Skin, Eyes, Ears FALL 2011 Wilhelmina Rich MSN, RN [Review glossaries @ beginning of each chapter]

Basic Structure and Function of Skin

Epidermis dead cells fingers nails etc and Dermis nerves tissue etc Keratin Melanocytes gives pigmentation to skin where epidermis and dermis meet takes 30 days for skin to turnover skin is insoluble to water Functions 1. physical barrier 2. detection of sensations 3. regulation of body temperature 4. source of vitamin D 5. excretion of water, sodium, chloride, lactate, and urea 6. inhibits growth of many microorganisms

Inflammatory disorders of skin

Dermatitis/eczema: erythema(redness), pruritus (itchiness), skin lesions. 1. Drug induced skin reactions can resemble signs and symptoms of any skin disorder a. topical drug localized, contact dermatitis reaction b. systemic drugs- generalized skin lesions Psoriasis: chronic erythematous, dry, scaling, activated T lymphocytes. 0 Skin turns over every 4 days 1 Protentiated by drugs 2 Cant take beta blockers, changes in weather, external and internal factors Rosacea: erythema, telangietases, acne-like lesions 0 Chronic 0 Blood vessels

1 Set off by everything like spicy foods, alcohol, emberassment NOT curable but treatable psoriasis and rosacea 2 Dermatological Infections Bacterial: most often caused by streptococci or staphylococci. Fungal infections: most often caused by Candida albican immune suppressed 0 thrush vaginisis etc or too much antibiotics Viral infections: verrucal(warts) and herpes (blisters) herpes zoster-shingles

Other Skin Conditions

0 0 0 Trauma- major problem is infection because skin is broken and bacteria flow in Ulcerations- break down through the layers of tissue closes by granulation impairment to circulation etc. Acne- excess of oil; not bad eating habits or lack of cleanliness External otitisAnorectal disorders-hemorrhoids itching and bleeding

Types of Dermatological Drugs

Used for local effects; and systemic absorption is undesirable Antimicrobials- superficial disorders systemically soft tissue infections Antiseptics-for skin kill or inhibit bacteria; skin needs to be cleaned prior Disinfectant damages skin it only works on objects Corticosteroids- anti-inflammatory properties Ecsyma ets Emollients and moisturizers- when skin really dry it itches so makes skin elastic Enzymes- eat skin tissue or protein gets rid of it because old tissue prevents healing Surgery Immunosuppressants- activation of T lymphocytes Keratolytics- eat or break down keratin

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Calous Retinoids- vitamin A Sunscreens

Drug therapy for selected conditions- Burns

Silver sulfadiazine/silvadene: effective against the most common pathogens in a burn wound. 1st sunburn 2nd cold or too much heat thermal burn

3d burns through skin the skin cant regenerate need skin grafts Silvadene causes silver to be released bacteria cannot grow in presence of silver. Silver tarnishes so it leaves black stain kills bacterial in 2nd and 3d degree burns Mafenide/Sulfamylon: application painful and put on in handfuls 0 Absorbs in the system; keeps scabs from developing and scabs hold bacterias Significant amounts may be absorbed systemically with large burned areas and prolonged use. Nursing management how is the wound looking 0 Any signs of infection 1 Medicating patient

Drug therapy for selected conditions Acne Face taken over by problem Major Not just one pimple
0 Topical retinoids: tretinoin/Retin-A Vitamin A Start small then build up to full coverage of it staying there You cannot go to bed with this Build up to tolerate to an hour or two 2 HOURS MAX Oral Retinoids contraindicated for women of childbearing potential. Black Box warnings for Accutane/isotretinoin. Systemic 2 types of birthcontrol recommended Sign papers stating not pregnant and you will not become

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pregnant 6 months after taking it Incidences of teenage suicide increase Oral antiandrogens for females. Decrease testosterone in women dont decrease estrogen Norgestimate/ethinyl estradiol (OrthTri-Cyclen) & norethindrone acetate/ethinyl estradiol (Estrostep) are FDA approved. Dont switch back and forth Nursing considerations

Drug therapy for selected conditions Atopic Dermatitis/Eczema Skin is trying to break down Activation of T lymphocytes Best therapy Sedating, systemic antihistamines and moisturizures used to relieve itching and promotes rest & sleep. Oral antibiotics- 10 days time max Oral corticosteroid- decrease inflammation usually topical but may be give oral just to bring down initially Coal-tar preparation- anti-inflammatory effect alone or with steroids 0 NON TOXIC Nursing considerations 0 Stay with schedule 1

Drug therapy for selected conditions Psoriasis Systemic treatment

0 1 2 Tazorac/tazarotene- topical retinoid Calcipotriene/Dovonex topical synthetic vitamin D3 analog. Can be used as monotherapy Methotrexate- systemic suppression of inflammation & proliferation of T lymphocytes; HIGHLY TOXIC Used in chemotherapy Liver must be watched Category X-no pregancy Biologic agents either block tumor necrosis factor or

decrease the activity of T cells Black Box rheumatoid atritis Immunosuppressants make you prone to secondary infections

Drug therapy for selected conditions - Rosacea

Mild skin cleaners, oral tetracycline, topical metronidazole, isotretinoin/Accutane prevent or treat acneiform lesions. NOT FIXABLE Goes to remission Have to see dermatologist Miscellaneous Ectoparasiticidal drugs: Permethrin/Nix,lindane/ Kwell, Scabene Clean everything Washing sheets and clothes and drying them Person to person Get rid of nits Hair growth; Rogaine/minoxidil, Propecia for male pattern baldness Discovered for blood pressure Causes vasodilitation of hair follicles Propecia used on males females shouldnt handle it Sunscreens need UVB& UVA UVB causes aging UVA causes burns Minimum of 30 Nursing considerations

