Drugs for the Integumentary System PDF

**Acyclovir (Zovirax); Valacyclovir (Valtrex)\ ** 1. Use: Herpesvirus (Herpes simplex and herpes zoster) a. Herpes simplex virus (HSV) causes cold sores and genital herpes. It is one of the most common skin infections. b. Type 1 (HSV-1) is the most common. It causes cold sores...

**Acyclovir (Zovirax); Valacyclovir (Valtrex)\ ** 1. Use: Herpesvirus (Herpes simplex and herpes zoster) a. Herpes simplex virus (HSV) causes cold sores and genital herpes. It is one of the most common skin infections. b. Type 1 (HSV-1) is the most common. It causes cold sores (fever blisters) c. Type 2 (HSV-2) causes lesions in the genital area (genital herpes) d. This medication is not a cure, but shortens outbreak and lessens severity 2. Nursing Administration and Considerations: e. May be administered orally, topically, or IV. f. Oral 1. Most common form g. Topical 2. Ointment has shown no clinical benefit in treating recurrent lesions or relieving pain 3. Use gloves to apply 4. Cover lesion completely h. Intravenous 5. Reserved for severe or life-threatening infections involving CNS 6. Ensure adequate hydration to prevent crystallization in kidneys 7. Administer IV dose for at least 1 hour 3. Course of Treatment: i. Ideally administered within 72 hours of symptom onset j. Initial outbreak treated for 7-10 days k. Subsequent outbreaks treated for 5 days 8. Acyclovir may be administered for up to 5 years a. Assess for recurrent breakouts after 1 year l. Valacyclovir may be used as daily suppressive therapy 4. Side Effects: m. Systemic 9. Headache 10. Nausea and vomiting 11. Diarrhea 12. Seizures 13. Renal toxicity and phlebitis (IV administration) n. Topical 14. Burning 15. Rash 16. Pruritus 17. Stinging A. Precautions for delivery must be made in the event of becoming pregnant a. If a patient's skin is dry, emollients may help. b. **Alpha Keri; Curel; Eucerin; Lubriderm\ ** 1. Use: Moisturizing agent that soothes or softens the skin 2. Nursing Administration and Considerations: a. Topical 1. For external use only 2. Use caution when using in tub to avoid slipping 3. Course of Treatment: b. Dependent upon condition 4. Side Effects: 5. a. Diphenhydramine (Benadryl); Hydroxyzine (Vistaril) 1. Use: Urticaria; Angioedema; Contact dermatitis; Pityriasis rosea a. Blocks histamine at H~1~ receptor sites to inhibit allergic reaction b. Antipruritic 2. Nursing Administration and Considerations: c. If drowsiness occurs, advise patient to avoid activities that require concentration d. Avoid use with alcohol or other CNS depressants e. May also need epinephrine administration in severe allergic reactions 3. Course of Treatment: f. Dependent upon condition 4. Side Effects: g. Drowsiness h. Dizziness i. Confusion j. Dry mouth k. Urinary retention a. Benzoyl peroxide 1. Use: Acne vulgaris a. Antimicrobial b. Reduces inflammation c. Dries skin lesions 2. Nursing Administration and Considerations: d. Topical (Washes, soaps, and spot treatment) 1. Discontinue use if excessive drying or peeling occurs 2. Avoid contact with hair or fabric 3. Course of Treatment: e. Dependent upon condition and response to treatment f. May need to use multiple times per day for several weeks to see improvement 4. Side Effects: g. Excessive drying of skin h. Allergic reactions b. Isotretinoin (Accutane) 5. Use: Acne vulgaris i. Reduces sebum production and abnormal keratinization of gland ducts 6. Nursing Administration and Considerations: j. Oral 3. Absolutely contraindicated in pregnant women or those contemplating pregnancy as the medication has a destructive effect on fetal development a. Women of childbearing age must practice contraception one month before therapy, during therapy, and one month after therapy 4. Administer with meals 5. Do not take supplements containing vitamin A 6. Avoid exposure to sunlight 7. Watch for behavior changes 8. Monitor for hepatoxicity 7. Course of Treatment: k. Dependent upon condition and response to treatment 8. Side Effects: l. Teratogenic m. Depression n. Severe drying of the skin, mouth, eyes, mucous membranes, nose, and nails o. Fragile skin p. Epistaxis q. Joint and muscle pain r. Nausea s. Abdominal pain t. Hepatotoxicity u. May develop eczema c. Salicylic acid 9. Use: Acne vulgaris; Psoriasis; Verruca (wart) removal v. Reduces inflammation w. Keratolytic 10. Nursing Administration and Considerations: x. Topical 9. For external use only 10. May damage clothing, plastic, wood, and other materials on contact 11. Course of Treatment: y. Dependent upon condition and response