Dermatology Quiz on Keratolytics and Acne

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Questions and Answers

Which areas should keratolytics be avoided on?

Open wounds (correct)

Healthy skin

Skin with minor abrasions

Mildly irritated skin

What boxed warning is associated with acitretin?

Cardiovascular risks

Risk of photosensitivity

Teratogenic effects

Hepatotoxicity (correct)

Which is NOT a known factor contributing to acne formation?

Bacterial overgrowth

Keratin plugs

Dehydration (correct)

Increased sebum production

In which form can mild acne present?

Comedones Signup and view all the answers

What is a recommended nursing consideration when prescribing a keratolytic?

Provide client teaching about correct use Signup and view all the answers

What skin condition usually includes pustules?

Moderate acne Signup and view all the answers

Which skin area is considered sensitive and should be avoided when using keratolytics?

Near the eyes Signup and view all the answers

Which problem should be assessed when evaluating affected skin?

Presence of drainage Signup and view all the answers

What is a common withdrawal symptom that may occur if chlorzoxazone is discontinued abruptly?

Dry mouth Signup and view all the answers

What color does the urine become due to the metabolite of chlorzoxazone?

Orange or purplish-red Signup and view all the answers

Why is dantrolene contraindicated in clients with hepatic disease?

It has a boxed warning for severe hepatotoxicity Signup and view all the answers

Which skeletal muscle relaxant should be used with caution in patients with severe hepatic disease?

Tizanidine Signup and view all the answers

What should clients be taught to monitor for when taking skeletal muscle relaxants?

Symptomatic liver damage Signup and view all the answers

Which medication delivery system allows baclofen to be administered directly into the intrathecal space?

Implanted pump Signup and view all the answers

What is a potential risk when caring for a client with an intrathecal baclofen pump?

Infection at the insertion site Signup and view all the answers

Why should skeletal muscle relaxants generally be avoided during pregnancy?

They can cross the placenta Signup and view all the answers

What condition must be carefully monitored when using levetiracetam?

Hepatitis Signup and view all the answers

What is a key precaution when prescribing gabapentin?

Use with caution in clients experiencing suicidal thoughts. Signup and view all the answers

Which demographic groups require caution when using levetiracetam?

Pregnant clients and children under 3 years Signup and view all the answers

What is the mechanism by which vigabatrin operates?

Inhibits the reuptake of GABA Signup and view all the answers

Which side effect is NOT associated with levetiracetam?

Osteoporosis Signup and view all the answers

What is the primary purpose of reviewing diagnostic tests before prescribing antiepileptic medication?

To determine the type and frequency of seizures Signup and view all the answers

Which of the following should be monitored in clients prescribed phenytoin?

Recent diagnostic tests like ECG Signup and view all the answers

What condition is NOT advised against when using antiepileptic medications such as levetiracetam?

Asthma Signup and view all the answers

What is the primary mechanism by which erythromycin works to treat acne?

Limits bacterial growth and reduces inflammation Signup and view all the answers

Which of the following oral antibiotics is commonly used to treat acne?

Doxycycline Signup and view all the answers

What additional effect does isotretinoin have beyond limiting bacterial growth?

Decreases sebum formation and secretion Signup and view all the answers

How do oral contraceptives help in treating acne?

Decrease androgen levels, reducing sebum production Signup and view all the answers

What common side effect can topical medications for acne cause?

Photosensitivity Signup and view all the answers

What gastrointestinal disturbances can systemic medications for acne potentially cause?

Nausea, vomiting, and diarrhea Signup and view all the answers

What advice should be given to clients about washing their skin during acne treatment?

Wash gently twice a day with a mild cleanser Signup and view all the answers

Which is a common interaction to consider while treating acne with systemic medications?

Vitamin A supplements and alcohol Signup and view all the answers

Which of the following statements about antiepileptic medications is true?

Antiepileptics should be taken according to the prescribed schedule. Signup and view all the answers

What should be monitored regularly during the treatment with antiepileptics?

Mental status, mood, and behavior Signup and view all the answers

What is a potential side effect of combining antiepileptic medications with CNS depressants?

Increased risk of CNS depression Signup and view all the answers

Which class of antiepileptics works by blocking voltage-gated sodium channels?

Sodium channel blockers Signup and view all the answers

What symptom may indicate liver dysfunction in clients taking antiepileptic medications?

Anorexia, nausea, and vomiting Signup and view all the answers

Why is it important to confirm a negative pregnancy test before starting antiepileptic therapy in women of child-bearing age?

