PHARMACY PRACTICE I PHCY280 (2 CREDITS); PHCY280L (1CREDIT) SUMMER Christy Mary Sam

Transcription

1 PHARMACY PRACTICE I PHCY280 (2 CREDITS); PHCY280L (1CREDIT) SUMMER Christy Mary Sam

2 COMMUNICATION SKILLS Communication is the process involved with the exchange of any kind of information between a sender and a receiver Mainly 2 types Verbal and Non-verbal Non verbal messages are messages conveyed by ways other than the meaning of words-eg-eye contact Verbal-messages which are conveyed by meaning of spoken or written words, eg. Dialogue, leaflets 2

3 Use of open ended questions are helpful to get more information from patients and it is un influenced by the expectations of the interviewer Closed questions are suitable for verifying information Eg-open ended-how have you been feeling since the new medicine is started Closed ended-you are feeling better, aren t you? 3

4 Over the counter drugs OTC/ "over the counter," is the type of medication you can purchase at your local pharmacy without a doctor's prescription. OTC medications tend to have more benefits than risks, a low risk for drug abuse, and are easy to select and use without the help of a healthcare professional. OTC drug labels should contain the information you need so you can take them safely. Prescription drugs A prescription drug is a medication that can be purchased or given out only with written instructions from a licensed healthcare provider, such as a doctor, dentist, to a pharmacist. These written instructions are known as a prescription. 4

5 Dermatology/skin disorders 5

6 LEARNING OBJECTIVES: By the end of the topic you shall be able to: Discuss the various management options for acne, dandruff, etc. Describe the triggers for referrals Discuss OTC management options for various skin diseases 6

7 Skin is the largest organ of the body Its functions: - barring entry to microorganisms, - acting as a sensory organ (for pain or pressure), - regulating body temperature - maintaining body s homeostatic balance 7

8 ACNE VULGARIS 8

9 ACNE VULGARIS Acne, is a skin problem that starts when oil and dead skin cells clog up your pores. Affects mainly the adolescents Girls 14-17yrs, boys 15-19yrs Causative factors- Increased keratin/blockage of the skin pores and sebum production/ overactive oil glands, the activity of skin bacteria and products of inflammation Age is a contributory factor; hormonal changes especially androgens Certain occupation can predispose- automobile mechanics with a long term contact with oil 9

10 Clinical features of acne vulgaris- black and white heads mainly on face, sometimes affect the chest and upper back. Acne may be classified as - mild, - moderate - severe In moderate and severe cases lesions may be often painful and have a possibility of scarring Conditions to eliminate- rosacea and adverse drug reaction Rosacea- in patients over 40 yrs, acne like lesions and recurrent flushing of central face, especially nose and medial cheeks, sometimes associated with eye irritation 10

11 Medicines can cause acne-like eruptions - Lithium - Oral contraceptives - Phenytoin - Azathioprine - Rifampicin When to refer a patient with Acne Vulgaris - Moderate or severe acne - OTC treatment failure - Suspect to have rosacea - Who does not respond to treatment within 8 weeks 11

12 NON PHARMACOLOGICAL MANAGEMENT OF ACNE VULGARIS Gentle cleansing with warm water and a mild soap at least twice a week Use water-based rather than oily foundations/ cream make up Clean make up before going to bed Avoid touching or pricking the affected area Encourage exposure to sunlight, the UV light in sunlight helps in peeling effect, drying or degreasing of skin 12

13 PHARMACOLOGICAL MANAGEMENT OF ACNE VULGARIS Over-the-counter medicines include - Benzoyl peroxide - Salicylic acid - Sulphur Prescription medicines for acne - Topical retinoids- Tretinoin, Isotretinoin - Topical antibiotics- Erythromycin,Clindamycininflammatory acne - Oral antibiotics- Tetracycline, Minocycline, Doxycycline, Sulfamethoxazole- Trimethoprim. 13

14 MANAGEMENT OF ACNE VULGARIS Benzoyl peroxide- mild to moderate acne, - First line treatment option - Broad spectrum bactericidal agent - start with mild concentration and dose especially for sensitive or fair skin; 2.5%, 5%, 10% - wash your hands before and after application - wash affected area before applying medicine, - Apply 1 to 2 times a day, all over the affected area - Treatment should continue for long period, it takes min of 6 to 8 weeks - Sufficient quantity/finger tip units 14

15 Adverse effects- concentration dependent skin irritation, drying, redness, burning and peeling of skin on initial application; - If it happens, inform patients to stop for a day or two and then start again with low dose. Available as creams/ gels, but when it is combined with anti-bacterials, it should be prescribed Bleaches hair and may discolor clothes etc. If applied at night; advise patient to protect bed sheets and pillow covers from bleaching Salicylic acid & Sulphur- Soaps, they are second line treatments, have keratolytic action 15

