NURS 309: MEDS TO TREAT DERMATOLOGIC DISORDERS

Benzoyl Peroxide – Class & Action

A client is prescribed benzoyl peroxide. What is its mechanism of action?

Benzoyl Peroxide – Therapeutic Use

What is benzoyl peroxide used for?

Treatment of acne vulgaris.

Benzoyl Peroxide – Nursing Assessment

What should the nurse assess?

Review the client’s medical history for hypersensitivity to benzoyl peroxide or related compounds (such as benzoic acid derivatives or cinnamon). Assess skin condition and irritation before and during therapy.

Benzoyl Peroxide – Administration

How is benzoyl peroxide administered?

Topical use only. Available in 2.5%, 5%, and 10% concentrations (OTC and prescription). Apply to affected skin as directed. Do not apply to mucous membranes.

Benzoyl Peroxide – Common Side Effects

What side effects may occur?

Burning, itching (pruritus), peeling, dryness, photosensitivity, and bleaching of hair or fabrics.

Benzoyl Peroxide – Adverse Effects

Which serious adverse effects should be monitored for?

Severe hypersensitivity reactions including anaphylaxis and angioedema.

Benzoyl Peroxide – Drug Interactions

What interactions are important?

• With topical sulfone → yellow/orange skin discoloration

• With hydroquinone → increased skin irritation

• With topical tretinoin → decreased tretinoin efficacy

• With isotretinoin → increased dryness and irritation

Benzoyl Peroxide – Contraindications

Who should NOT use benzoyl peroxide?

Clients with known hypersensitivity to benzoyl peroxide.

Benzoyl Peroxide – Precautions

Who requires caution?

Clients with sensitive skin, history of allergies to related compounds, or those using other acne medications that increase irritation or dryness.

Benzoyl Peroxide – Client Teaching

What should clients be taught?

Do not ingest medication. Avoid contact with eyes, lips, and mucous membranes. Use sunscreen and avoid sun/UV exposure. May bleach clothing, towels, and hair. Stop use and report severe irritation or allergic reaction.

It is a topical dermatologic acne agent that exerts antibacterial activity against Cutibacterium acnes, reducing bacterial growth & inflammation in acne lesions.

Doxycycline – Class & Action

A client is prescribed doxycycline. What is its mechanism of action?

Doxycycline – Therapeutic Use

What is doxycycline used for?

Treatment of acne vulgaris and other bacterial infections.

Doxycycline – Nursing Assessment

What should the nurse assess?

Monitor BUN, creatinine, CBC, and liver function tests during long-term therapy. Assess for signs of infection resolution and GI intolerance.

Doxycycline – Administration

How is doxycycline administered?

Oral administration. Take with food and full glass of water, and remain upright after taking to prevent esophageal irritation.

Doxycycline – Common Side Effects

What side effects may occur?

GI upset including nausea, vomiting, abdominal pain, epigastric discomfort, and anorexia.

Doxycycline – Adverse Effects

Which serious adverse effects should be monitored for?

Hepatotoxicity, renal failure, Clostridioides difficile–associated diarrhea, esophageal ulceration or strictures.

Doxycycline – Drug Interactions

What interactions are important?

Antacids, iron, calcium, magnesium, aluminum, and bacteriostatic agents can decrease absorption and effectiveness.

Doxycycline – Contraindications

Who should NOT take doxycycline?

Pregnancy, hypersensitivity to tetracyclines, and severe renal impairment (caution depending on formulation).

Doxycycline – Precautions

Who requires caution?

Clients with renal or hepatic impairment and those at risk for bacterial resistance or prolonged antibiotic use.

Doxycycline – Client Teaching

What should clients be taught?

Take with food and a full glass of water. Remain upright for at least 30 minutes after taking. Avoid antacids and mineral supplements near dosing. Use sun protection due to photosensitivity risk.

It is a tetracycline antibiotic that inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, preventing bacterial growth & replication.

Isotretinoin – Class & Action

A client is prescribed isotretinoin. What is its mechanism of action?

Isotretinoin – Therapeutic Use

What is isotretinoin used for?

Severe, recalcitrant acne vulgaris.

Isotretinoin – Nursing Assessment

What should the nurse assess?

Monitor liver function tests, lipid profile, CBC, creatinine phosphokinase (CPK), and mental health status (including depression or suicidal ideation). Ensure pregnancy testing before and during therapy. Eye exam should be completed before starting therapy.

Isotretinoin – Administration

How is isotretinoin administered?

Oral medication. Taken exactly as prescribed. Requires strict monitoring program for pregnancy prevention and lab work.

Isotretinoin – Common Side Effects

What side effects may occur?

Dry lips (cheilitis), dry skin (xerosis), dry mouth, dry eyes, photosensitivity, itching, and joint or muscle pain.

Isotretinoin – Adverse Effects

Which serious adverse effects should be monitored for?

Severe teratogenicity, hepatotoxicity, hypertriglyceridemia, Stevens-Johnson syndrome, toxic epidermal necrolysis, bone pain, and suicidal ideation or depression.

Isotretinoin – Drug Interactions

What interactions are important?

Do NOT use with tetracyclines (risk of pseudotumor cerebri). Avoid concurrent oral retinoids. Alcohol may increase liver toxicity risk.

Isotretinoin – Contraindications

Who should NOT take isotretinoin?

Pregnancy (absolute contraindication), or anyone who may become pregnant without strict pregnancy prevention measures.

Isotretinoin – Precautions

Who requires caution?

Clients with psychiatric disorders, hyperlipidemia, diabetes, bone disorders, or hepatic impairment.

