Integumentary Drugs and Antibiotics PDF

Integumentary Drugs and Antibiotics Classification of Antimicrobial Medications  Narrow-spectrum  Broad-spectrum  Bactericidal medications  Bacteriostatic medications Identification of Causative Agent  Laboratory testing  Gram stain to identify the micro-organism...

Integumentary Drugs and Antibiotics Classification of Antimicrobial Medications  Narrow-spectrum  Broad-spectrum  Bactericidal medications  Bacteriostatic medications Identification of Causative Agent  Laboratory testing  Gram stain to identify the micro-organism  Culture- the micro-organism is placed on a culture medium to grow for several days. This is preferable when the gram stain doesn’t identify the organism.  Nurses should obtain specimens for culture prior to first dose with antibiotics  Nurses must collect specimens carefully to prevent contamination. Host Factors  Immune system  Site of infection  Blood brain barrier  Endocarditis  Purulent abscesses with poor blood supply  Surgical removal of drainage increases effect of abx  Phagocytes attack foreign objects (pacemaker, grafts, valves, surgical mesh) become less able to destroy bacteria around these objects.  Age  Pregnancy  Presence of previous allergic reaction Combination therapy  Used to tx severe infections  Infections with more than one bacteria  Prevent bacterial resistance  Decreases risk of toxicity by reducing the dosage of each medicine  More effective tx  Adverse effects  Increased resistance if not properly taken  Increased cost  More adverse and toxic reactions  Antagonistic effects among abx  Increases risk of superinfection Prophylaxis Treatment  Prevention of infections for clients undergoing gi, cardiac, peripheral vascular, orthopedic, or gyn surgery  STI exposure to prevent conversion  Clients who has prosthetic heart valves prior to dental or other procedures because of danger of bacterial endocarditis  Recurring urinary tract infections Preventative Measures  Hand hygiene before and after client contact  Recognize invasive procedures that increase the risk of infection (catheter, IV, cardiac cath)  Encourage prevention by having clients maintain UTD immunizations  Take full course to prevent resistance and recurrence  Use aseptic technique, standard and transmission precautions, careful assignment of rooms  Monitor effectiveness  Post tx cultures  Monitor clients for improvements Resistance to Drugs  Drug resistance becomes an issue when  Antibiotics are regularly used by a patient A group of people live in close proximity  Bacteria: Naturally resistant or acquired resistance to drug, such as MRSA  Emergence of a new resistance associated with bacteria that have both a natural and an acquired resistance ability, such as VRE  Chancroid Sulfonamide  Effective antibiotic drugs against infections Uses:  Urinary tract infections  Otitismedia, chancroid, pertussis, shigellosis, and Pneumocystis pneumonia  Treat infections caused by second- and third-degree burns Sulfonamide: Adverse Reactions  Common reactions: Anorexia, nausea, vomiting, diarrhea, abdominal pain, chills, fever, stomatitis  Hyperkalemia  Kernicterus  Urine and skin take on an orange-yellow color: This is not abnormal  Crystalluria: Increase fluid intake  Photosensitivity: Wear protective clothing or sunscreen Sulfonamide: Adverse Reactions  Hypersensitivity reactions  Pruritus (itching)  Urticaria (hives)  Generalized skin eruptions  Severe reactions leading to potentially lethal conditions, such as toxic epidermal necrolysis or Stevens-Johnson syndrome Stop med Sulfonamide  Observe for hematologic changes during prolonged sulfonamide therapy  Thrombocytopenia; aplastic anemia; leukopenia Sulfonamide: Contraindications and Precautions  Patients with hypersensitivity to sulfonamides  During lactation; near the end of pregnancy; in children less than 2 years old  Infections caused by group A beta-hemolytic streptococci  Use cautiously for: Renal impairment, hepatic impairment and bronchial asthma Sulfonamide: Interactions Interactant drug Effect of interaction Oral Increased action of anticoagulants the anticoagulant