OTC Products #3

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DrJBlack
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82765
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OTC Products #3
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2011-05-04 14:05:02
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OTC Exam
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OTCs for Third Exam
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  1. Stratum Corneum
    • outermost layer of the epidermis
    • rate limiting step for drug absorption
  2. Layers of the Skin (1-2 mm thick)
    • Epidermis - no blood flow; mostly dead skin cells that usually takes about 2 weeks to sloff off the layer
    • Dermis - 40 times thicker than epidermis; nerves and pain sensation
    • Hypodermis - fatty comonent of the skin; cushions the bones underneath the skin
  3. Skin Functions
    • protective barrier to keep stuff out of the body
    • moisture control
  4. Sweat
    • cools the body (evaporation)
    • somewhat acidic - keeps normal skin pH between 4.5-5.5
    • (bacteria resides in pH 6.5-7.5)
  5. Patient Assessment
    • onset - when did it start
    • location - where did it start
    • distribution - is it spreading, how it's spreading, have you had this medication before or previous treatments
  6. Flat, circumscribed lesions - defined marking, defined area, margin
    • macule - flat rash less than 1 cm.
    • plaque - ex. suriasis scaly
    • patch - greater than 1 cm.
  7. Elevated, cricumscribed lesions - Solid
    • papule - less than 1 cm (a big infected zit with a whitehead and a hair inside)
    • nodule - greater than 1 cm
    • tumor - large, well defined mass it is a nodule
  8. Elevated, circumscribed lesions - fluid
    • vesicile - fancy word for blisters -> you shouldn't pop blisters because it protects the new, immature skin
    • bulla - huge blister
    • pustule - less than a cm full of pus
    • abscess, furuncle - greater than a cm -> Best way to treat is cut it and drain it, otherwise white blood cells and collagen go to the abscess and it gets hard so that no antibiotics can reach abscess - TX PT BEFORE!!
    • ***For these type of lesions, get a triple antibiotic and put a band-aid on it or get moleskin
  9. Absorption of Drugs
    • increase skin temperature -> increase blood flow -> vasodialtion -> increase in drug absorption
    • DO NOT use hot water for swelling, because it will just increase the swelling
    • 2% systemic absorption for topical drug -> the more damaged the skin is, the more systemic absorption you get especially when it is a cut
    • drugs absorbed by skin through passive diffusion
    • creams will rub in, but ointments will not
    • ointments are occlusive; protect moisture from being lost (trap moisture)
    • 20 second rule: should take patient 20 seconds to rub creams in to the skin; >20 sec = too much; <20 sec = too little
  10. Magnet Therapy
    • there is some researchthat shows magnets helping with pain by interruping the pain stimulus
    • patients on pacemakers and/or ICD efribilators shouldn't use because magenets turn them on/off
  11. Refer to physicial - topical products
    • when rash is spreading quickly
    • when the rash is around they eyes
    • covers a large area
    • OTC is not effective
    • rash becomes infected
  12. Signs of infected rash
    • area is warm
    • swollen
    • red line up the arm -> cut with a pink/red line that goes up the arm, which means infection is traveling up the veins to heart
  13. Drugs and skin reactions - photosensitivity
    • photoallergy - least common immunological reaction; drug that allows UV radiation - antigen
    • photoxic - drug makes skin more sensitive to the sun (UV A rays)
    • example: Retin-A used for acne; if they don't wipe it off -> massive sunburn
  14. Selecting Dosage Forms for topical products
    • solution - if it is a hairy area
    • ointment - dry skin, if it's an area of friction; NEVER put ointment on a burn - very occlusive
    • cream - wants something that rubs right into the skin
    • gel - somewhat more potent
    • spray - if it's a wide area; good for sensitive areas
    • lotions - used for hairy areas
    • powders - absorb liquid a lot of friction
  15. External Analgesics - diseases
    • muscle pain/muscle strain
    • bursitis
    • sprains
    • strains
    • bruises
  16. Muscle Pain/Muscle Strain - tendinitis
    • macro-trauma - excessive force
    • micro-trauma - overuse of the muscle
    • Drugs: ibuprofens, aleves, etc
  17. Bursitis
    friction b/t a tendon and a bone such as in the elbow
  18. Sprain
    deals with a ligament (attaches from bone to bone)
  19. Strain
    partially torn the muscle: tear in muscle fibers from overuse, overforce, etc
  20. Bruise
    "Hematoma" - damaged tissue
  21. Patient Assessment
    • Pain - shouldn't use products for more than 7 days -> severity = how bad is the pain?
