Ch 56- Dermatologic Drugs

Acne

Acne is caused by Propionibacterium acnes, acne vulgaris is the most common skin infection

Nursing Implications (5)

Always assess allergies, if a patient is allergic to a systemic antibacterial, they will also be allergic to topical dosage forms; Topical anesthetics are used to therapeutically numb the skin, indications for use include insect bites, sunburn, poison ivy, and prevention of pain from injections; Corticosteroids are some of the most widely used topical drugs and indicated for relief of topical inflammatory and pruritic disorders

clindamycin (Cleocin T)

Antibiotic; Used topically to treat acne; Adverse reactions are usually limited to minor local skin reactions, including burning, itching, dryness, oiliness, and peeling

Topical Antipruritic Drugs

Antihistamines; Corticosteroids (Antiinflammatory effects, Antipruritic effects, Vasoconstrictor actions)

Topical Dermatologic Drugs

Antimicrobial drugs (Antibacterial drugs, Antifungal drugs, Antiviral drugs); Antiinflammatory drugs; Antineoplastic drugs (used to treat forms of skin cancer); Antipruritic drugs (for itching); Burn drugs (severe sun burn and other burns); Emollients (soften skin); Keratolytics (cause softening and peeling of the stratum corneum); Local anesthetics (provide numbing effects); Topical vasodilators (increase blood flow to the skin); Débriding drugs (promote wound healing); Sunscreens

Nursing Implications (2)

Assess area affected thoroughly before applying medication; Keep in mind that systemic absorption is higher in the very young and very old because the skin may be more permeable; Follow specific manufacturer's guidelines for administration techniques; Cleanse the area thoroughly to remove debris and residual medication; follow specific recommendations; Wear gloves when applying topical drugs; Apply dressings (e.g., wet, wet-to-dry, occlusive) as prescribed

Nursing Implications (1)

Assess for presence of contraindications, especially drug allergies; Do not apply antiinfective drugs until culture and sensitivity testing (if ordered) are completed; For isotretinoin (Amnesteem): Ensure that strict guidelines are in place for monthly pregnancy testing and prescription renewal, Monitor liver function before and during therapy

Topical fungal infections caused by

Candida albicans: a yeastlike opportunistic fungus present in the normal flora of the mouth, vagina, and intestinal tract; Dermatophytes: tinea or ringworm infections

benzoyl peroxide

Causes death of the anaerobic P. acnes bacteria by slowly releasing oxygen; Antibacterial, antiseptic, drying, and keratolytic actions; Keratolytic: softens scales and loosens the outer layer of the skin; May cause peeling skin, redness, or sensation of warmth; Produces improvement in 4 to 6 weeks

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. Reduce the dosage of the isotretinoin to every other day. Switch to tretinoin (retinoic acid). Consult an obstetrician.

Correct answer: A 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 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? sodium hypochlorite (Dakin's solution) hydrogen peroxide collagenase (Santyl) Sterile water

Correct answer: C Rationale: 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.

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? 1315 1400 1530 1700

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

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? bacitracin neomycin polymyxin B mupirocin (Bactroban)

Correct answer: D Rationale: 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.

Topical Fungal Infections

Difficult to eradicate; Therapy may be prolonged: Several weeks to 1 year (prolonged systemic treatment requires pre-treatment evaluation of liver function followed by ongoing monitoring

Nursing Implications (3)

Document: Site of application; Drainage (color, amount); Swelling, temperature; Odor, color, pain, or other sensations; Type of treatment given; Patient's response

Most common bacteria are Streptococcus pyogenes and Staphylococcus aureus

Folliculitis; Impetigo; Furuncles; Carbuncles; Cellulitis; Pustules; Vesicles; Papules

Skin

Largest organ of the body; Two layers: Dermis Epidermis

Antiacne

Main adverse effects are local inflammatory reactions, which are reversible when therapy is discontinued; Common adverse effects are excessively red and edematous blisters, crusted skin, and temporary alterations in skin pigmentation

Nursing Implications (4)

Protect medicated/affected area from sunlight; Do not double up on dose if a dose is missed; Ensure proper disposal of contaminated dressings; Provide patient/family teaching as necessary for self-care to include administration, and effectiveness to ensure compliance with treatment regimen; Monitor for therapeutic responses-decrease or resolution of problems associated with condition; Monitor for adverse effects-increased severity of symptoms associated with condition

Functions of the Skin

Protective barrier for the internal organs; Senses changes in temperature, pressure, or pain; Regulates body temperature; Excretes fluid and electrolytes; Stores fat; Synthesizes vitamin D; Provides a site for drug absorption

Sunscreens

Rated by sun protection factor (SPF), which is a number ranging from 2 to 50 (or higher) in order of increasing potency of UV protection; Only those with SPF of 15 or greater may state they reduce the risk of skin cancer and early skin aging

silver sulfadiazine (Silvadene)

