of sebaceous glands.
5) Keratolytics breakdown protein in keratin causing the loss of the stratum
corneum skin layer.
 Drug Classification
Drugs Classification Drugs Classification
Anti-inflammatory Antiparasitic
Betamethasone Dexamethasone Malathion Permethrin
Hydrocortisone Triamcinolone Lindane
Antibacterial Antifungals
Gentamicin Sulfate Neomycin sulfate Ketoconazole Clotrimazole
Silver sulfadiazine Polymyxin B Miconazole nitrate Griseofulvin
Bacitracin Nystatin
Antivirals Keratolytics & Antipsoriasis
Acyclovir Penciclovir Salicylic acid Resorcinol
 Drugs Classification

Antipruritics

Cyproheptadine Calamine lotion

Diphenhydramine

Antiacne

Clindamycin Erythromycin

Tetracycline Benzoyl peroxide

Isotretinoin Tretinoin

Azelaic acid (Cleanses/Antiseptics)

Indications
• Dermatitis (Anti-inflammatory).
• Allergic skin reactions (Anti-inflammatory).
• Bacterial skin infection (Antibacterial).
• To treat fungal infections (Antifungal)
• To treat herpes simplex virus infections (Antiviral)
• To treat scabies pediculosis (lice) (Antiparasitic)
• To treat pruritic (Antipruritics)
• To treat acne vulgaris and acne rosacea (Antiacne)
• To treat superficial fungal functions Psoriasis, corns, cellulitis
(Keratolytics).
Contraindications/ Precautions
• Hypersensitivity.
• Pregnancy.
• Breast feeding.
 Adverse Effects
• Skin irritation. • Antiacne may cause
• Bone marrow suppression. burning, itching, redness of
• Behavioral changes. the eye & scaling pain of
• Suppressed immune lips also may cause
photosensitivity reactions.
response.
• Hemolytic anemia.
• Leukopenia.
• Fluid and electrolyte
imbalances.
Drug interactions

•Excessive use of antiacne products

may increase skin reactions.
 Nursing Responsibilities:
• Nurse should assess before applying topical drug, assess
skin and remove any previous applied medications.
• Always use aseptic technique while applying medications to
open lesions.
• Instruct to patient that topical drugs are for external use only
and to avoid contact with the eyes.
• Teach the patient how to apply drugs.
• Remember that if we are giving anti parasitics to control
spread of infestation to other fly members. And if, need to
be treated.
 Nursing Responsibilities:
• Follow these guidelines when applying acne products.
Clean and asses the affected area before applying acne
preparations.
Teach the patient using tetracyclines to be careful to cover
the entire affected area not to go in sunlight.
Advise the patient isotretinoin and tretinoin to apply
sunscreen and wear protective clothing to prevent
photosensitivity reactions.
Advise women using isotretinoin and tretinoin to use
contraception.
 Topical Drugs used for disease of Eye.
Drug Preparations Uses
Ciprofloxacin 0.3% Drops & ointment Bacterial conjunctivitis
Gentamycin 0.3% Drops Bacterial conjunctivitis
Acyclovir 0.3% ointment Herpes simplex keratitis
Betamethasone 0.1% Drops & ointment Allergic and inflammatory conditions of the eye.
Dexamethasone 0.01% Drops Allergic and inflammatory conditions of the eye.
Diclofenac 0.1% Drops Post operative ocular inflammation
Azelastine 0.05% Drops Allergic conjunctivitis
Dorzolamide 2% Drops Glaucoma
Timolol 0.25% Drops Glaucoma
Pilocarpine 0.5% & 2% drops Glaucoma
Tropicamide 1% drops Uveitis, as mydriatic for refraction testing.
Atropine 1% Drops & ointment Uveitis, as mydriatic for refraction testing.
 Topical Drugs used for disease of Nose
Drug Preparations Uses

Azelastine 0.1% Nasal spray Allergic rhinitis

Beclomethasone 500 mcg/ puff nasal spray Allergic rhinitis

Oxymetazoline 0.05% nasal drops Nasal Decongestant

 Drug Preparations Uses for diseases of Ear.
Drug Preparations Uses

Ciprofloxacin 0.2% drops Bacterial infection.

Clotrimazole 1% drops Fungal infection.

