Integumentary Medications
Medications For Acne
Isotretinoin is an oral acne medication derived from vitamin A. Due to teratogenic risk and severity of side effects (eg, Stevens-Johnson syndrome, suicide risk), isotretinoin is used to treat only severe and/or cystic acne not responding to other treatments. Exposure to any amount of this medication during pregnancy can cause birth defects. Clients are required to enter a Web-based risk management plan (iPLEDGE) and use 2 forms of contraception.
Clients need to be instructed to avoid tetracycline, excess sun and tanning, and vitamin A supplements. Women of child-bearing age should use 2 forms of contraception to prevent pregnancy.
Tetracyclines should be taken 1 hour before or 2 hours after meals with plenty of water. They should not be taken with dairy products or within 2 hours of taking antacids. Clients should use sunblock due to photosensitivity and plan to use additional contraceptive techniques.
The following should be taught to clients taking tetracyclines (eg, tetracycline, doxycycline, minocycline):
- Take on an empty stomach – for optimum absorption, tetracyclines should be taken 1 hour before or 2 hours after meals (Option 3)
- Avoid antacids or dairy products – tetracyclines should not be taken with iron supplements, antacids, or dairy products as they bind with the drug and decrease its absorption (Option 1)
- Take with a full glass of water – tetracyclines can cause pill-induced esophagitis and gastritis; the risk can be reduced by taking with a full glass of water and remaining upright after pill ingestion
- Photosensitivity – severe sunburn can occur with tetracycline. The client should use sunblock
Other Medications:
Silver
Sulfadiazine (Silvadene) and Mafenide Acetate (Sulfamylon) Silver sulfadiazine (Silvadene) and mafenide acetate (Sulfamylon) are sulfonamides that disrupt the synthesis of folic acid necessary for DNA, RNA, and protein synthesis. This action makes the sulfonamides broad-spectrum antimicrobials. These medications are indicated for burns and open wound care. Side effects of mafenide acetate include pain and acidosis. Prior to performing wound care, analgesics should be administered to decrease pain.
Burns Silver sulfadiazine and mafenide acetate are indicated to decrease bacterial colonization in patients with second- and third-degree burns. The medications may help prevent the progression of second-degree (partial-thickness) wounds into third-degree (full-thickness) wounds. Silver sulfadiazine softens eschar and helps with the removal of dead tissue for grafting. Unlike mafenide, it does not have significant side effects.
Silver sulfadiazine and mafenide acetate are used to decrease infection in open wounds. The wounds may be caused by herpes blisters or open second- and third-degree burns. Assess the condition of the skin surrounding the wound for skin breakdown caused by maceration of tissue.
Mafenide Muffin-knight The mechanism of mafenide is similar as other sulfonamides may cause pain and acidosis.
Topical application of silver sulfadiazine does not cause pain. Mafenide, however, may cause pain upon application, especially in partial thickness burns. Administer analgesics prior to wound care, especially during the application of mafenide to minimize pain.
Unlike silver sulfadiazine, mafenide causes acidosis by metabolizing into a chemical that decreases the kidneys’ ability to excrete acids. While taking mafenide, the patient should be frequently monitored for acid-base status. The drug should be temporarily discontinued for 1-2 days if the patient experiences severe acidosis.
Azoles (Ketoconazole)
Azoles are a class of antifungal medication that work by inhibiting fungal ergosterol synthesis, disabling the fungus from growing. They are used for local and less serious systemic mycoses. Common side effects of azole drugs include liver dysfunction and testosterone synthesis inhibition.
“-azole” suffix Easels Drugs in this class are easily recognizable, as they share the “-azole” suffix. Examples include fluconazole and ketoconazole.
Indications
Local and Less Serious Systemic Mycosis, these medications can be used to treat local and less serious systemic mycoses. Exceptions to this include fluconazole, which can be used for chronic suppression of cryptococcus, along with candidiasis in AIDS patients.
Side Effects
These medications can lead to liver damage, and can worsen pre-existing liver disease.
Medications like ketoconazole inhibit testosterone synthesis by inhibition of cholesterol desmolase, and can lead to symptoms such as gynecomastia and hormone imbalance.