    • Cause of Pain - reason (ex. gall bladder pain -> referred pain)
    • Has it been Diagnosed - ex. arthritis
    • previous prescription or OTC use - what was tried previously
  22. External Anagelsics
    • used TID-QID
    • Definition: distractors
    • Indications: all but trolamin don't hae any pharmacological effect dealing with inflammation (muscle pain, joint pain, arthritis)
  23. Counterirritants
    • MOA: work by inducing sensation of warmth and cold
    • Indications: same as external analgesics - muscle pain, joint pain, arthritis
  24. Counterirritants that produce redness
    • allyl isothiocyanate 0.5 - 5% -> mustard seeds
    • strong ammonia solution, diluted to 1-2.5% ammonia -> vapors are toxic
    • **methyl salicylate 10-60% - most common; create warm sensation and does not penetrate skin
    • turpentine oil 6-50%
  25. Counterirritants that produce cooling sensation
    • camphor 3-11%
    • menthol 1.25-16%
  26. *** Counterirritants that don't produce redness
    • Zostrix-HP
    • capsaicin 0.025-0.25% -> chillipeppers
    • capsicum containing 0.025-0.25% capsaicin
    • capisicum oleroesin containing 0.025-0.25% capsaicin
    • depletes substance P and interrupts the pain stiumulus - type C neuron/fiber
    • Remember to wash your hands
    • Excellent for diabetic neuropathy -> pain in extremities (feels like pins and needles in hands and feet)
  27. Trolamine Salicylate
    • MOA: it's not a counterirritant, but gets into joins and stays local
    • 60% absorption in tissues and anti-anflammatory activity
    • Products: Sportscreme, Myoflex, Aspercreme -> doesn't have asprin
  28. Miscellaneous Counterirritant Products
    • Ben-Gay - menthylsalicylate and menthol -> don't help inflmmation but used for irritation
    • Theragesic - 16% menthol and methylsalicylate -> extremely hot
    • Joint-ritits - glucosamine and chondroitin -> waste of money and chemically infeasible
    • DMSO - dimehtylsulfaoxide -> some anti-inflmmatory properites; used alot in race horses; very well absorbed across skin for systemic absorption; side effects can deform the lenses of the eyes
    • BioFreeze - menthol and ilex -> neural extract from plant; helps relieve pain and inflammation; never know how much it works b/c no intense study
    • Super Blue Staff -> MSM (methylsulfonyl menthane) -> anti-inflammatory activities -> EmuOil (big fat bird that has oil in thier skin)
    • Benalg - methylsalicylate and menthol
  29. Patient Counseling - External Analgesics
    • when using external analgesics, don't tightly wrap the area b/c you'll force more chemical into the skin and cause blistering
    • don't use a heating pad b/c it will be even worse and get the chemical into the muscles and kill the muscles
    • don't apply it before strenous exercise b/c of vasodialation which will cause an increase in systemic absorption
    • keep it away from the mucous membranes
    • no more than 7 days use
  30. ThermaCare Heat Wraps
    • deliver 104 degrees F of heat -> like wearing a heating pad on a low setting
    • deliver heat up to 8 hours
    • comes in multiple sizes
    • really doesn't heat up until it gets placed on the skin/body
  31. What does PRICE stand for?
    • protection, rest, ice, compression, elevation
    • should begin ASAP (10-15 minutes following injury)
  32. Protection
    use canes, crutches, slings, splints, etc
  33. Rest - how long should you rest?
    complete or partial immobilizatin of injured part for 24-72 hours, depending on severeity
  34. Icing- How should the patient ice (duration, how often)
    • Supports applying ice for 20-30 minutes at a time every 2 hours while patient is awake
    • longer than 30 minutes can increase chance of injury to the skin
    • treatment continues for 48-72 hours; some recommend a 7 day period
  35. Compression - duration?
    applied for at least 72 hours after an injury, both during and after cold application
  36. Elevation - how long and how high should the injured area be elevated?
    injured part should be elevated as far above the level of the heart as possible ASAP after injury, as as much as possible during the first 72 hours
  37. Two functions of NSAIDs according to article?
    • reduces tissues damage caused by release of degradative enzymes and other events
    • accelerates healing by shortening the duration of the initial inflammatory phase -> evidence shows that suppressing inflammatory response may actually delay or hinder healing
