Pharm - Chapter 56 - Dermatologic Drugs

The nurse is assessing a patient with acne who has been prescribed isotretinoin. Which instruction would the nurse give to the patient to ensure safe administration of this medication? 1 "You should not become pregnant while using this drug." 2 "You should not use oral contraceptives while using this drug." 3 "You should continue the drug for 1 month after becoming pregnant." 4 "You should use only one contraceptive method while using this drug."

1 "You should not become pregnant while using this drug." Isotretinoin is categorized as a pregnancy category X drug. It causes birth defects because of its close resemblance to retinoic acid, a natural vitamin A derivative that controls normal embryonic development. The nurse would inform the patient to avoid becoming pregnant while using this medication to prevent the teratogenic effects of the drug. The nurse would also inform the patient to take oral contraceptives during and 1 month after the completion of the therapy. The medication can cause fetal abnormalities at all stages of pregnancy. Hence, the nurse would advise the patient not to take this medication at any stage of pregnancy. The nurse would teach the patient to use at least two reliable contraceptive methods while taking isotretinoin because the drug induces birth defects.

Which epidermal layer of skin consists of flat cells? 1 Clear layer 2 Horny layer 3 Granular layer 4 Germinative layer

1 Clear layer The stratum lucidum, also called the clear layer, is the translucent layer of the skin that contains flat cells. The stratum corneum, also called the horny layer, consists of keratin cells. The stratum granulosum, also called the granular layer, consists of granulated cells. The stratum germinativum, also called the germinative layer, consists of melanocytes.

A patient with alopecia is prescribed topical minoxidil. Which assessment would indicate that the drug has been absorbed systemically? 1 Increased heart rate 2 Hearing impairment 3 Increased blood glucose 4 Increased blood pressure

1 Increased heart rate Minoxidil is a vasodilating drug administered systemically to treat hypertension. Alternatively, topical application of the drug on the scalp is used to stimulate hair growth. Because of systemic absorption of the topically applied minoxidil, the patient may have adverse effects such as increased heart rate (tachycardia), fluid retention, and weight gain. Minoxidil does not cause toxicity that would cause hearing impairment. Similarly, the drug does not alter levels of insulin, so it would not increase the patient's blood glucose concentration. Moreover, the drug has hypotensive effects, so the patient may not have increased blood pressure.

The nurse is caring for a patient who has been prescribed clotrimazole for the treatment of vaginal trichomoniasis. How will this drug be administered? 1 Insert 100- and 500-mg vaginal tablets. 2 Administer a 10-mg oral topical lozenge. 3 Insert 100- and 200-mg vaginal suppositories. 4 Apply a 2% aerosol spray topical formulation.

1 Insert 100- and 500-mg vaginal tablets. The primary health care provider instructs the nurse to insert 100- and 500-mg vaginal tablets into the vagina for the treatment of vaginal trichomoniasis. A 10-mg oral topical lozenge should be administered to infants who have oropharyngeal candidiasis. This medication is not used to treat vaginal trichomoniasis in adults. Both 100- and 200-mg vaginal suppositories must be inserted into the vagina to treat yeast infections such as vulvovaginal candidiasis. A formulation of 2% topical aerosol spray can be prescribed to treat topical vaginal infections; however, it is not used to treat systemic vaginal infections.

The nurse is caring for a patient with a viral infection who has been prescribed topical acyclovir. Which nursing interventions would the nurse perform for safe administration of the drug? Select all that apply. 1 Instruct the patient to apply the ointment every 3 hours daily. 2 Inform the patient that hair loss is the side effect of acyclovir. 3 Instruct the patient to discontinue the medication if itching occurs. 4 Instruct the patient to discontinue the medication during pregnancy. 5 Instruct the patient to wear a rubber glove during the application of the ointment.

1 Instruct the patient to apply the ointment every 3 hours daily. 4 Instruct the patient to discontinue the medication during pregnancy. 5 Instruct the patient to wear a rubber glove during the application of the ointment. Acyclovir is applied every 3 hours, or 6 times daily, for 1 week. The nurse would suggest that the patient discontinue the medication during pregnancy because acyclovir is classified as a pregnancy category C drug. It may produce birth defects. Rubber gloves should be worn during application of the ointment to help prevent the spread of infection. Hair loss is not a side effect of the drug. The nurse would advise the patient to apply the medication according to the prescription. If the patient reports irritation, the patient should be advised to notify the primary health care provider rather than stop the medication. The most common adverse effects are stinging, itching, and rash.

