Topical medications

Combination therapy with oral and topical medications gives the best results. 

Assess patient preference for systemic (oral) or local (topical) therapy. Would frequent application of topical medications be possible Would the patient accept topical medications with a medicinal odor ... 

Conjunctivitis medicamentosa A contact allergy to a topical medication. 

Rhinitis medicamentosa Inflammation of nasal mucous membranes due to excessive use of topical medication. 

Ointments are semisolid preparations that are intended for external use. Ointments may contain either finely powdered drugs or their mixtures, liquids, and other drug forms incorporated into appropriate bases. They are applied to the skin for their physical effects as emollients (which make the skin more pliable), protectants, lubricants, and drying agents. Ointment bases are also used as vehicles in which to incorporate topical medications which exert specific effect. There are four types of ointment bases, namely, oleaginous, absorption, water removable, and water soluble bases. 

Creams are semisolid preparations meant for external application as emollients or as topical medications. They are semisolid emulsions of either the oil-in-water or the water-in-oil type. 

Ocular complications following local or systemic administration of steroids include glaucoma, cataracts, adverse influence on specific ocular infections, pseudotumor cerebri, ptosis, mydriasis, subjective visual complaints, visual field defects, systemic absorption of the topical medication, conjunctival and palpebral petechiae, epithelial punctate keratitis, and, possibly, corneal and scleromalacia. ... 

Sticks are a convenient form of administering topical medications and come in different sizes and shapes. They are transportable and can be easily eompounded. Examples of eompoimded sticks include those containing antivirals for herpes and emollients and sunscreens for environmental exposure (Table 4). 

Treatment- A simple but uncomfortable solution is to completely withdraw the topical medication. A more acceptable method is to gradually withdraw therapy by initially discontinuing the medication in one nostril, followed by total withdrawal. Substituting an oral decongestant for a topical one may also be useful. 

Sulfur, resorcinol, benzoyl peroxide, or salicylic acid Caut ous y use concomitant topical medications because of possible interactions with tretinoin. Significant skin irritation may result. It also is advisable to rest a patient s skin until the effects of such preparations subside before use of tretinoin is begun. 

Topical application is the most common route of administration for ophthalmic drugs. Advantages include convenience, simplicity, noninvasive nature, and the ability of the patient to self-administer. Because of blood and aqueous losses of drug, topical medications typically do not penetrate in useful concentrations to posterior ocular structures and therefore are of no therapeutic benefit for diseases of the retina, optic nerve, and other posterior segment structures. 

There are a number of corticosteroids that are used in pulmonology as inhalation medications. For rhinitis sprays may be used which also contain corticosteroids. Coricosteroids in these topical medications include beclometasone, fluticasone, mometa-sone and also budesonide. 

Drug interactions Whether becaplermin interacts with other topical medication applied to the ulcer site is not known. 

Topical medications usually consist of active ingredients incorporated in a vehicle that facilitates cutaneous application. Important considerations in vehicle selection include the solubility of the active agent in the vehicle the rate of release of the agent from the vehicle the ability of the vehicle to hydrate the stratum corneum, thus enhancing penetration the stability of the therapeutic agent in the vehicle and interactions, chemical and physical, of the vehicle, stratum corneum, and active agent. 

Topical medications useful in protecting against sunlight contain either chemical compounds that absorb ultraviolet light, called sunscreens, or opaque materials such as titanium dioxide that reflect light, called sunshades. The three classes of chemical compounds most commonly used in sunscreens are p-aminobenzoic acid (PABA) and its esters, the benzophenones, and the dibenzoylmethanes. 

Factors that may have contributed to this metabolic acidosis included low birth weight, renal tubular immaturity, and impaired renal function, which may have resulted in systemic accumulation with repetitive dosing. This case stresses the fact that topical medications can cause systemic effects if a sufficient amount of drug is absorbed in a susceptible subject. 

Barnhart, K.T., et al. 2001. Distribution of topical medication in the human vagina as imaged by magnetic resonance imaging. Fert Steril 76 189. 

Webster GF. Topical medications a focus on antifun-gals and topical steroids. Clin Cornerstone. 2001 4 33-38. 

Van Ginkel, C.J., Bruintjes, T.D., and Huizing, E.H., Allergy due to topical medications in chronic otitis externa and otitis media. Clin. Otolaryngol. 20, 326-328, 1995. 

The normal rate of basal (unstimulated) tear flow in humans is approximately 0.5 to 2.2 mcl/min and decreases with age. Tear flow rate is stimulated by the ocular irritation resulting from many topical medications. The concentration of drug available in the tears for... 

High tissue concentrations can be obtained with drugs that poorly penetrate the epithelial layer of the cornea or conjunctiva. This method is useful in patients who do not reliably use topical medication. 

Ariturk N, Oge I, Erkan D, et al.The effects of nasolacrimal canal blockage on topical medications for glaucoma. Acta Ophthalmol Scand 1996 74 411-413. 

Huang TC, Lee DA. Punctal occlusion and topical medications for glaucoma. Am J Ophthalmol 1989 107 151-155. 

Krohn J.Topical medication interferes with face-down positioning after macular hole surgery. Acta Ophthalmol Scand 2003 81 226-229. 

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