  38. What medication should be used or not used to treat pain?
    • APAP used for acute soft tissue injuries; has no anti-inflammatory effects therefore carries no risk of imparing the healing process; preferred b/c it's associated with fewer adverse effects and drug interactions than NSAIDs
    • ASA shouldn't be used b/c it inhibits platelet aggregation and may increase bleeding
  39. Bacterial Infections
    • need to get treatment for infection quickly
    • we all have staph on the skin and Candida Albican
  40. Impetigo
    • cinnamon crunch like aroudn the mouth and nose
    • yellow, brown crusty stuff in the most outer layer of the skin
    • constant rubbing of the skin
    • usually in younger kids who have/had colds
    • will transmit to other broken damage skin
    • Treatment: wash it until you get the crust off; triple antibiotic ointment -> Neosporin after you was the crust with a wash cloth, soap, and water
    • for kids, ointment is better than creams b/c it will stay on longer
  41. Furuncles/Carbuncles
    • furuncles: infected hair usually caused by friction
    • carbuncles: bunch of infected hairs usually caused by friction
    • Tx: scrub it good, pull the hair out, bust it, antibiotics
  42. Herpes Simplex - Type I
    • Type I: cold sores that usually last 10-14 days
    • caused by increase cell lysis which spills out to other good cells of the body; colds, stress
    • Lysine tx is probably a waste of money
    • Type II: genital herpes
  43. Abreva
    • docosanol 10% for cold sores
    • expensive
    • forcefield -> cell protectant -> coats cells in the lips and prevents virus from entering and attaching
    • use early, otherwise infection of a lot of cells
    • works within 4-7 days
    • mainly for lips
  44. Herpes Zoster
    • cannot treat shingles with OTC
    • chicken pox and shingles affects nerve ending
    • early treatment, give Valtrex
    • very painful -> catch early
  45. Abrasions
    • scrape
    • get it clean with soap and water
    • bandage it with Telfa - non stick pad
  46. Punctures
    • step on a nail or get otu whatever you got in
    • get the foreign bodies out of womb
  47. Lacerations
    • cut
    • refer to ER if you think they need stitches
    • 6 hour actviely bleeding -> may not stitch back
    • give more protective barrier - less scarring, keep bacteria out
  48. Referral
    • deep wound/puncture
    • extreme tiredness/fever
    • infection (red, warm)
    • red streak - infection gone systemic
  49. Antiseptics
    • disinfection of skin around the wound
    • DON'T put on broken skin
    • Indications: on in tact skin
    • alchol dries out skin and must be/stay on for 30 seconds to have antiseptic effect; isopropyl alcohol dries skin more than rubbing alcohol
    • iodine kills bacteria/virus/fungi/protozoa/fungi spore; best antiseptic agent; stains
    • Betadine (povidone iodine) - similar to iodine; topical choice before surgery; stains everything
    • Warnings: keep rest of out of skin, skin dryness
  50. Boric Acid
    • don't use as antiseptic
    • now used to kill cock roaches
  51. Hydrogen Peroxide
    • H2O2 -> H2O + O2
    • bubbles = H2 being released
    • kills anaerobic bacteria
    • pour right onto wound and doesn't burn
    • lost potency: no fizz or bubbles
  52. Anitibiotic Ointments
    • Indication: prevent/treat minor skin infections
    • Don't Recommend: oxytetracycline and tetracycline
  53. Bacitracin/Bacitracin zinc
    • bacteriocidal that kills bacteria
    • kills gram + bacteria; rare resistance
  54. Neomycin
    • bacteriostatic
    • prevents bacterial growth/replication
    • 3-6% of individuals are allergic
    • stays in the GI tract
  55. Polymyxin B
    bacteriocidal
  56. Neosporin
    • bacitracin, neomycin, polymyxin B
    • preferred ointment
    • used for prevention
  57. Neosporin Max
    has all 3 but has twice the amount of polymyxin B
  58. Polysporin
    only has polymxing b and bacitracin
  59. Neosporin and pain relief
    • don't recommend
    • promoxine - weak anesthetic
  60. Neo to Go
    not triple antibiotic ointment
  61. Patient Counseling - topical anti-infectives
    • if it's a cut/womb -> wash with soap and water
    • pat dry
    • apply plentifully
    • non-stick pads -> Telfa
    • ointments stay on better than cream