Methotrexate Increased bone (Rheumatrex) marrow suppression Hydantoins (e.g., Increased serum phenytoin hydantoin level [Dilantin]) Sulfonamide  Diabetic patients: Assess for hypoglycemic reaction with clients who take sulfonureas for DMII  Cranberries/Cranberry juice: Prevents and relieves symptoms of UTIs  Combination of cranberries with antibiotics: Long-term suppression of UTIs Nursing Process  Implementation  Dosage: Empty stomach – 1 hour before or 2 hours after meals with 8 oz water  Drink at least 8 large glasses of water each day Sulfonamide: Treatment-Burn Injury  When instructed: Clean and remove debris from surface of the skin;  apply mafenide or silver sulfadiazine with a sterile gloved hand  Drug applied approximately 1/16 inch thick  Keep patient away from draft of air as slightest movement of air across the burned area can cause pain  Warn patient: Stinging or burning during and for a short time after application Drugs  Trimethoprim and sulfamethoxazole – Bactrim, Bactrim DS, Septra, Septra DS  Mafenide - Sulfamylon  Silver sulfadiazine - Silvadene Penicillins  Actions: weakens and lysis bacterial cell wall  Used against infectious diseases. Some include:  Meningitis  Syphilis  Extended spectrum pcn for difficult bacteria  Prophylaxis with bacterial endocarditis Penicillin: Adverse Reactions  Gastrointestinal reactions  Hypersensitivity reactions  Anaphylactic shock  Cross-sensitivity and cross-allergic  Superinfections: Bacterial,fungal  Hematopoietic changes Penicillin: Contraindications and Precautions  Contraindicated in patients with history of hypersensitivity to penicillin, cephalosporins, and imipenum  Use cautiously in patients with renal disease, asthma, bleeding disorders, gastrointestinal disease, pregnancy or lactation  Monitor cardiac status and electrolyte levels Penicillin: Interactions Interacting Drug Effect of Interaction with Penicillin Birth control pills Decreased BCP effectiveness Tetracyclines Decreased PCN effectiveness Anticoagulants Increase bleeding risks Beta-adrenergic May increase the risk for an blocking drugs anaphylactic reaction Penicillins  Take with meals – penicillin V, amoxicillin, and amoxicillin- clavulanate  All others with 8 oz water and 1 hours ac and 2 hours pc meals  Complete entire course of meds  Additional contraception!! Drugs  Penicillin G – Bicillin  Amoxicillin – Amoxil  Amoxicllin and clavulanate – Augmentin  Ampicillin/subactam – Unasyn  Piperacillin and tazobactam – Zosyn Cephalosporins  Broad spectrum bacteriocidal  Classification:Divided into first, second, third, and fourth-generation drugs  Each subsequent generation more likely to reach CSF, less susceptible to destruction, more effective against gram neg. organisms Cephalosporin: Uses  Used to treat infections caused by bacteria  Respiratory  Ear  Bone/joint  Genitourinary tract infections  Post-op infections  Meningitis  Prophylactically following sexual assault Cephalosporin: Adverse Reactions  Gastrointestinal reactions  Nausea; vomiting; diarrhea (may be an indication of pseudomembranous colitis- superinfection)  Administration route reactions  Intramuscularly – pain, tenderness, and inflammation at injection site; rotate sites dorsogluteal/ventrogluteal  Intravenously – phlebitis or thrombophlebitis  Other body system reactions  Headache; dizziness; malaise; heartburn; fever; nephrotoxicity; hypersensitivity; aplastic anemia; toxic epidermal necrolysis  Nursing alert  Allergy: Approximately 10% of people allergic to penicillin are also allergic to cephalosporins Cephalosporins: Contraindications and Precautions  Contraindicated in patients allergic to cephalosporins or penicillins  Cefotetan and ceftriaxone  Avoid with bleeding disorders and anticoagulants, monitor bleeding times  Have vitamin K available  Used cautiously in patients with:  Renal disease; hepatic impairment; bleeding disorder (other than above); pregnancy; known penicillin allergy Cephalosporins: Interactions Drug Common Effect of use interaction Aminoglycosides Anti- Increased risk infective for nephrotoxicity Oral Blood Increased risk anticoagulants thinner for bleeding Cephalosporins: Interactions  Nursing alert  Disulfiram-like reaction: If alcohol consumed within 72 hours  Symptoms: Flushing; throbbing; respiratory problems; nausea, vomiting; sweating; chest pain; hypotension, palpitations, blurred vision  Severereaction: Arrhythmias and unconsciousness Nursing Process: Implementation  Question patient regarding allergy to cephalosporins or penicillins  Shake oral suspensions (store in refrig.)  