A topical medication is a medication that is applied to a particular place on or in the body. Most often topical administration means application to body surfaces. Clinical guideline on topical administration from Great Ormond Street Hospital. Topical application of NOS antiserum significantly attenuated the upregulation of neuronal NOS following SCI in the T9 and the T12 segments (Figs. 2 and 4).
administration • Topical
A thorough skin check is required prior to administration to avoid adverse effects. In addition, assessment of the application site prior to administration is critical to prevent the skin irritation caused by the medication.
A common mistake is administrating topical medication at a concentration unsuitable for the application site. For instance, a topical antibiotic has formulations for both the skin and eyes and, if applied incorrectly, could result in the loss of vision.
Cool or cold otic medications may also cause dizziness and nausea. Another common mistake is a failure to remove the patch medication before applying a new one, resulting in a higher dose of the medication, which constitutes a medication error.
Previous patch medications may still contain active medication, which will continue to be absorbed after the intended length of use, resulting in a medication overdose. In addition, the removal of any transdermal patch medications prior to magnetic resonance imaging MRI is necessary to prevent serious skin burns. A subscription to J o VE is required to view this article. You will only be able to see the first 20 seconds.
Fill out the form below to receive a free trial or learn more about access: Enter your email below to get your free 1 hour trial to JoVE! Add to Favorites Embed Share. General medication administration considerations. In the patient's room, review the patient's medical history for medication allergies and previous administration times in the electronic Medication Administration Record MAR. Confirm any patient preferences regarding topical transdermal patch administration, such as preferred site of application, any previous side effects, and previous applications of transdermal patches.
Address any patient concerns prior to acquiring and preparing the medication. Disinfect the hands by washing with soap and warm water, or by using a hand sanitizer if the hands are not visibly soiled; apply vigorous friction for at least 20 s. Acquire the topical medications from the medication dispensing device, using the five "rights" during the first safety check, as indicated in the "Safety Checks and Five Rights of Medication Administration" video.
Compare the medication names listed on the label with the medication names listed on the MAR. At this point, the "Right Medication" step is complete. Some prescriptions specify the exact amount to be applied, and these are generally supplied as single-dose applications in a patch form. If the medication is in an ointment tube, such as nitroglycerin, the MAR will describe the amount to be applied e.
The medication will be secured to the skin with an occlusive dressing to allow for gradual absorption. Verify that the medication routes listed on the label are consistent with the routes listed on the MAR. At this point, the "Right Route" step is complete. Some topical medications are available in different concentrations, depending upon the location to which they are to be applied.
It is your responsibility to verify that the concentration of the topical medication provided is appropriate for the location specified in the prescription. Review the MAR to confirm that it is the right time for administration.
At this point, the "Right Time" step is complete. Topical steroidal creams should be applied using gloves to prevent the accidental absorption of hormones into your skin.
Take the medications and supplies with you to the patient's room. Upon entering the patient's room, perform hand hygiene, as described previously. Compare this information with that provided on the name band. Compare the patient's name and medical record number MRN from the name band with the patient identifiers provided on the MAR. At this point the, "Right Patient" step for the third safety check is complete. Compare the topical medication names listed on the label with the medication names listed on the MAR.
At this point, the "Right Dose" step is complete. Compare the medication routes listed on the label with the medication routes and application sites listed on the MAR. Review the MAR to confirm that it is the right time for administering the medications. Teach the patient about the topical medication. Tell the patient the medication name, indication, and action.
Review with the patient any side effects or adverse effects associated with the medications. Discuss any patient concerns regarding the medications and address them prior to administering the medications.
Administer the topical transdermal patch medication. Inform the patient that application of the topical transdermal patch medication will require exposing the application site. Ensure the patient's privacy and dignity by covering intimate body sites as much as possible with a blanket or towel during administration. Before administration, again wash hands with soap and warm water, applying vigorous friction for at least 20 s.
Put on clean gloves. In the case of transdermal patch application, determine the last site of administration. Carefully remove the previously applied patch and clean the skin of any remaining medication.
Expose the application site and, if necessary, clean the site according to institutional policy and standards of nursing practice. Wash hands with soap and warm water, applying vigorous friction for at least 20 s. Apply the new patch by carefully removing the outer packaging, removing the clear protective liner, and placing it in an area free of hair and that undergoes little movement. If using ointment topical medication, such as nitroglycerin, squeeze out the appropriate amount of topical percutaneous medication onto a measurement and application device.