Topical antiinfective; Used to prevent or treat infection at the site of second- and third-degree burns; Adverse effects: pain, burning, and itching; Do not use in patients who are allergic to sulfonamide (sulfa) drugs

isotretinoin (Amnesteem, Claravis)

Treatment of severe cystic acne; Inhibits sebaceous gland activity and has antikeratinizing (anti-skin hardening) and antiinflammatory effects; The company that produced the brand name Accutane has withdrawn it from the market (generics are available now); Stringent guidelines for prescribing and use; Required patient counseling regarding use of two forms of contraception and not becoming pregnant during use; Required "iPLEDGE" program for safety; Monitor for signs of depression, suicidal ideations

Herbal Products: Aloe

Used for wound healing; Adverse effects: Diarrhea, Abdominal pain, Dermatitis; Drug interactions: digoxin, Antidysrhythmics, Diuretics

Topical Anesthetic Drugs

Used to reduce pain or pruritus associated with Insect bites, Sunburn, Poison ivy exposure; Also used to numb the skin before a painful injection; Ointments, creams, sprays, liquids, jellies: EMLA: lidocaine/prilocaine combination (used prior to IV insertion, apply 1 hour prior to procedure) Ela-max: lidocaine (effective within 30 mins)

tretinoin (retinoic acid, vitamin A acid) (Renova, Retin-A)

Used to treat acne; Also used to reduce dermatologic changes associated with sun damage; Stimulates the turnover of epithelial cells, resulting in skin peeling

mupirocin (Bactroban)

Used topically for Staph and Strep impetigo; Intranasal form for methicillin-resistant S. aureus (MRSA); Available by prescription

Wound Care Drugs

Vitamin C (ascorbic acid); Zinc; Topical wound care drugs: Used to prepare wound bed for healing, Remove nonviable tissue (débridement), Antibacterial; sodium hypochlorite (Dakin's solution); cadexomer iodine (Iodosorb); collagenase (Santyl); biafine topical emulsion; acetic acid (vinegar)

Topical Antiviral Drugs

acyclovir (Zovirax) and penciclovir (Denavir): Both used to treat initial and recurrent herpes simplex infections; Do not cure viral skin infections, but may reduce healing time and pain; Systemic drugs have been shown to be better for controlling viral skin conditions; Most common adverse effects are stinging, itching and rash

Most common Antibacterial drugs

bacitracin; neomycin; polymyxin; neomycin and polymyxin B (Neosporin); mupirocin (Bactroban)

Drugs used to treat acne (Antiacne)

benzoyl peroxide; erythromycin; tetracycline ( teratogenic); isotretinoin (Amnesteem); clindamycin (Cleocin T); tretinoin (Renova, Retin-A); Oral contraceptives (for female patients with acne)

Topical Antifungal Drugs

clotrimazole (Lotrimin, Mycelex-G): Lozenge for oral candidiasis (thrush); Vaginal suppository or cream for yeast infections Other forms used for other fungal infections----- miconazole (Monistat): Topical cream; Vaginal suppository or cream; Most commonly reported adverse effects are local irritation, pruritus, burning sensation and scaling

Systemic hair growth drug (IMPORTANT)

finasteride (Propecia) (*Recall-alopecia means baldness) Finasteride is classified as a pregnancy category X drug Women are not to handle this drug without gloves or crush this drug, thereby making it airborne

Topical antineoplastics

fluorouracil (Efudex): Basal cell carcinoma Actinic keratosis

Skin Preparation Drugs

isopropyl alcohol (70%); povidone-iodine (Betadine) (used prior to and during surgical procedures); chlorhexidine (Hibiclens) (used prior to surgical procedures); benzalkonium chloride (Zephiran)

Topical ectoparasiticidal drugs to treat pediculosis (Phthirus pubis, Pediculus humanus corporis, Pediculus humanus capitis) and scabies (Sarcoptes scabiei)

lindane (Kwell); malathion (Ovide); crotamiton (Eurax); benzyl alcohol 5% (Ulesfia); spinosad (Natroba)

Topical hair growth drug

minoxidil (Rogaine)-- For men and women

Immunomodulators

pimecrolimus (Elidel): Treats atopic dermatitis; imiquimod (Aldara): Treats actinic keratosis, basal cell carcinoma, and anogenital warts

Antipsoriatic drugs (treatment typically begins with topical corticosteroids for mild to moderate cases, if not successful antipsoriatic drugs are used)

tazarotene (Tazorac); tar-containing products; anthralin (Anthra-derm); calcipotriene (Dovonex); etanercept (Enbrel) (given by subcutaneous injection); alefacept (Amevive) (given by IM injection); ustekinumab (Stelara) (given subcutaneously, pts must receive FDA approved patient medication guide)