Integumentary Medications Flashcards
1
Q
Poison Ivy Treatment
A
- treatment of lesions include calamide lotion and commercial products that soothe lesions, compresses and solutions that are astringent and antiseptic, and/or colloidal oatmeal baths to relieve discomfort.
- topical corticosteroids are effective to prevent or relieve inflammation, especially when used before blisters form.
- oral corticosteroids may be prescribed for severe reactions, and an antihistamine such as diaphenhydramine may be prescribed.
- products used: Bentoquatam (for preventive use), Calamine lotion, Hydrocortisone, Zinc acetate, isopropanol, benzyl alcohol.
2
Q
Medications to Treat Dermatitis
A
- May be treated with moisturizer and topical glucocorticoids (preferred treatment); systemic immunosupressants may need to be prescribed if topical treatment is ineffective.
Topical Immunosupressants: - Tacrolimus and Pimecrolimus creams
- side and adverse effects include redness, burning, and itching; causes sensitization of the skin to sunlight (treated areas should be protected).
- Tacrolimus may increase the risk of contracting varicella zoster infection in children and may increase the risk of developing skin cancer and lymphoma.
Systemic Immunosupressants: - Azathioprine, Cyclosporine, Methotrexate, Oral glucocorticoids.
3
Q
Topical Glucocorticoids
A
- antiinflammatory, antipruritic, and vasoconstrictive actions.
- systemic effects are more likely to occur with prolonged therapy and when extensive skin surfaces are treated.
- topical can be absorbed into the systemic circulation and is greater in permeable skin areas (scalp, axilla, face and neck, eyelids, perineum) and less in areas where permeability is poor (palms, soles, back).
- contraindications: previous sensitivity to corticosteroids, current systemic fungal, viral, or bacterial infections, current complications related to glucocorticoid therapy.
- local side and adverse effects: burning, dryness, irritation, itching, thinning of the skin, striae, purpura, telangiectasia, skin atrophy, acneiform eruptions, hypopigmentation, overgrowth of bacteria, fungi, and viruses.
- systemic adverse effects: growth retardation in children, adrenal suppression, Cushing’s syndrome, ocular effects (glaucoma and cataracts).
- interventions: wear gloves, wash area before application, rub gently a thin film, avoid the use of dry occlusive dressing. Monitor plasma cortisol levels if prolonged therapy is necessary.
4
Q
Medications to Treat Actinic Keratosis
A
- treatment includes meds and therapies such as excision, cryotherapy, curettage, and laser therapy.
- Diclofenac sodium: a nonsteroidal antiinflammatory topical med; may take up to 3 months to be effective. Side and adverse effects include dry skin, itching, redness, and rash.
- Fluorouracil: a topical med that affects DNA and RNA synthesis and causes a sequence of responses that results in healing; results are usually seen in 2-6 weeks but may take 1-2 months longer for complete healing. Side and adverse effects include itching, burning, inflammation, rash, and increased sensitivity to sunlight.
- Imiquimod 5% cream: in addition to treating actinic keratosis, it has been used to treat veneral warts; may take up to 4 months to be effective. Side and adverse effects include redness, skin swelling, itching, burning, sores, blisters, scabbing, and crusting of the skin.
- Igenol mebutate: risk of allergic reaction and development of herpes zoster. Side and adverse effects include skin reactions, erythema, flaking/scaling, crusting, swelling, postulation, and erosion/ulceration; allergic reactions; herpes zoster.
5
Q
Sunscreens
A
- Ultraviolet (UV) light can damage skin and cause premalignant actinic keratoses and some types of skin cancer.
- sunscreens prevent the penetration of UV light and protect skin.
- organic (chemical) sunscreens absorb UV light; inorganic (physical) reflect and scatter UV light.
- a sunscreen that protects against both UVB and UVA rays and one that has a factor (SPF) of at least 15 should be used.
- most effective applied at least 30 min before exposure to the sun.
- should be reapplied every 2-3h and after swimming or sweating.
- can cause contact dermatitis and photosensitivity reactions.
- sunscreens containing para-aminobenzoic acid or padimate O require application 2h before exposure and should be avoided by individuals allergic to benzocaine, sulfonamides, or thiazides.