    • bandage -> snug, but not tight
    • if skin is warm and pink around the womb -> refer to physician
    • tetanus shot -> in general is good for 8 years
  62. Antifungals
    • live in the outer layer of the skin (feed of dead skin cells)
    • live in between the toes (loves warm, moist environments)
    • don't wear socks so that feet can breathe
    • nail fungus = OTCs won't work
  63. Tinea Capitis (Ringworm of scalp)
    • Symptoms: circular and crusty; usually itchy; sometimes will lose their hair in that area
    • Treatment: any OTC antifungal, but use solution
  64. Tinea Corporis (body ringworm)
    • Symptoms/sings: circular and crusty; usually itchy; sometiems will lose their hair in that area; very contagious
    • Treatment: any OTC antifungal will treat it
  65. Tinea Cruris (jock itch)
    • not gender selective , bathing suit , underwear area
    • Symptoms/sings: very red, swollen, very, very itchy; pain w/ itch, itch w/ pain
    • Tx: don't wear underwear; no boxer briefs or "tighty whities," all OTCs will treat jock itch; increase air circulation; keep it dry
  66. Tinea Pedis (athlete's foot)
    • Symptoms/signs: itchy, scaly, sometiems will begin to crack if not treated
    • Tx: all antifungals treatment
  67. Tolfnate 1%
    • Indications: jock's itch; ringworm; athlete's foot
    • OTC antifungal that has the FDA indication for preventing athlete foot
    • MOA: interrupts the mycelium, which is responsible for growth and feeding of the fungal cell
    • Dose: BID 2-4 weeks -> takes 2 weeks for the skin to be "sloffed" or taken off
    • Products: Tinactin, Lamisil, Defense
  68. Miconazole nitrate 2%
    • Indications: jock itch, ringworm, athlete's foot
    • MOA: inhibits ergosterol, which is needed for the cell wall; cell wall looses its integrity, cell lysis
    • Dose: BID 2-4 weeks
    • Products: Micatin, Lotrimin AF
  69. Clotrimazole 1%
    • Indications: ringworm, jock itch, athlete's foot
    • MOA: interrups ergosterol
    • Dose: BID 2-4 weeks
    • Products: Lotrimin AF
  70. Undecylenic acid/ calcium undecylenate, copper undecylenate, zinc undeylenate (individually) or any ratio that provides total undecylenate content of 10-25%
    • Indications: RW, JI, AF
    • MOA: fungistatic -> inhibits protein synthesis
    • Dose: BID 2-4 weeks; people don't like the drug b/c it stinks and it has to interact with sweat; sweat activates the drugs
    • Products: toe nail products
  71. Clioquinol 3%
    • Indications: has antibacterial effects
    • MOA: unknown
    • Dose: BID 2-4 weeks; this drug can interfere with thyroid tests
    • Products: Vioform
  72. Povidone-Iodine 10%
    • Indications: use as an antifungal
    • MOA: denatures the cell wall
    • Dose: NOT RECOMMENDED
    • Products: Betadine solution
  73. Terbinafine 1%
    • Indications: treats JI, RW, AF
    • MOA: inhibits squalene oxidase, which is used to make ergosterol
    • Dose: BID for one week
    • Products: Lamasil AT
  74. Butenafine 1%
    • MOA: inhibits squalene oxidase
    • Dose: BID for one week or QD for 4 weeks
    • Products: Mentax (Rx form) and Lotrimin Ultra
  75. Patient Counseling - antifungals
    • don't expect tramatic changes immediately
    • relief may take several days
    • compliance, Compliance, COMPLIANCE
    • 2-4 week product; minimum of 2 weeks
    • clean it regularly -> soap and water
    • socks made of cotton -> breathable material
    • hot water to wash clothes
    • powder sweaty feet
    • *** fungi is hard to kill
  76. Vaginitis - Vaginal Discharge & Inflammation of vulvar or vaginal areas
    • Normal: white or clear, floccular, nonhomogeneous, variable amount; None
    • Canidida Vulvovaginitis: White, "curd-like" clumped, sometimes increased amount; erythema of vaginal and vulvar epithelium, dermatitis
    • Bacterial Vaginosis: white or gray, malodorous, thin, homogenous, smoothly coats vaginal walls, often increased amount; None
    • Trichomonas Vaginitis: yellow or green, malodorous, frothy, homogeneous, low viscosity, greatly increased amount; erythema and swelling of vaginal and vulvar epithelium, "stawberry cervix"
  77. Fungal/Candidasis
    Symptoms/Signs: white, clumpy, curd-like discharge with inflammation, redness, itchy area, swollen
  78. Bacterial Vaginoisis
