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).
Topical administration •
The proliferative phase progresses with an intense proliferation and migration of fibroblasts, endothelial cells, and keratinocytes as well as formation of the granulation tissue rich in type III collagen and progressive reepithelialization [ 1 — 3 ]. At the maturation phase, type III collagen is gradually replaced by type I collagen, which originates more thicker and resistant collagen fibers [ 2 — 4 ]. It has been demonstrated that flaws on the leukocyte recruitment and function can impair the healing process due to reductions in the synthesis of regulatory molecules that drives the extracellular matrix assembly [ 5 — 7 ] and neoangiogenesis [ 8 ].
In this way, the development of drugs and alternative treatments that favor the migration and cellular activity during the inflammatory and proliferation phases may enhance the skin wound repair. Skin wounds represent a serious health problem worldwide frequently associated with high costs and inefficient treatments [ 9 , 10 ]. The use of herbal drugs is opening a new perspective for the treatment of skin wounds, mainly in developing countries.
Although several plant species are currently used in the popular medicine to treat skin wounds worldwide [ 11 — 14 ], the scientific evidence that supports this practice is scarce. Thus, determining the security and efficiency of herbal drugs is an urgent and challenging task, which is essential to develop new technologies and products potentially applied in wound care.
In general, the healing properties of plant products are related to specific secondary metabolites, especially tannins, saponins, flavonoids, and alkaloids [ 11 , 47 , 48 ]. Plant products present a broad spectrum of biological functions such as astringent, antimicrobial, antioxidant, and anti-inflammatory [ 49 — 54 ] functions, which has been systematically associated with the beneficial effects in stimulating the healing process [ 49 , 52 , 54 ].
Before extrapolation to the human condition, preclinical researches using animal models have been useful for testing the toxicological security and biological effects of plant fractions and isolated molecules with potential applicability in the treatment of skin wounds [ 11 , 52 ]. Despite the increasing number of experimental trials in the last decade, few advances were observed in the treatment of skin wounds, especially in humans. Considering that studies using animal models are conceived to support clinical investigations, there is a clear limitation in translating the findings obtained from animal models of wound healing to the human context.
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.
In general, the animals treated with isolates and fractions of plants presented an elevated closure rate of the wound, representing The use of plant based strategies is opening a new perspective for the treatment of skin wounds, mainly in developing countries, once it represents a simple, low cost, and affordable therapy [ 1 , 7 , 56 — 58 ].
There are several studies indicating beneficial effects of herbal medicines in all phases of the healing process. In fact, most of the studies included in this systematic review reported that plant fractions and isolates were able to improve the skin wound healing. Apparently, these medicines were especially favorable in controlling the cutaneous inflammatory and oxidative response and in stimulating the granulation tissue formation, collagen maturation, and reepithelialization.
In this review, we did not include studies testing crude plant extracts, since the chemical characterization of the extracts makes it difficult to determine the herbal components responsible for the effects reported.
Even in case of including only studies with murine models, different animal strains were observed. This aspect makes the generalizability of the results difficult, since the biological variability directly influences the response to the treatments. Also, the administration of the topical medications requires wearing gloves to protect the healthcare provider from accidental exposure and absorption of the medication.
Topical medications should never be applied with the bare hands. This video will demonstrate techniques of the safe administration of topical medications, including transdermal patch skin , optical eye , and otic ear application, within the context of the standards of safe medication practices.
Preparing and Administering Topical Medications. Complete the second safety check using the five "rights" of medication administration. Gather the necessary supplies, such as clean gloves and sterile gauze for cleaning. Additional supplies, like cottons balls, sterile swabs, or occlusive dressing may be necessary in certain cases.
Cotton balls may be needed for eardrop administration. Topical antibiotic medications should be applied using swabs to prevent cross-contamination of the application site with environmental contaminants. Occlusive dressing is necessary for the application of ointment, such as nitroglycerin. Complete the third safety check using the five "rights" of medication administration.
Upon exiting the patient room, disinfect your hands again, as has been described earlier. While the administration of topical medications may appear to be simple and harmless, it is associated with many side effects if not performed properly. Topical medications are an important and common mode of drug delivery, often offering continuous absorption of the medication over several hours. This video will demonstrate techniques of the safe administration of topical medications, including transdermal patches, optical formulations, and otic drops.
First, let's review the steps that one needs to perform before administration of any of these medications. In the patient's room, review the patient's medical history for medication allergies and previous administration times in the electronic medication administration record. Confirm any patient preferences regarding topical administration and address any patient concerns such as preferred site of application or any previous side effects noted. Before handling any medication, disinfect the hands with soap and warm water and vigorous friction for at least 20 seconds, or apply a hand sanitizer with friction if the hands are not visibly soiled.
Next, acquire the topical medications from the medication dispensing device using the five "rights" during the first safety check, as indicated in the video, "Safety Checks and Five Rights of Medication Administration.
Note that some topical medications are available in different concentrations depending on the location where they are to be applied. It is the nurse's responsibility to verify that the concentration of the topical medication provided is appropriate for the location specified in the prescription.
Review information regarding the proper application of topical medications with a nursing drug guide and institutional policies. Now, gather necessary supplies, such as clean gloves and sterile gauze for cleaning, and take the medications and supplies with you to the patient's room. Upon entering the patient's room, perform hand hygiene as described previously.
At this point, complete the third safety check. Like before any medication administration, tell the patient the medication name, indication, and action. Review any side effects and discuss any concerns they might have.
