SUN-INDUCED DISORDERS, BURNS,

AND SLEEP DISORDERS

Molly Corder, PharmD

PGY1 Ambulatory Care Pharmacy Resident
Nonprescription Therapeutics
ABOUT ME
 Educate a patient on proper sunscreen
application

LEARNING Given a patient case, recommend

appropriate treatment options for a
OBJECTIVES burn or referral to physician

Given a patient case, utilize appropriate

probing questions to assess a patient
and determine best treatment options
for sleep complaint
SUNSCREEN & SUN-INDUCED
DISORDERS
 WHY DO WE WANT TO
RECOMMEND APPROPRIATE
SUNSCREEN?

1 in 5 Americans are expected to develop a type

of skin cancer
 RISK FACTORS

Fair skin Light eyes Light hair

Autoimmune
Family hx of Hx of severe
conditions or
melanoma sunburn
immunosuppressants

Existing UV-induced Photosensitizing Excess lifetime

disorder drug use exposure to UVR
 Single spectrum vs broad spectrum

Water resistance claims (still need

to be applied after 40-80 mins)
ALL ABOUT
SUNSCREENS!
Chemical vs physical

Only 2 FDA products recognized as

GRASE
 SUNBURN

• Result of cellular damage from UVB

• Peaks ~12-24 hours, resolves ~72 hours

Clinical Presentation
• Erythema
• Edema
• Pain
• Tenderness
Severe Situations
• Blisters
• Bullae
• Fever/ Chills
• Weakness
• Shock
EXAMPLES
 SKIN CANCER

ABCDE criteria for melanoma

Moles or lesions that have
• A: asymmetric shape
• B: border irregularity
• C: color variation/ change
• D: diameter > 6 mm
• E: evolving size, shape, or color
 Tanning protects against future sunburns, cancer or other UVR related health
risks
FALSE
Avoidance is the best option
TRUE
Utilize at a minimum SPF 15 or 30, particularly 30 if you are fair skinned (don’t
forget your lips

TRUE OR FALSE? TRUE

Single spectrum is recommended over broad spectrum
FALSE
Age cut off of 6 months of age
TRUE
Apply 15-30 mins before exposure, reapply every 4 hours.
FALSE
BURNS
 WHEN TO REFER TO PHYSICIAN

Electrical or inhalation Eyes, ears, face, hands,

Burn > 2% BSA
burns feet, or perineum

Chemical burns (first DM, multiple medical

Immunocompromised aid → medical disorders, advanced
attention) age

No improvement or
Fever or chills Confusion
worsening in 7 days
NON PHARMACOLOGIC
THERAPY
 COOLING TREATMENT

• Cool tap water x 10 mins

Thermal burns • Decrease histamine
release & edema

• Cool tap water

All burns • Do not use ice due to
vasoconstriction
 CHEMICAL BURNS

• Remove clothing near area • Flush eye with tap water x 15-30 minutes
• Wash with tap water x 15 minutes • Flush from nasal side → outside corner
POISON CONTROL

(800)-222-1222
 BANDAGE/ DRESSINGS

Hydrocolloid
dressings
preferred Keep hydrated

Contain gelatin or sodium carboxymethylcellulose → promotes moist environment for healing using body’s enzymes
 HYDRATION

Water drawn to -Drink extra water

surface of skin -Use moisturizers
→dehydration after showering
 APAP, NSAIDs

Skin protectants
PHARMACOLOGIC
THERAPY Topical anesthetics

Topical antibiotics

Aloe vera

NSAIDS
Ibuprofen (Advil)
Naproxen (Aleve)
• MOA:
• reversible inhibition of
COX 1 & 2
• Prostaglandin inhibition
• AE: swelling, acute renal
failure, GI bleed
ANALGESICS
APAP ASA
Acetaminophen (Tylenol) Aspirin (Ecotrin)
• MOA: • MOA:
• Weak prostaglandin • Irreversible inhibition of
inhibition COX 1 & 2
• Peripherally block pain • Prostaglandin inhibition
impulse generation • AE: platelet inhibition, GI
• AE: hepatotoxicity Bleeding
 ALOE VERA