    • discharge is white and very thin
    • 50% of patients have a fishy ordor that gets worse if sex is had
    • no redness/itching of area
  79. Trichomonas vaginitis
    • protzoa STD
    • redness, swelling, itching, foaming, green
    • Tx: Metronidazole
  80. Clotrimazole
    • Indications: swelling, redness, itching, white clumpy curd-like discharge
    • being sexually active will increase yeast infections
    • oral contraceptives will increase fungal infections
    • Precautions/Warnings: recurrent yeast infections -> previously diagnosed once by a physician in patients 12 and older; refer to doctor -> fever and at least 4 yeast infections in a 12 month period
    • Directions: 1% cream or 100 mg for 7 days; 2% cream or 200 mg of suppositories for 3 days
    • Products: Gyne-Lotrimin and Mucelex
  81. Miconazole
    • Indications: swelling, redness, itching, white clumpy curd-like discharge
    • being sexually active will increase yeast infections
    • oral contraceptives will increase fungal infections
    • Precautions/Warnings: recurrent yeast infections -> previously diagnosed once by a physician in patients 12 and older; refer to doctor -> fever and at least 4 yeast infections in a 12 month period
    • Products: Monistat-1, Vagistat-3; combo pack has external cream and suppository
  82. Butoconazole nitrate
    • Indications: swelling, redness, itching, white clumpy curd-like discharge
    • being sexually active will increase yeast infections
    • oral contraceptives will increase fungal infections
    • Precautions/Warnings: recurrent yeast infections-> previously diagnosed once by a physician in patients 12 and older; refer to doctor -> fever and at least 4 yeast infections in a 12 month period
    • Directions: use at night for at least three nights
    • Products: Femstat-3
  83. Tioconazole
    • HIGHLY RECOMMENDED
    • Indications: swelling, redness, itching, white clumpy curd-like discharge
    • being sexually active will increase yeast infections
    • oral contraceptives will increase fungal infections
    • Precautions/Warnings: ointment based allows drug to vagina for several days and may take 3-5 days for symptoms to resolve... will not resolve overnight
    • Directions: 1 time treatment; may take 3-5 days
    • Prodcuts: Vagistat-1 and Monistat-1-Day
  84. UTIs and OTC Prodcuts
    • cranberries work to inhibit bacteria adhering to the wall of the bladder
    • phenazopyridine = NOT ANTIBIOTIC, but acts like an anesthetic
    • women have a shorter urethra which is why there is more prevalence of UTIs
  85. Patient Counseling - Yeast Infections
    • for external itching, you can apply externally
    • complete the full course o f therapy
    • avoid condems and diaphragms
    • 3 days -> not working, then refer to physician
    • don't use a tampon
  86. UTIs
    • Drink 8-10 glasses of water/day -> This will help more frequent urination throughout day and prevent bacteria replication
    • Drink cranberry juice or take vitamin C -> no conclusive clinicial data = data suggest that there are compounds in both to prevent E. coli from sticking to lining of bladder and also suggests that they may inhibit bacterial growth by acidfying urine
    • Always wipe from front to back -> bacteria linger in vaginal and rectal areas so wiping this way prevents them from entering urethra
    • Reduce intake of foods such as coffee, caffeinated/carbonated beverages, alchohol and spicy or highly acidic foods -> may cause bladder irritation
    • avoid wearing nylon-crotch panties -> may create an environemnt for bacteria growth
  87. Different UTIs and Symptoms
    • Most common are urethritis and cystitis
    • Infection of urethra (urethritis) - pain or burning snesation when urinating
    • Bladder infection (cystitis) - pain or burning senasation when urinating; frequent urination, urgent need to urinate, but little urine is passed
    • Kidney infection (pyelonephritis) - fever, bloody/cloudy urine, chills, nausea, back pain, and vomiting
  88. Types of burns
    • chemical
    • electrical
    • thermal
  89. Symptoms/signs/severity of burns
    • First degree: usually affects the epidermis; red, but no blisters; usuallys heals within 3-10 days; no scarring
    • Second degree: burning all the way through epidermis and a little through dermis; usually blisters, red; 3-4 weeks to heal; no scarring
