Pharm Chapter 85: Skin
A patient asks a nurse what a sun protection factor (SPF) of 15 indicates. The nurse will tell the patient that an SPF of 15 indicates: a. a 93% block of UVB radiation. b. half the protection of a sunscreen with an SPF of 30. c. low protection. d. that it takes 15 minutes for the sun to burn.
ANS: A A sun protection factor of 15 indicates a 93% block of UVB. As the SPF increases, the increment in protection gets progressively smaller, so an SPF of 15 is not half that of an SPF of 30. Low protection is indicated by an SPF of 2 to 14. The SPF is calculated by the time required for the development of erythema in the protected region divided by the time required for development of erythema in the unprotected region.
A patient with severe psoriasis will begin taking acitretin [Soriatane]. The nurse obtains a health history and learns that the patient takes a combination oral contraceptive. What will the nurse do? a. Counsel the patient to use another form of birth control along with the OCP. b. Tell the patient she may stop using contraception when the medication is withdrawn. c. Tell the patient that acitretin is safe to take during pregnancy. d. Tell the patient to report spotting to the provider so that another form of contraceptive may be ordered.
ANS: A Acitretin is contraindicated during pregnancy and can reduce the effectiveness of progestin-only oral contraceptives. Patients should be counseled to use two reliable forms of birth control when taking this drug. Patients must continue using birth control for at least 3 months after treatment has stopped. Acitretin is teratogenic. Patients may experience spotting with progestin-only contraceptives, which this woman is not taking.
An adolescent has recently been experiencing pimples. The nurse notes several closed comedones across the patient's forehead and on the nose. The nurse will expect to teach this patient about the use of which medication? a. Benzoyl peroxide b. Topical clindamycin c. Topical erythromycin d. Topical retinoids
ANS: A Benzoyl peroxide is a first-line drug for mild to moderate acne. Other topical antibiotics and retinoids are used when first-line therapy fails.
A female patient with baldness asks a nurse about the safety and efficacy of minoxidil [Rogaine]. What will the nurse tell the patient? a. Hair regrowth is most effective when baldness has developed recently. b. Minoxidil cannot be used by female patients. c. Once hair has been restored, minoxidil may be discontinued, because hair loss will stop. d. Systemic side effects, such as headaches and flushing, are common.
ANS: A Minoxidil is most effective at treating recent hair loss. It may be used in female patients. Hair loss may continue even with uninterrupted treatment. Systemic side effects are not common.
To provide protection against the full range of ultraviolet (UV) radiation, an organic sunscreen must contain which agent? a. Avobenzone b. Para-aminobenzoic acid (PABA) c. Titanium dioxide d. Zinc oxide
ANS: A Only one organic sunscreen, avobenzone, absorbs the full range of UV radiation. The other agents do not protect against the full range of UV radiation. Titanium dioxide and zinc oxide are inorganic screens.
An adolescent has begun using benzoyl peroxide lotion twice daily to treat acne. The patient reports experiencing drying and burning of the skin. What will the nurse suggest? a. Applying lotion to the skin after applying the drug b. Reducing the frequency to one application a day c. Discontinuing the medication, because this is likely an allergic reaction d. Requesting a prescription for a gel formulation of the drug
ANS: B Benzoyl peroxide may cause drying and peeling of the skin. If signs of severe local irritation occur, such as burning or blistering, the frequency of application should be reduced. Applying lotion is not indicated. These symptoms are not consistent with an allergic reaction. There is no difference in skin reactions between the gel and the lotion formulations.
A 50-year-old patient receives botulinum toxin type A [Botox] injections for the first time on her forehead and around her eyes. One week later, she calls the clinic to report that she is experiencing droopy eyelids. The nurse will tell the patient that this effect: a. is normal and will resolve in a few days. b. may persist for 3 to 6 months but will resolve. c. may progress to cause drooling and dysphagia. d. represents an adverse effect that may be permanent.
ANS: B Botox is a neurotoxin that acts on cholinergic neurons to block the release of acetylcholine. Injection into the wrong site or diffusion from the correct site into surrounding tissues can weaken muscles not intended as targets. This patient's droopy eyelids are an example of the wrong site being affected. Weakening of muscles can last 3 to 6 months but will resolve. It is incorrect to tell the patient that it is a normal effect or that it will resolve in a matter of days. Drooling and dysphagia are likely when injections are around the mouth. It is not a permanent effect.
