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Page 1
Over the Counter Review
Topical Management
Peter A. Kreckel
Adjunct Assistant Professor of Pharmacology
St Francis University, Loretto PA
With special thanks to: Gretchen M. Kreckel Garofoli Clinical Assistant Professor West Virginia University Morgantown, WV
PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education
Legal Disclaimer: The material presented here does not necessarily reflect the views of Pharmaceutical Education Consultants (PharmCon) or the companies that support
educational programming. A qualified healthcare professional should always be consulted before using any therapeutic product discussed. Participants should verify all
information and data before treating patients or employing any therapies described in this educational activity.
This program has been supported by
PharmCon
Over the Counter Review
Topical Management
Accreditation:
Pharmacists: 0798-0000-11-082-L01-P
Pharmacy Technicians: 0798-0000-11-082-L01-T
Nurses: N-706
CE Credits: 1 contact hour
Target Audience: Pharmacists Technicians
& Nurses
Program Overview:
Over the counter (OTC) products are vital to the everyday existence of many individuals. This program will discuss a
number of the most commonly treatable afflictions and what the consumer can get at the pharmacy to deal with them. Each
topic is addressed briefly in terms of what causes certain afflictions before a number of products are then introduced and
discussed in how they work and of what they are composed. This program is a must for any health care professional
Objectives:
• Identify appropriate topical over-the-counter medications for self-treatable conditions
• Appropriately consult patients on proper utilization and side effects of topical OTC medications
This program has been
supported by PharmCon
Over the Counter Review
Topical Management
PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of
continuing pharmacy education
Legal Disclaimer: The material presented here does not necessarily reflect the views of Pharmaceutical Education Consultants (PharmCon) or the
companies that support educational programming. A qualified healthcare professional should always be consulted before using any therapeutic product
discussed. Participants should verify all information and data before treating patients or employing any therapies described in this educational activity.
This program has been
supported by PharmCon
Speaker: Peter A. Kreckel R.Ph. is a graduate of the University of Pittsburgh, Bachelor of Science in Pharmacy,
Magna Cum Laude, Class of 1981. He served as the President of the Pharmacy School Class of 1981 for 3 years,
and President of the Pharmacy School Student Council for 2 years. During this time he received the Upjohn
Achievement Award for leadership and academic achievement. In addition to managing a retail pharmacy,
pharmacist Kreckel is an Adjunct Assistant Professor of Pharmacology, Department of Physicians Assistant
Sciences, St. Francis University. His assignments include teaching a HIV pharmacotherapy course for Physician
Assistant students, currently doing their clinical rotations, that are pursuing a Masters of Medical Science Degree
from St. Francis University.
Speaker Disclosure: Mr. Kreckel has no actual or potential conflicts of interest in relation to this
program.
Goals and Objectives
Goal:
The goal of this program is to educate fellow pharmacists regarding the selection process of appropriate topical over-the-counter medications
Objectives:
Identify appropriate topical over-the-counter medications for self-treatable conditions
Appropriately consult patients on proper utilization and side effects of topical OTC medications.
Disclaimer: The speaker reports no conflicts of interest in the preparation and presentation of this review program
Reproduction in whole or in part without permission is prohibited.
Page 2
Back in the old days……..
Diphenhydramine, Chlorpheniramine,
Clemastine, Ketotifen drops
Loratadine, Fexofenadine, Cetirizine
Cimetidine, Famotidine, Ranitidine
Omeprazole, Lansoprazole
Hydrocortisone
Terbinifine, Miconazole, Clotrimazole
Ibuprofen, Naproxen
PEG-3350
Dermatophytes: is there a fungus
among us??
Topical fungal infections affect scalp, skin, nails, such as mucus membranes such as oral cavity and vagina. Superficial fungal infections are sometimes called dermatophytic. Usually treated topically due to decreased side effects of this route of administration.
