Useful for Nursing and medical students

1. Drug used in skin and mucus
membrane
Mr. Dipti Y. Sorte, Associate Professor
Himalayan College of Nursing, SRHU.
Dehradun.

2. Drugs used in skin & mucous membrane are:
• Corticosteroids:
1. Glucocorticoids.
2. Mineralocorticoids.
• Antipruritics:
1. Anti-inflammatory.
2. Anti-Bacterials.
3. Antivirals.
4. Anti-fungals.
5. Anti-paracitics.
6. Antiacne.
7. Keratolytics & Antipsoiatics.
Drug used for Eye, Ear & Nose
Enzymes used in Therapy

3. Corticosteroids

4. 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.

5. 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.

6. 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

7. 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.

8. Contraindications/ precautions
•Serious infections.
•Mineralocorticoids use cautiously with
cardiovascular and hypertension disease
patients.

9. 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.

10. 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.

11. 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.

12. Antipruritics

13. 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.

14. 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.

15. 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

16. Drugs Classification
Antipruritics
Cyproheptadine Calamine lotion
Diphenhydramine
Antiacne
Clindamycin Erythromycin
Tetracycline Benzoyl peroxide
Isotretinoin Tretinoin
Azelaic acid (Cleanses/Antiseptics)

17. 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).

18. Contraindications/ Precautions
•Hypersensitivity.
•Pregnancy.
•Breast feeding.

19. Adverse Effects
•Skin irritation.
•Bone marrow suppression.
•Behavioral changes.
•Suppressed immune
response.
•Hemolytic anemia.
•Leukopenia.
•Fluid and electrolyte
imbalances.
•Antiacne may cause
burning, itching, redness of
the eye & scaling pain of
lips also may cause
photosensitivity reactions.

20. Drug interactions
•Excessive use of antiacne products
may increase skin reactions.

21. 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.

22. 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.

23. 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.

24. 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

25. 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.

26. Drugs used in the treatment of scabies and pediculosis
Drug Formulations Details
Permethrin 1% & 5% Cream
5% lotion
5% Gel
1% soap.
Most efficacious and most frequently used drug for scabies and
pediculosis (head and pubic lice)
For Scabies: 5% permethrin is applied to the skin over the body from
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
Benzene
Hexachloride
(Lindane)
1% emulsion
1% lotion
1% cream
1% ointment
1% soap
Very effective drug for both pediculosis & scabies.
For Scabies: 1% Lindane is applied to the skin from neck to toes; a
thorough scrub bath is given is given after 12 hours to wash off drug
from the body. Application can be repeated if necessary after 7 days.
For pediculosis: 1% Lindane is applied over the scalp and hair
carefully without touching the eyes. Side effects include skin rashes,
headache, restlessness, convulsions and cardiac arrhythmias.
Contraindicated in children, epileptics and pregnant women.

27. Continued
Drug Formulations Details
Benzyl
Benzoate
25% emulsion
25% lotion
25% Emulsion/lotion is applied to the skin over the body from neck to
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.
10% cream
It has scabicidal, pediculicidal and Antipruritics activities. It is applied
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
(Dicophane)
1-2% lotion
1-2% ointment
It is toxic, hence is rarely used for scabies and pediculosis.
Ivermectin Tablet (Oral)
0.2mg/kg.
Anti-filarial drug used orally for scabies and pediculosis. Single dose
produces almost complete cure. It is contraindicated in children,
pregnant and lactating women.

28. Enzymes used in therapy

29. 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.

30. Chymotrypsin
•Source: OX pancreas.
•Availability & Routes: Tablet (PO) and topical ointment.
•Action: Proteolytic enzyme.
•Uses:
1. To reduce post operative edema..

31. 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.

32. 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.

33. 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.

34. 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.

35. L – Asparaginase
•Source: Escherichia coli.
•Availability & Routes: IV
•Action: Catalyzes the hydrolysis of asparagine to aspartic acid
•Uses:
Acute Lymphoblastic leukemia.

36. Reference:
1. Dr. P.K. Panwar, Essentials of pharmacology for nurses, AITBS pub.
2017, India, Pg no. 85 – 79.
2. Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics for
nurses, Jaypee pub. 2016 India Pg no 253 – 255.
3. Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for
undergraduate, Elsevier pub. 2014. Pg no. 490 – 492.
4. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barlet
pub 2010 India, Pg no 194-201.
5. Govind s. mittal, Pharmacology at a glance, Paras medical book pub. 2009
India 51 – 56.
6. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India
1st edition, Pg no 240.

37. THANKS