The nurse is assessing a patient with acne and hyperpigmentation. The nurse learns that the patient works outdoors. Which drug will the nurse expect to be a part of the treatment plan? 1 Tretinoin 2 Mupirocin 3 Clindamycin 4 Benzoyl peroxide

1 Tretinoin Tretinoin is a vitamin A derivative. It is prescribed for the treatment of acne and hyperpigmentation caused by sun damage. It stimulates the production of new epidermal cells and repairs tissue damage. Mupirocin is an antibacterial product. It is prescribed for the treatment of impetigo, which is caused by staphylococcal and streptococcal bacteria. Clindamycin is a systemic antibiotic. It shows bacteriostatic activity by killing the bacteria colonizing the skin infection. It is used for the treatment of acne caused by bacterial infection. Benzoyl peroxide combats infection by continuously releasing active oxygen into the skin. Therefore it is prescribed for the treatment of acne caused by an anaerobic bacterium such as Propionibacterium acnes.

Which drug stimulates the turnover of epidermal cells resulting in skin peeling? 1 Tretinoin 2 Bacitracin 3 Isotretinoin 4 Clindamycin

1 Tretinoin Tretinoin stimulates the turnover of epidermal cells, which results in skin peeling. This decreases the free fatty acid levels of the skin, which means that the horny cells of the outer epidermis cannot adhere to one another. Bacitracin is a polypeptide antibiotic that inhibits bacterial cell wall synthesis, leading to cell death. Isotretinoin inhibits sebaceous gland activity. Clindamycin is an antibiotic.

The nurse is caring for a patient with anogenital warts who has a history of skin cancer. Which medication will the nurse expect to be prescribed? 1 Minoxidil 2 Imiquimod 3 Collagenase 4 Fluorouracil

2 Imiquimod A health care provider would prescribe imiquimod for the treatment of anogenital warts. Because the patient has a history of skin cancer, this antineoplastic drug would be effective. Minoxidil is prescribed for the treatment of hypertension (systemic) and to stimulate hair growth (topical). Collagenase is used to clean wounds. It is not prescribed for the treatment of anogenital warts. Fluorouracil is prescribed for the treatment of skin cancer such as basal cell carcinoma but not for the treatment of anogenital warts.

Which roles are the physiologic functions of the skin? Select all that apply. 1 Digestion 2 Sensation 3 Protection 4 Absorption 5 Circulation

2 Sensation 3 Protection 4 Absorption The major physiologic functions of skin are sensation, protection, and absorption. The skin is supplied by many nerves. This helps in sensation by sending impulses from heat, cold, touch, pressure, vibration, and tissue injury. The skin acts as a protective barrier for the internal organs and protects against harmful external agents such as microorganisms and chemicals. Exchange of gases such as oxygen, nitrogen, and carbon dioxide takes place through the pores present on the skin. Medications that are applied on the skin enter into the body through the pores by diffusion. Therefore the skin has a significant role in absorption. The skin does not have any role in digestion because it does not secrete digestive enzymes. The skin has no role in promoting circulation.

Which statement would the nurse make to the patient's family regarding the patient with scabies? 1 "Avoid giving milk and dairy products to the patient." 2 "Avoid using insecticide sprays to prevent suffocation." 3 "Avoid direct contact, and do not use personal articles of the patient." 4 "Avoid talking with the patient because scabies is an airborne disease."

3 "Avoid direct contact, and do not use personal articles of the patient." Scabies is caused by Sarcoptes scabiei. It is a communicable disease and is transmitted by direct contact with the patient. The nurse would inform the patient's family to avoid sleeping beside the patient and using the personal articles of the patient to prevent the spread of infection. During infections, the patient may be fatigued and may need to eat food high in calories and protein. Therefore the nurse would suggest giving milk and dairy products to the patient. Because the infection is caused by scabies mites, the nurse would suggest using insecticide sprays to eradicate the mites (disease-causing pathogens). Scabies is not an airborne disease; therefore the patient's family can talk with the patient.

