UNIT-7- Drugs used in treatment of integumentary system
Drugs Used in the Treatment of Integumentary System Disorders: Introduction 1. Introduction The integumentary system consists of the skin, hair, nails, and glands . It acts as a protective barrier against infections, regulates body temperature, and enables sensation. Disorders affecting this system include infections, inflammatory conditions, autoimmune diseases, and skin cancers , requiring various topical and systemic medications .
Categories of Integumentary Drugs
Antimicrobial Agents (Antibiotics, Antifungals, Antivirals)Anti-Inflammatory Drugs (Corticosteroids, NSAIDs)Keratolytics & Emollients (Moisturizers, Salicylic Acid)Antipruritic Agents (Antihistamines, Calamine)Wound Healing Agents (Silver Sulfadiazine, Collagen Dressings)Immunosuppressants (Tacrolimus, Methotrexate for Psoriasis)Skin Lightening Agents (Hydroquinone, Retinoids)Anti-Acne Drugs (Benzoyl Peroxide, Isotretinoin)Anti-Parasitic Agents (Permethrin, Ivermectin)Chemotherapeutic Agents (5-Fluorouracil for skin cancer)
These drugs can be topical (creams, ointments, gels, lotions) or systemic (oral, IV, or injections) depending on the severity and type of skin condition.
Antihistaminics & Antipruritics: 1. Introduction Antihistaminics and antipruritics are used to treat allergic reactions, itching (pruritus), inflammation, and other skin-related conditions . They work by blocking histamine receptors , reducing itching, swelling, and redness. These drugs are used for skin allergies, urticaria, eczema, insect bites, and anaphylaxis .
2. Antihistaminics A. Composition of Antihistaminics Antihistamines are classified based on their action on histamine receptors :
Types of Antihistaminics Class Examples Target Receptor 1st Generation (Sedative) Diphenhydramine, Chlorpheniramine, Hydroxyzine H1 Receptor 2nd Generation (Non-Sedative) Loratadine, Cetirizine, Fexofenadine H1 Receptor H2 Blockers (Used for acid control but also reduce histamine effects in skin) Ranitidine, Famotidine H2 Receptor
B. Mechanism of Action
H1 Antihistamines : Block H1 receptors, reducing itching, swelling, and allergic reactions .H2 Antihistamines : Block H2 receptors, reducing gastric acid production (also helpful in some allergic reactions).
C. Dosage & Route Drug Dosage Route Diphenhydramine 25-50 mg every 6-8 hrs Oral, IV, IM Loratadine 10 mg once daily Oral Cetirizine 5-10 mg once daily Oral Fexofenadine 60-180 mg once daily Oral Hydroxyzine 25-100 mg every 6 hrs Oral, IM
D. Indications
Allergic reactions (hives, rashes, insect bites) Atopic dermatitis (eczema) Seasonal allergies (hay fever, allergic rhinitis) Anaphylaxis (adjunct to epinephrine) Motion sickness & nausea (Diphenhydramine, Hydroxyzine) Insomnia (First-generation antihistamines) Anxiety (Hydroxyzine)
E. Contraindications
Severe liver/kidney disease Glaucoma (First-generation antihistamines) Benign Prostatic Hyperplasia (BPH) (Can cause urinary retention) Severe respiratory conditions (Sedative antihistamines can depress breathing) Pregnancy & breastfeeding (Certain antihistamines may not be safe)
F. Drug Interactions Interacting Drug Effect CNS Depressants (Alcohol, Benzodiazepines, Opioids) Increased sedation MAO Inhibitors Prolonged antihistamine effects Anticholinergic Drugs (Atropine, Antidepressants) Increased risk of dry mouth, blurred vision H2 Blockers & Proton Pump Inhibitors Can interfere with absorption
G. Side Effects First-Generation Second-Generation Drowsiness Minimal drowsiness Dry mouth, Blurred vision Headache Urinary retention Fatigue Dizziness, Confusion (Elderly) Nausea
H. Adverse Effects & Toxicity
First-generation antihistamine overdose :
Severe sedation, hallucinations, seizures, respiratory depression .
Management : Supportive care, activated charcoal, IV fluids.
Second-generation antihistamine overdose :
Less severe, but may cause headache, tachycardia, dizziness .
I. Role of the Nurse in Antihistaminic Therapy ✅ Before Administration
Assess for allergy history .
Monitor liver/kidney function .
Avoid in glaucoma, urinary retention .
✅ During Administration
Give with food if GI upset occurs.Monitor for drowsiness (especially first-generation).
✅ After Administration
Educate about avoiding alcohol .Caution against driving or operating machinery .Monitor for overdose symptoms .