Administer with food Drugs  Cefadroxil – Duricef  Cefazolin – Ancef  Cefprozil – Cefzil  Cefdinir – Omnicef  Cefixime – Suprax  Cefotaxime – Claforan  Ceftriaxone - Rocephin Tetracyclines  Used as broad spectrum antibiotic  Uses:  Treats infections caused by rickettsiae, intestinal amebiasis; skin and soft tissue; uncomplicated urethral, endocervical, or rectal infections; Acne; Mycoplasmal pneumonia; lyme disease  adjunctive treatment; Helicobacter pylori; Anthrax Tetracyclines: Adverse reactions  GI/other body system reactions  NVD  Epigastric distress  Stomatitis  Sore throat  Skin rashes  Hepatotoxic  Superinfection such as C diff (pseudomembranous colitis), etc  Photosensitivity reaction  Advise to avoid exposure to the sun, tanning lamp or bed; completely cover arms and legs and wear wide-brimmed hat to protect face and neck; sunscreen may or may not be effective; consult primary health care provider Tetracyclines: Contraindications  Contraindicated in patients with hypersensitivity or during pregnancy, lactation  Pregnancy D  Nursing alert  Not given to children younger than 8-9 years of age r/t discoloration of teeth or pregnant  Prolonged therapy: Bacterial/fungal overgrowth of non-susceptible organisms Tetracyclines: Precautions  Used cautiously in patients with:  Impaired renal function  Liver impairment  Chronic care alert  May increase the risk of digitalis toxicity in patients who take digitalis drugs for heart disease  Don’t take at bedtime as it increases risk of esophageal ulceration Nursing Process: Implementation  Oral administration: Tetracyclines On an empty stomach and with a full glass of water (Exceptions: Minocin and Terramycin) If GI distress with food  Nursing alert: Do not give with dairy products, antacids, magnesium laxatives, or products containing iron; if prescribed – give 2 hours before/after administration of tetracycline Tetracyclines: Interactions Interactant drug Effect of interaction Antacids containing Decreases aluminum, zinc, magnesium, effectiveness of or bismuth salts tetracyclines Oral anticoagulants Increases risk for bleeding Oral contraceptives Decreases effectiveness of BC Digoxin Increases the risk for digitalis toxicity Calcium-rich foods Causes potentially impaired absorption of tetracycline Tetracyclines Doxycycline – Vibramycin Tetracycline – Sumycin Macrolides: Uses  Used as prophylaxis before dental or other procedures in patients allergic to penicillin against rheumatic fever and bacterial endocarditis and in the treatment of:  Legionnaires’disease, pertussis, acute diphtheria  Chlamydial infections  Mycoplasmal pneumonia  Streptoccocal infections Macrolides: Adverse Reactions  Gastrointestinal (GI) and other reactions  Nausea  Vomiting  Diarrhea  Abdominal pain or cramping  Pseudomembranous colitis  Visual disturbances  Ototoxicity  Thrombophlebitis  Prolonged QT interval causes dysrhythmias and sudden cardiac death Macrolides: Contraindications and Precautions  Contraindicated in patients with hypersensitivity to the macrolides; preexisting liver disease and prolonged QT  Used cautiously in patients with liver dysfunction; myasthenia gravis; during pregnancy or lactation (pregnancy categories B and C) Nursing Process: Implementation  Oral administration: Macrolides  Except for azithromycin, administer on empty stomach with 8 oz water. Unless GI upset occurs  Avoid other meds that affect liver fx  Exceptions:Azithromycin; Dirithromycin; Erythromycin  Monitor PT or INR with Coumadin; liver function greater than 2 weeks  Avoid concurrent administration with diltiazem and verapamil Macrolides: Interactions Interactant drug Effect of interaction Antacids (kaolin, Decreases absorption aluminum salts, or and effectiveness of magaldrate) macrolide Digoxin Increases serum levels of digoxin Anticoagulants Increases risk of bleeding Clindamycin, Decreases therapeutic lincomycin, or activity of the chloramphenicol macrolide Theophylline Increases serum theophylline level Drugs  Azithromycin – Zithromax  Clarithromycin – Biaxin  Erythromycin – E-Mycin Lincosamides  Used for treating serious infections in which penicillin or erythromycin is not effective  Used for the more serious infections  Used in conjunction with other antibiotics  Effective in the treatment of infections caused by a wide range of gram-negative and gram-positive microorganisms Lincosamides: Adverse Reactions  Gastrointestinal/other body reactions  Abdominal pain  Esophagitis  Nausea  Vomiting  Diarrhea  Skin rash  Blood dyscrasias Lincosamides: Contraindications and Precautions  Contraindicated in patients with hypersensitivity to the lincosamides; having minor bacterial or viral infections  Used cautiously for patients with history of GI disorders; renal disease; liver impairment; myasthenia gravis Nursing Process: Implementation  Oraladministration: Lincosamides Food impairs absorption Patient should not take anything by mouth for 1 to 2 hours before and after Give clindamycin with food or a full glass of water Drugs  Clindamycin – Cleocin  Lincomycin - Lincocin Fluoroquinolones: Uses  Broad-spectrum  Used to treat infections caused by gram-positive and gram-negative microorganisms (bacteriocidal)  Used for the treatment of:  Lower respiratory and GI infections  Bone and joint infections  Urinary tract infections and infections of the skin Fluoroquinolones: Adverse Reactions  Common adverse effects  Nausea; diarrhea; headache; abdominal pain or discomfort; dizziness  Serious adverse effects  Achilles tendon rupture  No one less than 18 with some exceptions  Photosensitivity and hypersensitivity  Bacterial or fungal superinfections  Superinfections: Pseudomembranous colitis (increased with Cipro), yeast, thrush Fluoroquinolones: Contraindications and Precautions  Contraindicated in patients with:  Historyof hypersensitivity; in children younger than 18 years; during pregnancy; who cannot follow precautions regarding photosensitivity  Used cautiously in patients with:  Renalimpairment; history of seizures; geriatric patients; patients on dialysis Fluoroquinolones: Interactions Interactant drug Effect of interaction Theophylline Increased serum level Cimetidine (Tagamet) Hampers elimination of antibiotic Oral anticoagulants Increased risk of bleeding Antacids, iron salts, or Decreased antibiotic zinc absorption Dairy products Decreased absorption Fluoroquinilones: Implementation  Promoting an optimal response therapy Fluoroquinolones: Increase fluid intake  Patients receiving: Antacid: Administer ciprofloxacin and moxifloxacin 2-4 hours before or 6-8 hours after the antacid Fluoroquinolones  Ciprofloxacin (Cipro)  Enoxacin (Penetrex)  Gatifloxacin (Tequin)  Lomefloxacin (Maxaquin)  Moxifloxacin (Avelox)  Ofloxacin (Floxin)  Sparfloxacin (Zagam) Aminoglycosides: Uses  Primaryuse: Treatment of infections caused by gram-negative microorganisms (bacteriocidal)  Usedto reduce bacteria in the bowel: For patients having abdominal surgery or in a hepatic coma  Canbe used in conjunction with other meds to treat TB Aminoglycosides: Adverse Reactions  Hypersensitivity  Photosensitivity  Signs and symptoms of adverse reactions  Nephrotoxicity: Proteinuria; hematuria; increased BUN level and serum creatinine concentration; decreased urine output  Ototoxicity: Tinnitus; dizziness; roaring in the ears; vertigo  Streptomycin:  Neurotoxicity: Numbness; skin tingling; circumoral (around the mouth) paresthesia  Changes in the level of consciousness may cause difficulty swallowing and danger of aspiration; withhold drug and contact the primary health care provider Aminoglycosides: Contraindications and Precautions  Contraindicated in patients with:  History of hypersensitivity to aminoglycosides; preexisting hearing loss; myasthenia gravis (can cause respiratory