Chapter 12
Skin Medications
Introduction
• The skin is the largest organ of the body
– Affected by many conditions
– Ailments range from minor to severe
– Treatment is usually topical or local
– Sometimes treated internally with oral
medications or injections
• Topical skin preparation categories
– Antipruritics
– Corticosteroids
– Emollients and protectants
– Keratolytic agents and enzymatic agents
– Scabicides and pediculicides
– Local anti-infectives
– Burn medications
– Acne agents
• Factors that influence the rate of absorption of
topical medication
– Condition and location of the skin
– Heat
– Moisture
• The following slides discuss various types of
skin medications
– Refer to chapter for specific side effects,
precautions and contraindications
Antipruritics
• Used short term to relieve discomfort from
dermatitis (rashes) associated with allergic
reactions, poison ivy, hives, and insect bites
– Relieve itching by use of products singly
or in combination containing local
anesthetics, drying agents, anti-
inflammatory agents and antihistamines
Corticosteroids
• Used both topically and systemically to treat
dermatological disorders associated with allergic
reactions
– Available in a variety of dosage forms and
potencies
– See Chapter 23, “Endocrine System
Drugs”
Emollients and Protectants
• Used topically to soothe, soften, protect (via
creation of a lipid barrier), and seal out wetness in
minor dermatological conditions
– Examples: diaper rash, irritation,
abrasions, and minor burns
Keratolytics
• Used to control conditions of abnormal scaling of
the skin, such as dandruff, seborrhea, and psoriasis
– Also used to promote peeling of the skin
in conditions such as acne, hard corns,
calluses, and warts
Enzyme Preparations
• Bedridden patients are prone to decubitus ulcers
(pressure sores) and diabetic patients are prone to
develop foot ulcers
– Must be removed in order to promote
proper healing
• Collagenase (Santyl) is a topical
enzyme ointment used for the
chemical debridement (removal of
dead or damaged tissue) of dermal
ulcers and burns
• Table 12-1: Antipruritics, emollients, protectants,
keratolytics and enzymatics
Scabicides and Pediculicides
• Scabies
– Caused by an itch mite that burrows under
the skin
• Pediculosis (lice)
– Caused by infestation of lice on the hairs
of the scalp, pubic area, and trunk
• Treatments
– Laundering or dry cleaning all clothing
and bedding, scabicides, and pediculicides
Local Anti-Infectives
• Local anti-infectives are used to treat diseases
caused by microorganisms
– Include fungal, viral, and bacterial
diseases of the skin
Antifungals
• Useful in the treatment of fungal infections,
including ringworm or tinea (pedis, corporis,
cruris) and yeast (candidiasis), such as thrush,
diaper rash, and vaginitis
– Effective treatment includes topical
administration according to directions on
the package insert and good hygiene
practices
Antivirals
• Acyclovir has an antiviral effect on herpes
simplex, herpes zoster, and varicella zoster
viruses
– Not a cure and does not reduce frequency
or delay appearance of new lesions
– Generally decreases duration of viral
shedding, duration of pain and itching,
and time required for crusting and healing
of lesions
– Newer antivirals such as Valtrex and
Famvir can be dosed less frequently
Antibacterial Agents
• Mupirocin is an antibiotic that is structurally
unrelated to any other topical or systemic
antibiotics
– Used topically to treat impetigo caused by
Staphylococcus aureus, certain species of
Streptococci and MRSA
– Used to treat secondarily infected
traumatic skin lesions
Antiseptics
• Antiseptics: substances that inhibit the growth
of bacteria
– Frequently used to describe chemicals
applied to body tissues, especially the
skin
• Major antiseptics in use today are
chlorhexidine and povidone-
iodine (Betadine), used for
surgical scrubs and as
bacteriostatic skin cleansers
• Table 12-2: Scabicides, pediculicides, antifungals,
antivirals, antibacterials and antiseptics
Burn Medications
• Burns
– Injuries to the skin and tissues below the
skin caused by heat from flames, hot
liquids, steam, heated objects, chemicals,
friction, electricity, radiation, or the sun
• Usually classified as first-,
second-, or third-degree burns,
depending upon their severity and
the depth to which tissues have
been damaged
– Treatments include topical application of
medications to prevent or treat infections
Sunscreens
• Overexposure to the sun is considered to be the
primary cause of skin cancer
– Most common form of all cancers in the
United States
• Ultraviolet (UV) radiation is a type of invisible
light emitted by the sun
– Divided into two types: UVA and UVB