Causative organisms: Trichophyton, Epidermophyton or Microsporum
Tinea cruris : “jock itch”
Tinea corporis: “ringworm”
Tinea capitas: “ringworm of the scalp”
Tinea pedis: “athletes foot”
Tinea versicolor: “sweat rash”
Treatment of Dermatophytes
(-azole antifungals)
Mechanism: impairs the synthesis of ergosterol, the
main sterol of fungi membranes, allowing increased
permeability and leakage of cellular components.
Inhibits fungal CYP 450 14-alpha-desmethylase
thereby decreasing ergosterol.
Miconazole (Micatin®)
Clotrimazole (Lotrimin®)
Terbinifine (Lamisil®): inhibits the fungal enzyme squalene 2,
3 epoxidase, which ultimately decreases the synthesis of ergosterol
Diaper Rash
Etiology
Two-thirds of infants experience diaper rash.
Disposable diapers have greatly decreased incidence.
Breast fed babies have less than bottle fed babies.
Causes include: moisture, bacteria, alkaline pH , mechanical disruption of the area, digestive enzymes & bile salts. Thinner skin in infants and elderly predispose them to this condition. Bacteria may include: Peptostreptococcus, streptococci, staphylococci, bacteroides, and E. coli, however 80% of the cases where symptoms have been present for at least 3 days, Candida albicans is found.
Untreated overgrowth of C. albicans leads to ulceration, maceration and UTI.
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Germ Killers!
Betadine: used to decontaminate Lunar
module after Neil Armstrong moonwalk-1969.
Povidine iodine topical antiseptic.
Hibiclens: chlorhexidine- used for MRSA
Soap and Water
Alcohol
Hand gels (62% ethanol and higher)
Alcohol based hand sanitizer
1."Caregivers should wash hands with a non-antimicrobial soap and water or an anti-microbial soap and water when hands are visibly dirty or contaminated with proteineous material, such as blood or feces" (Recommendation 1)
2."If hands are not visibly soiled, caregivers should use an alcohol-based waterless antiseptic agent for routinely decontaminating hands"
(CDC Guideline for Hand Hygiene in Healthcare Settings: Recommendation 2)
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Page 10
Neti Pot
Advise patients to keep their neti pots and irrigation bottles clean to reduce contamination. Wash after every use. Do not share!
If patients who irrigate get frequent nasal infections, review their cleaning methods or suggest a trial off irrigation.
Limit nasal irrigation to once or twice daily. More frequently can be overly drying and irritating.
No difference between isotonic (0.9%) or hypertonic saline solutions. The range of concentrations of hypertonic saline used in the various studies was from 2% to 3.5%.4
Hemorrhoids –Stage I and II
goal is to reduce straining and downward
pressure.
Avoid straining, and sitting on toilet longer than
necessary.
Treat with high fiber diet, and bulk laxatives.
Increase bulk intake and water intake.
Stool softeners will also reduce straining.
OTC creams, ointments and foams will provide
relief
Hemorrhoids DRUG PROTECTANT ANESTHETIC VASOCON-
STRICTOR
ASTRINGENT ANTI-INFLAMMATORY
Nupercainal Dibucaine
Preparation-H Mineral oil,
Petroatum,
Shark oil
Phenyl
ephrine
Prep-H cooling gel Phenyl
ephrine
Witch hazel
Prep-H anti-itch Hydrocortisone 1%
Tucks (former-
Anusol)
Hydrocortisone 1%
Tronolane Zinc oxide Pramoxine Zinc oxide
Calmol-4 Cocoa
butter
Zinc oxide
Tucks-Pads Witch hazel
Prep-H Wipes Witch Hazel
Personal
Lubricants
Basic formula: (are NON-petroleum based)
Lubricants: glycerin, hydroxyethyl cellulose,
propylene glycol, Polysorbate-60, purified water
Preservatives: chlorhexidine gluconate, glucono
delta-lactone, methylparaben and sodium hydroxide
or benzoic acid
INDICATIONS: enhances the comfort and ease of
intimate activity and acts as a moisturizer for vaginal