depression, paralysis); parkinsonism; during lactation or pregnancy  Used cautiously with:  Elderly patients; patients with renal failure and neuromuscular disorders  Watch renal and hepatic labs Aminoglycosides: Interactions Interactant drug Effect of interaction Cephalosporins Increased risk of nephrotoxicity Loop diuretics (water Increased risk of pills) ototoxicity Aminoglycosides: Implementation  Check peak and trough levels  Acute pain: Tissue injury  Inspectneedle site; rate of infusion; vein for signs of tenderness, pain, and redness Aminoglycosides  Amikacin (Amikin)  Gentamicin (Garamycin)  Kanamycin (Kantrex)  Neomycin (Mycifradin)  Netilmicin (Netromycin)  Streptomycin  Tobramycin (Nebcin) Linezolid (Zyvox): Miscellaneous Actions and Uses  Bacteriostatic and bactericidal  Used in the treatment of:  Vancomycin-resistant enterococcus (VRE)  Health care and community- acquired pneumonias  Skin and skin structure infections Linezolid: Adverse Reactions  Common adverse effects: Nausea; vomiting; diarrhea; headache and dizziness; insomnia; rash  Lesscommon adverse effects: Fatigue; depression; nervousness; photosensitivity  Serious adverse effects: Pseudomembranous colitis; thrombocytopenia Linezolid: Contraindications and Precautions  Contraindicated in patients:  Who are allergic to the drug; pregnant (pregnancy category C) or lactating; with phenylketonuria  Used cautiously in patients with:  Bonemarrow depression; hepatic dysfunction; renal impairment; hypertension; hyperthyroidism Linezolid: Interactions Interactant drug Effect of interaction Antiplatelet drugs Increased risk of bleeding and thrombocytopenia MAOIs; Decreased antidepressants effectiveness Large amounts of food Risk of severe containing tyramine hypertension Vancomycin (Vancocin): Actions and Uses  Inhibits bacterial cell wall synthesis and increases cell wall permeability – acts against susceptible gram- positive bacteria  Used in the treatment of:  MRSA  Anti-infective–associated pseudomembranous colitis caused by Clostridium difficile Vancomycin: Adverse Reactions  Common adverse reactions  Nephrotoxicity  Ototoxicity  Other adverse reactions  Red man syndrome  IM/IV – site pain, thrombophlebitis  Infusionreaction: Nausea; chills; fever; urticaria; sudden fall in blood pressure with parenteral administration; skin rashes Vancomycin: Contraindications, Precautions, and Interactions  Contraindicated in patients with known hypersensitivity to the drug  Allergy to corn or corn products  Used cautiously in patients with renal or hearing impairment; during pregnancy and lactation  Interaction  Other ototoxic (Lasix and aminoglycosides) and nephrotoxic drugs: Additive effects may occur Quinupristin/Dalfopristin (Synercid): Action, Uses, and Adverse Reactions  Bacteriostatic agent  Used in the treatment of vancomycin-resistant Enterococcus faecium (VREF)  Adverse reactions  Irritation in the vein; incompatibility with saline or heparin flush solutions; nausea, vomiting, and diarrhea Quinupristin/Dalfopristin: Contraindications, Precautions, and Interactions  Contraindicated in patients with known hypersensitivity to the drug; during pregnancy and lactation  Interaction  Serum levels of the following drugs may increase: Antiretrovirals; antineoplastic and immunosuppressants; calcium channel blockers; benzodiazepines Antiviral Drugs  Drugs will shorten the length of the outbreaks  Will not prevent spread of disease  Effective against  Acyclovir - Herpes Simplex virus 1 and 2 and herpes zoster  Ganciclovir - HIV, organ transplants can take ganciclovir prophylactically, Cytomegalovirus retinitis  Interferon alfa - Hepatitis B and C  Oseltamivir - Influenza A and B  Ribavirin - RSV (Respiratory syncytial virus) Adverse Reactions  Systemically – orally or IV  Rapid IV administration may result in crystalluria  Nephrotoxic – acyclovir  Bone marrow suppression- Ganciclovir  GI disturbances – N/V/D  Headache, Rash, Fever, Insomnia  Topically  Burning, stinging, and pruritus Contraindications and Precautions  Hypersensitivity  Ribavirin should not be used in patients with unstable cardiac disease.  