1. PYRAMID POINTS CHAPTER 50: INTEGUMENTARY MEDICATIONS

2. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-2 PYRAMID POINTS I. Emollients and Lotions  Emollients Used for dry, scaly, itchy inflammatory conditions Used for dry, scaly, itchy inflammatory conditions  Solutions and lotions Lotions are predominantly water, but have drying effect on skin when water evaporates Lotions are predominantly water, but have drying effect on skin when water evaporates Used as wash for skin or as wet dressings on wounds Used as wash for skin or as wet dressings on wounds  Therapeutic baths Cleanse, soothe the skin Cleanse, soothe the skin Provide anti-inflammatory effects if medicated Provide anti-inflammatory effects if medicated

3. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-3 PYRAMID POINTS II. Rubs and Liniments  Temporary relief of muscular aches, rheumatism, arthritis, sprains, neuralgia  Over-the-counter products contain combinations of antiseptics, local anesthetics, analgesics, counterirritants  Some products contain salicylates, which can cause side effects, such as tinnitus, nausea, vomiting  Do not use heating pad simultaneously

4. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-4 PYRAMID POINTS III. Anti-infective Agents  Description Include antiseptics and antibacterial, antifungal, antiviral, antiparasitic medications Include antiseptics and antibacterial, antifungal, antiviral, antiparasitic medications  Antiseptics Sodium hypochlorite (Dakin’s solution) Sodium hypochlorite (Dakin’s solution)  Loses potency during storage  Should not come into contact with healing or normal tissue  Should be rinsed off immediately following irrigation Chlorhexidine gluconate (Hibiclens) Chlorhexidine gluconate (Hibiclens)  Used for irrigating and cleansing wounds, but not for packing wounds

5. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-5 PYRAMID POINTS III. Anti-infective Agents (continued)  Antiseptics (continued) Acetic acid preparations Acetic acid preparations  Healthy skin surrounding wound must be protected with petroleum barrier Hydrogen peroxide Hydrogen peroxide  Used to irrigate, clean necrotic tissue, purulent drainage from open wounds  When epithelial tissue begins to form, use discontinued Hexachlorophene (pHisoHex, Septisol) Hexachlorophene (pHisoHex, Septisol)  Absorbed through broken skin; may cause neurotoxicity  Should be rinsed well from skin after use  Antifungals: May cause erythema, stinging, blistering, peeling, pruritus, urticaria, general skin irritation

6. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-6 PYRAMID POINTS III. Anti-infective Agents (continued)  Antibacterials Mupirocin calcium (Bactroban): Effective against Staphylococcus aureus, beta-hemolytic streptococci, Streptococcus pyogenes Mupirocin calcium (Bactroban): Effective against Staphylococcus aureus, beta-hemolytic streptococci, Streptococcus pyogenes  Antivirals Acyclovir (Zovirax) Acyclovir (Zovirax)  Use rubber gloves to apply ointment  Ointment may cause mild pain, transient burning and stinging  Antiparasitics Used to treat scabies (mites), pediculosis (lice) Used to treat scabies (mites), pediculosis (lice) May be harmful during pregnancy and to young children; may irritate skin, eyes, mucous membranes May be harmful during pregnancy and to young children; may irritate skin, eyes, mucous membranes

7. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-7 PYRAMID POINTS IV. Antipruritics  Used to allay itching  Applied as wet dressings, pastes, lotions, creams, ointments  Persons with dry skin should be instructed to bathe less frequently

8. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-8 PYRAMID POINTS V. Keratolytics  Description Soften scales, loosen horny layer of skin by dissolving keratin Soften scales, loosen horny layer of skin by dissolving keratin  Salicylic acid Can be absorbed systemically Can be absorbed systemically Not applied to large surface areas or open wounds Not applied to large surface areas or open wounds  Masoprocol Used to treat keratosis Used to treat keratosis Occlusive dressings should not be used Occlusive dressings should not be used

9. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-9 PYRAMID POINTS VI. Stimulants and Irritants  Description Produce mild irritation to skin surface; cause hyperemia and inflammation, promotes healing process Produce mild irritation to skin surface; cause hyperemia and inflammation, promotes healing process  Coal tar Used to treat psoriasis, seborrheic dermatitis, atopic dermatitis Used to treat psoriasis, seborrheic dermatitis, atopic dermatitis Has unpleasant odor, can stain skin and hair; can cause phototoxicity Has unpleasant odor, can stain skin and hair; can cause phototoxicity  Benzoin compound Protects skin when client has sore, cracked nipples or fissures Protects skin when client has sore, cracked nipples or fissures

10. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-10 PYRAMID POINTS VII. Protectives  Description Preparations that provide film on skin to protect from irritants such as light, moisture, air, dust Preparations that provide film on skin to protect from irritants such as light, moisture, air, dust Promote natural healing without formation of crust over wound Promote natural healing without formation of crust over wound  Sunscreens Most effective when applied 30 to 60 minutes before exposure to sun; reapplied every 2 to 3 hours after swimming or sweating Most effective when applied 30 to 60 minutes before exposure to sun; reapplied every 2 to 3 hours after swimming or sweating  Nonadherent dressings Woven or nonwoven dressings may be impregnated with saline, petrolatum, antimicrobials Woven or nonwoven dressings may be impregnated with saline, petrolatum, antimicrobials

11. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-11 PYRAMID POINTS VIII. Enzymes  Description Used to promote healing of wounds, débride skin ulcers Used to promote healing of wounds, débride skin ulcers  Enzymes used to débride, remove exudates Sutilains used to remove nonviable, necrotic tissue, or purulent enzymes from burns, ulcers, traumatic injury sites, peripheral vascular disease wounds Sutilains used to remove nonviable, necrotic tissue, or purulent enzymes from burns, ulcers, traumatic injury sites, peripheral vascular disease wounds Collagenase (Santyl) used as topical débriding agent Collagenase (Santyl) used as topical débriding agent  Discontinued when necrotic tissue gone Fibrinolysin and desoxyribonuclease used to débride wounds. Fibrinolysin and desoxyribonuclease used to débride wounds. Dextranomer (Debrisan) used as cleaning agent Dextranomer (Debrisan) used as cleaning agent

12. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-12 PYRAMID POINTS IX. Corticosteroids  Topical forms have anti-inflammatory, antipruritic, vasoconstrictive actions  Contraindications Previous sensitivity to corticosteroids Previous sensitivity to corticosteroids Clients with current systemic fungal, viral, bacterial infections Clients with current systemic fungal, viral, bacterial infections Clients with current complications related to corticosteroid therapy Clients with current complications related to corticosteroid therapy  Local adverse effects Hypopigmentation; contact dermatitis; burning, dryness, irritation, pruritus of skin; overgrowth of bacteria, fungi, viruses Hypopigmentation; contact dermatitis; burning, dryness, irritation, pruritus of skin; overgrowth of bacteria, fungi, viruses

13. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-13 PYRAMID POINTS IX. Corticosteroids (continued)  Systemic adverse effects Rare occurrence, but include adrenal suppression, Cushing’s syndrome Rare occurrence, but include adrenal suppression, Cushing’s syndrome  Interventions Wash area prior to administration; increases absorption Wash area prior to administration; increases absorption Apply sparingly in light film, rubbing gently Apply sparingly in light film, rubbing gently May apply to skin alone or with dry occlusive dressing as prescribed May apply to skin alone or with dry occlusive dressing as prescribed

14. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-14 PYRAMID POINTS X. Acne Products  Description Come in variety of forms, including bar soaps Come in variety of forms, including bar soaps liquid cleansers, creams All products should be kept away from eyes, inside of nose, mucous membranes, hair All products should be kept away from eyes, inside of nose, mucous membranes, hair  Benzoyl peroxide is keratolytic agent  Tretinoin and Adapalene acids of vitamin A

15. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-15 PYRAMID POINTS X. Acne Products (continued)  Tretinoin (Retin-A) Therapeutic results should be seen after Therapeutic results should be seen after 2 to 3 weeks, with optimal results after 6 weeks Teach client to apply liberally to skin, wash hands thoroughly after applying Teach client to apply liberally to skin, wash hands thoroughly after applying  Isotretinoin (Accutane) Used to treat severe acne; eliminate alcohol consumption during therapy; avoid vitamin A; decrease sun exposure Used to treat severe acne; eliminate alcohol consumption during therapy; avoid vitamin A; decrease sun exposure

16. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-16 PYRAMID POINTS continued …  Local antibiotics Include clindamycin (Cleocin T), tetracycline Include clindamycin (Cleocin T), tetracycline  May cause contact dermatitis; burning, stinging of skin

17. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-17 PYRAMID POINTS XI. Poison Ivy Treatment  Treatment includes calamine lotion, aluminum acetate (Burow solution) compresses, colloidal oatmeal (Aveeno) baths  Topical corticosteroids; prevent or relieve inflammation  Oral corticosteroids for severe reactions

18. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-18 PYRAMID POINTS XII. Burn Products  Nitrofurazone (Furacin) Broad-spectrum topical antibiotic Broad-spectrum topical antibiotic Applied as 1/16-inch film to area Applied as 1/16-inch film to area  Mafenide acetate (Sulfamylon) Water-soluble cream Water-soluble cream Bacteriostatic for gram-negative, gram-positive organisms Bacteriostatic for gram-negative, gram-positive organisms Applied as 1/16-inch film directly to burn Applied as 1/16-inch film directly to burn

19. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-19 PYRAMID POINTS XII. Burn Products (continued)  Silver sulfadiazine (Silvadene) Broad-spectrum bactericidal Broad-spectrum bactericidal Active against gram-negative, gram-positive bacteria, yeast Active against gram-negative, gram-positive bacteria, yeast May cause localized side effects, such as rash, itching, and systemic side effects, such as leukopenia, interstitial nephritis May cause localized side effects, such as rash, itching, and systemic side effects, such as leukopenia, interstitial nephritis Apply 1/16-inch film; burn always kept covered Apply 1/16-inch film; burn always kept covered  Silver nitrate Antiseptic solution active against gram-negative bacteria Antiseptic solution active against gram-negative bacteria Dressings applied to burn, then kept moist with silver nitrate Dressings applied to burn, then kept moist with silver nitrate Do not apply directly to burn area Do not apply directly to burn area

20. ADULT HEALTH: Integumentary Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.50-20 An adolescent client with severe cystic acne has been prescribed isotretinoin (Accutane). The nurse would correct the client’s misunderstanding of the medication if the client made which of the following statements? 1. “I need to be sure to take my vitamin A supplement so that the treatment will work.” 2. “I will return to the clinic for blood tests.” 3. “If my lips begin to burn, it is probably because of the medication.” 4. “My eyes may become dry and burn as a result of the medication.”