Amphotericin B
Amphotericin B is a polyene medication, which works by binding to ergosterol in fungal cell membranes. It forms membrane pores, causing electrolytes to leak, killing the fungal cell. It is used for serious, systemic mycoses. It can lead to the side effects of fever and chills, nephrotoxicity, arrhythmias, anemia and IV phlebitis.
Indications
Is used to treat various systemic fungal infections. Examples include patients who are critically ill, comorbidly infected, or immunocompromised with suspected Cryptococcus.
To treat fungal meningitis, such as cryptococcal meningitis.
Can also be used intravenously to treat otherwise-untreatable parasitic protozoan infections like visceral leishmaniasis and amoebic meningoencephalitis from Naegleria Fowleri.
Side Effects
Can acutely lead to high fever and shaking chills, which led to the “shake and bake” terminology.
Has been linked to nephrotoxicity, which can be very severe, and is sometimes irreversible.
The nephrotoxic symptoms seen with amphotericin B administration can be milder when the drug is co-administered with liposomes.
Hippo-BP Patients who are initially given this drug may become hypotensive. This can subside with later application of the drug, which points to the idea that the hypotension occurs because of histamine release.
Several forms of anemia can occur, along with other blood dyscrasias. Patients can display hemolysis, along with leukopenia and thrombocytopenia.
Acute reactions to injection can occur, and patients have been noted to display IV phlebitis.
Another side effect of using this medication is the development of arrhythmia. Due to renal tubular damage, potassium and magnesium levels can be altered. These should be closely monitored, as patients can develop serious arrhythmias, including ventricular fibrillation and cardiac failure.
Nystatin
Nystatin is a polyene medication that works by binding ergosterol and forming membrane pores in the fungus it is treating. It is used for treating candidiasis, and is administered for topical infections because it is too toxic for systemic administration. Nystatin works in the same mechanism as amphotericin B
Indications
Nystatin is recommended for use against various forms of candidiasis, as this fungus responds well to this medication.
Nystatin is indicated for use against yeast infections, or vaginal candidiasis.
Oral Nystatin is used to treat thrush, also known as oral candidiasis. It can also be given prophylactically in patients with AIDS or low CD4+ counts.
This medication can be administered for cutaneous fungus, or thrush infections.
Side Effects
Patients taking this medication can have hypersensitivity reactions and rashes. Serious reactions can manifest as Stevens-Johnson syndrome.
Echinocandins
Echinocandins are antifungal medications that work by inhibiting cell wall synthesis. They do this by inhibiting the synthesis of Beta-glucan. These drugs are used for treating invasive aspergillosis and candida. Side effects of echinocandin use, though rare, include GI upset and flushing, due to histamine release.
“-Fungin” suffix. Echinocandins are recognizable because they share a “-fungin” suffix. Example medications include caspofungin and micafungin.
Indications
These medications are used empirically in patients with invasive aspergillosis. It can also be used in patients who have refractory infection, or are intolerant of other medications, such as amphotericin B or itraconazole.
This drug class is approved for use against invasive candidiasis as well, with specific indications for intra-abdominal abscesses, peritonitis, pleural cavity infections, and esophagitis.
Side Effects
This drug class has a very low incidence of side effects, but patients have been known to complain of GI upset and distress.
Patients can complain of flushing or hypersensitivity reactions, as echinocandins can promote histamine release.
Griseofulvin
Griseofulvin is an oral antifungal medication used to treat infections of the skin. It can be used for ringworm and tinea infections but has several side effects. These include headache, confusion, teratogenic effects and inducing cytochrome P450
Indications
Griseofulvin is an antifungal used against superficial infections, such as ringworm or tinea. It is reserved for infections affecting the nail, hair or large body surfaces.
This medication inhibits dermatophytes, which may cause ringworm or tinea. Griseofulvin can be used for all tineas, such as cruris, pedis, capitis and corporis (ringworm).
Side Effects
Griseofulvin is a teratogen and should not be given to expecting mothers. P450 Inducer Pea 450 Inducer-rocket This medication is a cytochrome P450 inducer, and can increase the metabolism of (and decrease effectiveness of) several medications, such as OCPs.
Confusion is a common side effect of this medication.
Head-egg-lump Among the several non-specific symptoms patients can complain of, headache is one of the most common and is seen in roughly 15% of patients.