Apply clear, occlusive dressing over the ointment application device, securing it to the skin. Never rub or message ointment into the skin, as this may increase the absorption rate. Label the transdermal patch medication with the initials, time, and date of application using an indelible marker.
Wash the hands with soap and warm water, applying vigorous friction for at least 20 s. Administering ophthalmic eye medication. Describe the application process and ensure patient privacy, as described in step 6. Wash hands and don clean gloves, as described in step 6. Assist the patient to lie back, with the head tilted and neck extended.
If neck injuries are present, do not extend the neck. Assess the eyelids and inner canthus for crusts or drainage. If drainage or crusts are present, gently cleanse the area with normal saline and gauze pads. Administering ophthalmic eye drops. While holding the eyedrop medication in the dominant hand, gently rest the heal of the hand on the patient's forehead.
Hold the medication approximately cm above the lower lid. With the non-dominant hand, gently pull the lower lid down to expose the conjunctival sac. Ask the patient to look up towards the ceiling. A cotton ball or tissue may be used to hold the lower lid down. Point the tip of the medication bottle towards the conjunctival sac, keeping it cm above the eye.
Considering that herbal drugs are extensively used in the popular medicine, we still do not know where the gap is that hinders the implementation of experimental findings for the development of innovations and technologies potentially useful in the clinical management of skin wounds. Thus, we systematically revised preclinical studies with murine models that investigated the effects of plant fractions and isolated molecules on the treatment of skin wounds.
Beyond determining the relevance of plant derivatives in the skin repair, we analyzed the methodological quality of all preclinical studies identified, especially considering that the quality of evidence generated from flawed methodological studies could compromise the generalizability of the findings and derail conducting clinical studies.
The search strategy was constructed by four components: A standardized search filter for animal studies was applied in PubMed database [ 55 ]. The same search strategy was adapted and used to recover studies in the Scopus platform. The standard animal filter provided by Scopus was used. The complete search strategy is described in Table S1 in Supplementary Material available online at http: Language restrictions were applied to recover only articles in English, Spanish, and Portuguese.
Duplicate studies were removed and only studies investigating the effect of fractions and isolated molecules from plant extracts in murine models of skin wound healing were considered. After the initial search, all relevant studies were recovered in full text and evaluated by eligibility criteria.
Works containing unrefined extracts, commercial isolates, in vitro assays, humans, nontraumatic injuries, other animal models, first intention wounds, metabolic diseases associates, and secondary studies i.
Data were extracted and tabulated in a descriptive way Tables 1 a , 1 b , 2 a , and 2 b. Reporting of In Vivo Experiments. These criteria are based on short descriptions that indicate essential characteristics of all studies with animal models, such as theoretical and methodological basis, research objective, refinement of the analytical methods, statistical design, sample calculations, and measure outcomes [ 15 ].
Recently there has been an increasing interest in the systematic reviews of research involving animals [ 16 ]. Considering the purpose of the systematic review on evaluating important aspects of the referenced publications, we built a table summarizing all the aspects investigated as well as their relevance, describing positive and negative characteristics of the recovered studies Tables 2 a and 2 b.
From the PubMed and Scopus database, articles were recovered. After recovery of articles in full text, studies were excluded for not meeting the eligibility criteria. Thus, 26 studies were included in the systematic review. The reference list of all included studies was carefully analyzed to ensure the identification of additional relevant studies.
Thus, six studies were additionally identified and recovered, completing 32 works added to this review. From these studies, 19 studies utilized fractions, 12 studies utilized plant isolates, and 1 study used both fractions and isolates for the treatment of cutaneous wounds Figure 1.
The analyzed studies were conducted in 13 different countries, especially India Considering the animal strain, Half of the experimental models used male animals , More than half of the studies did not describe the popular name of the plant species investigated The first treatments utilized on the control group were as follows: The calculations used to measure the wound area were described in only All the works described the interval in which the wound area was measured, and the most common interval was daily, From the 32 species of plants, 23 different families were reported, and the main ones are Asteraceae The most used plant structures were the leaves representing The fruit, the whole plant, and the latex were mentioned once, representing 3.