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Retin-A 1. applied tid for 6 weeks? T F a. false all topical retinoids reduce acne lesions usually with in 12 weeks 2. skin may become red and irritated for the drug. T F a. true most common adverse reaction its acidic local irritation 3. Acne should be mostly gone by on week TF

a. False see #1 4. Sunlight will increase the healing time? TF a. False increase susceptibility to sunburn 5. Rated pregnancy category D ?TF a. False all topical forms of tretinois are ratec category C b. Isotretinoin rated category X and is only oral. Systemic c. Make sure to get tretinoins right

Drugs used in Ophthalmic Conditions

Ocular anatomy & physiology Cornea transparent no vessels Below it theres a part that has blood vessels and cover iris Disorders of the Eye Refractive Errors: where does the light on the back of the eye 1.myopia/nearsightedness 2. hyperopia/farsightedness, 3. presbyopia, aging eye 4. astigmatism cornea and lens not smooth Inflammatory and Infectious Conditions 1. conjunctivitis- pink eye; bacterial- sends kids from school viral2. blepharitis- stye 3. keratitis-destroy sight scaring 4. bacterial corneal ulcers5. fungal infections-

Disorders of the Eye

Glaucoma: primary open-angle and closed angle Leading causes of blindeness in US Increased pressure causes optic nerve damage Can be born with it Hypertension increases Being nearsightedness increases

Long time use of steroids increases Anticholinergics- dilation of pupil can lead to acute

Ophthalamic Drug Therapy

0 1 2 0 1 0 1 2 Anesthetic- 20 sec eye becomes numb Antihistamines-Visine Mast cell stabilizers-Tromolin respiratory asthma Related to allergic type of conjectivitis Not used more than a few days Antimicrobials- only works on outside of eye Not systemic Vonomide-pink eye Corticosteroids- inflammation to prevent scaring over lens Short term use typically Long term use more prone to glaucoma or optic never damage & Can lead to cataracts Non-steroidal anti-inflammatory (NSAIDs]- aspirin Tylenol etc block synthesis of proasta glandins that can cause an inflammatory response Fluorescein dye turns eye green and damage turns clear Prostaglandin analogs- antiglaucoma drugs that reduce inner ocular pressure by increasing outflow of aquous humour so it wont cause damage Kind of burns Darkens eye color permanently Can alter eyelashes Latisse Autonomic Nervous System Drugs (preferred for those with Glaucoma itself) a. Adrenergics decrease interoccular pressure used after eye surgery b. Alpha2 Adrenergic agonist c. beta blockers decrease actual production of aquous humour d. cholinergics decrease the outflow by cause pupil to constrict e. anticholinergic cause dilatation of pupils to check out eye (DIAGNOSTIC ONLY)

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Carbonic anhydrase inhibitors & Osmotic agents Secreted in kidneys Carbonic anhydrase Decrease prduction of aquous humour Every 10-15 min before surgery Osmotic agents Sucks life out of it sends to vascular bed Emergencies like acute glaucoma with extreme pain and huge pressure 0

Drugs for selected conditions-Glaucoma

Primary goal-prevent damage to optic nerve First line drugs: [ANS] beta adrenergic blocker [ aqueous formation] , alpha2 adrenergic agonist [ aqueous formation], & prostaglandin analogs [ aqueous outflow] Prototypes: timolol/Timoptic (beta blocker); brimonide/Alphagen ( 2 adrenergic agonist); latanoprost/Xalatan (prostaglandin analog) Second line drugs: cholinergic agonist [ increase aqueous outflow] , carbonic anhydrase inhibitors [decrease aqueous formation], nonselective adrenergic agonists [ increase aqueous outflow] Prototypes: Pilopine,Isopto Carpine/pilocarpine (cholinergic agonist); Diamox/actezolamide ( carbonic anhydrase);

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Nursing considerations Wash hands Avoid touching eye or eyelashes with eyedropper instill solution/ointment in the conjunctival sace Apply pressure on lacrima sac for 1 min Eye doesnt absorb put on lower lid(mucous membrane) to be absorbed by tissue with a lil pressure on lacrimal gland with finger

Ointment use a thin ribbon for touching mucous membrane Review: Does ophthalmic medication need to be sterile? Yes eye medication should be kept sterile to avoid infection. Once open, refrigerate solution. A nurse should be alert to which of the following effects likely to occur if a person is receiving a ophthalmic beta blocker and systemic beta blocker? increased bradycardia. These agents may be absorbed systematically and cause all the ADR associated with oral or parenteral drugs. Corticosteroids eye drops are prescribed for an inflammatory eye disorder Prevents scarring and loss of vision What drug classes increase effects of cholinergic drugs? Anticholinergics What drug classes decrease effects of cholinergic drugd Anticholinergic & drugs with effects similar ATROPINE Corticosteroids Sympathomimetic drugs

Drugs used for the ear Disorders of the ear

Otitis media toddlers pulling at ear Acute: pain medication required and antibiotics only when clearly indicated. Recurrent: short-term and prophylactic antibacterial therapy considered With effusion(fluid in confined space causing pressure on timpatic membrane): antibiotics have minimal effect

Otitis externa swimmers ear Acute: topical or oral antibiotics Necrotizing(ulcerations of canals): IV therapy Fungal/otomycosis Wax impaction: earwax emulsifier

Ototoxic agents
Analgesic- too much aspirin get ringing in ears tenistin can cause hearing loss AntibioticsAntineoplastics- treatment for cancer can cause hearing loss Loop diuretics- Lasix hearing loss

Nursing considerations Instilling eardrops up and back Straightening the ear canal of a child by pullin the pinna down and back Massage outside to calm down Make sure they have intact tempanic membrane