Pregnancy (cat C) and lactation when benefits outweigh risks (except Ribavarin X)  Use cautiously in:  Renal impairment  Low blood cell counts  h/o epilepsy  History of respiratory disease Interactions  Probenecid – increases acyclovir levels  Cimetidine – increases valavyclovir (Valtrex)  Theophylline – with acyclovir only, increased serum level of theophylline. Antiviral Patient Management Issues  Smallfrequent meals with soft, nonirritating foods if nausea is mild  Usegloves for application of topical antivirals  Maybe given without regard to food unless GI distress  Nosexual intercourse while patient has lesions  Infuse slowly (1 hour or greater)  Drugs  Acyclovir (Zovirax)  Ribavirin (Virazole) – – Herpes simplex – RSV, chronic – Herpes zoster hepatitis C  Valacyclovir (Valtrex)  Amantadine (Symmetrel) – Shingles, herpes – Parkinsons and simplex 1, 2 influenza A  Topical Antivirals  Famciclovir (Famvir)  Docosanol (Abreva) – Shingles  Penciclovir  Oseltamivir (Tamiflu) (Denvavir) – Influenza Antifungals  Superficial mycotic infection occur on surface or just below the skin or nails  Tinea pedia – athlete’s foot  Tinea cruris - jock itch  Tinea corporis - ringworm  Onchomycosis – nail fungus  Yeast infections – Candida albicans  Deep mycotic infections can develop inside the body (lungs, brain, or GI tract) Antifungals  Fungicidal  Fungistatics  Superficial and deep fungal infections  Systemic infections such as candidiasis and cryptococcal meningitis  Superficial infections of nailbeds and oral, anal, and vaginal areas  For ringworm infections keep towels and washcloths separate from those of other family Antifungals: General Adverse Reactions  Infusion reactions  Fever, chills, rigors, and headache 1-3 hr post IV  Topical – few adverse reactions, but possibly irritation, burning, redness, stinging locally.  Thrombophlebitis  Nephrotoxicity  Bone marrow suppression  Electrolyte imbalance  Esp potassium Ketoconazole Adverse Rx  Hepatotoxicity  Gynecomastia  Irregular menses Antifungals: Contraindications and Precautions  Contraindicated:  Pregnancy  Lactation  Renal impairment  Precautions  Renal dysfunction  Bone marrow suppression  Anemia  Electrolyte imbalance Antifungals: Patient Management Issues  Superficial and deep fungal infections respond slowly to antifungal therapy.  I&O r/t nephrotoxicity  Creatinine and BUN  If for thrush, patient should swish and swallow  Complete therapy  Pregnancy D fluconazole in high doses.  Topical Antifungals  Uses:  Nsg. Interventions:  Athlete’s  Do not foot chew/swallow  Jock itch troches  Tineacorporis  Clean applicators (ringworm) after use  Yeast infections  Clean site prior to application  Clean old cream/lotion off  Swish and swallow Topical Antifungals  Clotrimazole—Lotrimin  Gentian Violet  Miconazole—Monistat  Tolnaftate—Tinactin Antifungals  Amphotericin B (Fungizone) (IV, po, topical)  Fluconazole (Diflucan)  Griseofulvin (Fulvicin, Grifulvin)  Ketoconazole (Nizoral) – candidiasis, histoplasmosis  Nystatin, oral (Mycostatin) - candidiasis  Terbinafine (Lamisil) - onchomycosis Systemic Antifungals: amphotericin B--Fungizone   Side Effects to report (May Uses require premedication)  Systemic treatment  Nephrotoxicity (check of fungal infections lab) and meningitis  Lyte imbalance  Candidal infections  Malaise, fever, chills,  H/A, N/V, hypotension, Side Effects to Expect tachypnea  Dry skin, slight skin  Thrombophlebitis irritation with  Nsg. Interventions topical preparations  Protect IV preparation  Use cautiously in from light (may need to use protective covering patients who while hanging) currently use  Topical will stain clothing antineoplastic drugs Systemic: fluconazole--Diflucan  Uses  Side Effects to  Cryptococcal Report meningitis  Rash  Candidiasisof  Hepatotoxicity mouth, esophagus,  Drug Interactions vagina  Tagamet inhibits  Side effects to expect action of  NVD Diflucan  Diureticsinhibit excretion of Diflucan  Systemic: griseofulvin--Fulvicin   Side Effects to Uses Expect  Ringworm of scalp, body,  NV, anorexia, nails, feet—treatment may take several months cramping  Side Effects to  