Gentamicin 0.3% drops Bacterial infection

Betamethasone 0.1% drops Eczema of Ear, as an anti-

inflammatory agent
Sodium Bicarbonate 5% Drops To soften ear wax.
 Drugs used in the treatment of scabies and pediculosis
Drug Formulations Details

Permethrin 1% & 5% Cream Most efficacious and most frequently used drug for scabies
5% lotion and pediculosis (head and pubic lice)
5% Gel For Scabies: 5% permethrin is applied to the skin over the body from
1% soap. neck to toes; thorough hot water bath after 10-12 hours to wash off
the drug.
For pediculosis: 1% Permethrin is applied to the scalp/pubis and
washed off after 10 mins. Treatment may be repeated, if necessary
after 1week. Side effects are skin rashes, redness, itching, burning etc.

Gamma 1% emulsion Very effective drug for both pediculosis & scabies.
Benzene 1% lotion For Scabies: 1% Lindane is applied to the skin from neck to toes; a
Hexachloride 1% cream thorough scrub bath is given is given after 12 hours to wash off
(Lindane) 1% ointment drug from the body. Application can be repeated if necessary after
7 days. For pediculosis: 1% Lindane is applied over the scalp and
1% soap
hair carefully without touching the eyes. Side effects include skin
rashes, headache, restlessness, convulsions and cardiac
arrhythmias.
Contraindicated in children, epileptics and pregnant women.
 Continued
Drug Formulations Details
Benzyl 25% emulsion 25% Emulsion/lotion is applied to the skin over the body from neck to
Benzoate 25% lotion toes twice at 12 hours interval after a scrub bath; wash off 12hours
after the 2nd application. Side effect are skin rash and dermatitis.
Crotamiton 10% lotion. It has scabicidal, pediculicidal and Antipruritics activities. It is applied
10% cream to skin over body below the chin twice at 24hrs interval after a scrub
bath. It is less efficacious, hence requires repeated administration. It
can be used in children. Side effects include skin rashes, itching,
dermatitis etc.
Sulphur 10% ointment It is used for scabies, it is less efficacious, requires
repeated applications, has bad odour, hence is rarely used
at present.
DDT 1-2% lotion It is toxic, hence is rarely used for scabies and pediculosis.
(Dicophane) 1-2% ointment
Ivermectin Tablet (Oral) Anti-filarial drug used orally for scabies and pediculosis. Single
0.2mg/kg. dose produces almost complete cure. It is contraindicated in
children, pregnant and lactating women.
Enzymes used in therapy
 Hyaluronidase
• Source: Mammalian testes.
• Availability & Routes: Topical SC/IM and intraarticular.
• Action: Depolymerizes hyaluronic acid and increases the permeability of
the tissues.
• Uses:
1. To promote the absorption of drug and fluids given SC /IM and
intraarticularly.
2. To aid the reabsorption of extravasated fluid or blood in hematoma or
post operative edema.
3. To facilitate the diffusion of local anesthetic in ophthalmology.
 Chymotrypsin
• Source: OX pancreas.
• Availability & Routes: Tablet (PO) and topical ointment.
• Action: Proteolytic enzyme.
• Uses:
1. To reduce post operative edema..
 α-Chymotrypsin (Alfa – Chymotrypsin)
• Source: OX pancreas.
• Availability & Routes: Injection & Tablet (PO).
• Action: Mucolytic & Proteolytic action.
• Uses:
1. During cataract surgery to facilitate removal of the lens.
2. To reduce inflammatory edema due to trauma, injection, surgery etc.
 Serratiopeptidase
• Source: Serratia species.
• Availability & Routes: Tablet (PO).
• Action: Anti-inflammatory activity.
• Uses:
To relieve pain and inflammation due to surgery, trauma, injection and
chronic condition like osteoarthritis, rheumatoid arthritis, etc.
 Urokinase
• Source: Isolated from human fetal kidney cell culture.
• Availability & Routes: IV
• Action: Fibrinolytic (Dissolve clot)
• Uses:
 Acute MI, Deep vein thrombosis, Pulmonary embolism, etc.
 Tissue plasminogen activator (t-PA)
• Source: Derived from recombinant DNA technology.
• Availability & Routes: IV
• Action: Fibrinolytic (Dissolve clot)
• Uses:
 Acute MI, Deep vein thrombosis, Pulmonary embolism, etc.
 L–
Asparaginase
• Source: Escherichia coli.
• Availability & Routes: IV
• Action: Catalyzes the hydrolysis of asparagine to aspartic acid
• Uses:
 Acute Lymphoblastic leukemia.