Vasoconstriction, topical

Cocaine Same as above also has sympathomimetic effects Same as above Procedures requiring high surface activity and vasoconstriction Topical or parenteral duration 1-2 h Toxicity CNS excitation, convulsions, cardiac arrhythmias, hypertension, stroke... 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Topical corticosteroids (Table 16-1) may halt synthesis and mitosis of DNA in epidermal cells and appear to inhibit phospholipase A, lowering the amounts of arachidonic acid, prostaglandins, and leukotrienes in the skin. These effects, coupled with local vasoconstriction, reduce erythema, pruritus, and scaling. As antipsoriatic agents, they are best used adjunc-tively with a product that specifically functions to normalize epidermal hyperproliferation. 

Selected Topical Corticosteroids and Vasoconstricting Potency (Continued)... 

Topical and systemic decongestants are sympathomimetic agents that act on adrenergic receptors in the nasal mucosa to produce vasoconstriction, shrink swollen mucosa, and improve ventilation. Decongestants work well in combination with antihistamines when nasal congestion is part of the clinical picture. 

Cocaine is still a drug of choice among many physicians as a topical local anesthetic because the drug has vasoconstrictive qualities (shrinks and stops the flow of blood). Synthetic local anesthetics such as novacaine and xylocaine (lidocaine) have also been discovered and used extensively as a local anesthetic. 

Topical corticosteroids produce anti-inflammatory, anti-itching, and vasoconstricting effects. A wide variety is available (described in detail in Drug Information 2004 and other references and compendia). Such steroids are classified into five categories that reflect a... 

Functional antagonists of mediators of allergy, a) a-Sympathomi-metics, such as naphazoline, oxymeta-zoline, and tetrahydrozoline, are applied topically to the conjunctival and nasal mucosa to produce local vasoconstriction, and decongestion and to dry up secretions (p. 90), e.g., in hay fever. Since they may cause mucosal damage, their use should be short-term. 

Rebound congestion (rhinitis medicamentosa) May occur following topical application after the vasoconstriction subsides. Patients may increase the amount of drug and frequency of use, producing toxicity and perpetuating the rebound congestion. 

Pharmacology Epinephrine, a direct-acting sympathomimetic agent, acts on and receptors. Topical application, therefore, causes conjunctival decongestion (vasoconstriction), transient mydriasis (pupillary dilation), and reduction in intraocular pressure (lOP). It is believed lOP reduction primarily is caused by reduced aqueous production and increased aqueous outflow. The duration of decrease in lOP is 12 to 24 hours. 

Butcher s Broom (Ruscus aeuleatus) Uses Rx of circulatory disorders such as PVD, varicose veins, leg edema hemorrhoids diuretic laxative inflammation arthritis Action Vasoconstriction d/t direct activation of the a-receptors of the smooth-muscle cells in vascular walls Available forms Raw ext 7—11 mg once/d, PO tea 1 tsp in 1 cup water topical oint apply PRN Notes E GI upset, N/V Interactions T Effects OF anticoagulants, MAOIs X effects OF antih5 pCTten-sives EMS Hypertensive crisis may occur if administered w/MAOIs T effects OF anticoap ulants... 

Local anesthetics are used extensively on the mucous membranes in the nose, mouth, tracheobronchial tree, and urethra. The vasoconstriction produced by some local anesthetics, cocaine especially, adds a very important advantage to their use in the nose by preventing bleeding and inducing tissue shrinkage. Topical anesthesia permits many diagnostic procedures in the awake patient, and when it is combined with infiltration techniques, excellent anesthesia may be obtained for many... 

Cocaine hydrochloride remains useful primarily because of the vasoconstriction it provides with topical use. Toxicity prohibits its use for other than topical anesthesia. 

Mechanism of Action Topical corticosteroids exhibit anti-inflammatory, antipruritic, and vasoconstrictive properties. Clinically, these actions correspond to decreased edema, erythema, pruritus, plaque formation, and scaling of the affected skin. Pharmacokinetics Approximately 3% is absorbed during an 8-hr period. Metabolized in the liver. Excreted in the urine. 

Mechanism of Action A topical corticosteroid that inhibits accumulation of inflammatory cells at inflammation sites, suppresses mitotic activity, and causes vasoconstriction. Therapeutic Effect Decreases or prevents tissue response to inflammatory process. 

Mechanism of Action A topical corticosteroid that has anti-inflammatory, antipruritic, and vasoconstrictive properties. The exact mechanism of the anti-inflammatory process is unclear. Therapeutic Effect Reduces or prevents tissue response to the inflammatory process. 

Vasoconstriction and pupil dilatation Topical A drop of a suitable topical anesthetic maybe applied, followed in a few minutes by 1 drop of the phenylephrine HCl 2.5% on the upper limbus. 

Glaucoma Topical in certain patients with glaucoma, temporary reduction of intraocular tension may be attained by producing vasoconstriction of the intraocular vessels this maybe accompanied by placing 1 drop of the 10 % solution on the upper surface of the cornea. This treatment maybe repeated as often as necessary. 

Compounds like naphazoline and xylometazoline are relatively selective agonists, which on topical application produce local vasoconstriction. They are used as nasal decongestants and have longer duration of action. Prolonged use can produce atrophic rhinitis and anosmia. 

Exacerbation of angina pectoris has been described in association with latanoprost (81). PGF2a is a vasoconstrictor, and systemic absorption of topical latanoprost can cause vasoconstriction in coronary arteries. 

Epinephrine (Adrenalin, Bronkaid Mist, Primatene Mist, others). Epinephrine appears to directly stimulate all adrenergic receptor subtypes and is administered for a variety of reasons. Epinephrine is found in many antiasthmatic inhalation products because of its ability to stimulate beta-2 receptors on the bronchi. Because it stimulates vascular alpha-1 receptors, epinephrine may be applied topically to produce local vasoconstriction and control bleeding during minor surgical procedures (e.g., suturing superficial wounds). Likewise, epinephrine may be mixed with a local anes-... 

Cocaine, which blocks the uptake of catecholamines, produces dose-dependent effects, initially causing euphoria, vasoconstriction, and tachycardia, and in toxic doses, convulsions, myocardial depression, ventricular fibrillation, medullary depression, and death. Cocaine is able to block nerve conduction and currently is used only for topical anesthesia. 

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