A patient with athlete's foot who has been applying miconazole for 3 weeks reports rashes on the skin. After assessment, the nurse finds that the patient has developed an allergy. Which medication would the nurse expect to be added to the prescription? 1 Nystatin 2 Butenafine 3 Clotrimazole 4 Butoconazole

3 Clotrimazole Athlete's foot is a common contagious fungal infection of the skin that causes scaling, flaking, and itching of the affected areas. Miconazole is used to treat athlete's foot, but it is contraindicated in patients with hypersensitivity and may result in severe allergic reactions. In these cases, clotrimazole can be added to the prescription. Nystatin and butoconazole are anesthetic, antipruritic, antipsoriatic, and other miscellaneous dermatologic drugs and are used in the treatment of candidiasis. Butenafine is used in the treatment of tinea pedis.

Which type of cells comprises the germinative layer of the epidermis? 1 Flat cells 2 Keratin cells 3 Melanin cells 4 Granulated cells

3 Melanin cells The germinative layer of the epidermis is composed of melanin cells, which are new skin cells that are germinated from this layer. These cells determine the skin's color. Flat cells are translucent and located in the clear layer of the epidermis. Keratin cells are dead skin cells present in the horny layer of the epidermis, which helps in protection. Granulated cells are located in the granular layer of the epidermis.

Which skin preparations are effective for preventing and treating bacterial, viral, and fungal infections? Select all that apply. 1 Collagenase 2 Chlorhexidine 3 Povidone-iodine 4 Isopropyl alcohol 5 Benzalkonium chloride

3 Povidone-iodine 4 Isopropyl alcohol Povidone-iodine and isopropyl alcohol are the skin preparations that are effective for preventing and treating bacterial, viral, and fungal infections. Collagenase is used for cleaning wounds with granulation. Chlorhexidine and benzalkonium chloride are effective for preventing and treating bacterial and fungal infections.

The nurse is caring for a patient who is on isotretinoin treatment. Which cautionary factor does the nurse warn the patient about while using this medication? 1 Skin oiliness 2 Skin swelling 3 Risk to the fetus in pregnancy 4 Alteration in skin pigmentation

3 Risk to the fetus in pregnancy Isotretinoin is a pregnancy category X drug, which is proven to be a human teratogen. Female patients should be warned not to get pregnant while using this drug. Patients who are on clindamycin may experience oiliness of the skin. Patients on benzoyl peroxide treatment may experience swelling or blistering of the skin, which is an allergic reaction to the drug and is an indication that the treatment should be stopped. Patients on tretinoin treatment may experience temporary alterations in skin pigmentation.

The nurse is assessing a patient with acne who has been prescribed benzoyl peroxide. Which bacterial infection would the nurse suspect in the patient? 1 Clostridium infection 2 Staphylococcus aureus infection 3 Streptococcus pyogenes infection 4 Propionibacterium acnes infection

4 Propionibacterium acnes infection The microorganism Propionibacterium acnes, which causes acne, is an anaerobic bacterium. It needs an environment poor in oxygen to grow. Benzoyl peroxide is effective in combating such infection because it releases active oxygen slowly and continuously into the skin. This creates an environment that is unfavorable for the continued growth of the P. acnes bacteria, thus leading to their death. Clostridium is the bacteria that causes local skin infections. Staphylococcus aureus and Streptococcus pyogenes are the bacteria that cause common skin disorders such as folliculitis, impetigo, furuncles, carbuncles, papules, pustules, vesicles, and cellulitis.

Which layer of the skin is abundant in adipose tissue? 1 Dermal 2 Epidermal 3 Transdermal 4 Subcutaneous

4 Subcutaneous The subcutaneous layer of the skin is abundant in adipose tissue, which provides thermal insulation and cushioning or padding. The dermal layer is rich in different types of tissues except adipose tissue, blood vessels, and nerves. The epidermal layer is abundant in several types of cells that shed and germinate. Various drugs are delivered across the layers of skin through the transdermal route of administration.

A teenage female patient is going to be prescribed isotretinoin for acne. Which information is important for the nurse to include in the education of the patient? 1 The drug is supplied in oral form. 2 The drug is used in treatment of severe acne. 3 Providers who prescribe this medication must be registered with the U.S. Food and Drug Administration (FDA). 4 The patient must use at least two forms of contraception while taking this medication.

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