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Integumentary Medication

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Integumentary Medication. Integumentary Medication. . EMOLLIENTS AND LOTIONS A.Emollients ( Box 41-1 ) 1.Oily or fatty substances that soften and soothe irritated skin by allowing the skin to retain water 2.Available as creams or ointments

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Integumentary Medication
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  1. Integumentary Medication

  2. Integumentary Medication • . EMOLLIENTS AND LOTIONS • A.Emollients (Box 41-1) • 1.Oily or fatty substances that soften and soothe irritated skin by allowing the skin to retain water • 2.Available as creams or ointments • 3.Used for dry, scaly, itchy inflammatory conditions • B.Solutions and lotions (Box 41-2) • 1.Liquid suspensions or dispersions • 2.Require shaking before application • 3.Although lotions are predominantly water, they have a drying effect on the skin when the water evaporates • 4.Used as a wash for the skin, as soaks, or as wet dressings on ulcers or burns • 5.Used for subacute inflammatory lesions after the severe exudate phase has ceased • 6.Medicated lotions are often used as anti-inflammatory agents because they provide a drying, protective, and cooling effect

  3. EMOLLIENTS AND LOTIONS • BOX 41-1 Emollients • Cold cream • Glycerin • Lanolin • Lubriderm • Petrolatum • Zinc ointment • Vitamin A and D ointment • BOX 41-2 Solutions and Lotions • Aluminum acetate solution (Burow's solution) • Calamine lotion (Caladryl lotion)

  4. RUBS AND LINIMENTS • RUBS AND LINIMENTS (Box 41-3) • A.Used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia • B.Over-the-counter (OTC) products contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants • C.Some products contain salicylates and, if used over a large area of the skin, may cause salicylate side effects such as tinnitus, nausea, or vomiting • D.A heating pad is not used with these products, because irritation or burning of the skin may occur

  5. ANTI-INFECTIVE AGENTS • A.Description • 1.Includes antiseptics and antibacterial, antifungal, antiviral, and antiparasitic medications • 2.Topical antibiotics are safe and effective in certain conditions; extensive use may encourage the emergence of resistant bacteria • B.Antiseptics • 1.Sodium hypochlorite (Dakin solution) • a.A chloride solution that loosens, dissolves, and deodorizes necrotic tissue and blood clots • b.It kills most common bacteria, including spores, amebas, fungi, protozoa viruses, and yeast • c.Itis used for irrigating and cleaning necrotic or purulent wounds • d.Loses its potency during storage, so fresh solution is prepared frequently • e.It should not be in contact with healing or normal tissue

  6. BOX 41-3 Rubs and Liniments • Aspercreme • Ben-Gay • Icy Hot • Myoflex

  7. 2.Chlorhexidine gluconate (Hibiclens) • a.Effective for cleaning wounds caused by staphylococci and other gram-positive bacteria • b.Used for irrigating and cleansing wounds, but not for packing wounds because it may cause contact dermatitis

  8. 3.Acetic acid • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 4 of 33 — printed page 493) • a.Effective for irrigating, cleansing, and packing wounds infected by Pseudomonas aeruginosa • b.Healthy skin surrounding the wound must be protected with a petroleum barrier because it excoriates the skin

  9. 4.Hydrogen peroxide • a.As a 3% solution, it has effervescent action that releases gas and breaks up necrotic tissue • b.It is used to irrigate and clean necrotic tissue and pus from open wounds • c.It is not used to pack wounds because it decomposes too rapidly • d.When epithelial tissue begins to form, hydrogen peroxide is discontinued because it inhibits tissue formation

  10. 5.Hexachlorophene (pHisoHex, Septisol) • a.A combination of hexachlorophene and alcohol • b.Hexachlorophene is a bacteriostatic agent with activity against staphylococci and other gram-positive bacteria • c.Hexachlorophene is heavily absorbed through broken skin and can cause neurotoxicity; it should not be used on wounds • d.The alcohol component dries and irritates tissue, is not a very effective germicide, and forms a film that can actually promote infection • e.All hexachlorophene products are well rinsed from the skin after their use to prevent systemic absorption