    • Third and fourth degrees -> start worrying about infection
    • Third degree: burns all the way through epidermis and dermis; sometimes is blisters; almost burns al of the melanin out of skin making it white/opaque; several months to heal with scarring
    • Fourth degree: burns all the way through the 3 layers and some of the tissues; looks black/charcoal; usually will need a skin graft
  90. Categories of burns
    • Minor: first/secondary burn usually on 15% or less of the surface area
    • Major: third/fourth degree burns or more than 15% of the body
  91. Rule of 9's -> 9%
    • 9 out of 11 areas of the body burned
    • Trunk - 2 9's -> 18%
    • Back - 2 9's -> 18%
    • each arm - 9 -> 18%
    • each side of leg -> 2 9's + 2 9's = 18% + 18% = 36%
    • head = 9 = 9%
  92. Sunburn
    • UV-B -> burning rays from the sun
    • melanin -> what gives us color -> oxidizes melanin
    • Intermediate phase: faint red color that usually fades 30 min when you leave sun exposure
    • Delayed phase: 2-6 hours after sun exposure; a sunburn will peak 11-24 hours after sunburn exposure; 2-4 days it will start to fade; 4-7 days later the skin peels
  93. Treating minor burns
    • Best tx: leave it alone
    • apply cool water for 30 minutes but make sure to get it on within the first 4 hours
    • clean the burn with soap and water; don't peel off dead skin otherwise you'll peel of good skin too
    • Dressing: adaptic = slimy, oily gauze; put adaptic on first then on top telfa and then on top the gauze
  94. Burn Products - Protectants
    • Indications: protection fro irritation
    • Apply PRN
    • Ex. cocoa butter 50-100% (reduces dryness and helps reduce peeling; put on before peeling occurs)
  95. Burn Products - Local anesthetics
    • MOA: deaden nerve transmission
    • Dose: 3-4 times a day, no more than four
    • Duration: 15-45 min; should save last dose for bedtime
    • products usually come in sprays
    • benzocaine 5-20% (Solarcaine, Dermoplast, Americaine) - is the best topical anesthetic
    • lidocaine (Bactine) - don't recommend if patient has trouble with thier heart; don't use on open sunburn otherwise you'll have more systemic effect
  96. Burn Products - Antihistamines
    • diphenhydramine (Benadryl) 1-2% - oral for itching for sunburn and used for sleep as well
    • hydrocortisone 0.25-1% - anti-inflammatory, vasoconstrictior, not good for sunburn
  97. Burn Products - Home Remedy
    ** Ice tea: tea bag brewed hot, then take a bath with the possible tans
  98. Burn Products - Aloe Vera
    • HIGHLY RECOMMENDED
    • does have anti-inflammatory effect
    • penetrates skin very well
    • increase blood flow to area without causing swelling
    • great for sunburns
  99. Other Products for sunburn
    oral analgesic for pain
  100. Sunscreens/Sutan
    SPF 30 is about the maximum for effectiveness; above 30 is not really beneficial
  101. Ultraviolent Radiation
    • 180,00 new cases of skin cancer
    • treatments do include surgery if necessary
    • melanin protects from UV rays because it absorbs light
    • UV-A: tanning rays; still can get burned; cause skin cancer and aging
    • UV-B: burning rays; can't rush skin/tanning
  102. Tanning
    • at a minimum, it will take 2 weeks to get a long term, dark tan
    • Sunburn tan: ~24 hours -> fade in 2-4 days; oxidation of melanin: no new melanin
    • Short-term tan: lasts about 1 day-2 weeks (regular sun exposure); increase dispersion of melanin; fade in a few days
    • Long-term tan: more than 2 weeks; melanin production; may fade later
  103. Types of sunscreens
    • chemical: rubs in and absorbs UV light; different chemicals blocks different rays
    • physical: barrier (reflection); blocks UV-A and UV-B; good for nose and ear; turns white or distinct color
  104. Desginations/Sunscreens
    • SPF (sun protection factor): 15 -> means "can stay in the sun 15 times longer than normal
    • Minimal sun protection product: start burning after 28 minutes; receive dark skin (don't burn much but receive a tan); SPF 15-20
    • Very high sun protection product: in 15 minutes, light skin (fairly light complected) burns easily but evenutally will get a tan; SPF 20-30
