ch 56 - dermatologic drugs

Antimicrobial drugs

1. Antibacterial drugs 2. Antifungal drugs 3. Antiviral drugs

Topical Antipruritic Drugs

1. Antihistamines 2. Corticosteroids -Antiinflammatory effectS -Antipruritic effects -Vasoconstrictor actions Betamethasone, fluocinolone, triamcinolone, hypdrocortisone

Antiacne (oral and topical)

1. benzoyl peroxide, 2. clindamycin, 3. erythromycin, 4. tetracycline, 5. isotretinoin, 6. retinoic acid **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, - temporary alterations in skin pigmentation

NURSING IMPLICATIONS

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 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 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 PROTECT AFFECTED AREA FROM SUNLIGHT Do not double up on dose if a dose is missed Ensure proper disposal of contaminated dressings

isotretinoin (Amnesteem, Claravis, Sotret

"ISO" "tretinoin" -acne Required patient counseling regarding use of TWO FORMS of CONTRACEPTION and NOT BECOMING PREGNANT during use Ø Required "iPLEDGE" program for safety ** MONITOR for signs of depression, suicidal ideations

Topical Anesthetic Drugs

**REDUCE PAIN AND PRURITUS associated with INSECT BITES - Sunburn - Poison ivy exposure - Also used to numb the skin before a painful injection EMLA: lidocaine/prilocaine combination Ela-max: lidocaine

silver sulfadiazine (Silvadene)

**Topical antiinfective **PREVENTION of 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 drugs

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

*SUN DAMAGE Stimulates the turnover of epithelial cells, resulting in skin peeling "tretinoin"

mupirocin (Bactroban)

*impetigo *MRSA (intranasal) *remember: M FOR M

clindamycin (Cleocin T) - adverse effects

Adverse reactions are usually limited to: - minor local skin reactions, - including burning, - itching, - dryness, - oiliness, - peeling

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? A. "Call your prescriber immediately if you experience any signs of depression." B. "If you should become pregnant, the dose of isotretinoin will be cut in half." C. "Isotretinoin is administered by subcutaneous injection directly into the acne areas." D. "Isotretinoin should not be used with any form of birth control."

Correct answer: A Rationale: 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 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? A. Stop the isotretinoin immediately. B. Reduce the dosage of the isotretinoin to every other day. C. Switch to tretinoin (retinoic acid). D. 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.

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? A. miconazole (Monistat) B. acyclovir (Zovirax) C. clotrimazole (Lotrimin) D. anthralin (Anthra-Derm)

Correct answer: B 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.

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? A. "Improvement is usually seen in 1 week." B. "If you want faster results, a pill form of benzoyl peroxide will be used." C. "Overuse of this drug can result in painful, reddened skin." D. "Benzoyl peroxide causes the skin to blister or swell to clear the acne."

Correct answer: C 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.

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? A. sodium hypochlorite (Dakin's solution) B. hydrogen peroxide C. collagenase (Santyl) D. 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? A. 1315 B. 1400 C. 1530 D. 1700

Correct answer: D Rationale: Biafine topical emulsion SHOULD NOT be APPLIED W/in 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? A. bacitracin B. neomycin C. polymyxin B D. 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 3Xdaily and intranasally 2XDAILY to treat MRSA colonization. Adverse reactions are usually limited to LOCAL BURNING, ITCHING, OR MINOR PAIN.

Antifungal

FUNGAL: candida albicans (mouth, vagina, intestine) & tinea (ringworm) treatment: clotrimazole (Lotrimin) miconazole (monistat) **Difficult to eradicate: -therapy may be prolonged **Several weeks to 1 year

Ectoparasiticidal

INFECTIONS W/: - Lindane (Kwell) scabies - pediculosis (lice) Ø lindane (Kwell) Ø malathion (Ovide) Ø crotamiton (Eurax) Ø benzyl alcohol 5% (Ulesfia) Ø spinosad (Natroba)

clotrimazole (Lotrimin)

Lozenge for oral candidiasis (thrush) Vaginal suppository or cream for yeast infections Other forms used for other fungal infections

neomycin & polymyxin B

Neosporin

Topical hair growth drug

ROGAINE

fluorouracil (Efudex)

Topical antineoplastics 1. Basal cell carcinoma 2. Actinic keratosis

miconazole (Monistat)

Topical cream Vaginal suppository or cream

Antiviral HSV

acyclovir (Zovirax) and penciclovir (Denavir) **Do not cure viral skin infections, but may reduce healing time and pain

bacitracin

bacterial skin infections

Antipsoriatics

etanercept (Enbrel) Raptiva

benzoyl peroxide side effects

Ø May cause peeling skin, redness, or sensation of warmth Ø Produces improvement in 4 to 6 weeks

NURSING IMPLICATION - DOCUMENTATION

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