  11. C.Antibacterials (Box 41-4) • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 5 of 33 — printed page 493) • 1.Description: Used for superficial skin infections • 2.Mupirocin (Bactroban) • a.Topical antibacterial active against Staphylococcus aureus, beta-hemolytic streptococci, or Streptococcus pyogenes • b.Applied three times daily; if improvement is not observed within 3 to 5 days, it is discontinued

  12. D.Antifungals • 1.May cause erythema, stinging, blistering, peeling, pruritus, urticaria, and general skin irritation • 2.Client is re-evaluated if no results are obtained after 4 weeks of treatment

  13. E.Antiviral: Acyclovir (Zovirax) • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 6 of 33 — printed page 493) • 1.Inhibits DNA replication in the virus • 2.Used for herpes simplex virus types 1 and 2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus • 3.Can cause mild pain and transient burning and stinging. • 4.Applied completely over the lesion every 3 hours six times daily for 1 week • 5.Rubber gloves are used to apply the ointment to prevent the spread of infection

  14. F.Antiparasitics • 1.Used to treat scabies (mites) and pediculosis (lice) • 2.May be harmful during pregnancy and in young children • 3.May irritate the skin, eyes, and mucous membranes • 4.May cause allergic reactions • 5.Permethrin 5% (Elimite)

  15. a.Wash, rinse, and towel dry the hair; apply sufficient volume to saturate the hair and scalp • b.Allow to remain on the hair 10 minutes and then rinse with water • 6.Lindane (Kwell) • a.Applied in a thin layer to the entire body below the head; no more than 30 g (1 oz) should be used • b.The medication is removed by washing 8 to 12 hours later; usually, only one application is required

  16. BOX 41-4 Antibacterials, Antifungals, Antiviral, and Antiparasitics • ANTIBACTERIALS • Bacitracin • Chlortetracycline • Chloramphenicol • Erythromycin • Gentamicin • Mupirocin (Bactroban) • Mycitracin Triple Antibiotic (neomycin, bacitracin, polymyxin B) • Neomycin

  17. ANTIFUNGALs • Amphotericin B (Fungizone) • Betamethasone and clotrimazole (Lotrisone) • Ciclopiroxolamine (Loprox) • Clioquinol (Vioform) • Clotrimazole (Lotrimin, Mycelex) • Econazole nitrate (Spectazole) • Haloprogin (Halotex) • Ketoconazole (Nizoral) • Miconazole (Micatin) • Nystatin (Mycostatin) • Tolnaftate (Tinactin) • Triacetin (Fungoid) • Undecylenic acid (Desenex)

  18. ANTIVIRAL • Acyclovir (Zovirax)

  19. ANTIPARASITICS • Crotamiton (Eurax) • Lindane (Kwell) • Permethrin 5% (Elimite) • Malathion (Ovide)

  20. . ANTIPRURITICS (Box 41-5) • A.Used to relieve itching • B.Applied as wet dressings, pastes, lotions, creams, or ointments • C.Persons with dry skin should be instructed to bathe less frequently

  21. . KERATOLYTICS (Box 41-6) • A.Description • 1.Preparations that dissolve keratin • 2.Soften scales and loosen the horny layer of the skin, resulting in minimal peeling or extensive desquamation • 3.Used to treat superficial fungal infections, dermatitis, psoriasis, and localized dermatitis

  22. VB.Salicylic acid • 1.Used to treat seborrheic dermatitis, acne, psoriasis, and to thin and remove calluses • 2.Can be absorbed systematically and can cause salicylism, characterized by dizziness and tinnitus; is not applied to large surface areas or open wounds

  23. C.Podophyllum resin • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 9 of 33 — printed page 494) • 1.Used for various types of skin cancer • 2.Causes lesions to slough off, leaving a superficial ulcer and moderate dermatitis • 3.After the therapy is discontinued, the lesions are treated with a mild antiseptic ointment; healing usually occurs within a few days

  24. D.Cantharidin (Cantharone) • 1.Used in treating warts • 2.Has an exfoliation effect only on epidermal cells • 3.May cause tingling, itching, and burning • 4.Site may be very tender for a period of 2 to 6 days

  25. E.Masoprocol (Actinex) • 1.Has antiproliferative activity against keratinocytes and is used to treat keratosis • 2.Occlusive dressings are not to be used • 3.Transient burning may be experienced after administration

