Antivirals
Drugs like acyclovir (Zovirax) and penciclovir (Denavir) are used to treat the herpes simplex virus (HSV), such as cold sores. These agents inhibit viral DNA replication. It is critical to note that while these drugs decrease symptoms and shorten healing time, they do not eradicate the virus from the body.
Anti-inflammatories and Antipruritics
When the skin becomes irritated, patients often experience pruritus (itching) and inflammation.
- Topical Corticosteroids: Hydrocortisone is a common example used to reduce redness and itching from dermatitis or insect bites. However, prolonged or excessive use can lead to skin atrophy (thinning of the skin).
- Topical Antihistamines: Diphenhydramine (Benadryl) can provide temporary relief by blocking H1 receptors.
Clinical Tip: Never apply corticosteroids to untreated bacterial, fungal, or viral infections, as they may actually make the infection worse.
Specialized Skin Treatments
Psoriasis Management
Psoriasis is a chronic condition characterized by silver plaques. Treatment varies based on severity:
- Mild/Localized: Treated with calcipotriene (a Vitamin D analog) to slow keratinocyte proliferation, salicylic acid (a keratolytic) to remove scales, or topical corticosteroids.
- Moderate-to-Severe: May require systemic immunosuppressants like methotrexate or biologic agents (e.g., adalimumab). A major nursing concern for patients on systemic immunosuppressants is the increased risk of infection.
Hair Loss Medications
Hair loss treatments often require months of continuous use before results are visible.
- Minoxidil (Rogaine): A topical agent that promotes hair growth.
- Finasteride (Propecia): A 5-alpha-reductase inhibitor that decreases the conversion of testosterone to dihydrotestosterone (DHT).
- Spironolactone: Used off-label for female hair loss due to its antiandrogen effects, but it carries risks of hyperkalemia and hypotension.
Antineoplastics and Sun Protection
- Antineoplastics: 5-fluorouracil (5-FU) is an antimetabolite used to treat precancerous lesions like actinic keratoses. It works by inhibiting DNA synthesis, which causes a predictable local inflammatory response, including redness and scaling.
- Sunscreen: To prevent skin cancer and aging, patients should use a broad-spectrum sunscreen (protecting against both UVA and UVB) with an SPF of 30 or higher.
Wound Care and Skin Preparation
Effective wound healing requires a combination of proper nutrition and topical agents.
Nutrition for Healing
- Vitamin C: Essential for collagen synthesis.
- Zinc: Supports tissue repair and immune function.
- Protein and Calories: Adequate intake is necessary to provide the energy required for repair.
Topical Wound Agents
- Collagenase (Santyl): An enzymatic debriding agent used to break down necrotic (dead) tissue in chronic wounds.
- Antiseptics:
- Chlorhexidine (CHG): A broad-spectrum antiseptic with persistent activity, often used for surgical skin preparation. It should never be used near the eyes, ears, or meninges.
- Isopropyl Alcohol: Provides rapid antimicrobial activity and is commonly used before injections.
Nursing Considerations for Topical Therapy
When administering any topical medication, nurses must assess the skin's integrity and check for allergies.
Systemic Absorption Risk:
One of the most important considerations is the risk of systemic absorption, where the drug enters the bloodstream despite being applied to the skin.
- Older Adults and Infants: These populations are at a significantly higher risk for systemic absorption and adverse effects due to differences in skin integrity and immune function.
- Application Technique: Avoid applying medications to large areas, broken skin, or under occlusive dressings unless specifically prescribed, as these can increase absorption.
Ophthalmic Concepts: Pupil Control and Glaucoma
The autonomic nervous system controls the size of the pupil, which is a critical concept when administering ophthalmic drugs.
- Parasympathetic Stimulation: Stimulates the iris sphincter muscle, causing miosis (constriction).
- Sympathetic Stimulation: Stimulates the iris dilator muscle, causing mydriasis (dilation).
Glaucoma and Intraocular Pressure (IOP)
Glaucoma involves progressive optic nerve damage, often caused by increased intraocular pressure (IOP) due to impaired drainage of aqueous humor.
- Open-Angle Glaucoma: The most common form; drainage is slow and gradual, often making it asymptomatic in early stages.
- Angle-Closure Glaucoma: A medical emergency where the iris obstructs the drainage angle, causing a sudden, painful spike in IOP. Symptoms include severe eye pain, headache, nausea, and vomiting.
Ophthalmic Drug Classes
- Miotics (Cholinergic Agonists): Drugs like pilocarpine cause miosis and increase aqueous humor outflow to decrease IOP.
- Beta-Adrenergic Blockers: Drugs like timolol decrease the production of aqueous humor.
- Alpha-2 Agonists: Brimonidine decreases production and increases outflow.
- Osmotic Agents: Used in emergencies to rapidly reduce severely elevated IOP.
Nursing Tip: To reduce systemic absorption of ophthalmic drops, apply nasolacrimal (punctal) occlusion by pressing on the inner corner of the eye for at least one minute after administration.
Otic (Ear) Medications
Hearing loss can be conductive (blocked sound in the outer/middle ear) or sensorineural (damage to the inner ear/nerve).
- Cerumenolytics: Agents like carbamide peroxide (Debrox) are used to soften impacted earwax.
- Antibiotics/Steroids: Used for otitis externa (swimmer's ear). Note that some antibiotics, like neomycin, should be avoided if the tympanic membrane is not intact due to the risk of ototoxicity.
Administration Tip: To instill ear drops, pull the pinna up and back for adults/children ≥3 years, and down and back for children <3 years. Always ensure drops are at body temperature to avoid causing dizziness or vertigo.