3. Antipruritics (Anti-Itching Drugs) A. Composition of Antipruritics Class Examples Formulation Topical Antihistamines Diphenhydramine Cream Cream, Lotion Corticosteroids Hydrocortisone, Betamethasone Ointment, Cream Counterirritants Menthol, Camphor, Calamine Lotion, Gel Topical Immunomodulators Tacrolimus, Pimecrolimus Cream, Ointment Oral Antihistamines Hydroxyzine, Cetirizine Tablets, Syrup
B. Mechanism of Action
Antihistamines : Reduce itching by blocking histamine release.Corticosteroids : Reduce inflammation, swelling, and redness.Counterirritants (Calamine, Menthol, Camphor) : Provide cooling relief and distract nerve receptors.Immunomodulators (Tacrolimus, Pimecrolimus) : Reduce immune response in chronic skin conditions like eczema and psoriasis .
C. Dosage & Route Drug Dosage Route Hydrocortisone Cream 1% Apply 2-3 times daily Topical Calamine Lotion Apply as needed Topical Tacrolimus Ointment Apply twice daily Topical Oral Hydroxyzine 25-50 mg every 6-8 hrs Oral
D. Indications
Pruritus (Itching) from eczema, hives, psoriasis Insect bites, allergic skin reactions Poison ivy, sunburn relief Chronic inflammatory skin conditions (Psoriasis, Atopic Dermatitis) Post-surgical wound itching relief
E. Contraindications
Open wounds, infections (Topical Steroids & Antihistamines) Severe skin infections (Immunosuppressants like Tacrolimus) Liver/kidney disease (Systemic antipruritics)
F. Drug Interactions Interacting Drug Effect Other topical medications May interact and reduce effectiveness Systemic Corticosteroids Increased side effects when combined with topical steroids
G. Side Effects
Topical Steroids : Skin thinning, redness, irritation Counterirritants : Burning sensation, rash Oral Antipruritics : Drowsiness, dizziness, dry mouth
H. Adverse Effects & Toxicity
Prolonged steroid use : Skin thinning, adrenal suppression Antihistamine overdose : Hallucinations, seizures, coma Tacrolimus toxicity : Severe skin burning, risk of lymphoma with long-term use
🔹 Management of Toxicity :
Stop drug immediately Hydration & symptomatic treatment Activated charcoal for oral overdose
I. Role of the Nurse in Antipruritic Therapy ✅ Before Administration
Assess for allergies & skin conditions .
Monitor for open wounds or infections .
✅ During Administration
Apply thin layers of steroids to avoid side effects.Monitor for burning sensation in tacrolimus use.
✅ After Administration
Educate on avoiding overuse of steroids .Caution against prolonged antihistamine use .Monitor for systemic side effects .
Drugs Used in the Treatment of Integumentary System Disorders 1. Introduction The integumentary system (skin, hair, and nails) is prone to infections, inflammatory conditions, autoimmune disorders, and cancers . Various topical and systemic drugs are used to treat bacterial, fungal, viral infections, inflammation, wounds, acne, hyperpigmentation, and parasitic infestations .
2. Antimicrobial Agents A. Antibiotics Composition & Examples Class Examples Formulation Topical Antibiotics Mupirocin, Fusidic Acid, Neomycin Cream, Ointment Systemic Antibiotics Amoxicillin, Doxycycline, Clindamycin Oral, IV Broad-Spectrum Ciprofloxacin, Metronidazole Oral, IV
Mechanism of Action
Inhibit bacterial cell wall synthesis (Penicillins, Cephalosporins).Inhibit protein synthesis (Macrolides, Tetracyclines).Disrupt bacterial DNA replication (Fluoroquinolones).
Dosage & Route
Mupirocin (topical) : Apply 2-3 times daily .Amoxicillin (oral) : 500 mg every 8 hours .
Indications
Bacterial skin infections (impetigo, cellulitis)
Acne (Doxycycline, Clindamycin) Post-surgical wound infections
Contraindications
Allergy to antibiotics Severe liver or kidney disease
Drug Interactions
Tetracyclines & Dairy Products : Reduced absorption.Macrolides & Anticoagulants : Increased bleeding risk.
Side Effects & Adverse Effects
GI disturbances (Nausea, diarrhea).Allergic reactions (Rash, anaphylaxis).Antibiotic resistance with misuse .
Role of the Nurse ✅ Monitor for allergies, complete full course, and prevent resistance .
B. Antifungals Composition & Examples Class Examples Formulation Topical Antifungals Clotrimazole, Ketoconazole Cream, Powder Oral Antifungals Fluconazole, Itraconazole Oral IV Antifungals Amphotericin B IV
Mechanism of Action
Disrupt fungal cell membrane (Azoles).Inhibit fungal growth (Terbinafine).