  26. BOX 41-5 Antipruritics • Calamine lotion • Cornstarch or oatmeal baths • Solutions of bismuth salts, aluminum acetate, or boric acid • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 10 of 33 — printed page 494) • BOX 41-6 Keratolytics • Cantharidin (Cantharone) • Imiquimod (Aldara) • Masoprocol (Actinex) • Podophyllum resin • Podofilox (Condylox) • Resorcinol • Salicylic acid • BOX 41-7 Stimulants and Irritants • Coal tar • Compound benzoin tincture

  27. . STIMULANTS AND IRRITANTS (Box 41-7) • A.Description: Produce a mild irritation to the surface of the skin, causing hyperemia and inflammation that promote the healing process

  28. VIB.Coal tar • 1.Used in treating psoriasis, seborrheic dermatitis, and atopic dermatitis • 2.Has an unpleasant odor and frequently stains the skin and hair • 3.Can cause phototoxicity

  29. C.Compoundbenzoin tincture • 1.Protects the skin when the client has bed sores, ulcers, cracked nipples, and fissures of any orifice • 2.Causes a mild irritation that produces increased blood flow and healing • Top of Form

  30. . PROTECTIVES (Box 41-8) • A.Description • 1.Preparations that provide a film on the skin to protect it from irritations such as light, moisture, air, and dust • 2.Promote natural healing without the usual formation of dry crust over the wound • 3.Allow exudate to collect beneath the dressing, forming an artificial blister • 4.Designed to be left in place for up to 7 days or until leakage occurs around the dressing • 5.Uniflex and PolySkin may be used to cover central and peripheral IV sites • 6.Opsite, Tegasorb, Mediskin, and Vigilon may be used for skin burns

  31. BOX 41-8 Protectives • Benzoin • DuoDerm • Mediskin • Opsite • Polyskin • Tegaderm • Tegasorb • Uniflex • Vigilon • Zinc oxide paste (Unna Boot)

  32. B.Sunscreens • 1.Act by absorbing ultraviolet rays • 2.Most effective when applied about 30 to 60 minutes before exposure to the sun; should be reapplied every 2 to 3 hours after swimming or sweating • 3.Can cause contact dermatitis and photosensitivity reactions

  33. C.Nonadherent dressings • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 13 of 33 — printed page 495) • 1.Woven or nonwoven dressings that may be impregnated with saline, petrolatum, or antimicrobials • 2.Nonadherent dressings include Adaptic, Exu-Dry, Sofsorb, Telfa, vaseline gauze, and Xeroform

  34. GROWTH FACTORS • A.Description • 1.Used to promote wound healing • 2.Stimulate cells to divide and migrate, which results in wound healing, formation of granulation tissue, and new epidermis

  35. . B.Procuren solution • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 14 of 33 — printed page 495) • 1.Promotes healing by actively stimulating growth and granulation tissue, capillaries, and epithelium • 2.Applied to the wound and covered with petrolatum-impregnated gauze • 3.Left in place for 12 hours and then washed off; during the remaining 12 hours of the day, the wound is covered with sulfadiazine (Silvadene)

  36. ENZYMES • A.Description • 1.Used to promote healing of wounds and to debride skin ulcers • 2.Reduce inflammation resulting from trauma and infection • 3.Dissolve fibrin clots, which helps reduce the size of surface hematomas • 4.To be effective, must be in contact with affected tissue in adequate concentrations for a sufficient length of time • 5.Wound may need to be surgically debrided prior to application; if not administered to a clean, debrided wound, healing may be delayed

  37. BOX 41-9 Enzymes That Promote Wound Healing • Hyaluronidase (Wydase) • Papain (Panafil, Panafil White)

  38. B.Enzymes that promote wound healing (Box 41-9) • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 15 of 33 — printed page 495) • 1.Papain (Panafil, Panafil White) • a.Does not injure or affect healthy tissue or cells • b.Enzyme must be in immediate contact with the purulent wound material • c.Wounds are cleansed with prescribed irrigating solution between applications • d.Hydrogen peroxide cannot be used to irrigate the wound, because it inactivates the papain • e.Light dressings and cellophane wrap may be used over the wound to prevent soiling of clothing • f.Dressings are changed frequently to prevent contamination and to remove necrotic debris

