Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 56 Dermatologic Drugs

2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Skin  Largest organ of the body  Two layers  Dermis  Epidermis

3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Functions of the Skin  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

4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5 Topical Dermatologic Drugs  Antimicrobial drugs  Antibacterial drugs  Antifungal drugs  Antiviral drugs  Antiinflammatory drugs  Antineoplastic drugs  Antipruritic drugs (for itching)  Drugs for burn treatment

6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Dermatologic Drugs (cont’d)  Emollients (soften skin)  Keratolytics  Local anesthetics  Topical vasodilators  Debriding drugs (promote wound healing)  Sunscreens

7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antimicrobial Drugs  Antibacterial drugs  Antifungal drugs  Antiviral drugs

8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs  Most common bacteria are Streptococcus pyogenes and Staphylococcus aureus  Folliculitis  Impetigo  Furuncles  Carbuncles  Cellulitis  Others

9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d)  Most common drugs  bacitracin  neomycin  polymyxin B  Neosporin: neomycin + polymyxin B

10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d)  mupirocin (Bactroban)  New; by prescription only  Used topically for Staph and Strep impetigo  Intranasal form for MRSA

11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d)  silver sulfadiazine (Silvadene)  Topical antiinfective  Used to prevent or treat infection at the site of second- and third-degree burns

12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antibacterial Drugs (cont’d)  silver sulfadiazine (cont’d)  Cannot be used if allergic to sulfa drugs  1% Topical cream  Apply to cleansed, debrided, burned areas with sterile gloves

13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antiacne Drugs  Acne is caused by Propionibacterium acnes  Drugs used to treat acne  benzoyl peroxide  erythromycin  tetracycline  isotretinoin (Accutane)  clindamycin (Cleocin-T)  tretinoin (Renova-Retin A)

14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antiacne Drugs (cont’d)  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  Produces improvement in 4 to 6 weeks

15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antiacne Drugs (cont’d)  benzoyl peroxide (cont’d)  May cause peeling skin, redness, or sensation of warmth  Available in many formulations

16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antiacne Drugs (cont’d)  clindamycin (Cleocin T)  Antibiotic  Used topically to treat acne  May cause skin reactions

17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antiacne Drugs (cont’d)  isotretinoin (Accutane)  Oral  Inhibits sebaceous gland activity  Pregnancy category X

18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antiacne Drugs (cont’d)  isotretinoin (Accutane) (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

19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Antiacne Drugs (cont’d)  tretinoin (retinoic acid, vitamin A acid)  Used to treat acne  Also used to reduce dermatologic changes associated with sun damage  Stimulates the turnover of epithelial cells, resulting in skin peeling  May result in severe irritation and skin peeling

20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Fungal Infections  Difficult to eradicate  Therapy may be prolonged  Several weeks to 1 year  Topical fungal infections caused by  Candida spp. (candidiasis)  Dermatophytes (tinea)

21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antifungal Drugs  clotrimazole (Lotrimin)  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

22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antiviral 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

23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Anesthetic 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

24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antipruritic Drugs  Antihistamines  Corticosteroids  Antiinflammatory effects  Antipruritic effects  Vasoconstrictor actions

25 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs  Antipsoriatic drugs  tazarotene (Tazorac)  tar-containing products  anthralin (Anthra-derm)  calcipotriene (Dovonex)

26 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs (cont’d)  Topical ectoparasiticidal drugs to treat pediculosis (three forms) and scabies  lindane (Kwell)  malathion (Ovide)  crotamiton (Eurax)

27 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs (cont’d)  Topical hair growth drug  minoxidil (Rogaine)  For men and women  Systemic hair growth drug  finasteride (Propecia)  Topical antineoplastic drug  fluorouracil (Efudex)

28 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Topical Dermatologic Drugs (cont’d)  Immunomodulators  pimecrolimus (Elidel) Treats atopic dermatitis Treats atopic dermatitis  imiquimod (Aldara) Treats actinic keratosis, basal cell carcinoma, and anogenital warts Treats actinic keratosis, basal cell carcinoma, and anogenital warts  Sunscreens

29 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Wound Care Drugs  Topical wound care drugs  Used to prepare wound bed for healing  Remove nonviable tissue  Antibacterial

30 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Wound Care Drugs (cont’d)  sodium hypochlorite (Dakin’s solution)  cadexomer iodine (Iodosorb)  collagenase (Santyl)  Topical emulsion (Biafine)

31 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Skin Preparation Drugs  isopropyl alcohol  povidone iodine (Betadine)  chlorhexidine (Hibiclens)  benzalkonium chloride (Zephiran)

32 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Herbal Products: Aloe  Used for wound healing  Adverse effects  Diarrhea  Abdominal pain  Dermatitis  Drug interactions  digoxin  Antidysrhythmics  Diuretics

33 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Assess for presence of contraindications, especially drug allergies  Do not apply antiinfective drugs until culture and sensitivity testing (if ordered) are completed

34 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  For isotretinoin (Accutane)  Ensure that strict guidelines are in place for monthly pregnancy testing and prescription renewal  Monitor liver function before and during therapy

35 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

36 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Follow specific manufacturer’s guidelines for administration techniques  Cleanse the area thoroughly to remove debris and residual medication; follow specific recommendations

37 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Wear gloves when applying topical drugs  Apply dressings (e.g., wet, wet-to-dry, occlusive) as ordered

38 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Document  Site of application  Drainage (color, amount)  Swelling, temperature  Odor, color, pain, or other sensations  Type of treatment given  Patient’s response

39 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Protect affected area from sunlight  Do not double up on dose if a dose is missed  Ensure proper disposal of contaminated dressings

40 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Provide patient/family teaching as necessary for self-care  Monitor for therapeutic responses  Monitor for adverse effects