Dermatology Quiz on Keratolytics and Acne

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.