A 14-year-old patient has moderate acne that has not responded to topical drugs. The nurse will suggest that the patient and her parents discuss which treatment with the provider? a. Combination oral contraceptive medication b. Doxycycline [Vibramycin] c. Isotretinoin [Accutane] d. Spironolactone
ANS: B For moderate to severe acne, oral antibiotics are indicated. Doxycycline is a drug of first choice. Hormonal agents, such as oral contraceptive pills (OCPs), are used in female patients who are at least 15 years old. Isotretinoin is used when other treatments fail and acne is severe. Spironolactone is used when OCPs fail.
A teenaged female patient has begun to develop acne and asks a nurse how to minimize pimple formation. What will the nurse recommend? a. Asking the provider about oral contraceptives b. Cleansing the face gently 2 to 3 times daily c. Eliminating greasy foods from the diet d. Using an abrasive agent to scrub the face
ANS: B Gentle cleansing 2 to 3 times a day can reduce surface oiliness and help minimize acne lesions. Oral contraceptives are not first-line treatment for acne. Eliminating greasy foods from the diet does not affect pimple formation. An abrasive agent is not indicated for mild acne.
A patient has actinic keratosis and is unable to tolerate the effects of fluorouracil. The provider orders the nonsteroidal anti-inflammatory drug diclofenac sodium [Solaraze] 3% gel. What will the nurse include when teaching this patient about this medication? a. "Apply this medication three times daily for 30 days." b. "Dry skin, itching, and rash are common local side effects." c. "This drug has the same risk of GI side effects as with oral NSAIDs." d. "You do not need to protect your skin from sunlight with diclofenac."
ANS: B Localized skin reactions are common effects with diclofenac. The medication is applied twice daily for 60 to 90 days. The risk of GI side effects is very low. Diclofenac causes sensitization to UV radiation, so patients should be taught to avoid exposure and to use sunscreen.
A patient will begin initial treatment for severe acne. Which regimen will the nurse expect the provider to order? a. Clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A] b. Doxycycline [Vibramycin] and tretinoin [Retin-A] c. Erythromycin [Ery-Tab) and benzoyl peroxide d. Topical clindamycin and isotretinoin [Accutane]
ANS: B Oral antibiotics are used for moderate to severe acne and are usually combined with a topical retinoid. Combination clindamycin/benzoyl peroxide and tretinoin are used for mild to moderate acne. Erythromycin can be used as an oral antibiotic but would need to be combined with a topical retinoid. Isotretinoin is used for severe acne that has not responded to other treatments.
A patient is using a high-concentration keratolytic agent containing 20% salicylic acid to remove warts. What will the nurse teach this patient? a. Peeling and drying are desired effects of this drug. b. Systemic effects may occur with this medication. c. Tinnitus is a common side effect of little concern. d. Tissue injury is unlikely at this dose.
ANS: B Salicylic acid is readily absorbed through the skin, and systemic toxicity can result. Peeling and drying are not desired effects of salicylic acid. Tinnitus is a symptom of systemic toxicity. Tissue injury is likely in any concentration above 6%.
A nurse is discussing the use of tazarotene [Tazorac] with a patient who has psoriasis. Which statement by the patient indicates a need for further teaching? a. "I should use a sunscreen when using this medication." b. "I understand the gel can cause staining of clothing." c. "I will apply this once daily in the evening." d. "I will apply the medication to dry skin."
ANS: B Tazarotene will not stain clothing. It is true that patients should use sunscreen while using this drug. It should be applied once daily in the evening to dry skin.
An infant has a severe contact diaper dermatitis. The provider orders triamcinolone acetonide [Kenalog] 0.1% cream to be applied 3 times daily. When teaching the infant's parents about this medication, the nurse will instruct them to apply: a. a thick layer and massage the cream into the skin. b. a thin layer and leave the diaper open as much as possible. c. the cream and place an occlusive dressing over the area. d. the cream and put the infant's diaper on tightly.
ANS: B Topical glucocorticoids can be absorbed systemically and cause adverse effects. To minimize systemic and local adverse effects, the medication should be applied sparingly. Parents should be taught to avoid tight-fitting diapers. The cream should be rubbed gently into the skin. Occlusive dressings increase the risk of adverse effects. Putting the diaper on tightly creates an occlusive dressing.