  39. 2.Hyaluronidase (Wydase) • a.Facilitates the absorption of fluid administered by subcutaneous hypodermoclysis • b.Can be injected subcutaneous into an infiltrated IV site when a potent vasoconstrictor such as norepinephrine (Levophed) or metaraminol (Aramine) has infiltrated • c.It reduces the sloughing of tissue likely to occur secondarily to infiltration

  40. C.Enzymes to debride and remove exudates (Box 41-10) • 1.Description • a.Alter the thick, purulent drainage to a thin, liquid material that can be easily wiped or irrigated off the wound • b.Enzyme contact with the wound is necessary to promote wound healing • c.Wound needs to be cleansed; cross-hatching of eschar on burns is performed prior to application

  41. 2.Sutilains (Travase) • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 16 of 33 — printed page 496) • a.Used to remove nonviable or necrotic tissue and purulent enzymes from burns, ulcers, traumatic injury, and peripheral vascular disease wounds

  42. BOX 41-10 Enzymes to Debride and Remove Exudates • Collagenase (Santyl) • Dextranomer (Debrisan) • Fibrinolysin and desoxyribonuclease (Elase) • Sutilains (Travase) • b.Inactive on viable tissue • c.The wound is moistened with normal saline or sterile water before application

  43. 3.Collagenase (Santyl) • a.Used as a topical debriding agent • b.Provides effective debridement of the collagen tissue at the wound edges where necrotic tissue is anchored • c.Encourages the formation of granulation tissue at the wound edges and quicker epithelization of wounds • d.Apply with a tongue depressor directly into deep wounds • e.Prior to application, cleanse wound of debris by gently rubbing with a gauze pad with sterile water or Dakin solution, followed by sterile normal saline • f.Remove all excess ointment each time dressing is changed • g.Apply only to injured area; causes erythema in healthy tissues • h.Protect healthy tissue by applying zinc oxide paste • i.Discontinued when necrotic tissue is gone

  44. 4.Fibrinolysin and desoxyribonuclease (Elase) • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 17 of 33 — printed page 496) • a.Used to debride wounds, including burns, decubitus ulcers, and inflamed or infected lesions • b.Clean wound with sterile water, pat dry; flush away necrotic debris with normal saline, then apply a thin layer and cover with petrolatum gauze

  45. D.Dextranomer (Debrisan) • 1.Not a debriding agent but a cleansing agent that actually absorbs peptides and proteins • 2.Effective in wet wounds only • 3.It is not packed tightly into the wound because maceration of surrounding tissue may occur from contact with the agent

  46. . CORTICOSTEROIDS • A.Have anti-inflammatory, antipruritic, and vasoconstrictive actions • B.Contraindications • 1.Clients demonstrating previous sensitivity to corticosteroids • 2.Those with current systemic fungal, viral, or bacterial infections • 3.Those with current complications related to corticosteroid therapy

  47. XC.Local adverse effects • 1.Hypopigmentation • 2.Acneform eruptions • 3.Contact dermatitis • 4.Burning, dryness, irritation, itching • 5.Overgrowth of bacteria, fungi, and viruses • 6.Skin atrophy

  48. D.Systemic adverse effects • 1.Occur rarely • 2.Adrenal suppression • 3.Cushing's syndrome • 4.Striae, skin atrophy • 5.Ocular effects (glaucoma and cataracts)

  49. E.Topical steroids • Top of Form • Bottom of Form • CHAPTER 41 Integumentary Medications (page 19 of 33 — printed page 496) • 1.Monitor plasma cortisol levels if prolonged therapy is necessary • 2.Wash area just prior to application to increase medication penetration • 3.Apply sparingly in a light film, rubbing gently • 4.May apply to skin alone or with a dry occlusive dressing if prescribed by the physician • 5.Instruct the client to report burning, irritation, or signs of infection to the physician

  50. ACNE PRODUCTS (Box 41-11) • A.Description • 1.Mild acne can be treated with bar soaps, soap-free cakes, liquid cleansers, lotions, gels, and creams • 2.For moderate acne, topical anti-inflammatory medication such as benzoyl peroxide, tretinoin (Retin-A), isotretinoin (Accutane), azelaic acid (Azelex), and adapalene (Differin) may be prescribed; antibiotics may also be prescribed • 3.Side effects can include excessive redness, extreme dryness of the skin leading to blistering and crusting, temporary pigmentation changes, and peeling of the skin • 4.All products are kept away from the eyes, inside the nose, mucous membranes, and hair