To mitigate potential risks to fetal development Signup and view all the answers

Which of the following changes might indicate an increased risk of suicidal behavior in clients on antiepileptic medications?

Increased agitation and anxiety Signup and view all the answers

What effect do GABA inhibitors have in the management of seizures?

They increase GABA availability in the synaptic cleft. Signup and view all the answers

What is the primary function of acetylcholinesterase inhibitors in the treatment of Alzheimer's disease?

To prevent the breakdown of acetylcholine Signup and view all the answers

Which of the following side effects is commonly associated with NMDA receptor antagonists?

Drowsiness Signup and view all the answers

Which medication form is available for rivastigmine?

Topical patch Signup and view all the answers

In patients with severe hepatic impairment, which of the following should be considered before administering NMDA receptor antagonists?

They are contraindicated and should not be used Signup and view all the answers

Which of the following is an important baseline assessment before administering either an acetylcholinesterase inhibitor or an NMDA receptor antagonist?

Measuring weight and vital signs Signup and view all the answers

What can increased levels of acetylcholine cause in patients taking acetylcholinesterase inhibitors?

Cholinergic side effects such as miosis Signup and view all the answers

What is a critical aspect of patient education regarding the administration of acetylcholinesterase inhibitors?

Patients should understand how the medication helps slow disease progression Signup and view all the answers

Which of the following is a precaution for using NMDA receptor antagonists?

Care should be taken in patients with epilepsy Signup and view all the answers

Study Notes

ANTIBIOTICS - TOPICAL: NURSING PHARMACOLOGY

Topical antibiotics treat skin infections in damaged areas like burns, wounds, cuts, and surgical incisions.
Common topical antibiotics include bacitracin-polymyxin B, mafenide acetate, and silver sulfadiazine.
These are non-prescription ointments applied topically.
They prevent infection by inhibiting bacterial growth.
Side effects of bacitracin-polymyxin B are usually mild skin irritation or urticaria.
Mafenide may cause mild skin irritation, burning sensation, and metabolic acidosis.
Severe side effects of mafenide include hypersensitivity reactions, facial swelling and potentially fatal hemolytic anemia in clients with G6PD deficiency.
Silver sulfadiazine can cause temporary black skin discoloration, burning, rash, and skin necrosis.
Systemic absorption of silver sulfadiazine can lead to severe hypersensitivity reactions like Stevens-Johnson syndrome and toxic epidermal necrolysis.
Topical antibiotics should be used with caution during pregnancy, breastfeeding, and in clients with skin conditions like eczema or viral infections (e.g., herpes, shingles).
Prolonged use may lead to bacterial or fungal superinfection.
Assess the affected area for drainage, odor, redness, warmth, swelling, or pain before applying topical antibiotics.
Ensure approximated edges on surgical incisions before applying topical antibiotics.
Topical application to the skin only, avoid mucous membranes.
Instruct clients to cleanse the area with mild soap and water, then pat dry.
Advise clients to wash hands before and after application.
Instruct on proper medication use and to monitor for signs of infection and adverse effects.
Monitor therapeutic effects (resolution of skin infection)

KERATOLYTICS: NURSING PHARMACOLOGY

Keratolytics treat skin conditions causing rough or scaly skin (acne, seborrheic keratosis, warts, dandruff, psoriasis, eczema).
Common keratolytics include salicylic acid, pyrithione zinc, coal tar, retinoids (tretinoin, acitretin), and alpha-hydroxy acids (glycolic, lactic acid).
They soften and shed the stratum corneum, decreasing skin thickness and improving moisture.
Common side effects include skin irritation, erythema, burning, and photosensitivity, especially with retinoids.
Retinoids and alpha-hydroxy acids increase sun sensitivity; avoid direct sunlight.
Contraindicated on open wounds, burns, cuts, irritated skin or sores.
Avoid use near eyes and mouth.
Acitretin has a boxed warning for hepatotoxicity; retinoids contraindicated during pregnancy.
Assess the condition and location of affected skin before use.
Emphasize correct topical application.
Advise clients to avoid sunlight and use sunscreen.

