Topical Medications
Objectives
1. Identify major categories of medications used topically.
2. Describe specific administration techniques for topical products.
3. List at least three preparations used to treat eye, ear, and skin problems.
Key Terms
anorectal preparations (ā-nō-RĔK-tăl, p. 411)
antiglaucoma agents (ĂN-tĭ-glăw-KŌ-mă, p. 416)
antipsoriatics (ĂN-tĭ-SŌ-rē-ĂT-ĭks, p. 417)
antiseptics (ăn-tĭ-SĔP-tĭks, p. 412)
mydriasis (mĭ-DRī-ă-sĭs, p. 416)
pediculicides (pĕ-DĬK-ū-lĭ-sīdz, p. 417)
scabicides (SKĂB-ĭ-sīdz, p. 417)
vasoconstrictors (vās-ō-kŏn-STRĭK-tŏrz, p. 417)
Overview
http://evolve.elsevier.com/Edmunds/LPN/
This chapter presents a brief overview of the many products that may be used topically somewhere on the skin or mucous membranes. Many of these products are purchased over the counter (OTC). Because hundreds of preparations are available, and new products come onto the market very quickly, only a few selected examples of drugs in the major categories can be presented. The nurse may play a major role in teaching the patient the proper administration of these medications and precautions for their use. Side effects are usually local unless systemic sensitization (allergic reaction) develops or absorption systemically (throughout the body) occurs.
Integumentary System
The integumentary system is made up of the skin, hair, nails, and sweat glands (Figure 23-1). The skin provides the most important barrier to infection and protects the body, regulates temperature, prevents water loss, and produces the chemicals that develop into vitamin D.
The skin; mucous membranes; and surfaces of the eye, ear, nose, mouth, and vagina are often the sites of minor infections. Medications are frequently used to treat conditions in these areas. For medication to go deep within these tissues, special preparations and procedures are required.
Topical Medications
Anorectal Preparations
Action and Uses
Anorectal preparations include emollients, foams, and gels for topical anesthesia or healing of the rectal area. They are used for symptomatic relief of discomfort from hemorrhoids. They may be used on a long-term basis or briefly for hemorrhoids associated with pregnancy, prolonged sitting, or other temporary problems. Table 23-1 presents a summary of these preparations.
Table 23-1
| GENERIC NAME | TRADE NAME | COMMENTS |
| dibucaine | Nupercainal (OTC) | Patient should apply ointment morning and night and after each bowel movement. For suppositories, one should be inserted after each bowel movement. |
| hydrocortisone acetate | Anusol-HC | Contains hydrocortisone. |
| zinc sulfate monohydrate | Anusol (OTC) Preparation H (OTC) |
Suppository should be inserted in the morning and at bedtime for 3-6 days or until inflammation subsides; or cream may be applied to anal area and gently rubbed in 3 to 4 times daily for 3-6 days. |
| hydrocortisone foam | ProctoFoam-HC | Steroid used for antiinflammatory treatment of ulcerative proctitis and distal ulcerative colitis. Contains hydrocortisone. Patient should insert one applicator full in rectum daily or twice daily for 2-3 wk, then every other day, decreasing therapy gradually. |
Adverse Reactions
The patient may have sensitization to the product.
Mouth And Throat Preparations
Action and Uses
Miscellaneous products are used to soothe minor irritation in the mouth and throat. Some release oxygen to provide cleansing, whereas others contain an anesthetic property to reduce pain. These preparations are used for minor oral inflammation, such as canker sores, dental irritation, and pain after dental procedures; for relief of dryness of the mouth and throat; or for treatment of minor sore throat discomfort and control of cough caused by colds.
Products are available in mouthwashes, sprays, solutions, troches, lozenges, and disks. The patient should be taught the appropriate administration technique for the drug form being used. Patients should not take these products for longer than 3 or 4 days for normal therapy. Table 23-2 presents a summary of these products.
Table 23-2
| GENERIC NAME | TRADE NAME | COMMENTS |
| Oral Preparations | ||
| carbamide peroxide | Orajel | Do not dilute. Apply directly to affected area 4 times daily, spit out after 2-3 min. |
| Lozenges and Troches | ||
| — | Cepacol Cepastat Robitussin Sucrets |
For mouth pain. Dissolve 1 lozenge in mouth up to every hour if needed. Take no more than 12 lozenges daily. |
| clotrimazole | Mycelex | For oral thrush. Take 1 troche 5 times/day for 14 days. Dissolve slowly in mouth. |
| Gargles, Gels, Mouthwashes, and Sprays | ||
| — | Cepacol Chloraseptic |
For mouth pain. Follow directions on bottle or package. Wide variation exists among products. |
| nystatin | Mycostatin | Antifungal; for oral thrush. Take 400,000-600,000 units for 10-14 days. Dissolve slowly in mouth. |
| Saliva Substitutes | ||
| — | Salivart | Used to relieve dry mouth and throat; spray into mouth as needed. |
Ophthalmic Drugs
Action and Uses
A wide variety of preparations are used for eye problems (Table 23-3). Local anesthetics are useful in procedures such as tonometry, gonioscopy, cataract surgery, and removal of foreign bodies from the cornea. Antiseptics are compounds capable of preventing infection. They are used for the prevention of gonorrheal ophthalmia neonatorum when babies are born or any time germicidal or astringent (tissue constricting) action is needed. Antiinfectives are used to treat common eye infections caused by bacteria, fungi, or viruses. Artificial tears provide lubrication to relieve dry eyes, eye irritation secondary to wearing contact lenses, or deficient tear production caused by a wide variety of disorders. Diagnostic products include topical fluorescein stains, which are used to detect foreign bodies or scratches.
