Chapter 56 Dermatologic Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Chapter 56

Dermatologic Drugs

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Largest organ of the body Two layers

Dermis Epidermis

Skin

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

Protective barrier for the internal organs Senses changes in temperature, pressure, or

pain Regulates body temperature Excretes fluid and electrolytes Stores fat Synthesizes vitamin D Provides a site for drug absorption

Functions of the Skin


Antimicrobial drugs Antibacterial drugs Antifungal drugs Antiviral drugs

Antiinflammatory drugs Antineoplastic drugs Antipruritic drugs (for itching) Burn drugs

Topical Dermatologic Drugs


Emollients (soften skin) Keratolytics (cause softening and peeling of the

stratum corneum) Local anesthetics Topical vasodilators Débriding drugs (promote wound healing) Sunscreens

Topical Dermatologic Drugs (cont’d)


Antibacterial drugs Antifungal drugs Antiviral drugs

Topical Antimicrobial Drugs


Most common bacteria are Streptococcus pyogenes and Staphylococcus aureus Folliculitis Impetigo Furuncles Carbuncles Cellulitis Pustules Vesicles Papules

Antibacterial Drugs


Most common drugs bacitracin neomycin polymyxin neomycin and polymyxin B (Neosporin) mupirocin (Bactroban)

Antibacterial Drugs (cont’d)


mupirocin (Bactroban) Used topically for Staph and Strep impetigo Intranasal form for methicillin-resistant S. aureus

(MRSA) Available by prescription



silver sulfadiazine (Silvadene) Topical antiinfective Used to prevent or treat 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



Classroom Response Question

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)


Acne is caused by Propionibacterium acnes Drugs used to treat acne

benzoyl peroxide erythromycin tetracycline isotretinoin (Amnesteem) clindamycin (Cleocin T) tretinoin (Renova, Retin-A) Oral contraceptives (for female patients with acne)

Antiacne Drugs


benzoyl peroxide Causes death of the anaerobic P. acnes bacteria by

slowly releasing oxygen Antibacterial, antiseptic, drying, and keratolytic

actions Keratolytic: softens scales and loosens the outer layer

of the skin May cause peeling skin, redness, or sensation of

warmth Produces improvement in 4 to 6 weeks

Antiacne Drugs (cont’d)


clindamycin (Cleocin T) Antibiotic Used topically to treat acne Adverse reactions are usually limited to minor local

skin reactions, including burning, itching, dryness, oiliness, and peeling



isotretinoin (Amnesteem, Claravis, Sotret) Treatment of severe recalcitrant cystic acne Inhibits sebaceous gland activity and has

antikeratinizing (anti–skin hardening) and antiinflammatory effects

The company that produced the brand name Accutane has withdrawn it from the market




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.


isotretinoin (cont’d) Stringent guidelines for prescribing and use Required patient counseling regarding use of two

forms of contraception and not becoming pregnant during use

Required “iPLEDGE” program for safety Monitor for signs of depression, suicidal ideations



tretinoin (retinoic acid, vitamin A acid) (Renova, Retin-A) Used to treat acne Also used to reduce dermatologic changes associated

with sun damage Stimulates the turnover of epithelial cells, resulting in

skin peeling



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, and temporary alterations in skin pigmentation



Difficult to eradicate Therapy may be prolonged

Several weeks to 1 year Topical fungal infections caused by

Candida albicans: a yeastlike opportunistic fungus present in the normal flora of the mouth, vagina, and intestinal tract

Dermatophytes: tinea or ringworm infections

Topical Fungal Infections


clotrimazole (Lotrimin, Mycelex-G) Lozenge for oral candidiasis (thrush) Vaginal suppository or cream for yeast infections Other forms used for other fungal infections

miconazole (Monistat) Topical cream Vaginal suppository or cream

Topical Antifungal Drugs


acyclovir (Zovirax) and penciclovir (Denavir) Both used to treat initial and recurrent herpes simplex

infections Do not cure viral skin infections, but may reduce

healing time and pain Systemic drugs have been shown to be better

for controlling viral skin conditions

Topical Antiviral Drugs


Used to reduce pain or pruritus associated with Insect bites Sunburn Poison ivy exposure

Also used to numb the skin before a painful injection

Ointments, creams, sprays, liquids, jellies EMLA: lidocaine/prilocaine combination Ela-max: lidocaine

Topical Anesthetic Drugs


Antihistamines Corticosteroids

Antiinflammatory effects Antipruritic effects Vasoconstrictor actions

Topical Antipruritic Drugs


Antipsoriatic drugs tazarotene (Tazorac) tar-containing products anthralin (Anthra-derm) calcipotriene (Dovonex) etanercept (Enbrel) alefacept (Amevive) ustekinumab (Stelara)

Other Topical Dermatologic Drugs


Topical ectoparasiticidal drugs to treat pediculosis (Phthirus pubis, Pediculus humanus corporis, Pediculus humanus capitis) and scabies (Sarcoptes scabiei) lindane (Kwell) malathion (Ovide) crotamiton (Eurax) benzyl alcohol 5% (Ulesfia) spinosad (Natroba)

Other Topical Dermatologic Drugs (cont’d)


Topical hair growth drug minoxidil (Rogaine) For men and women

Systemic hair growth drug finasteride (Propecia) Finasteride is classified as a pregnancy category X

drug Women are not to handle this drug without gloves or

crush this drug, thereby making it airborne



Sunscreens Rated by sun protection factor (SPF), which is a

number ranging from 2 to 50 (or higher) in order of increasing potency of UV protection

Only those with SPF of 15 or greater may state they reduce the risk of skin cancer and early skin aging



Topical antineoplastics fluorouracil (Efudex)

• Basal cell carcinoma

• Actinic keratosis



Immunomodulators pimecrolimus (Elidel)

• Treats atopic dermatitis

imiquimod (Aldara)• Treats actinic keratosis, basal cell carcinoma, and anogenital

warts



Vitamin C (ascorbic acid) Zinc Topical wound care drugs

Used to prepare wound bed for healing Remove nonviable tissue (débridement) Antibacterial

Wound Care Drugs


sodium hypochlorite (Dakin’s solution) cadexomer iodine (Iodosorb) collagenase (Santyl) biafine topical emulsion acetic acid (vinegar)

Wound Care Drugs (cont’d)



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



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


isopropyl alcohol (70%) povidone-iodine (Betadine) chlorhexidine (Hibiclens) benzalkonium chloride (Zephiran)

Skin Preparation Drugs


Used for wound healing Adverse effects

Diarrhea Abdominal pain Dermatitis

Drug interactions digoxin Antidysrhythmics Diuretics

Herbal Products: Aloe


Assess for presence of contraindications, especially drug allergies

Do not apply antiinfective drugs until culture and sensitivity testing (if ordered) are completed

Nursing Implications


For isotretinoin (Amnesteem) Ensure that strict guidelines are in place for monthly

pregnancy testing and prescription renewal Monitor liver function before and during therapy

Nursing Implications (cont’d)


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



Follow specific manufacturer’s guidelines for administration techniques

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



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



Protect affected area from sunlight Do not double up on dose if a dose is missed Ensure proper disposal of contaminated

dressings



Provide patient/family teaching as necessary for self-care

Monitor for therapeutic responses Monitor for adverse effects



Case Study

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.”


Case Study (cont’d)

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.”


Case Study (cont’d)

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)


Chapter 56 Dermatologic Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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