Pharm 3: skin – Flashcards
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types of topical drugs
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ointment cream
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best method of delivery
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ointment
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most common cause of contact dermatitis in older patients
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topical drugs
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topical dermatological drugs
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antimicrobials antiinflammatory antineoplastic antipruritic (itching) burn drugs emollients (soften) keratolytics (softening/peeling of stratum corneum) local anesthetics topical vasodilators debriding drugs (wound healing) sunscreens
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most common bacteria
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Strep pyogenes Staph aureus
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most common skin bacterial infections
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folliculitis impetigo furuncles carbuncles cellulitis pustules vesicles papules
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most common antibacterial drugs
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bacitracin noemycin & polymyxin B (neosporin) mupirocin (Bactroban) silver sulfadiazine (silvadene) fluroroquinolones
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what is neomycin & polymycin
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neosporin topical antiseptic for minor skin wounds
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Mupirocin (Bactroban)
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treatment of staph/strep impetigo treats nasal MRSA -MRSA becoming resistant
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Silver sulfadiazine
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BURN PATIENTS-->prevents infections
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nursing implications for silver sulfadiazine
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apply thin layer w/ sterile, gloved hand
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contras for silver sulfadiazine
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Sulfa drug allergy
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adverse effects of silver sulfadiazine
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pain burning itching
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skin antibiotics safest for preggos
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amoxicillin + clavulanate = augmentin
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fluoroquinolones
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MOST SERIOUS SKIN INFECTIONS numerous adverse reactions
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anti-acne drugs
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Benzoyl peroxide Clindamycin Isotretinoin Tretinoin (retin-A= Vit A acid)
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acne is caused by...
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Propionibacterium acnes
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Drugs used for treatment/prevention of acne
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antibiotics: minocycline, doxycline, tetracycline oral contraceptives
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benzoyl peroxide contra
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pregnancy cat C
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benzoyl peroxide indications
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anti-bact anti-septic anti-acne drying keratolytic (loosens outerlayer of skin)
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benzoyl peroxide MOA
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causes death to P. acne by slowly releasing O2
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benzoyl peroxide adverse effects
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peeling skin redness warm sensation
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benzoyol peroxide time to improvement
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4-6 wk
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least likely antibiotic to cause acne breakout
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topical clindamycin
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topical clindamycin adverse effects
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minor skin reactions: burning itching dry oily peeling
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Isotretinoin contras
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PREGGO CAT X!!! -signed form of 2 different contraceptions
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isotretinoin uses
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severe cystic acne
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Tretinoin (Retin-A) uses
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(vitamin A acid) used to treat acne reduce changes associated w/ sun damage
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tretinoin MOA
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-stimulates turnover of epithelial cells, resulting in skin peeling -INC fibroblasts/collagen to reduce skin damage appearance
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Tretinoin adverse effects
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excessive redness edematous blisters crusted skin temporary alterations in SKIN PIGMENTATION skin peeling PHOTOSENSITIVITY
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issues with antifungals
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oral: cause liver damage non-adherence (difficult to eradicate fungi)
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antifungal therapy
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prolonged -several wks - 1 yr
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nursing implications for antifungals
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take baseline liver function & ck every 6-8 wks
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topical fungal infections caused by
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Candida albicans (yeast) Dermatophytes (tinea/ringworm)
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Tinea unguium (onychomycosis) Tx
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systemic antifungals, NOT topical
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Clotrimazole use
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anti-fungal for candidiasis oral: lozenge vaginal: suppository/cream other forms also
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Miconazole (monistat) use
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anti-fungal Topical vaginal suppository/cream
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Tx w/ clotrimazole & miconazole
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therapy discontinued 1-2 wk after lesions clear
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what is NOT recommended for tinea versicolor
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SELSUN BLUE
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prophylactic treatment of fungal infections:
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antifungal powders/sprays (athletes foot powder)
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tinea capitis
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scalp
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tinea pedis
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foot
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tinea cruris
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jock itch
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tinea corporis
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body
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tinea unguium
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nails
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Topical antiviral drugs
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acyclovir penciclovir -not cure, treats symptoms/reduces healing time
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Used to treat initial/recurrent herpes simplex 1 & 2 & HPV
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topical antivirals: acyclovir & penciclovir
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Acyclovir indications
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dramatically DEC post-neuralgia length in herpes ZOSTER patients (60+ days to 20 days)
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topical antiviral drugs nursing implications
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finger clot/rubber glove worn when applying the ointment -to keep infection from spreading
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ointment vs cream
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cream: > H2O/dries up quickly ointment: > medicine/stays longer
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shown to be better for controlling viral skin conditions
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systemic drugs over topical
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topical anasthetic drugs uses
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reduce pain/pruritis associated w/: -insect bites -sunburn -poison ivy also, numb skin before painful injection
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most frequently used topical anasthetics
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Lidocaine [Ela-max] lidocaine combo [EMLA] (mostly w/ peds)
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topical antipruirutics/antiinflammatory
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anti-histamines (anti-inflamm) or corticosteroids -itch and inflammation