Table 23-3
| GENERIC NAME | TRADE NAME | COMMENTS |
| Local Anesthetics | ||
| benoxinate | Fluress | Often used when suturing of eye is required. Use before eye procedures. |
| proparacaine | Alcaine | Use immediately before tonometry, 2-3 min before suture removal or removal of foreign body. |
| tetracaine | Pontocaine | Use drops or ointment to lower conjunctival area. |
| Antiseptic Ointments | ||
| silver nitrate | Silver Nitrate | After birth, clean infant’s eyes with cotton ball and use 2 gtt 1% solution once. |
| Ophthalmic Antiinfectives (Preparations Must be Labeled “Ophthalmic”) | ||
| Alpha2-Adrenergic Agonist | ||
| brimonidine | Alphagan P | Use 1 drop in the affected eye(s) q8h. |
| Antibiotics | ||
| bacitracin | AK-Tracin | Apply sparingly into conjunctival sac 2 to 3 times daily. |
| chloramphenicol | Apply small amount of ointment to lower conjunctival sac, or use 2 drops of solution q3h for the first 48 hr, then PRN. Continue for at least 48 hr after the eye appears to be normal. | |
| ciprofloxacin | Ciloxan | Put into conjunctival sac, close eyes, and apply light pressure over lacrimal sac for 1 minute. |
| erythromycin | Ilotycin | Apply to affected eye 3 times daily or more often, depending on severity of infection. |
| gentamicin | Garamycin Genoptic Gentacidin |
Put drops into affected eye q4h. In severe infections, dosage may be increased to hourly. Apply ointment sparingly 2 to 3 times daily. |
| levofloxacin | Quixin Levaquin | Use drops in the affected eye(s) q2h while awake, up to 8 times/day for 2 days. Then use drops in affected eye(s) q4h while awake, up to 4 times/day for days 3 through 7. |
| norfloxacin | Noroxin | Put into conjunctival sac, close eyes, and apply light pressure over lacrimal sac for 1 min after. |
| ofloxacin | Ocuflox | Put into conjunctival sac, close eyes, and apply light pressure over lacrimal sac for 1 min after. |
| polymyxin B | polymyxin B | Use very hour PRN. |
| sulfacetamide sodium | AK-Sulf Sodium Sulamyd | Use drops q2-3h during day, less at night. May also apply ointment in lower conjunctival sac at night. |
| tobramycin | Tobrex AK-Tob | Use drops 4 to 6 times daily. |
| Antiviral Agents | ||
| fomivirsen | Adults: Use a single intravitreal injection every other week for 2 doses followed by maintenance dose once every 4 wk in treatment of cytomegalovirus retinitis. | |
| ganciclovir | Vitrasert | Used in treating cytomegalovirus retinitis in patients with AIDS. Provided as a 4.5-mg insert designed to release drug over a 5- to 8-mo period. May be repeated as needed. |
| trifluridine | Viroptic | Put onto ulcerated cornea of eye q2h while awake for a maximum of 9 drops/day. Continue until reepithelialization, then for 7 days give q4h while awake. |
| Artificial Tears | ||
| — | Isopto Tears Liquifilm Forte Refresh Plus Systane Tearisol Tears Plus |
Drops may be used in eyes 3 to 4 times daily or PRN. Some preparations, such as Tearisol, are not to be used with soft contact lenses. Keep solution free from contamination. |
| — | Lacrisert | Insert once a day into inferior cul-de-sac beneath base of tarsus. |
| Antiglaucoma Agents | ||
| Sympathomimetics | ||
| apraclonidine | Iopidine | Use solution before laser surgery. |
| dipivefrin | Propine | Put into eyes q12h. |
epinephrine  |
Use drops into affected eyes daily to twice daily. | |
| Use daily or twice daily. | ||
| Beta Blockers | ||
| betaxolol | Betoptic | Use drops twice daily. |
| carteolol | Ocupress | Use drops twice daily. |
| levobetaxolol | Betaxon | Use drops twice daily. |
| levobunolol | Betagan Liquifilm |
Use drops daily. |
| metipranolol | OptiPranolol | Use drops twice daily. |
| timolol | Timoptic | Use drops twice daily. |
| Miotics, Direct-Acting | ||
| acetylcholine Cl | Miochol-E | Use drops 3 times daily. |
| carbachol | Isopto-carbachol | Use drops up to 3 times daily. |