• Sun Protection Factor (SPF)
– Measure of the protection a sunscreen
offers
– Greater than 30 reduces the risk of skin
cancer
Agents Used to Treat Acne
• Acne is a common condition of the skin
– Affects almost everyone to some degree
• Most commonly seen on the face,
scalp, neck, chest, back, and
shoulders
– Mild acne may be treated with
nonprescription topical medications
– Severe acne may be treated with a
combination of a retinoid and topical
antibiotics or oral antibiotics
• Table 12-3: Burn and Acne Medications
Cautions for Topical Medications
• Skin medications by prescription or OTC are
too numerous to mention
– Many patients use products without
adequate instruction in administration,
side effects, or precautions
• Health care practitioners have a
responsibility to advise patients to
use great caution with self-
medication
• Practitioners and laypeople alike
should read instructions carefully

Chapter 19
Analgesics, Sedatives, and Hypnotics
Introduction
• Analgesics, sedatives, and hypnotics
– Depress central nervous system (CNS)
action to varying degrees
– Some drugs can be classified into more
than one category, depending on the
dosage
• Analgesics: relieve pain
• Sedatives: calm, soothe, or
produce sedation
• Hypnotics: produce sleep
• The following slides discuss various analgesics,
sedatives, and hypnotics
– Refer to the chapter for specific side
effects, precautions, contraindications,
and interactions
Analgesics
• Pain is the most common reason for patients to
seek out medical care
– Most common types: back, neck,
migraine, and facial or jaw pain
– Is subjective: can be experienced or
perceived only by the individual subject.
Pain scale: 1 to 10
– Can be blocked by endorphins
• Endogenous analgesics produced
within the body as a reaction to
severe pain or intense exercise
• Opioid analgesics
– Full or pure agonists, partial agonists, or
mixed agonist-antagonists
• Each bind to specific receptors
with varying degrees of action
• Classified as controlled
substances
• Potential for abuse and
psychological dependence
• Tolerance and physiological
dependence
• See Table 19-1
• Opioid induced constipation (OIC)
– Not-self limiting
– Occurs because the digestive tract
contains similar receptors (mu) that are
targeted in pain relief, slowing the transit
time
– Most of the time, hydration, stool
softeners or stimulant are effective
– For severe OIC, prescription strength
medication is required.
• Tramadol (Ultram)
– Centrally acting synthetic analog of
codeine with a dual mechanism of action
– Produces analgesia by weak inhibition of
norepinephrine and serotonin reuptake; is
an opioid receptor agonist
– Less potential for abuse or respiratory
depression (although both may occur)
• Nonopioid analgesics
• See Table 19-2
– Many available without prescription as
over-the-counter (OTC) medications
– Given for relieving mild to moderate pain,
fever, and anti-inflammatory conditions
– Used as a coanalgesic in severe acute or
chronic pain requiring opioids
• Salicylates (aspirin) are most commonly used for
their analgesic and antipyretic properties, as well
as for their anti-inflammatory action
• Acetaminophen has analgesic and antipyretic
properties, but very little effect on inflammation.
(major changes in Tylenol dosing)
• Aspirin and acetaminophen are frequently
combined with opioids or with other drugs for
more effective analgesic action
• Nonsteroidal anti-inflammatory drugs (NSAIDS)
are discussed in Chapter 21
• Adjuvant analgesics
– May enhance analgesic effect with opioids
and nonopioids, produce analgesia alone,
or reduce side effects of analgesics
– Treatment for nerve pain and fibromylagia
• Tricyclic antidepressants
– Treats fibromyalgia and nerve pain
associated with herpes, arthritis, diabetes,
and cancer, migraine or tension
headaches, insomnia, and depression
– Pain often described as “burning”
• Anticonvulsants
– Examples: Neurontin and Tegretol
– Commonly used for management of nerve
pain associated with neuralgia, herpes
zoster (shingles), and cancer
– Implemented when patient describes pain
as “sharp,” “shooting,” “shock-like pain,”
or “lightning-like”
Local Anesthetic
• Lidocaine patch (Lidoderm)
– Approved for management of
postherpetic neuralgia
– Can provide significant analgesia in other
forms of neuropathic pain
• Diabetic neuropathy and
musculoskeletal pain such as
osteoarthritis and low back pain

– Provides pain relief through a peripheral
effect and generally has little, if any,
central action
– Must be applied to intact skin
Antimigraine agents
• Migraine is the most common neurovascular
headache and may include nausea, vomiting, and
sensitivity to light and noise.