Therapeutic effects may not be seen for some time Report  Urticaria, rash,  Drug Interactions pruritus  Coumadin may be diminished  Nephro/  Impaired absorption when hepatotoxic given with barbiturates  Photosensitivity  OBC—decreased efficacy  Hematologic  Not recommended for those changes with severe liver disease  Confusion,  Griseofulvin has a possible dizziness PCN cross sensitivity Topical Antipsoriatics: Actions, Uses, Contraindications, and Precautions  Used to treat psoriasis by helping to remove the plaques associated with disorder  Examples of antipsoriatics:  Anthralin and calcipotriene  Contraindicated in patients with known hypersensitivity to drugs  Used cautiously in patients during pregnancy and lactation Keratolytics:  Remove excess growth of epidermis in disorders such as warts  Used to remove:  Warts  Calluses  Corns  Seborrheic keratoses  Contraindicated in patients:  With known hypersensitivity to drugs  For use on moles, birthmarks, warts with hair growing from them, on genital or facial warts, warts on mucous membranes, on infected skin  Used cautiously during pregnancy and lactation Miscellaneous Medications  Mafenide (Sulfamylon) – Penetrates thick eschar  Silver sulfadiazine (Silvadene) – Broad spectrum.  Silver nitrate – topical anti-infective  Aluminum acetate solution – Burrow’s solution, Astringent  Calamaine lotion – astringent Topical Drugs Used in the Treatment of Skin Disorders Nursing Process: Implementation  Monitoring and managing patient needs  Impaired skin integrity: Advise patient to keep nails short, use warm water with mild soap for cleaning the skin, rinse and dry skin thoroughly  Pain:Use cool, wet compresses or bath to relieve itching with itching and rash  Risk for infection: Observe skin for signs of infection; report any sign Topical Antiseptics and Germicides: Actions  Chlorhexidine (Hibiclens) Affects wide range of microorganisms, including gram-positive and gram-negative bacteria  Iodine:Anti-infective action against bacteria, fungi, viruses, yeasts, protozoa – Povidone-iodine – Betadine – Stains Topical Antiseptics and Germicides: Uses  To reduce number of bacteria on skin surfaces  As surgical scrub and as preoperative skin cleanser  Cleanse the skin at home  Prevent infection on minor cuts and abrasions Topical Corticosteroids: Actions and Uses  Exert localized anti-inflammatory activity  Reduce itching, redness, swelling when applied to inflamed skin  Use to treat skin disorders  Psoriasis; dermatitis; rashes; eczema  Insect bites; First- and second- degree burns, including sunburns Topical Corticosteroids: Contraindications, Precautions, and Interactions  Topical corticosteroid: Apply ointments, creams, or gels sparingly in light film; rub in gently Do not use bandages, dressings, cosmetics, or other skin products over treated area unless directed  Contraindicated in patients:  Withknown hypersensitivity to drug or any component of drug  Used cautiously during pregnancy and lactation Topical Enzymes:  Used to help remove necrotic tissue from:  Chronic dermal ulcers  Severely burned areas  Aid in removal of dead soft tissues by hastening reduction of proteins into simpler substances  Contraindicated in patients with:  Known hypersensitivity to drugs  Wounds in contact with major body cavities or where nerves are exposed  Used cautiously during pregnancy and lactation Topical Local Anesthetics: Actions and Uses  Temporarily inhibits conduction of impulses from sensory nerve fibers  Topical anesthetics: Apply anesthetic as directed by primary health care provider Cleanse and dry area before first application Remove all previous residue Instruct patient not to eat food for 1 hour after use  Relieve itching and pain due to skin conditions  Minor burns; fungal infections; insect bites; rashes; sunburn; plant poisoning Topical Local Anesthetics: Contraindications, Precautions, and Interactions  Contraindicatedin patients with known hypersensitivity to any component of preparation  Used cautiously in patients receiving Class I antiarrhythmic drugs, as the toxic effects are additive and potentially synergistic