Drugs for Dermatologic Disorders Chapter 50 Drugs for Dermatologic Disorders Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Causes of Skin Lesions Acne vulgaris Psoriasis Eczema dermatitis Contact dermatitis Drug-induced dermatitis Burn infections Viral infections Herpes simplex, herpes zoster Fungal infections Tinea pedis, tinea capitis Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Types of Skin Lesions Macules Papules Vesicles Plaques Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Acne Vulgaris Characteristics Nonpharmacologic approach Antiacne drugs Keratolytics Benzoyl peroxide Resorcinol Salicylic acid Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Acne Vulgaris (Cont.) Antiacne drugs Topical Oral antibiotics Tretinoin (Retin-A, Renova) Adapalene (Differin) Azelaic acid (Azelex) Tazarotene (Tazorac) Oral antibiotics Doxycycline Minocycline Tetracycline Erythromycin Topical glucocorticoids Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Acne Vulgaris (Cont.) Antiacne drugs Systemic: isotretinoin (Amnesteem) Side effects of isotretinoin Skin irritation, thrombocytopenia, nosebleeds, teratogenic effects Monitoring of blood work Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

iPLEDGE Risk management program for isotretinoin Includes implications for Patient Health care provider Pharmacist Wholesaler Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Psoriasis Characteristics Psoriasis drug treatment Topical: Salicylic acid, sulfur, topical glucocorticoids, anthralin (Psoriatec), calcipotriene (Dovonex), tazarotene (Tazorac), and coal tar (Scytera) Ultraviolet light Systemic: Methotrexate Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Psoriasis (Cont.) Biologic agents Alefacept (Amevive) Etanercept (Enbrel) Infliximab (Remicade) Adalimumab (Humira) Ustekinumab (Stelara) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Verruca Vulgaris (Warts) Characteristics Drugs for treatment Salicylic acid Podophyllum resin Imiquimod (Aldara, Zyclara) Podofilox (Condylox) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Acne Vulgaris and Psoriasis Assessment Nursing diagnosis Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drug-Induced Dermatitis Characteristics Rash, urticaria, papules, and vesicles Life-threatening: erythema multiforme (red blisters over a large portion of the body), Stevens-Johnson syndrome (large blisters in the oral and anogenital mucosa, pharynx, eyes, and viscera), toxic epidermal necrolysis (widespread detachment of the epidermis from underlying skin layers) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drug-Induced Dermatitis (Cont.) Etiology Penicillin hypersensitivity Toxic epidermal necrolysis Discoid lupus erythematosus (DLE) Exfoliative dermatitis  Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Contact Dermatitis Characteristics Causes Nonpharmacologic measures Chemical: cosmetics, perfume Plants: poison ivy Nonpharmacologic measures Pharmacologic measures Burow’s solution (aluminum acetate) Calamine lotion Glucocorticoid ointments, creams, or gels Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Impetigo Etiology Population affected Treatment Topical Systemic Mupirocin (Bactroban) Retapamulin (Altabax) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Hair Loss and Baldness Etiology Treatment Family history Aging Drug-induced Febrile illnesses Pregnancy Myxedema Treatment Minoxidil (Rogaine) Finasteride (Propecia, Proscar) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Sunscreens Categories of sunscreen Sun protective factor (SPF) Chemical Physical Sun protective factor (SPF) UVB radiation Preventive measures Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Burns and Burn Preparations Degrees of burns Topical drugs for burns Mafenide (Sulfamylon Cream) Side effects/adverse reactions Burning sensations, blistering, superinfection, acidosis Silver sulfadiazine (Silvadene) Side effects Skin discoloration Silver nitrate 0.5% solution Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Burns Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #1 Finasteride (Propecia) is used to treat male pattern baldness. The nurse knows that in higher doses, the drug is used to treat which condition? Benign prostatic hypertrophy Gastroesophageal reflux Migraine headache Impotence Answer: A Rationale: Finasteride (Propecia, Proscar) is an oral drug used for male baldness. It is available in 1-mg tablets. (A 5-mg tablet is prescribed for benign prostatic hyperplasia.) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #2 A patient is ordered to receive isotretinoin (Amnesteem) for acne vulgaris. What is considered priority information in teaching this patient? Good skin hygiene Optimal nutritional practices Contraception or abstinence from sexual intercourse Methods to avoid infection Answer: C Rationale: Isotretinoin must not be used during pregnancy because of its powerful teratogenicity. For female patients, two effective methods of contraception are required 1 month before, through the duration, and 1 month after terminating isotretinoin treatment. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #3 A patient is admitted to the emergency department with a burn that consists of pearly white skin with areas that are charred. The patient is not in pain. The nurse documents the burn as superficial epidermal. partial thickness superficial. deep thickness. full thickness. Answer: D Rationale: Superficial epidermal burns are red and painful; partial thickness superficial burns are blistering and very painful, and deep thickness burns are mottled and blistering with intense pain. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #4 Patients receiving extensive amounts of mafenide acetate (Sulfamylon Cream) for the treatment of burns are most at risk for the development of which imbalance? Hypomagnesemia Metabolic acidosis Respiratory acidosis Hypocalcemia Answer: B Rationale: If used extensively, mafenide acetate (Sulfamylon Cream) may cause metabolic acidosis. Calcium and magnesium levels are generally not affected, and respiratory alkalosis can occur as adverse reactions. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #5 Which medication does the nurse anticipate administering to a patient with venereal warts? Salicylic acid Podophyllum resin Etanercept Anthralin Answer: B Rationale: Podophyllum resin is indicated mainly for venereal warts and is not as effective against the common wart. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.