– Simple/opioid analgesics and NSAIDs are
effective, especially if taken at initial sign
of migraine
• Serotonin receptor agonists (SRAs)
– Action: serotonin levels decrease, while
vasodilation and inflammation of blood
vessels in brain increase as migraine
symptoms worsen
• Effective treatment for nausea
and vomiting
Sedatives and Hypnotics
• Medications used to promote sedation in smaller
doses, and sleep in larger doses
• Insomnia is one of the most prevalent sleep
disorders
• Antihistamines (Benadryl) and Barbiturates
• Benzodiazepines (BZDs) and nonbenzodiazepines
– Less abuse potential
– Withdrawal effects are observed after
long-term use and respiratory depression
(when taken with alcohol) can be
potentially fatal
• Melatonin receptor agonist
– Ramelteon (Rozerem): first FDA-
approved prescription medication that
acts on melatonin receptor
• Mimics action of melatonin to
trigger sleep onset
• Dependence and abuse potential
are eliminated
• Not classified as a controlled
substance
• Works quickly, generally
inducing sleep in less than one
hour
Chapter 20
Psychotropic Medications, Alcohol, and Drug Abuse
Introduction
• Psychotropic refers to any substance that acts on
the mind
– Psychotropic medications are drugs that
can exert a therapeutic effect on a person’s
mental processes, emotions, or behavior
• Classified according to the
purpose for administration: CNS
stimulants, antidepressants,
anxiolytics, antimanic, and
antipsychotic medications
• The following slides discuss various psychotropic
medications
– Refer to the chapter for specific side
effects, precautions or contraindications,
and interactions
• Drug and alcohol abuse is also discussed
– Refer to the chapter for specific symptoms
and treatment options
CNS Stimulants
• CNS (central nervous system) stimulant
medications
– Given to promote CNS functioning
• Caffeine
– Helps fight fatigue and drowsiness
• Examples: NoDoz, Vivarin, and
caffeine citrate
– Prolonged, high intake of caffeine in any
form may produce tolerance, habituation,
and psychological dependence
• Amphetamine/methylphenidate preparations
– Controlled substances (Schedule II)
– Treats attention-deficit hyperactivity
disorder (ADHD) in children over age six
and for narcolepsy
• Examples: Adderall and Ritalin
• Wakefulness-promoting agents
– Provigil is a psychostimulant approved for
narcolepsy, sleep apnea, and shift-work
sleep disorder
Selective Norepinephrine Reuptake Inhibitor (SNRI)
for ADHD
• Atomoxetine (Strattera)
– Selective norepinephrine reuptake
inhibitor
– First nonstimulant, noncontrolled drug
approved for attention-deficit
hyperactivity disorder (ADHD)
– Structurally related to fluoxetine
– Does not have a potential for abuse, has
less insomnia, less effect on growth, and
has been shown to be safe and effective

Antidepressants
• Major depressive disorder (MDD)
– Caused by a chemical imbalance in the
brain
– Mental disorder characterized by an all-
encompassing low mood accompanied by
low self-esteem and loss of interest or
pleasure in normally enjoyable activities
– Antidepressant medications, sometimes
called mood elevators, are used primarily
to treat patients with various types of
depression
• “Black box” warning
• Tricyclic antidepressants
– Mechanism of action involves
potentiation of norepinephrine and
serotonin activity by blocking their
reuptake
• Monamine oxidase inhibitors (MAOIs)
– Mechanism of action involves increasing
concentrations of serotonin,
norepinephrine, and dopamine in the
neuronal synapse by inhibiting the MAO
enzyme that degrades or breaks down
these nuerotransmitters
• Selective serotonin reuptake inhibitors (SSRIs)
– First-line medications for treatment of
depression
– Greater safety in the cases of overdose
– Selectively block reabsorption of
serotonin, helping to restore the brain’s
chemical balance
– Example: Prozac and Zoloft
• Selective norepinephrine reuptake inhibitors
(SNRIs)
– Inhibit reuptake of serotonin and
norepinephrine
– Affective in patients with chronic pain
– Examples: Cymbalta and Effexor
• Heterocyclic antidepressants
– Comparable efficacy to first-generation
tricyclic antidepressants,
– Differing effects on dopamine,
norepinephrine, and serotonin
– Distinctly different adverse effect profiles
– Examples: Wellbutrin and Remeron
Antimanic Agents
• Bipolar disorder
– Mental illness characterized by severe
fluctuations in mood extremes
– Patients may experience high (mania) and
low (depression) mood swings with a
diminished capacity for daily functioning
• Lithium
– Treatment of mania, lowered the suicide
– Serum levels are checked to prevent
toxicity