6
Q
Medications to Treat Psoriasis: topical meds
A
- Glucocorticoids: used for mild psoriasis and should not be applied to the face, groin, axilla, or genitalia, because the med is readily absorbable, making the skin vulnerable to glucocorticoid-induced atrophy.
- Tazarotene: a vit A derivative; local reactions include itching, burning, stinging, dry skin, and redness; other less common effects include rash, desquamation, contact dermatitis, inflammation, fissuring, and bleeding. Sensitization to sunlight can occur (instruct to use sunscreen and protective clothing). Usually applied once daily in the evening to dry skin.
- Calcipotriene: an analog of vit D; may take up to 1-3 weeks to produce a desired effect; can cause local irritation; high-dose rarely caused hypercalcemia.
- Coal tar: suppresses DNA synthesis, miotic activity, and cell proliferation; has a unpleasant odor and may cause irritation, burning, and stinging; can also stain the skin and hair and increase sensitivity to sun; may increase risk for cancer development in high doses.
- Keratolytics: soften scales and loosen the horny layer of the skin, resulting in minimal peeling to extensive desquamation. Salicylic acid can be absorbed systemically and can cause salicylism (dizziness, tinnitus, hyperpnea, psychological disturbances) and is not applied to large surface areas or open wounds. Sulfur promotes peeling and drying and is used to treat acne, dandruff, seborrheic dermatitis, and psoriasis.
7
Q
Medications to Treat Psoriasis: Systemic meds
A
- Methotrexate: reduces proliferation of epidermal cells; can be toxic and causes GI effects such as diarrhea and ulcerative stomatitis and bone marrow depression leading to blood dyscrasias. Can be hepatotoxic (should be monitored) and is teratogenic (women should wait 3 months after discontinuation to get pregnant).
- Acitretin: inhibits keratinization, proliferation, and differentiation of cells; has inflammatory and immunomodulator actions; used for severe psoriasis and reserved for use in those who have not responded to safer meds. Is embryotoxic and teratogenic (contraception must begin at least 1 month before treatment and continue for 3 years after treatment is discontinued). Effects include hair loss, skin peeling, dry skin, rash, pruritis, nail disorders, rhinitis, inflammation of the lips, dry mouth, dry eyes, nose bleed, gingivitis, stomatitis, bone and joint pain, and spinal disorders. Can be hepatotoxic (should not be taken with alcohol, vit A sup, or tetracycline.
- Cyclosporine: an immunosuppressant that inhibits proliferation of B and T cells; can be toxic and cause kidney damage; used for severe psoriasis and reserved for those who have not responded to safer meds.
8
Q
Medications to Treat Psoriasis: Systemic Biological meds
A
- clients should be tested for TB before initiation.
- injected into the skin or bloodstream; they block the altered immune system.
- some are tumor necrosis factor alpha-blockers, some bind to inflammation, causing proteins/interleukins; some are a human antibody that works against interleukins.
- adverse effects, which are generally not severe, include upper respiratory infections, abd pain, headache, rash, injectionsite reactions, and UTI; may promote serious infections, including bacterial sepsis, invasive fungal infections, TB, and reactivation of hepB; some meds increase the risk of developing lymphoma.
- contraindication; history of certain cancers, severe or recurrent infections, heart failure, or demyelinating neurological diseases; given with caution to persons with numbness or tingling.
- client should not receive any live virus vaccines and should not receive BCG during the year before or 1 year after treatment.
- client should inform if receiving phototherapy, has any medical condition, is pregnant or plans to be, breast-feeding.
9
Q
Medications to Treat Psoriasis: Phototherapy
A
- coal tar and UVB irradiation
- involves the application of coal tar for 8 to 10 hours; coal tar is washed off and the area exposed to short-wave UV radiation.
- photochemotherapy (psoralen and UVA); combines the use of long-wave radiation (UVA) with oral methoxsalen (used in very specific cases; photosensitive med); causes pruritus, nausea, erythema; may accelerate the aging process of the skin; may increase the risk of skin cancer.