ANTIFUNGALS - TOPICAL: NURSING PHARMACOLOGY

Topical antifungals treat infections on skin, hair, or nails.
Common antifungals include nystatin, tavaborole, ciclopirox, and azoles (e.g., ketoconazole, miconazole).
They disrupt or damage fungal cell walls, halting growth/killing fungi.
Potential Side Effects: skin rash, itching, and burning.
Instruct clients to clean the area with mild soap and water.
Apply a thin layer of cream.
Topical application only; avoid eyes/mucous membranes.
Monitor for increased or worsening symptoms or signs of infection and report to provider.
Evaluate therapeutic effects (resolution of infection)

TOPICAL CORTICOSTEROIDS: NURSING PHARMACOLOGY

Topical corticosteroids treat inflammatory skin conditions (psoriasis, eczema, lichen sclerosus, bullous pemphigoid, pemphigus foliaceus, urticaria).
Classified by potency (low, intermediate, high).
Available as ointments, creams, gels, or lotions.
Reduce inflammation by acting on glucocorticoid receptors.
Side effects include itching, skin irritation, impaired wound healing, skin atrophy, stretch marks, and easy bruising, plus facial dermatoses (acne, rosacea, perioral dermatitis).
Prolonged use increases risk of skin infections.
Avoid application on open wounds, cuts or rashes
Use clean technique.
Monitor for signs of infection or adverse reactions.
Stress the importance of reporting side effects, especially systemic ones (weight gain, mood changes) to the provider.
Monitor for therapeutic improvement.

DEBRIDEMENT AGENTS: NURSING PHARMACOLOGY

Debridement agents remove dead tissue from wounds to aid healing and reduce infection.
Examples include collagenase and a combination treatment (trypsin, balsam peru, castor oil).
Collagenase breaks down collagen in non-viable tissue.
Side effects include skin irritation, which manifests as burning, pain, redness.
Emphasize wound care.
Assess client's health conditions (impaired mobility, circulation, nutrition, diabetes).
Evaluate the extent and severity of necrotic tissue and signs of infection (redness, swelling, drainage).
Monitor for therapeutic effects, including cleared necrotic tissue.

ANALGESICS: NURSING PHARMACOLOGY

Analgesics relieve pain.
Classified as non-opioid (e.g., NSAIDs, acetaminophen) or opioid (e.g., morphine, codeine).
Non-opioids target COX enzymes, reducing inflammation and pain.
Opioids bind to opioid receptors, increasing pain tolerance.
Side effects include gastrointestinal issues, respiratory depression, and sedation with opioids.
Monitor vital signs, especially respiratory rate (opioids), for adverse effects.
Assess client’s pain intensity, location, duration, quality, and type.
Encourage non-pharmacological pain management techniques.
Provide client education on medication and side effects to report.

SKELETAL MUSCLE RELAXANTS: NURSING PHARMACOLOGY

Skeletal muscle relaxants reduce muscle spasms and spasticity.
Centrally-acting relaxants (e.g., cyclobenzaprine, methocarbamol, baclofen) affect CNS neurons.
Direct-acting relaxants (e.g., dantrolene) prevent calcium release in muscle cells.
Common side effects: CNS depression (drowsiness, dizziness, headaches, weakness), gastrointestinal effects (anorexia, nausea, vomiting, constipation).
Monitor for extrapyramidal symptoms (dystonia, akathisia, pseudoparkinsonism); report immediately.
Advise clients to avoid activities requiring alertness while taking the medication.
Educate clients on safe handling and administration.

ANTIEPILEPTICS: NURSING PHARMACOLOGY

Antiepileptics treat various seizures.
Groups: sodium channel blockers (phenytoin, carbamazepine, valproic acid, lamotrigine), calcium channel blockers (ethosuximide, levetiracetam), GABA inhibitors (vigabatrin), and GABA analogues (gabapentin).
Side effects vary by medication (e.g., GI issues, blood disorders, skin rashes, suicidal thoughts).
Monitor for adverse effects, especially in those with liver/kidney problems.
Teach clients on correct medication use and importance of regular follow-up.
Alert about potential toxicity and interactions with other medications.

ANTIDEPRESSANTS (SSRIs & SNRIs): NURSING PHARMACOLOGY

SSRIs (e.g., fluoxetine, sertraline) and SNRIs (e.g., duloxetine, venlafaxine) treat depression and anxiety by increasing serotonin and/or norepinephrine levels.
Side effects include GI issues, anxiety, insomnia, drowsiness, sexual dysfunction, and increased suicidal thoughts, especially in adolescents/young adults; monitor closely.
Contraindicated in those on MAOIs and with other conditions (pregnancy, renal/hepatic disease, glaucoma, QT-prolonging heart conditions.).
Monitor for suicidal ideation, baseline vital signs and weight, and emphasize importance on consistent medication use for therapeutic effectiveness. Provide client and family support.

