56 Dermatologic drugs

Jane is a 17-year-old patient who is being seen in the dermatology clinic for treatment of acne vulgaris. The nurse practitioner prescribes benzoyl peroxide topically four times a day. Jane tells the nurse that she wants take the drug more frequently so the acne will go away quickly. What information will the nurse provide to Jane?

"Overuse of this drug can result in painful, reddened skin." Rationale: Overuse of this drug and also of tretinoin is common in teenage patients who are attempting to cure their acne quickly. The result can be painful, reddened skin, which usually resolves on return to use of these medications as prescribed. Benzoyl peroxide generally produces signs of improvement within 4 to 6 weeks. Benzoyl peroxide is available in multiple topical dosage forms. Blistering or swelling of the skin is generally considered an allergic reaction to the product and is an indication to stop treatment.

At 1300 the nurse assesses a patient who has just returned to the oncology unit after receiving radiation therapy. The patient tells the nurse that his skin "burns a little" in the area that was radiated. The nurse notes an order for biafine topical emulsion. When will the nurse apply the biafine?

1700 Rationale: Biafine topical emulsion should not be applied within 4 hours of radiation therapy.

other nursing implications

• Assess area affected before applying med • System absorption is higher in very young and very old bc skin is more permeable • Follow guidelines for administration • Cleanse area thoroughly to remove debris/residual meds • Wear gloves when applying topical drugs • Document: site of application, drainage (color,amount), swelling, temp, odor, color, pain, other sensations, type of treatment given, pt's response • Protect area from sunlight • Do not double up on dose if dose is missed • Ensure proper disposal of contaminated dressings • Provide pt/family teaching as necessary for self-care • Monitor for therapeutic/adverse effects

Isotretinoin SE

• Birth defects: make sure pt is not preganant & doesn't want to get pregnant • Depression

isotretinoin indications

• Cystic Acne: last resort to treat acne due to SE. Oral med.

Istretinoin Nursing implications

• Strict guidelines for prescribing/use: need monthly pregnancy testing/prescription renewal • Counsel pt to use 2 forms of contraception/don't become pregnant during use. Missed period, notify physician. • Become pregnant, stop immediately • Required "iPLEDGE" program for safety • Monitor s/s depression, suicidal ideations: want to kill yourself, notify physician. • Monitor liver function before/after therapy

A patient is prescribed bacitracin topical ointment. What does the nurse suspect as the possible diagnosis based on the medication prescribed?

Bacterial infection Bacitracin is a polypeptide antibiotic that is applied topically for the treatment or prevention of local skin infections caused by susceptible aerobic and anaerobic gram-positive organisms such as staphylococci, streptococci, anaerobic cocci, corynebacteria, and clostridia.

A patient is being seen for acne issues. The nurse is discussing use of various topical drugs. Which drugs are used in the treatment of acne?

Benzoyl peroxide, clindamycin, and vitamin A acid are available in topical treatment options for acne. Isotrentinoin is only an oral option. Acne vulgaris is an off-label use for the oral contraceptive norethindrone and ethinyl estrdiol (Ortho-Novum)

A few months later, it is determined that Jane is not responding to treatment and is now prescribed isotretinoin. Which statement will the nurse include when teaching Jane about isotretinoin therapy?

Call your prescriber immediately if you experience any signs of depression." There have been case reports of suicide and suicide attempts in patients receiving this medication. Educate patients to report any signs of depression immediately to their prescribers. Isotretinoin is one of relatively few medications that are classified as pregnancy category X drugs. This means that it is a proven human teratogen. It is imperative that female patients of childbearing age be counseled and agree not to become pregnant during use of the drug. It is now officially required that at least two reliable contraceptive methods be used by sexually active women during therapy with isotretinoin and for 1 month after completion of therapy. Isotretinoin is available only for oral use.

A patient who is prescribed the drug miconazole (Monistat), a topical antifungal, has most likely been diagnosed with which condition?

Candidiasis Miconazole is used in the treatment of candidiasis, which is commonly known as a yeast infection

Isotretinoin MOA

Inhibits sebaceous gland activity. Has antikeratinizing (ant-skin hardening) & anti-inflammatory effects.

A woman who is taking isotretinoin calls the office to say that she thinks she may be pregnant. What will the nurse instruct the patient to do first?

Stop the isotretinoin immediately. Rationale: While she will need to consult an obstetrician to verify her pregnancy, if she suspects that she is pregnant, she must stop the medication immediately because it is a pregnancy category X drug and a known teratogen.

A teenage female patient is going to be prescribed isotretinoin (Amnesteem) for acne. Which information is most important for the nurse to include in the education of the patient?

The patient must use at least two forms of contraception while taking this medication. The most important and mandatory teaching by the Food and Drug Administration is the requirement to use two different forms of contraception if the patient is female and of childbearing age.

A male patient has been ordered clotrimazole (Lotrimin, Mycelex-G) after a diagnosis of jock itch. What is the technical name the nurse would use to document the diagnosis on the chart and the reason the patient has been prescribed this medication?

Tinea cruris Infections caused by dermatophytes are called tinea, or ringworm, infections. Tinea infections are identified by the body location where they occur: tinea pedis (foot), tinea cruris (groin), tinea corporis (body), and tinea capitis (scalp). Tinea infections of the foot are also known as athlete's foot and those of the groin as jock itch.

Isotretinoin (Amnesteem) and tretinoin (Retin-A) are common dermatologic drugs used to treat

acne Isotretinoin and tretinoin are effective topical treatments for acne vulgaris. Isotretinoin inhibits sebaceous gland activity, and tretinoin stimulates the turnover of epidermal cells, resulting in skin peeling.

During a regular follow-up visit, Jane points out a sore that she has developed on her mouth. She is diagnosed with herpes simplex. Which medication does the nurse anticipate Jane will receive?

acyclovir (Zovirax) Rationale: Herpes simplex is a viral infection. Acyclovir (Zovirax) and penciclovir (Denavir) are topical antiviral drugs available to treat viral infections such as herpes simplex. Miconazole (Monistat) is a topical antifungal drug. Clotrimazole (Lotrimin, Mycelex-G) is available as a lozenge for the treatment of oropharyngeal candidiasis.

A patient has an infected stage II pressure ulcer that contains some necrotic tissue and some normal, healing granulation tissue. The patient is taking warfarin (Coumadin). Which product would be most appropriate for wound care?

collagenase (Santyl) Collagenase (Santyl) is good for patients taking anticoagulants or in whom surgery is contraindicated. Collagenase (Santyl) selectively removes necrotic tissue, does not harm normal tissue, and is approved for use with infected wounds. Dakin's solution can aid in debridement; however, it is partly toxic and irritating to healing tissue. Hydrogen peroxide can also be harmful to normal cells. Sterile water does not aid in debridement.

The nurse will anticipate application of which medication to treat a patient diagnosed with impetigo?

mupirocin (Bactroban Impetigo is a skin disorder caused by bacteria and is treated with a topical antibacterial agent, mupirocin.

The nurse is assessing a patient who has been diagnosed with MRSA on the right arm. The nurse anticipates use of which medication to treat the MRSA?

mupirocin (Bactroban) Mupirocin (Bactroban) is an antibacterial product available only by prescription. It is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically and intranasally to treat nasal colonization with MRSA. The drug is applied topically three times daily and intranasally twice daily to treat MRSA colonization. Adverse reactions are usually limited to local burning, itching, or minor pain.

When planning care for a burn patient, the nurse would anticipate applying which topical medication?

silver sulfadiazine (Sulfadine) Silver sulfadiazine is a topical antiinfective drug used to treat and prevent infection in second- and third-degree burns.