to treatment 12. Side Effects: z. Topical 11. Local irritation 12. Erythema 13. Scaling d. Retinoids (Tretinoin, adapalene, tazarotene, acitretin) 13. Use: Acne vulgaris; Psoriasis a. Reduces inflammation 14. Nursing Administration and Considerations: b. Topical 14. Do not combine with over the counter (OTC) washes and medications c. Systemic 15. Course of Treatment: d. Dependent upon condition and response to treatment 16. Side Effects: e. Topical 15. Redness 16. Burning 17. Sensitivity to sunlight e. Hormone therapy (Combination contraceptives containing estrogen and progestin) 17. Use: Acne vulgaris f. Reduces sebum production f. Antibiotics 18. Use: Acne vulgaris g. Reduces bacterial counts a. **Antibiotics (Type dependent upon condition and bacteria)\ ** 1. Use: Reduce bacterial counts a. Acne vulgaris 1. Erythromycin, clindamycin, tetracycline b. Cellulitis 2. Penicillin, cephalexin, erythromycin c. Impetigo contagiosa 3. Erythromycin, dicloxacillin, penicillin, cephalosporin, beta-lactam(ase) inhibitor 4. Mupirocin (Bactroban) for topical use 5. Retapamulin (Altabax) approved for topical treatment of methicillin-susceptible *Staphylococcus aureus* and *Streptococcus pyogenes* in those over 9 months old d. Systemic lupus erythematosus (SLE) prophylaxis 6. **NOTE**: Other medications used for SLE include... a. Antimalarials (Control discoid, skin lesions, and rheumatic manifestations) 1. Hydroxychloroquine (Plaquenil) 2. Chloroquine b. Antineoplastics (Achieve remission or control signs and symptoms) 3. Azathioprine (Imuran) 4. Chlorambucil (Leukeran) c. Analgesics d. Diuretics e. Folliculitis, furuncles, carbuncles, and felons f. Paronychia g. Bacterial infections 2. Nursing Administration and Considerations: h. Topical 7. Antiseptic soap and cleansing agents should be used to thoroughly clean the area and removed crusted exudate prior to topical antibiotic application 8. Topical antibiotics are applied using sterile technique i. Oral 9. Reduces effectiveness of oral contraceptives 10. Teach the patient the importance of taking the entire antibiotic regimen 11. NOTE: Tetracycline may not be used for children younger than 9 years or those who are pregnant or breastfeeding j. Intravenous (Severe infections) k. Assess for secondary conditions such as yeast infections 3. Course of Treatment: l. Dependent upon condition and response to treatment a. 1. Use: Skin cleanser 2. Nursing Administration and Considerations: a. Topical 1. For external use only 2. Do not use on broken skin unless directed by a health care provider 3. Course of Treatment: b. Dependent upon condition 4. Side Effects: c. Topical 3. Irritation 4. Dermatitis 5. Allergic reactions b. Povidone-iodine (Betadine) 5. Use: Skin cleanser 6. Nursing Administration and Considerations: d. Topical 6. For external use only 7. May stain skin and clothing 7. Course of Treatment: e. Dependent upon condition 8. Side Effects: f. Topical 8. Local irritation a. b. **Coal tar (Estar gel, PsoriGel)\ ** 1. Use: Treatment of pruritic dermatoses, to include eczema and psoriasis a. Keratolytic b. Reduces skin inflammation. 2. Nursing Administration and Considerations: c. Topical 1. For external use only 2. Applied once a day at bedtime with a moisturizer 3. Avoid sun exposure for 72 hours after application 4. May stain clothes and bathtub 3. Course of Treatment: d. Dependent upon condition 4. Side Effects: e. Topical 5. Photosensitivity 6. Dermatitis 7. Allergic reactions c. Salicylic acid\ **NOTE:** **See LSA 5 Antiacne Agents for more information** 5. Use: Psoriasis f. Keratolytic d. Other psoriasis medications include: 6. Methotrexate g. Antimetabolite 7. Cyclosporine h. Immunosuppressant 8. Infliximab (Remicade) i. Biologic classification drug used to control the severe plaque form of the disease a. **Corticosteroids (Type dependent upon condition)\ ** 1. Use: Reduces inflammation, pruritus, scarring, and tumor size a. Eczema; SLE; Pediculosis; Skin tumors; Keloids; Psoriasis; Pityriasis rosea; Dermatitis; Herpes Zoster; Angioedema 2. Nursing Administration and Considerations: b. Topical 1. Fluocinonide (Lidex); Triamcinolone (Kenalog); Hydrocortisone; Betamethasone valerate (Valisone) 2. Do not use occlusive dressing unless directed by a health care provider 3. Washing or soaking the area before application increases drug penetration c. Intravenous 4. Methylprednisolone (Solu-Medrol) d. Oral 3. Course of Treatment: e. Dependent upon condition 4. Side Effects: f. Topical 5. Local irritation 6. Maceration 7. Superinfection 8. Atrophy 9. Itching 