ACETYLCHOLINESTERASE INHIBITORS: NURSING PHARMACOLOGY

Acetylcholinesterase inhibitors increase acetylcholine in the synapses of the neuromuscular junction, thus improving muscle strength for clients with myasthenia gravis.
Common side effects: cholinergic crisis (miosis, nausea, diarrhea, bronchospasm, urinary urgency).
Importance of monitoring for and reporting adverse effects.
Importance of consistent medication schedule and administration times.

ANTIPSYCHOTICS: NURSING PHARMACOLOGY

Antipsychotics treat psychotic disorders (e.g., schizophrenia) by targeting dopamine D2 receptors.
Side effects are significant, including extrapyramidal symptoms (dystonia, akathisia, parkinsonism, tardive dyskinesia).
Clozapine carries a risk of serious blood disorders
Monitor for adverse effects, including weight gain and metabolic changes.
Emphasize the importance of avoiding alcohol and CNS depressants.

MOOD STABILIZERS: NURSING PHARMACOLOGY

Mood stabilizers (e.g., lithium, valproic acid, carbamazepine) treat bipolar disorder by regulating mood swings.
Lithium carries a serious risk of toxicity; monitor blood levels closely.
Contraindications include dehydration, renal impairment, some medications that may decrease its excretion, thyroid disease, pregnancy, and clients younger than 12.
Emphasize importance of consistent medication use, hydration, and sodium intake to prevent toxicity.
Monitor for suicidal ideation consistently.

STIMULANT MEDICATIONS FOR ADHD

CNS stimulants (e.g., amphetamine, dextroamphetamine, methylphenidate) treat ADHD by increasing norepinephrine and dopamine levels.
Side effects include high potential for abuse and dependence, hyperactivity, insomnia, anorexia, weight loss, tachycardia, palpitations, hypertension, and rare cases of seizures.
Contraindicated in clients with cardiovascular disease and some psychiatric conditions.
Monitor for close for side effects and medication adherence in children; teach caretakers to manage potential side effects, nutritional needs and other symptoms like changes in behavior/ mood .

ANALGESICS FOR OBSTETRICS

Analgesics are used to control pain during labor and delivery, and postpartum.
Opioids and regional anesthetics (e.g., epidural), and non-opioids like acetaminophen are common options.
Avoid NSAIDs during pregnancy to prevent fetal harm.
Careful administration to prevent complications, especially for epidural administration.
Monitor client and fetus for adverse effects.

ERGOT ALKALOIDS

Ergot alkaloids (e.g., methylergonovine) are used postpartum to prevent or treat excessive bleeding.
Side effects include nausea, vomiting, abdominal pain, uterine hyperstimulation, and cardiovascular effects like hypertension/hypotension, or ergotism (gangrene/ seizures).
Contraindicated in clients with bleeding disorders, hypertension, pregnancy, previous uterine surgery.
Monitor for signs of toxicity (e.g., nausea/vomiting, abnormal bleeding patterns, tingling in the extremities.).

OXYTOCIN

Oxytocin is used to induce labor and for postpartum management of bleeding.
Side effects include uterine hyperstimulation, nausea ,vomiting, hypertension, fluid retention, cardiac arrhythmia, and fetal distress.
Monitor vital signs, intake/output (especially in individuals with fluid overload risks), uterine contractions and FHR continuously.

PROSTAGLANDINS

Prostaglandins (e.g., dinoprostone, misoprostol) are used for cervical ripening and induction of labor.
Common side effects: uterine hyperstimulation, nausea, vomiting, diarrhea, and diaphoresis .
Contraindicated with clients who have previous uterine surgeries, a history of pelvic infections, active infection or sepsis, and clients diagnosed with grand multiparity, meaning they've given birth 5 or more times.

TOCOLYTICS

Tocolytics (e.g., magnesium sulfate, nifedipine, beta-agonists, NSAIDs) stop uterine contractions.
Side effects include nausea, flushing, headache, neurological symptoms, tachycardia, palpitations, hypotension, potential for fetal complications, and potential for increased risk of maternal complications.
These drugs must be monitored frequently, and client teaching on signs to report to their provider is an important aspect of care.

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Description

Test your knowledge on keratolytics, their use, and associated risks in dermatology. This quiz covers various aspects of acne formation and nursing considerations when prescribing these treatments. Delve into the specifics of skin conditions and their presentations.