Enzymes & fatty acids

Vitamins A, C, E, B12 inflammation Minerals, sugars, amino
folic acid, choline, (bradykinase & lupeol acids
enzymes ( analgesic properties
too)

AE: redness, stinging, Interactions: Increased

“anecdotal data” –
burning (try it on a absorption of
tradition/ theory
small area first) hydrocortisone
TOPIC AL ANESTHETICS

Use lower concentrations only 3-4 x daily

Duration: 15-45 minutes
AE: skin irritation
 TOPICAL ANTIBIOTICS

CAN be used when skin is not intact

Bacitracin → inhibits cell wall synthesis

Neomycin → inhibits protein synthesis

Polymyxin B sulfate → alters cell wall permability

SKIN PROTECTANTS
 PATIENT CASE

• JD is a 47 year old male with a history of

hypertension, uncontrolled diabetes, hypothyroidism,
and history of a renal transplant. He reports to have
forgotten his sunscreen when he went to the beach
last weekend. He is going on day 7, and he thinks the
burn on his shoulders, back, and neck have somehow
gotten even worse. What do you recommend for JD?
SLEEP DISORDERS
WHY DO WE C ARE?

30-50% of
population

Quality of
life
 WHAT CAUSES TROUBLE SLEEPING?

Pregnancy Stress Hospitalization Travel

Poor sleep Late exercise

Night work Caffeine
habits or meals

Environmental
factors
 CONDITIONS THAT CAN CAUSE
TROUBLE SLEEPING

Asthma/COPD Anxiety and/or Restless leg

Allergies
or Sleep apnea depression syndrome (RLS)

Gastroesophageal
Arthritis/Chronic Benign prostatic
Diabetes (DM) reflux disease
pain hyperplasia (BPH)
(GERD)

Peptic ulcer
Heart failure Menopause
disease (PUD)
 Alcohol
Antidepressants
Beta antagonists
MEDIC ATIONS CNS stimulants
THAT C AUSE
INSOMNIA Corticostweroids
Diuretics
ADHD medications
Thyroid medication
 Transient - <1 week, usually self
limiting

CLASSIFICATION Short term: 1-3 weeks

Chronic/ long term: >3 weeks to years

(often result of medical problems,
psych disorders, or substance abuse)
 PATIENT CASE

NB is a 40 YOM that presents to your pharmacy with complaints of

trouble sleeping. Upon further questioning you determine he
suffers from severe anxiety and recently received some bad news
that has caused him to have trouble concentrating at work. He has
been taking his work home each night, and drinking coffee until
around 10 pm to help him focus. He states he just needs some help
to get through this rough patch and he thinks sleeping better will
do the trick. NB admits to lying in bed for hours trying to fall
asleep, and once he finally does he usually wakes 2-3 times
throughout the night before morning.
 REFERRAL CRITERIA

Pregnancy Age > 65 Age <12

Frequent nocturnal Secondary to

Early morning awakenings psychiatric disorders
awakening + inability • 3 week duration or general medical
to fall back to sleep
disorders
SLEEP SYMPTOMS
DAYTIME SYMPTOMS
 SLEEP HYGIENE

Use bed for sleeping or intimacy only

Establish a regular sleep pattern

Make the environment conducive to sleep

Quiet & Dark

Engage in relaxing activities

Get out of bed

Do not watch the clock at night

Avoid Temperature extremes

Avoid Using electronic devices (phone, TV, tablets)

Avoid Exercise within 2-4 hours of bedtime

Avoid Meals 2 hours before bedtime

Caffeine, alcohol, or nicotine at least 4-6

Avoid hours before bedtime

Avoid Daytime napping

PHARMACOLOGIC THERAPY
KAHOOT
REGROUP/ REFLECT
QUESTIONS?
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