10. Dryness 11. More severe reactions and systemic effects possible with higher doses, higher potency, or when used with occlusive dressings a. **Crotamiton (Eurax)\ ** 1. Use: Scabies a. Treats Sarcoptes scabiei mites b. Antipruritic 2. Nursing Administration and Considerations: c. Topical 1. For external use only 2. Do not apply to severely irritated skin 3. Often used in conjunction with 4% to 8% sulfur in petrolatum 3. Course of Treatment: d. Dependent upon condition and response to treatment 4. Side Effects: e. Topical 4. Local irritation 5. Allergic reactions b. Lindane 5. Use: Scabies; Pediculosis f. Treats Sarcoptes scabiei mites g. Treats nits and lice h. Ovicide 6. Nursing Administration and Considerations: i. Topical 6. For external use only 7. Avoid applying to open skin lesions 7. Course of Treatment: j. Dependent upon condition and response to treatment 8. Side Effects: k. Topical 8. Local irritation 9. Dizziness 10. Seizures (Rare) c. Pyrethrin (RID) 9. Use: Pediculosis l. Treats nits and lice 10. Nursing Administration and Considerations: m. Topical 11. For external use only 12. Do not use for infestations of the eyebrows or eyelashes n. Pesticides cannot be used for children under the age of 2 years or pregnant women 13. Occlusive agents, such as petroleum jelly, are used in these groups o. Nits and lice need to be picked off after treatment, using a nit comb 11. Course of Treatment: p. Dependent upon condition and response to treatment 12. Side Effects: q. Topical 14. Local irritation d. Other medications used for pediculosis include: 13. Benzyl alcohol 14. Malathion a. **Fluconazole (Diflucan)\ ** 1. Use: Treatment of fungal infections 2. Nursing Administration and Considerations: a. Oral 1. Monitor for elevation in liver and kidney function tests 3. Course of Treatment: b. Dependent upon condition and response to treatment 4. Side Effects: c. Nausea d. Vomiting e. Headache f. Diarrhea b. Griseofulvin (Fulvicin, Grifulvin) 5. Use: Treatment of fungal infections, especially tinea capitis 6. Nursing Administration and Considerations: g. Oral 2. Avoid exposure to sunlight 3. Drug absorption increased when given with meals 4. Clinical response may appear only after full course of therapy is completed h. Addition of antifungal soaps and shampoos are recommended 7. Course of Treatment: i. Dependent upon condition and response to treatment 8. Side Effects: j. Hypersensitivity reactions k. Photosensitivity l. Nausea m. Fatigue n. Mental confusion c. Itraconazole (Sporanox) 9. Use: Treatment of fungal infections 10. Nursing Administration and Considerations: o. Oral 5. Administer with food 6. Monitor hepatic function 7. May increase prothrombin time (PT) 11. Course of Treatment: p. Dependent upon condition and response to treatment 12. Side Effects: q. Hypertension r. Headache s. Nausea t. Anorexia d. Terbinafine (Lamisil) 13. Use: Treatment of fungal infections 14. Nursing Administration and Considerations: u. Topical 8. For external use only 9. Do not use occlusive dressings unless directed by a health care provider 15. Course of Treatment: v. Dependent upon condition and response to treatment 16. Side Effects: w. Pruritus x. Local burning y. Erythema e. Tolnaftate (Tinactin, Aftate) 17. Use: Treatment of fungal infections, such as tinea corporis, tinea cruris, and tinea pedis 18. Nursing Administration and Considerations: z. Topical 10. For external use only 19. Course of Treatment: a. Dependent upon condition and response to treatment 20. Side Effects: b. Local irritation f. Other antifungals include miconazole (Lotrimin AF; Monistat-Derm, Desenex) and butenafine (Mentax) a. **Methoxsalen (Oxsoralen-Ultra)\ ** 1. Use: Psoriasis a. Administered concurrently with ultraviolet light A (UVA), a concept known as photochemotherapy 2. Nursing Administration and Considerations: b. Oral 1. Avoid all exposure to sunlight for 8 hours after oral ingestion 2. Wear UVA-absorbing sunglasses for 24 hours after oral ingestion 3. Use sunscreen 4. Administer with food, milk, or in divided doses c. Topical 5. Avoid all exposure to sunlight for several days after topical application 6. Use sunscreen 3. Course of Treatment: d. Dependent upon condition and response to treatment e. Clinical response may not appear for several months 4. Side Effects: f. Severe photosensitivity g. Nausea h. Nervousness i. Insomnia j. Headache k. Hypopigmentation a. Burns may result from thermal or nonthermal causes. Thermal burns are caused by flames, scalds, and thermal energy (heat) and are the most common type of burn injury.