A patient has severe acne that has been refractory to treatment. The patient is taking tetracycline and using topical tretinoin [Retin-A] and has been applying benzoyl peroxide twice daily. The provider asks the nurse to teach this patient about isotretinoin [Accutane], which the patient will begin taking in a few weeks. The nurse will include which statement when teaching this patient about this drug? a. "Alcohol may be consumed in moderation when taking this drug." b. "Skin rash, headache, and hair loss are common with this drug." c. "Tetracycline must be discontinued before beginning the isotretinoin." d. "Two pregnancy tests are required before each monthly refill of your prescription."
ANS: C Adverse effects of isotretinoin can be increased by tetracycline, so tetracycline must be discontinued before therapy is started. Alcohol should be avoided, since it can potentiate hypertriglyceridemia. Skin rash, headache, and hair loss are not common side effects, although they can occur. Two pregnancy tests are required at the beginning of therapy; at each refill, only one pregnancy test is required.
A child with eczema has been treated unsuccessfully with a topical glucocorticoid for a year and has skin atrophy and hypopigmentation. The nurse will suggest discussing which drugs with the provider? a. Higher potency topical glucocorticoids b. Topical keratolytic agents c. Topical immunosuppressants d. Topical nonsteroidal anti-inflammatory drugs (NSAIDs)
ANS: C If topical glucocorticoids fail to treat eczema without causing skin atrophy and hypopigmentation, topical immunosuppressants may be used. Higher potency glucocorticoids will only compound the adverse effects. Topical keratolytic agents are not indicated. Topical NSAIDs are not indicated.
A nurse is teaching a group of lifeguards about safe sunning. Which statement by a lifeguard indicates understanding of the teaching? a. "Sunscreen should be applied 30 minutes before going outside." b. "I do not need sunscreen when it is cloudy outside." c. "I should reapply sunscreen after swimming." d. "UV radiation does not penetrate through water."
ANS: C Sunscreens should be reapplied after swimming and with profuse sweating. Most sunscreens should be applied at least 30 minutes before going outdoors, but some require application 2 hours before exposure. Clouds do not protect from all UV rays. UV radiation can penetrate at least several centimeters of clear water.
A patient with psoriasis has been using a high-potency glucocorticoid. Because of skin atrophy, the provider has ordered a switch to calcitriol [Vectical], a vitamin D3 analog. What will the nurse teach this patient? a. "Calcitriol causes severe photosensitivity." b. "Itching, erythema, and irritation are indications of an allergic reaction." c. "Systemic effects do not occur with this topical agent." d. "You may apply calcitriol to all areas of the skin except the face."
ANS: D Calcitriol may be applied twice daily to all areas except the face. It does not cause severe photosensitivity. Skin irritation does not occur. Systemic effects may occur.
A patient with actinic keratoses has received a prescription for fluorouracil [Carac]. Which statement by the patient indicates understanding of this medication? a. "Healing should occur 6 weeks after beginning treatment." b. "I will apply this drug twice daily." c. "Severe inflammation is an indication for stopping treatment." d. "Tissue ulceration and necrosis are desired effects."
ANS: D Fluorouracil causes tissue disintegration, erosion, ulceration, and necrosis as part of the normal course of desired effects. Complete healing may take several months, although treatment lasts 2 to 6 weeks. Carac is applied once daily. Severe inflammation is part of the course of treatment and not an indication for discontinuing the medication.
An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide [BenzaClin] and tretinoin [Retin-A]. Which statement by the patient indicates understanding of this medication regimen? a. "I should apply the Retin-A immediately after bathing." b. "I should apply the Retin-A twice daily." c. "I should augment this therapy with an abrasive soap." d. "I should use sunscreen every day."
ANS: D Tretinoin increases susceptibility to sunburn, so patients should be warned to apply a sunscreen and wear protective clothing. Before applying Retin-A, the skin should be washed, toweled dry, and allowed to dry fully for 15 to 30 minutes. Retin-A is applied once daily. Abrasive soaps intensify localized reactions to Retin-A and should not be used.
A 50-year-old patient asks about using tretinoin [Renova] to minimize wrinkles. What will the nurse tell the patient? a. The drug may be discontinued once results are obtained. b. Results may be visible within a few weeks of starting therapy. c. Systemic toxicity is a common effect in patients with sensitive skin. d. The drug is not effective on coarse wrinkles or sun-damaged skin.
ANS: D Tretinoin is used to treat fine wrinkles, not coarse wrinkles, and does not repair sun-damaged skin. Treatment with Renova must continue to maintain the response to the drug. Results are not visible for up to 6 months after beginning therapy. Systemic toxicity is not common.