10
Q
Acne Products: Topical ATB
A
- Benzoyl peroxide: can produce drying and peeling; severe local irritation (burning, blistering, scaling, swelling) may require reducing the frequency of applications; some products may contain sulfites; monitor for serious allergic reactions.
- Salicylic acid and sulfur/sulfacetamide can be used as well.
- Clindamycin and Erythromycin: both are ATB that suppress the growth of P. acnes; combination therapy with benzoyl peroxide prevents the emergence of resistant bacteria; fixed-dose combinations include clindamycin/benzoyl peroxide and erythromycin /benzoyl peroxide.
- Dapsone: side and adverse effects include oiliness, peeling, dryness, and erythema of the skin (oral form of med is used to treat leprosy).
11
Q
Acne Products: Topical Retinoids
A
- Tretinoin: derivative of vit A; in addition to treating acne, it may be prescribed to reduce fine wrinkles, skin roughness, and mottled hyperpigmentation, as with age spots; can cause blistering, peeling, crusting, burning, and swelling of the skin; abrasive and keratolytic products are discontinued before using treninoin (reduce adverse effects); instruct the use of sunscreen greater than SPF 15 due to sensitivity to UV light.
- Adapalene: similar to tretinoin and sensitizes the skin to UV light; adverse effects include burning and itching after application, redness, dryness, and scaling of the skin; initially may worsen acne, benefits seen in 8-12 weeks.
- Tazarotene: derivative of vit A; in addition to acne, it is used to treat wrinkles and psoriasis; can cause itching, burning, and dry skin and sensitizes the skin to UV light.
- Azelaic acid: can cause burning, itching, stinging, and redness of the skin; can also cause hypopigmentation in clients with a dark complexion.
12
Q
Acne Products: Oral ATB
A
- includes doxycycline, minocycline, tetracycline, erythromycin, trimethoprim-sulfamethoxazole, cephalosporins, penicillins.
- improvement develops slowly and may take 3-6 months for some improvement; after control of symptoms, the client is usually switched to a topical ATB.
- Isotretinoin (rocutan): derivative of vit A (use of tetracyclines can increase adverse effects and should be discontinued, along with vit A sup); used to treat severe cystic acne; reserved for persons who have not responded to other therapies; side and adverse effects include nosebleeds, inflammation of the lips or eyes, dryness or itching of the skin, nose, or mouth, pain tenderness or stiffness in the joints, bones, or muscles, and back pain; less common include rash, hair loss, peeling of the skin, headache, and reduction in night vision; causes sensitization to UV light; elevates triglycerides levels; alcohol should be eliminated because could potentiate elevation of serum triglyceride levels; may cause depression; highly teratogenic (need to follow strict rules of iPLEDGE program).
13
Q
Acne Products: Hormonal meds
A
- oral contraceptives and spironolactone may be prescribed to treat acne in female clients.
- decrease androgen activity, resulting in decreased production of sebum.
- spironolactone is teratogenic; therefore, contraception is necessary.
- side and adverse effects of spironolactone include breast tenderness, menstrual irregularities, and hyperkalemia.
14
Q
Burn Products: Silver Sulfadiazine
A
- has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast.
- silver is released slowly from the cream, which is selectively toxic to bacteria.
- used primarily to prevent sepsis.
- keep burn covered at all times.
- side and adverse effects include rash and itching, blue-green or gray skin discoloration, leukopenia, and interstitial nephritis.
- monitor complete blood cell count (particularly WBC), if leukopenia develops, the PHCP is notified.
15
Q
Burn Products: Mafenide Acetate
A
- water-soluble cream that is basteriostatic for gram-negative and positive organisms.
- used to treat burns to reduce the bacteria present in avascular tissues.
- diffuses through the devascularized areas of the skin and may precipitate metabolic acidosis with the client displaying hyperventilation; monitor blood gases and electrolytes.
- apply 1.5mm film directly to the burn
- side effects include local pain and rash (medicate for pain before application).
- adverse effects include bone marrow depression, hemolytic anemia, and metabolic acidosis.
- keep the burn covered at all times.
- notify PHCP if hyperventilation occurs; if acidosis develops, wash the product off the skin and is usually discontinued for 1-2 days.