Isotretinoin – Client Teaching

What should clients be taught?

Use two forms of birth control and get monthly pregnancy tests. Avoid pregnancy completely during and after treatment. Report mood changes or depression immediately. Avoid waxing, skin resurfacing, and excessive sun exposure. Do not take tetracyclines.

It is an oral retinoid that inhibits sebaceous gland activity, decreasing sebum production & reducing acne formation.

Salicylic Acid (Topical) – Class & Action

A client is prescribed topical salicylic acid. What is its mechanism of action?

Salicylic Acid (Topical) – Therapeutic Use

What is salicylic acid used for?

Treatment of acne vulgaris.

Salicylic Acid (Topical) – Nursing Assessment

What should the nurse assess?

Screen for hypersensitivity to salicylic acid or related compounds. Assess skin condition and tolerance prior to and during therapy.

Salicylic Acid (Topical) – Administration

How is salicylic acid administered?

Topical application to affected skin once daily up to 3 times daily depending on product instructions.

Salicylic Acid (Topical) – Common Side Effects

What side effects may occur?

Skin irritation, burning, stinging, and dryness.

Salicylic Acid (Topical) – Adverse Effects

Which serious adverse effects should be monitored for?

Severe hypersensitivity reactions, photosensitivity, and tinnitus (with overuse or systemic absorption).

Salicylic Acid (Topical) – Drug Interactions

What interactions are important?

Avoid use with harsh soaps, alcohol-based products, benzoyl peroxide, and topical retinoids due to increased irritation.

Salicylic Acid (Topical) – Contraindications

Who should NOT use salicylic acid?

Clients with hypersensitivity to salicylic acid or salicylates.

Salicylic Acid (Topical) – Precautions

Who requires caution?

Clients with diabetes, hepatic or renal disease, and those with sensitive or broken skin. Avoid use during breastfeeding.

Salicylic Acid (Topical) – Client Teaching

What should clients be taught?

Do not ingest medication. Avoid sun and UV exposure. Apply to a small test area first. Do not apply to irritated skin. Stop use and report allergic reactions. Seek poison control if ingested.

It is a topical keratolytic agent that reduces inflammation, swelling, & redness by promoting exfoliation & unclogging pores.

Altretinoin – Class & Action

A client is prescribed altretinoin. What is its mechanism of action?

Altretinoin – Therapeutic Use

What is altretinoin used for?

Treatment of acne vulgaris and adjunctive treatment for aging-related skin changes.

Altretinoin – Nursing Assessment

What should the nurse assess?

Assess skin for redness, dryness, peeling, and signs of irritation or hypersensitivity before and during therapy.

Altretinoin – Administration

How is altretinoin administered?

Topical application to affected skin, usually applied at bedtime.

Altretinoin – Common Side Effects

What side effects may occur?

Skin peeling, burning, stinging, and dryness.

Altretinoin – Adverse Effects

Which serious adverse effects should be monitored for?

Severe skin irritation or reaction requiring discontinuation, excessive erythema, and severe hypersensitivity reactions.

Altretinoin – Drug Interactions

What interactions are important?

Avoid concurrent use with harsh soaps, hair dyes, depilatories, and other irritating skin products.

Altretinoin – Contraindications

Who should NOT use altretinoin?

Pregnancy and hypersensitivity to retinoids.

Altretinoin – Precautions

Who requires caution?

Clients with sensitive skin or those prone to irritation, photosensitivity, or skin breakdown.

Altretinoin – Client Teaching

What should clients be taught?

Apply only to clean, dry skin (wait ~20 min after washing). Use at bedtime. Avoid sun/UV exposure and use sunscreen. Do not apply to mucous membranes or broken skin. Expect dryness and peeling. Stop use if severe irritation occurs.

It is a topical retinoid that binds to retinoic acid receptors, increasing epithelial cell turnover & promoting skin cell renewal.

Triamcinolone – Class & Action

A client is prescribed triamcinolone. What is its mechanism of action?

Triamcinolone – Therapeutic Use

What is triamcinolone used for?

Treatment of inflammatory skin conditions such as atopic dermatitis, eczema, and psoriasis.

Triamcinolone – Nursing Assessment

What should the nurse assess?

Assess skin condition, signs of infection (fungal or bacterial), and monitor for worsening irritation or adverse skin changes, especially with prolonged use.

Triamcinolone – Administration

How is triamcinolone administered?

Topical application (cream, ointment, lotion, or solution). Apply a thin layer to affected area. Ointment is more potent than cream.

Triamcinolone – Common Side Effects

What side effects may occur?

Skin atrophy, striae, acne, rosacea, perioral dermatitis, purpura, and delayed wound healing.

Triamcinolone – Adverse Effects

Which serious adverse effects should be monitored for?

Systemic corticosteroid effects such as Cushing syndrome, hypertension, and hyperglycemia, especially with prolonged or excessive use.

Triamcinolone – Drug Interactions

What interactions are important?

May enhance hyperglycemic effects of other medications.

Triamcinolone – Contraindications

Who should NOT use triamcinolone?

Clients with untreated fungal, bacterial, or viral skin infections or hypersensitivity to corticosteroids.

Triamcinolone – Precautions

Who requires caution?

Pediatric clients and those requiring long-term or large-area application due to risk of systemic absorption.

Triamcinolone – Client Teaching

What should clients be taught?

Use fingertip unit (FTU) to measure dose. Apply thin layer only as directed. Avoid applying to infected skin unless treated. Do not overuse. Report skin thinning or worsening irritation.

It is a topical corticosteroid that suppresses inflammation & immune response in the skin.