Considering the popular indication, healing effects were described in Among the analyzed works, All studies described ethical approval and no work reported a blind controlled study. The choice of administration route was not justified in any study. The sex and weight were reported in A statistical analysis was conducted by all studies, but only No study reported mortality or modifications on the experimental protocol by adverse events.
Most often topical administration means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes including creams , foams , gels , lotions , and ointments. Topical medications may also be inhalational , such as asthma medications , or applied to the surface of tissues other than the skin, such as eye drops applied to the conjunctiva , or ear drops placed in the ear, or medications applied to the surface of a tooth.
The definition of the topical route of administration sometimes states that both the application location and the pharmacodynamic effect thereof is local. In other cases, topical is defined as applied to a localized area of the body or to the surface of a body part regardless of the location of the effect. Such medications are generally hydrophobic chemicals, such as steroid hormones.
Specific types include transdermal patches which have become a popular means of administering some drugs for birth control , hormone replacement therapy , and prevention of motion sickness. One example of an antibiotic that may be applied topically is chloramphenicol.
If defined strictly as having local effect, the topical route of administration can also include enteral administration of medications that are poorly absorbable by the gastrointestinal tract. One poorly absorbable antibiotic is vancomycin , which is recommended by mouth as a treatment for severe Clostridium difficile colitis. A medication's potency often is changed with its base. For example, some topical steroids will be classified one or two strengths higher when moving from cream to ointment.
As a rule of thumb, an ointment base is more occlusive and will drive the medication into the skin more rapidly than a solution or cream base. The manufacturer of each topical product has total control over the content of the base of a medication. Although containing the same active ingredients, one manufacturer's cream might be more acidic than the next, which could cause skin irritation or change its absorption rate.
For example, a vaginal formulation of miconazole antifungal cream might irritate the skin less than an athlete foot formulation of miconazole cream. These variations can, on occasion, result in different clinical outcomes , even though the active ingredient is the same. No comparative potency labeling exists to ensure equal efficacy between brands of topical steroids percentage of oil vs water dramatically affect the potency of topical steroid.
Studies have confirmed that the potency of some topical steroid products may differ according to manufacturer or brand. An example of this is the case of brand name Valisone cream and Kenalog cream in clinical studies have demonstrated significantly better vasoconstrictions than some forms of this drug produced by generic drug manufacturers.
In dermatology , the base of a topical medication is often as important as the medication itself. It is extremely important to receive a medication in the correct base, before applying to the skin. A pharmacist should not substitute an ointment for a cream, or vice versa, as the potency of the medication can change. Some physicians use a thick ointment to replace the waterproof barrier of the inflamed skin in the treatment of eczema, and a cream might not accomplish the same clinical intention.
There are many general classes, with no clear dividing line between similar formulations. As a result, what the manufacturer's marketing department chooses to list on the label of a topical medication might be completely different from what the form would normally be called.
For example, Eucerin "cream" is more appropriately described as an ointment than as a cream. Topical solutions can be marketed as rinses, sprays, or drops, and are generally of low viscosity and often use water or alcohol in the base. Alcohol in topical steroids can frequently cause drying if it is used as a base ingredient. There is significant variability between brands. There is a risk of irritation, depending on the preservative s and fragrances used in the base. Some examples of topical solutions are given below:.
Lotions are similar to solutions but are thicker and tend to be more emollient in nature than solution. They are usually an oil mixed with water, and more often than not have less alcohol than solutions. Lotions can be drying if they contain a high amount of alcohol.
There is a significant variability in the ingredients between different lotions. A mixture that separates into two or three parts with time. Frequently an oil mixed with a water-based solution needs to be shaken into suspension before use. A cream is an emulsion of oil and water in approximately equal proportions. It penetrates the stratum corneum outer layer of skin wall.
Topical Administration of Anticancer Drugs for Skin Cancer Treatment
Always clean the skin or wound before applying a new dose of topical medication . Checklist 53 lists Follow the SEVEN RIGHTS of medication administration. Topical medications should never be applied with the bare hands. This video will demonstrate techniques of the safe administration of topical medications. 1: Administration, Topical The application of drug preparations to the surfaces of the body, especially the skin (ADMINISTRATION, CUTANEOUS) or mucous.