| pilocarpine | Pilocar Pilostat | Use drops up to 6 times daily. |
| pilocarpine ocular therapeutic system | Ocusert | The system is placed in and removed from the eye by the patient, according to instructions in the package. Releases 20 or 40 mcg pilocarpine per hour for 1 wk. |
| Miotics, Cholinesterase Inhibitors | ||
| demecarium | Put drops into eyes daily. | |
| echothiophate | Phospholine Iodide | Use drops daily. |
| Carbonic Anhydrase Inhibitors | ||
| brinzolamide | Azopt | Use 3 times daily. |
| dorzolamide | Trusopt | Use 3 times daily. |
| Mydriatic-Cycloplegics | ||
| atropine | Use solution daily to 3 times daily, or ointment daily to 3 times daily. | |
| cyclopentolate | Cyclogyl | Use 1% or 2% solution; repeat in 5 min. Refraction can occur in 40-50 min. |
| homatropine | Isopto-Homatropine | Use 2% or 5% solution; repeat 2 to 5 times until desired results occur. |
| scopolamine | Isopto Hyoscine | Use 0.25% solution daily to 3 times daily. |
| tropicamide | Mydriacyl | Use 1% solution; repeat in 5 min. |
| Mydriatic | ||
| phenylephrine | Neo-Synephrine | Mydriasis: Use 2.5%-10% solution topically on conjunctiva. Repeat in 5 min PRN. Mydriasis: Use 2.5%-10% solution topically on conjunctiva. Repeat in 5 min PRN. Conjunctivitis: Use qh until condition improves, and then 1 drop 3 to 4 times daily. |
| Other Ophthalmic Preparations | ||
| Alpha-Adrenergic Blocking Agent | ||
| dapiprazole | Use drops, followed 5 min later by additional drops. | |
| Prostaglandin Agonists | ||
| bimatoprost | Lumigan | Use daily in the evening to reduce IOP. |
| latanoprost | Xalatan | Use drop in affected eye(s) once daily in the evening. Do not exceed prescribed dose. |
| travoprost | Travatan | Use drop daily in the evening to reduce IOP. |
| unoprostone | Use drop twice daily. May be used with other drops if administered at least 5 min apart. | |
| Antihistamines | ||
| azelastine | Optivar | Use drops twice daily to reduce itching from allergic conjunctivitis. |
| emedastine | Emadine | Use drops in affected eye(s) 4 times daily. Do not use if patient is wearing contact lenses. |
| olopatadine | Patanol | Use drops twice daily at intervals of 6-8 hr. |
| Vasoconstrictors and Mydriatics | ||
| hydroxyamphetamine | Use drops in conjunctival sac. | |
| naphazoline | Use drops 2 to 3 times daily PRN to relieve irritation or redness. Mydriasis occurs within 1 hr, recedes within 6 hr of administration. NOTE: DO NOT GIVE TO PATIENTS WITH ANGLE-CLOSURE GLAUCOMA OR NARROW ANTERIOR ANGLE. | |
| oxymetazoline | Use drops q6h. | |
| tetrahydrozoline | Murine Tears Plus Visine | Use drops in each eye 2 to 3 times daily PRN. Mydriasis occurs in 1 hr, recedes within 6 hr. NOTE: DO NOT GIVE TO PATIENTS WITH NARROW-ANGLE GLAUCOMA. |
| Eye Diagnostic Products | ||
| fluorescein | Fluor-I-Strip Ophthifluor Fluorescite AK-Fluor Ful-Glo | For examination of corneal and conjunctival epithelium, pour 1 drop sterile water on strip, touch to cornea, and close lid for 60 sec. Use Wood lamp to visualize. Add drops; patient should blink. Examine eye under fluorescing light, and areas of foreign body or abrasion should fluoresce bright green or yellow. |
| Nonsteroidal Antiinflammatory Drugs | ||
| diclofenac | Voltaren | Use drops in affected eye 4 times daily beginning 24 hr after cataract surgery and continuing throughout first 2 wk of postoperative period. |
| flurbiprofen | Ocufen | For inhibition of intraoperative miosis, for inflammation after cataract, glaucoma, or laser surgery and uveitis syndromes: Use every 30 min beginning 2 hr before surgery. |
| ketorolac | Acular | For relief of ocular itching caused by seasonal allergic conjunctivitis and treatment of postoperative inflammation of postcataract extraction: 1 drop to affected eye(s) 4 times daily beginning 24 hr after cataract surgery and continuing for 2 wk. |