16 Retinoids- Tretinoin, Isotretinoin, adapalene Reduces follicular plugging and reduces microcomedones, inflammatory acne lesions in moderate to severe acne Retinoids may cause primary irritant dermatitis- redness and skin peeling initially but settles with time A pharmacist must remember- Retinoids are contraindicated in pregnancy due to teratogenicity Ensure that patient is not pregnant, use effective contraception during treatment, and 1 month after stopping treatment 16

17 DANDRUFF (PITYRIASIS CAPTIS) A chronic relapsing non-inflammatory hyperproliferative skin condition resulting from increased cell turn over rate Dandruff is a form of skin eczema called seborrhea/ is a mild form of seborrhoeic dermatitis (SD), associated with the yeast Malassezia furfur. Clinical feature- scalp will be dry, itchy and flaky. Often dead cells seen on clothing It occurs in parts of the body with high oil production. (sebum) 17

18 Examine or ask if neck, trunk or back is involved Very common, affects all ages Cradle cap, a type of dandruff that affect babies, causes a scaling, crusty scalp, can occur anytime during infancy. Usually clears up on its own by the time a baby is a year old. Can be treated by using baby shampoo 18

19 SPECIFIC QUESTIONS TO ASK THE PATIENT Appearance - Differential diagnosis for severe dandruff is psoriasis - In psoriasis the scales are silvery-white and associated with red, patchy plaques and inflammation. Location - In dandruff the scalp is the only area affected. - In more wide spread SD, other areas where there are more sebaceous gland activity. - Psoriasis can affect the scalp as well as other areas 19

20 SPECIFIC QUESTIONS TO ASK THE PATIENT Severity- Dandruff is generally a mild condition. No redness observed on scalp unless severe itching has damaged the scalp Severe condition is associated with severe itching/scratching, break the skin and chances of infection Previous history- more chances as it is a chronic relapsing condition Aggravating Factors- Hair dyes and perms, inadequate rinsing after shampooing 20

21 When to refer a patient with dandruff OTC treatment failure with a medicated shampoo Suspected infection (crusting or weeping) Suspect psoriasis Management of Dandruff Dandruff should start to improve within 12 weeks of beginning treatment The aim of the treatment is to reduce the level of M. furfur on the scalp; therefore, agents with antifungal action are effective. Frequent washing (at least three times a week) is an important part of managing dandruff. For mild dandruff daily cleansing with a gentle shampoo reduces oil and skin cell buildup on the scalp Dandruff treatments need to be applied to the scalp and be left there for at least 5 min for best effect. 21

22 Management of Dandruff- medicated shampoo Ketoconazole (Nizoral) Selenium sulphide (Selsun) Zinc pyrithione (Head and shoulders) Coal tar (Polytar) Ketoconazole is the most and coal tar is the least effective. Ketoconazole 2% shampoo - broad-spectrum antifungal agent, - is used twice a week for 2 4 weeks, after which usage should reduce to weekly or fortnightly (once in 15 days) as needed to prevent recurrence. - It is considered first line in moderate-to-severe dandruff. 22

23 Selenium Sulphide 2.5%- apply twice per week for 2 weeks, then once weekly for 2 weeks, discolors hair and is irritant Acts by both slowing production of skin cells and also killing the fungi Inform patients that the treatment will not cure their dandruff permanently and that it will be sensible to use the treatment on a less frequent basis to prevent their dandruff from coming back. 23

24 Zinc pyrithione- kills the malassezia fungi which is partially responsible for dandruff. Coal tar shampoo helps slow production of dead skin cells If the problem quiets down or disappears, stop and use non medicated shampoos. Alternative therapy- Tea tree oil, from the leaves of Australian tea tree, has antiseptic, antibiotic and antifungal agent, but may cause allergy in some people 24

25 FUNGAL INFECTIONS Fungal infections are contagious and are transmitted directly from one host to another Fungal infections seen in a primary care includes tinea pedis (athlete s foot) - tinea corporis (ring worm) - tinea curis (jock itch) - tinea unguium (nail infection) - tinea captis affects scalp, now rare 25

26 Tinea pedis- athlete s foot- usually seen in the toe webs, especially the fourth web space, space next to the little toe; the skin appears white and soggy, area is itchy and the feet tends to smell, this infection can spread to sole or nail, then it should be referred Tinea curis- jock itch, fungal infection of the groin, the lesion is intensely itchy, reddish brown and has a well-defined edge. Prefer antifungal powder formulations as they absorb perspiration. Tinea unguium - nail becomes dull opaque, yellow appearance, over time nail thickens, becomes more brittle and prone to crumbling 26

27 MANAGEMENT Mild localised fungal infections of the skin (including tinea corporis, tinea curis, and tinea pedis) respond to topical therapy Systemic therapy is started if topical therapy fails, if many areas are affected, or if the site of infection is difficult to treat- nails, scalp Treatment must be continued after symptoms have gone to ensure eradication of the fungus. A minimum of 2 4 weeks treatment is usually needed. Treatment duration varies with the drug. 27