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Dermatology Pharmacology

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Dermatology Pharmacology DERMATOLOGY PHARMACOLOGY KELLIE WILSON, PharmD Kellie Wilson, is a Doctor of Pharmacy practicing in Anaconda, MT. She specializes in retail pharmacy at an independent pharmacy. She attended the University of Montana in Missoula, MT where she graduated in 2009 with a doctorate in pharmacy. She then when on to work in Boise, ID as a retail pharmacist for one of the big corporations for 2 years. She then moved home to Montana to work at a retail pharmacy that is independently owned. In the 8 years she has worked as an independent retail pharmacist she has become very involved in psychiatric pharmacy for two major behavioral health organizations that are located around all of Montana. Kellie loves working as a retail pharmacist because she enjoys the interaction with her customers. Pharmacy is always changing and keeping up to date with new medications is very challenging and very rewarding all at the same time and this is why Kellie has chosen a career in pharmacy and is pursuing more towards psychiatric pharmacy. NOAH CARPENTER, MD Dr. Noah Carpenter is a Thoracic and Peripheral Vascular Surgeon. He completed a Bachelor of Science in Chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of the Native Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, the Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education. 1 NurseCe4Less.com ABSTRACT Many types of skin diseases can occur in people that range in onset and severity. Health providers need to be informed of the varied skin conditions and pharmacological therapy in order to appropriately inform patients of drug benefits and risks and to deliver comprehensive medical treatment. Dermatological treatment may be directed toward the management of an inflammatory process, comorbid medical conditions, or it may be cosmetic. There are evolving dermatology drug products and market factors that providers will need to guide patients on when addressing their skin health concerns and treatment choices. The effect of certain dermatological agents in special populations, such as during pregnancy can range from inconclusive to a known potential risk. When used in excessive amounts for prolonged periods of time, there are product warnings related to certain drug treatments for skin disease in pediatric, elderly and pregnant women. In pregnant women, for example, topical steroids have been classified as category C drugs, therefore caution must be observed to avoid harm to fetal health. More research is needed to determine the benefits and risks of dermatological agents used as cosmeceuticals and in the prevention and treatment of skin disease. 2 NurseCe4Less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. Continuing Education Credit Designation This educational activity is credited for 4 hours at completion of the activity. Pharmacology content is 4 hours. Statement of Learning Need The skin is an important body organ, and health providers need to be informed about dermatology cosmeceuticals and medication used to treat various skin diseases. Many factors ultimately determine the therapeutic benefit of dermatology pharmaceuticals. A clinical knowledge of the many different types and forms of dermatology medication, an awareness of patient preferences for treatment, and the health benefits and risks of selected skin products, are essential for health clinicians when recommending, initiating and following the progress of skin treatment. Course Purpose To provide interdisciplinary health professionals who work in dermatology, surgical, and general medicine areas of patient care with a general knowledge of dermatology pharmacology for varied skin conditions and to support clinician efforts to educate patients on appropriate medication use and compliance. Target Audience Advanced Practice Registered Nurses, Registered Nurses, and other Interdisciplinary Health Team Members. Disclosures Noah Carpenter, MD, Kellie Wilson, PharmD, William Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures. There is no commercial support. 3 NurseCe4Less.com Self-Assessment of Knowledge Pre-Test: 1. _____________ is defined as a sudden, acute decrease in response to a drug after the drug is administered. a. Tapering down b. Rebound effect c. Tachyphylaxis d. Topical nonadherence 2. Skin lesions are classified into two categories: a. Primary and secondary skin lesions. b. Site involvement and structure affected. c. Congenital and acquired skin lesions. d. Skin lesions caused by an infectious agent or an autoimmune mechanism. 3. ____________ are at an increased risk of absorbing topical corticosteroids. a. Infants b. Individuals who are overweight c. Women d. The elderly 4. ______________ is an antimitotic that reduces inflammation and can help treat psoriasis. a. Mupirocin b. Clindamycin c. Ketoconazole d. Anthralin 5. The term ___________ refers to the inactive part of a topical preparation that brings a drug into contact with the skin. a. lidocaine b. vehicle c. prilocaine d. astringent 4 NurseCe4Less.com Introduction Patients with a dermatological concern may report a condition ranging from a serious diagnosis such as cancer to a cosmetic issue that impacts a person's physical and emotional health. A health provider will need to determine the cause of a skin disorder by evaluating whether there is a genetic abnormality, an infection, or an autoimmune mechanism that is causing a skin disorder. Identifying the site of involvement, the type of skin disorder, and the structure that is mainly diseased will be needed before determining treatment. Once a patient has been evaluated, there are topical medications, as well as oral or injectable medications that may be used for dermatological treatment. Topical treatments to select from are many and continue to grow in the area of dermatology, which may include antibiotics, antifungals, corticosteroids, retinoids and biologics. Depending on the patient’s condition, an oral or injectable medication may be recommended. The treatment of an infectious or inflammatory skin condition will sometimes require the use of an antiviral or immunosuppressive agent. Dermatological treatment is presented in the following sections with a primary focus on the most common medications used. The important role of biologics in treating psoriasis and the FDA-approved biologics used for psoriasis and psoriatic arthritis are discussed. Skin Disease Classifications and Treatments Skin diseases are classified in various ways. The classifications and subcategories of a skin condition are briefly listed here but these are evolving.1 It is useful to look at skin conditions by identifying the site of involvement, the cause of the skin condition, and the main structure affected by the disease.2,3 The site of involvement may include facial rashes or lesions on sun- exposed sites. Skin lesions are classified into two categories: 1) Primary skin lesions, which are abnormal skin conditions from birth or that are acquired over a person’s lifetime, and 2) Secondary skin lesions, which are the result of irritated or manipulated primary skin lesions, such as when a person scratches a mole until it bleeds. In such instances, the resulting lesion, a crust, 5 NurseCe4Less.com becomes a secondary skin lesion.4 Pathogenesis may include genetic abnormalities, infectious etiology or autoimmune mechanisms. The main diseased structure may be epidermal disease, abnormalities of melanocytes, and vascular changes.4 Many different medications are used to treat different skin infections or conditions. There are topical medications as well as oral medications and injectable medications. Topical Agents Topical medications use vehicles that are the inactive part of the topical preparation and that help bring the drug into contact with the skin. The vehicles that deliver topical therapies include inactive ingredients such as powders, liquids, oils, or a combination of products. The location of application of the topical medication, the cosmetic effects, and convenience determine the choice of the vehicle. Some common topical treatments for skin conditions include those listed in this section.2,5-10 ● Antibacterials: Mupirocin or clindamycin, are often used to treat or prevent infection. ● Anthralin: Anthralin is an antimitotic, is not often used because it can be irritating and can stain, but is used to reduce inflammation and can help treat psoriasis. ● Antifungal Agents: Clotrimazole (Lotrimin), ketoconazole (Nizoral), and terbinafine
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