If the patient refuses the medication, ensure that they are aware of the potential physiologic or psychologic impact of the refusal on their health and recovery. After the review of the common preparatory steps, let's get in the details of topical administration, starting with transdermal patch application.
To begin, inform the patient that the application of the patch will require exposing an application site. Ask the patient if they have a preferred site.
Ensure the patient's privacy and dignity by covering their intimate body sites as much as possible with a blanket or towel. Don clean gloves and carefully remove the previously applied patch, if present. Then clean the site, according to institutional policy and standards of nursing practice, in order to remove any remaining medication. Now remove the gloves, wash hands thoroughly, and don a new pair of gloves for medicine application.
Wearing gloves for any topical administration is important, as it protects the nurse from any accidental exposure and absorption of the medication. To apply the new patch, carefully remove the outer packaging. Remove the clear protective liner and place it in an area free of movement and hair. This placement should be compliant with the instructions provided on the MAR, institutional policy, and the description in the nursing drug guide.
If using an ointment topical medication, such as nitroglycerin, squeeze out the appropriate amount onto the measurement or application device provided by the manufacturer.
Place it on the skin and apply a clear occlusive dressing over the device, securing it to the surface. Never rub or massage the medication into the skin, as this will alter the absorption rate. For both types of patches, the last step is to label the transdermal patch with initials, time, and date of application using an indelible marker.
Remove the gloves and wash the hands with vigorous friction for at least 20 seconds. Next, let's review ophthalmic medication administration process, which includes eye drops and ointments.
Start by describing the application process. Then wash hands and don clean gloves. To start, assist the patient in lying back, with head tilted and neck extended. Note, in case of current or prior neck injury, do not extend the neck. Assess the eyelids, inner and outer canthus for crust or drainage. If present, cleanse the area with a gauze pad soaked in normal saline. For eye drops, pick the bottle up in the dominant hand.
Softly rest the heal of the hand on the patient's forehead while holding the medication approximately cm above the lower lid. With the non-dominant hand, carefully pull the lower lid down to expose the conjunctival sac. Now, ask the patient to look up towards the ceiling. Point the bottle tip towards the conjunctival sac, and while keeping it cm above the eye, allow the prescribed number of drops to fall into the conjunctival sac.
Finally, release the lower eyelid and instruct the patient to gently close the eyes. Never allow the bottle tip to touch the conjunctival sac or eye, and if the drops fall outside the lid, or if the patient blinks, causing a drop to miss the eye, repeat the procedure. Administration of ophthalmic ointment is similar.
First, rest the dominant hand on the patient's forehead, while holding the ointment tube cm above the lower lid, and with the non-dominant hand, expose the inner conjunctiva of the lower lid.
Now apply a thin line of ointment along the inner conjunctiva, from the inner canthus to the outer canthus. Break the ribbon of ointment by spinning the hand upwards before lifting the hand away, thus avoiding pulling the medication off the conjunctiva. Then release the lower eyelid and instruct the patient to blink and gently rub the eyelid to disperse the medication.
This completes the administration process. Now remove gloves and complete hand hygiene, as described before. Now, let's review how a nurse should administer otic drops. Begin with medication education; inform the patient that they may experience a feeling of water or bubbling in the ear when the drops enter the ear canal. Next, perform good hand hygiene and don a clean pair of gloves. Now, ask the patient to lay on their side, with the affected ear towards the ceiling.
Gently roll the medication between both hands for seconds to both re-suspend particles and warm the medication prior to administration, as cold ear medications may cause dizziness or nausea when administered. Using the non-dominant hand, gently pull the auricle up and outward to straighten the ear canal. For children 3 years old and younger, grasp the pinna and pull down and back to straighten the canal. Hold the bottle with the dominant hand approximately 1 cm above the ear canal and instill the prescribed number of drops.
Never allow the bottle tip to touch the ear or the canal. Then, rub the tragus or tug the pinna to help the drops flow down the ear canal. Ask the patient to remain on their side for minutes. As with all medication administration and patient contact, remove gloves and complete hand hygiene.
Documentation of topical medications should include the name of the medication, topical medication application site, date, exact time administered, and your initials.
Safe medication practice for transdermal patch administration also requires removal of previous patch documentation. Prior to leaving the room, remind the patient about any side effects, adverse effects, or considerations for which they should notify the nurse. Upon exiting the patient's room, disinfect your hands again, as has been described earlier. A common mistake is a failure to remove the previous patch medication before applying a new one, resulting in higher dose of the medication and medication error.
In cases of many transdermal patch pain medications, such as Fentanyl, this can be harmful, even deadly. These patches can sometimes be transparent and difficult to find.
Never assume the patch has fallen off or been removed by the patient. Unexpected inflammation and irritation should be reported to medical staff to prevent further tissue damage. For instance, a topical antibiotic has formulations for both skin and eyes and, if applied incorrectly, could result in loss of vision.
Therefore, warming them before administration is important. You've just watched JoVE's introduction to preparing and administering topical medications. You should now understand the different types of topical medications and the safe and effective application of each different type. As always, thanks for watching! This video reviewed the steps of topical medication administration.
Many transdermal patch pain medications, such as fentanyl, can be harmful or even deadly when a previous pain medication patch is not first removed. These patches can sometimes be transparent and difficult to find; never assume that the patch has fallen off or has been removed by the patient.
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.
Topical administration of medications in the lungs.
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.