    • Ultra high sun protection product: in 17 minutes; burns immediately but don't get tan; SPF 30
    • Water resistant: can stay on skin for 40 minutes in water
    • Very water resistant: can stay in water for 80 minutes but reapply for water
  105. Skin Types and Sunscreens
    • SPF 30: always burn easily, rarely tan
    • SPF 20-30: always burn easily, tan minimally
    • SPF 15-20: burns moderately; tans gradually
    • SPF 4-15: burn minimally; always tan well
    • SPF 4: rarely burn; tan profusely
  106. UVB Blocking Sunscreens- Active Ingredients that bind to skin well
    • aminobenzoic acid up to 15%
    • dioxybenzone up to 3%
    • ethyl 4-[bis(hydroxypropyl)] aminobenzoate up to 5%
    • oxybenzone up to 6%
    • padimate 0-8%
    • PABA = para-amino benzoic acid: highest allergic reaction
    • sulisobenzone up to 10%
  107. UVB Blocking Sunscreens- Active Ingredients that don't bind to skin well
    • cinoxate up to 3%
    • diethanolamine methoxycinnamate up to 10%
    • homosalate up to 15%
    • DON'T USE: lawsone up to 0.25% w/ dihydroxyacetone up to 3%
    • DON'T USE: menthyl anthranilate up to 5%
    • DON'T USE: ocotcrylene up to 10%
    • octyl methoxycinnamate up to 7.5%
    • octyl salicylate up to 5%
    • trolamine salicylate up to 12%
  108. UVB Blocking Sunscreens- Active Ingredients that are physical barriers
    • red petrolatum up to 100%
    • titanium dioxide up to 25%
    • zinc oxide

    • for continuous exposure: reapplying will not increase time of protection
    • ex. on skin for 4 hours, applying 3 times won't change anything
  109. UV-A sunscreen
    Arobenzone -> Parasol 1789
  110. Sunscreen that blocks both UV-A and UV-B
    • Ecamsule 2%
    • Product: Anthelios SX (avobenzone [A], ecamsule [A+B], and octocrylene [B]
    • Anthelios SX SPF 15 has the highest level of UV-A protection of any sunscreen
    • $30 for 3.4 oz - made by L'Oreal
  111. Sunscreen Patient Counseling
    • sun is most intense b/t 11 AM and 3 PM
    • shake well before use
    • apply sunscreen 15-30 minutes before exposure; this allows the sunscreen to bind to the skin; need to be applied to cool, dry skin
    • use about 1 oz to cover entire body (use plenty)
    • reapply every 1-2 hours (more often if siwmming or doing heavy exercises)
    • sunlight will reflect of sand and snow, which can cause burn, so use a sunscreen even on cloudy days when 80% of burning rays still reach skin
    • reapplication doesn't increase the lenght of protection beyond SPF limit
    • allergic reactions: small chance, but most likely are due to PABA or fragrances
    • 90% of sunlight penetrates water, and 20% to 30% of sunlight penetrates t-shirts and beach robes
    • don't use sunscreens on infants less than 6 months old; their skin is not fully developed and they will have a serious increase in systemic circulation
    • to properly remove a sunscreen, soap and water should be used
  112. Artificial Tanning Products
    • Accelerators: claim to stimulate tan, but aren't approved. Tyrosine is major ingredient (THEY DON'T WORK)
    • Quick tan (topical): simply dyes that stain fat cells of skin; offer no skin protection from sun; not sunscreens. Problem: uneven coloration and blotchy appearances and areas of dry skin absorb more dye
    • Quick tan (oral): AVOID AT ALL COSTS. MAY BE TOXIC. Patients ingesting large amounts of dye and if they want a quick tan product, suggest topical. Causes liver problems -> BANNED!!!
  113. Preventing Swimmer's Ear
    • Swimmer's Ear: an infection which occurs when water becomes trapped in the ear
    • skin on inside of ear has ideal breeding grounds for bacteria and fungus
    • Symptoms: itchy and swollen ear canal, ear pain, ear drainage, painful gland in neck.
    • Symptoms = phsician must clear up condition with antimicrobial agents
    • Prevention is best treatment for swimmer's ear
    • Products: Star Otic and Swim-Ear; sweet oil/olive oil SHOULD NOT be used
    • excessively dry and scaly ears -> mineral oil or baby oil should be applied before swimming
    • *** oral anitbiotics will not treat swimmer's ear
  114. Tips for Swimmer's Ear
    • Dont' remove ear wax; it contains friendly bacteria and acts a barrier in our own defense
    • don't clear the ear canal with objects that can cause scratches or cuts; may allow bacteria a place to grow
