Isotretinoin Therapy in a Female Patient

During a teaching session, the nurse remembers that there are a few drug interactions that may be of concern for the patient taking isotretinoin. Which of the substances listed below should be avoided while the patient is undergoing isotretinoin therapy? Select all that apply. A. Alcohol B. Penicillin C. Oral contraceptives D. Vitamin A supplements E. Vitamin D supplements F. Tetracyclines

A. Alcohol D. Vitamin A supplements F. Tetracyclines Adverse effects of isotretinoin may be increased if the drug is taken with tetracyclines and vitamin A. Alcohol can potentiate hypertriglyceridemia while the patient is taking isotretinoin, so it should be avoided during therapy.

The nurse is teaching a patient about the potential side effects of isotretinoin. Which of the following side effects are common with this drug? Select all that apply. A. Nosebleeds B. Dry skin C. Inflammation of the lips D. Depression E. Reduction in night vision F. Peripheral edema

A. Nosebleeds B. Dry skin C. Inflammation of the lips E. Reduction in night vision Common reactions include nosebleeds, inflammation of the lips, inflammation of the eyes, reduction in night vision, sunburn upon exposure to the sun, and dryness of the skin, nose, and mouth. There are several other less common side effects. Depression may pose a small risk but is not considered a common side effect.

The nurse recognizes that the Pregnancy Category X rating of isotretinoin indicates which of the following? A. The risks of use during pregnancy outweigh any possible benefits. B. Use of this drug during pregnancy may increase the chance of fetal abnormalities. C. The mother may suffer severe side effects during therapy if she becomes pregnant. D. The baby will be born prematurely if isotretinoin is used during pregnancy.

A. The risks of use during pregnancy outweigh any possible benefits. The FDA Pregnancy Risk Category X indicates that the risk of isotretinoin use during pregnancy outweighs any potential benefits of the drug. Major fetal abnormalities have occurred as a result of isotretinoin use during pregnancy.

Which statement by the patient indicates that the patient is aware of how to handle side effects that may occur with isotretinoin therapy? A. "I will use SPF 5 sunscreen when I'm outside." B. "I need to watch out for excessively dry skin." C. "I will continue the use of the topical vitamin A cream while starting isotretinoin." D. "I will cut down to only three beers a week."

B. "I need to watch out for excessively dry skin." Patients taking isotretinoin need to use sunscreen with SPF 15 or greater and wear protective clothing for adequate skin protection. Vitamin A may increase the adverse effects of isotretinoin, and drinking alcohol may cause hypertriglyceridemia. Patients need to watch for excessive dryness of the skin and lips.

When discussing prescription refills with a patient undergoing isotretinoin therapy, the nurse teaches the client that: A. pregnancy tests are necessary every other month while a patient is taking this medication. B. each prescription must have a qualification sticker applied in order to be filled. C. the pharmacy can take a telephone order if the patient's pregnancy test results are negative. D. prescriptions can be written as long as 2 weeks in advance.

B. each prescription must have a qualification sticker applied in order to be filled. The iPLEDGE program guidelines are strict regarding isotretinoin prescriptions. When the female patient's pregnancy test result is negative, the physician applies the qualification sticker to the prescription, and then the patient must fill the prescription within 7 days. A pharmacist cannot take a telephone order for an isotretinoin prescription.

The nurse is reviewing the lab work of a female patient who will be starting isotretinoin therapy. The patient can begin taking therapy when: A. one pregnancy test result is negative. B. two pregnancy test results are negative. C. triglyceride levels are within normal ranges. D. the oral contraceptive blood level is in the therapeutic range.

B. two pregnancy test results are negative. The iPLEDGE program guidelines require that pregnancy must be ruled out with two negative pregnancy test results before the initial prescription can be filled.

A 16-year-old patient has been taking isotretinoin for 4 months. His parents call the dermatology office because they think he is depressed. He has not been eating, and he stays up in his room instead of hanging out with his friends. The nurse's best response would be: A. "All teenage boys go through mood swings, and he is probably experiencing several during this time of his life." B. "You are right; depression is a common side effect of isotretinoin therapy. He should stop taking the medication immediately." C. "There may be a small risk of depression with isotretinoin therapy. Why don't you bring him to the office this afternoon? The therapy may have to be stopped." D. "Let's wait a few more weeks to see how he does. He only has a few more weeks to go until the 6-month therapy period is over."

C. "There may be a small risk of depression with isotretinoin therapy. Why don't you bring him to the office this afternoon? The therapy may have to be stopped." Isotretinoin may carry a small risk of depression and suicide. Patients on this therapy should be informed of the signs of depression. The drug should be withdrawn if these signs occur.

The female patient undergoing isotretinoin therapy demonstrates a correct understanding of pregnancy prevention when she states: A. "I will use the 'rhythm method' to avoid sex during my fertile times." B. "My partner has had a vasectomy, so I don't need to worry about birth control." C. "I had a tubal ligation 2 years ago, so I don't need to worry about birth control." D. "Even though I'm using a contraceptive patch, I will also use a condom."

D. "Even though I'm using a contraceptive patch, I will also use a condom." The iPLEDGE program guidelines require that each patient use two effective forms of birth control, even if one of the forms is tubal ligation or vasectomy of the male partner. Effective birth control is essential in preventing pregnancy in the female patient taking isotretinoin.