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most common antipruirutic/antiinflammatory
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corticosteroids b/c effective w/o harmful systemic effects
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topical corticosteroids classifications
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according to potency
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if topical corticosteroids ineffective,
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systemic corticosteroids used
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topical corticosteroids nursing implications
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apply after bathing (enhances absorption) occlusive dressing INC absorption
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topical corticosteroid implications
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anti-inflammatory antipruritic antipsoriatic vasoconstrictor
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adverse effects topical corticosteroids
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-ACNE, ATROPHY, allergic contact derm, burning, dryness -opportunistic growth b/c immunosuppressant
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contras for topical corticosteroids
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pt taking another corticosteroid (INC toxicity)
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antipsoriatic uses
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psoriasis
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what is psoriasis
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thick, reddened skin w/ silvery scales -result of disordered immune system
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antipsoriatic drugs
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Teratozine (cat X) tar-containing products Anthralin Calcipotriene corticosteroids emollients
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what is Teratozine
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antipsoriatic drug PREGGO CATEGORY X !!! -requires neg preg test 2 wk before starting
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among first things used to treat psoriasis
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tar-containing products
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tar-containing products indications
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antiseptic antibacterial antiseborrheic antipsoriatic
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what are Ectoparasiticals
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topical drugs to treat parasites on skin (pediculosis, & scabies)
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what is pediculosis
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lice
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pediculosis pubis vs corporis vs capitis
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pubis: pibic "crabs" corporis: body capitis: head -treat w/ pediculocides
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what do you treat scabies w/
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scabicides -caused by Sarcoptes scabiei
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what is Lindane
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Ectoparasitical drug (cream, lotion, shampoo) treats both scabies and pediculosis
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hair growth drugs
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minoxidil (Rogaine)
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Minoxidil
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Rogaine-hair growth -vasodilates to stimulate growth -4 mo to see effects -if systemic absoprtion occurs: tachycardia, fluid retention (wt. gain)
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Preg category X hair growth drug
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systemic: finasteride (Propecia) -women DONT handle drug w/o gloves & DONT crush b/c will become airborne
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Topical antineoplastics
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fluorouracil (Efudex) -treats premalignant & some basal cell carcinomas
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Immunomodulators
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1. Pimecrolimus: atopic dermatitis 2. Imiquimod: actinic keratosis, basal cell carcinoma, anogential warts
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Wound care drugs
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Acetic Acid VIT C (ascorbic acid)!! Sodium hypochlorite Cadexomer iodine collagenase biafine topical emulsion aloe (herbal)
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Aloe adverse effects
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diarrhea abd pain dermatitis
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aloe drug interactions
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digoxin antisdysrhythmics diuretics
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low cost wound care drug
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acetic acid
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sodium hypochlorite (Dakin's solution) uses
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aids in debridement reduces microbe count
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cadexomer iodine (Iodosorb) uses
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Slow release safe for viable cells absorbs exudates promotes wound healing
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Collagnase (Santyl) uses
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good for pt taking anticoag pt that cannot have surgery REMOVES NECROTIC TISSUE
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Biafine topical emulsion uses
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"TUNNELING" wounds as well as full thickness wounds & dermatitis
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Skin prep drugs
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isopropyl alcohol Povidone-iodine (Betadine) Chlorhexidine (Hibiclens) Benzalkonium chloride (Zephiran)
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skin prep drug that lowers bact count for 20-40 min after application
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isopropyl alcohol
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Povidone-iodine uses
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(Betadine) kills bact/fungi/viruses prevention/Tx of topical infections MOST WIDELY USED ANTISEPTIC
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povidone-iodine contras/nursing implicaitons
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Iodine allergies shellfish allergies
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most widely used antiseptic
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povidone-iodine (Betadine)
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skin drug that may cause CNS toxicity in neonates/burn patients
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Chlorhexidine (Hibiclens)
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Chlorhexidine (Hibiclens) use
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surgical scrub/hand washing agent skin prep drug
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benzalkonium chloride (zephiran) MOA
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skin prep drug -denatures microbes
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nursing implications of benzalkonium chloride
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DONT leave on skin too long CHEMICAL BURN
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category X skin drugs
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isotretinoin (Amnesteem/Accutane) Teratozine finasteride (Propecia) benzoyl peroxide (just Cat C)
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Skin drugs nursing implications
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1. DONT apply antiinfectives until culture/sensitivity completed (if ordered) 2. Monthly preggo testing for preggo categories 3. Monitor liver function (antifungals) 4. Systemic absorption higher in very young/old 5. Cleanse thoroughly 6. Wear gloves 7. Document 8. Protect from sunlight 9. DONT double dose if missed dose 10. Monitor TI & adverse effects
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emollients
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moisturizer usually aquaphor
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Which is NOT indicated for treatment of Psoriasis? A. Coal Tar B. Emollients C. Corticosteroids D. Benzoyl Peroxide
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D. Benzoyl peroxide
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which drug is LEAST likely to cause acne like breakout? A. Phenytoin B. Lithium C. Clindamycin D. Corticosteroids
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C. Clindamycin
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What is pulse dosing? A. Drug on/drug off schedules B. Drug schedules based on heart rate C. Drug dosage based on heart rate D. Incremental tapering off with decreases in dosage over time
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A. Drug on/drug off schedules
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Which antibiotic should be reserved for the most serious skin infections? A. Macrolides B. Mupirocin C. Fluoroquinolones D. Corticosteroids
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C. Fluoroquinolones
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What is a common reason for nonadherence to antifungal drug regimens? A. Prolonged treatment B. Complex schedules C. Secondary bacterial infections D. Pruritus becomes pleasurable
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A. Prolonged treatment