Anxiolytics
• Anxiety becomes a disorder when it becomes
excessive and difficult to control
• Types of anxiety disorders
– Social anxiety, post-traumatic stress
disorder, panic attacks, and obsessive
compulsive behavior
• Benzodiazepines (BDZs)
– For short-term treatment of anxiety
disorders, some psychosomatic disorders
and insomnia, and alcohol withdrawal
– Examples: Valium, Klonopin, and Versed
• Other anxiolytics
– Buspirone (BuSpar)
• Indicated for treatment of
generalized anxiety disorder, but
not other anxiety disorders (or
depression)
– Hydroxyzine (Vistaril)
• Used IM as a pre- and
postoperative antiemetic and
sedative
Antipsychotic Medications/Major Tranquilizers
• Also called neuroleptics
– First and second generation agents
• Useful in two major areas
– Relieving symptoms of psychoses
including delusion, hallucinations,
agitation, and combativeness
– Relieving nausea and vomiting
• Modify disturbed behavior and relieve severe
anxiety without impairment of consciousness
• Work primarily by blocking dopamine receptors
– Results in unbalanced cholinergic activity
• Causes frequent extrapyramidal
side effects to include tardive
dyskinesia
• Atypical antipsychotics
– Block both serotonin and transiently block
dopamine receptors
– Less potential for adverse effects
• There is no “ideal” antipsychotic medication
– Both conventional and atypical
antipsychotic medications are associated
with significant adverse drug reactions
Drug Abuse
• Drug abuse
– The use of a drug for other than
therapeutic purposes
• Drug addiction
– A combination of tolerance, psychological
dependence, physical dependence, and
withdrawal syndrome with physiological
effects
 rate
• Chemical dependency
– A condition in which alcohol or drugs
have taken control of an individual’s life
and affect normal functioning
Alcohol
• Ethyl alcohol, ethanol)
– Classified as a psychotropic drug and a
CNS depressant
– Number one drug problem in the U.S.
– Responsible for more than half of the
traffic accidents in the U.S and most
commonly abused drug among American
teenagers
– Fast acing depressant and rapid absorbed
from the GI tract
– Prolonged use can cause CNS damage
• Alcohol poisoning
– Symptoms include cold, clammy skin;
stupor; slow, noisy respirations; and
alcoholic breath
– Mortality associated with acute alcohol
poisoning alone is uncommon, but can be
an important factor when mixed with
recreational drugs
– Treatment: Refer to chapter text for
description
• Chronic alcoholism
– Refer to chapter text for symptoms and
treatment options
Prescription Drug Abuse
• Nation's fastest growing drug problem
• Second most-abused category of drugs after
marijuana
• According to the CDC, death rates from opioid
overdoses have more than tripled since 1999
• Proper disposal and storage is important for
deterring abuse
• Most often abused by medical professionals are
fentanyl, oxycodone, hydrocodone and BDZ’s
Illegal Drug Abuse
• Amphetamines
– Examples: methamphetamine (“crystal,”
“crank,” “ice,” “meth,” “speed”) and
methylenedioxymethamphetamine
(MDMA, “Ecstasy”)
– Abrupt withdrawal may unmask mental
problems
• Marijuana
– Active ingredient: tetrahydrocannabinol
(THC)
– CNS depressant, euphoriant, sedative, and
hallucinogen
– Marinol is approved for the prevention of
chemotherapy-induced nausea and
vomiting
• Synthetic cannabinoids
– “Spice”, “K2”, “skunk”, fake weed:
shredded plant material and chemical
additives
• Cocaine
– Highly addictive CNS stimulant
– Produces euphoria and increased
expenditure of energy
• Hallucinogens
– Produce bizarre mental reactions and
distortion of physical senses
– Examples: lysergic acid (LSD) and
phencyclidine (PCP)
• Dextromethorphan (DXM)
– Semisynthetic morphine derivative
– Safe, effective, nonaddictive, OTC cough
suppressant when used appropriately
– Often abused by teens because of its
phencyclidine-like euphoric effect
• Flunitrazepam (Rohypnol)
– Potent benzodiazepine approved for use in
Central and South America for ethanol
withdrawal
– Known on the street as “roofies” and the
“date-rape drug”
• Role of the medical personnel
– Have a thorough knowledge of
psychotropic drugs, action, and side
effects
– Be willing to participate in the education
of the patient, patient’s family, and others
– Give competent care to those under the
influence of drugs in a nonjudgmental
way
– Recognize drug abuse and make
appropriate referrals without exception
• Role of the medical personnel
– Keep complete and accurate records of
controlled stocks of drugs that could be
considered potential drugs of abuse
– Report any observed drug abuse to the
proper person in authority