  115. Xeroderma (dry skin)
    Symptoms/signs: roughness, scalyness
  116. What causes Xeroderma?
    • dry air
    • lack of water in stratum corneum
    • exceesive soap use: soap strips of natural oils of the skin and ointments are better for skin b/c of their occlusive nature
  117. Xeroderma treatment
    • Goals are to: maintain skin hydration
    • Cetaphil - the most mild soap on market
  118. Xeroderma Treatment - Lubrication
    • MOA: lubricate the skin
    • Ex: mineral oil - minimally effective for dry skin; bath oils - minmally occlusive -> NOT RECOMMENDED
  119. Xeroderma - Moisturizing Agents -> Humectants
    • MOA: draw moisture into the statum corenum
    • Glycerin and Propylene glycol
    • ex. Keri-Lotion
  120. Xeroderma - Moisturizing Agents -> Occlusive agents (emoilents)
    • MOA: physical barrier -> prevents moisture from leaving the skin
    • Products: Vaseline -> great preventative of moisture leaving the skin; Lanolin -> very thick and comes from sheep wool (dont' recommend if patient is allergic to animals)
  121. Xeroderma - Keratin-softening Agents -> Urea, lactic acid, alpha-hydroxy acids
    • MOA: incease water reuptake by the skin; accelerates fibrin digestion
    • alpha-hydroxy acids - can increase sunburn
    • Hydrocortisone is a vasoconstrictor
  122. Skin Therapy Pads
    • best for scars raised above the skin
    • stretch tightly over the scar w/ bandage -> flattens scar
    • have to be on 24 hrs/day for 8 weeks; place new pad on every day and don't cut them to size
    • scar will not disappear (no tramatic changes)
    • best for new scars
  123. Mederma Cream
    • Cephalin
    • onion extract comes from onion plant
    • 76% improvement on scars
    • not good for older scars, but will be better than pads
    • new scar less than 6 months old = TID for 8 weeks
    • old scar = TID for 3-6 months
  124. Patient Counseling on Xoderma
    • if it's wet dry it, if it's dry wet it
    • ointments are better than creams; however, if hands give cream
    • can be applied PRN
    • allergens: dyes, fragrances, "parabens"
    • Bag Balm - not FDA approved; used for hospice patients 2 days from dying, used for cow nutters, ALWAYS works
    • liquid bandages are not for scar therapy
  125. Diaper Rash (Diaper dermatitis)
    Symptoms/Sings: breast fed infants are less likely to get diaper rash than bottle fed infants; red, swollen, irritated
  126. Causes or Theories of Diaper Rash
    • Old Theory (ammonia theory): ammonia in the urine causes diaper rash (overhydration of the skin)
    • New Theory (enzymes): enzymes in the feces (proteases and lipases) that breakdown skin
  127. Treatment for diaper rash
    air circulation, keep area clean as much as possible, skin protectant
  128. Milaria (Prickly Heat)
    • Symptoms/signs: hot and humid weather; looks like diaper rash, but a lot more swollen, pin-point types of rash; bathing suit area or under the arms
    • Cause: obstructed/clogged sweat pores; dozens of little ruptured sweat pores
    • Treatment: increase in air circulation; wear boxer shorts/loose underwear;
    • Witch Hazel good for prickly heat, mosquitoe bites -> precipitates proteins on cell surface so cell swells
  129. Agents for Rashes - Skin Protectants for diaper rash
    • calamine is too thin
    • Cod liver oil (in combo) no effect on Vitamin E levels
    • Petrolatum - vasoline -> creates a good barrier
    • Talc - good for when skin is chapped/chaffed
    • White Petrolatum - vasoline
    • Zinc oxide - most have this -> Destin ointment ***
    • A&D Ointment - nothing more than Lanolin and Vaseline
    • Aquaphor - absorb its own weight in water
  130. Agents for Rashes - Antimicrobial
    boric acid (not category I) - not recommended
  131. Agents for Rashes - Speical Formula
    • prescription only
    • Auqaphor mixed with Maalox - has 50-50 of each and works the best
  132. Agents for Rashes - Powders
    • absorbs water
    • if the diaper rash is oozing, don't use b/c it will worsen; makes crusting worse
    • Caldescene -> corn starch -> NOT RECOMMENDED
  133. Other Agents for Rashes
    • Happy Bottom Spray - not good b/c it's not thick (thicker the better)
    • Boudreaux Butt Paste - Peruvian Balsam
    • Balmex-zinc oxide
    • Decitin - biggest amount of zinc oxide
  134. Patient Counseling of Diaper Rash/Heat Rash
    • air ciruclation
    • keep clean and dry
    • no steroid creams for babies less than 6 months
  135. Diapers
    • 1 - cloth diaper (service) best choice for diaper rash
    • 2 - disposable
    • 3 - cloth diapers (wash at home)
    • DON'T USE A HAIR DRYER TO DRY BOTTOM

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