Dosage & Route
Clotrimazole (topical) : Apply twice daily .Fluconazole (oral) : 150 mg once weekly .
Indications
Ringworm, Athlete’s foot, Yeast infections Fungal nail infections (Onychomycosis)
Contraindications
Liver disease (Oral antifungals) Pregnancy (Some azoles are unsafe)
Drug Interactions
Azoles & Warfarin : Increased bleeding risk.
Side Effects & Adverse Effects
Liver toxicity (Fluconazole, Itraconazole) .Skin irritation (Topical antifungals) .
Role of the Nurse ✅ Monitor liver function for oral antifungals .
C. Antivirals Composition & Examples Class Examples Formulation Topical Antivirals Acyclovir, Penciclovir Cream Oral Antivirals Acyclovir, Valacyclovir Oral IV Antivirals Foscarnet, Ganciclovir IV
Mechanism of Action
Inhibit viral DNA replication .
Dosage & Route
Acyclovir (topical) : Apply 5 times daily .Valacyclovir (oral) : 1g twice daily .
Indications
Herpes simplex (Cold sores, Genital herpes) Varicella (Chickenpox, Shingles)
Contraindications Drug Interactions
Acyclovir & Nephrotoxic Drugs : Increased kidney damage risk.
Side Effects & Adverse Effects
Nausea, Headache (Oral antivirals).Nephrotoxicity (IV antivirals) .
Role of the Nurse ✅ Encourage early treatment for best results .
3. Anti-Inflammatory Drugs A. Corticosteroids Composition & Examples Type Examples Formulation Topical Hydrocortisone, Betamethasone Cream Systemic Prednisone, Dexamethasone Oral, IV
Mechanism of Action
Suppress inflammation and immune response .
Dosage & Route
Hydrocortisone : Apply twice daily .Prednisone (oral) : 5-60 mg daily .
Indications
Eczema, Psoriasis, Allergic reactions .
Contraindications
Fungal infections (Steroids can worsen them).
Drug Interactions
NSAIDs & Corticosteroids : Increased risk of ulcers.
Side Effects & Adverse Effects
Skin thinning, delayed wound healing .Adrenal suppression (Systemic steroids) .
Role of the Nurse ✅ Apply thin layers, monitor long-term use .
B. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) Composition & Examples Drug Formulation Ibuprofen, Diclofenac Oral, Gel
Mechanism of Action
Block prostaglandin production , reducing inflammation.
Dosage & Route
Ibuprofen : 200-400 mg every 6-8 hrs .
Indications
Inflammatory skin conditions, sunburn relief .
Contraindications Drug Interactions
NSAIDs & Anticoagulants : Increased bleeding risk.
Side Effects & Adverse Effects
GI bleeding, Kidney damage .
Role of the Nurse ✅ Administer with food to reduce gastric irritation .
4. Other Drugs Category Examples Indications Keratolytics Salicylic Acid, Urea Psoriasis, Warts, Dandruff Antipruritics Calamine, Diphenhydramine Itching, Allergies Wound Healing Agents Silver Sulfadiazine, Collagen Dressings Burns, Chronic Ulcers Immunosuppressants Tacrolimus, Methotrexate Psoriasis, Eczema Skin Lightening Agents Hydroquinone, Retinoids Hyperpigmentation, Melasma Anti-Acne Drugs Benzoyl Peroxide, Isotretinoin Acne Vulgaris Anti-Parasitic Agents Permethrin, Ivermectin Scabies, Lice Chemotherapeutic Agents 5-Fluorouracil Skin Cancer
Drugs Used in the Treatment of Integumentary System Disorders 1. Introduction The integumentary system (skin, hair, and nails) is vulnerable to infections, inflammation, immune disorders, hyperpigmentation, wounds, and cancers . Various topical and systemic drugs are used to treat conditions like acne, eczema, psoriasis, wounds, parasitic infestations, and skin cancers .
2. Keratolytics & Emollients A. Composition of Keratolytics & Emollients Class Examples Formulation Keratolytics Salicylic Acid, Urea, Lactic Acid Cream, Lotion, Gel Emollients Petrolatum, Glycerin, Lanolin Cream, Ointment
B. Mechanism of Action
Keratolytics : Dissolve keratin in the skin, promoting exfoliation and renewal.Emollients : Hydrate and soften the skin by forming a protective layer.
C. Dosage & Route
Salicylic Acid (2-10%) : Apply twice daily (topical).Urea Cream (10-40%) : Apply once daily (topical).
D. Indications
Psoriasis, Eczema, Ichthyosis Dandruff, Warts, Acne Dry skin, Cracked heels
E. Contraindications
Open wounds (Strong keratolytics may cause irritation) Salicylic acid allergy Pregnancy (High doses of keratolytics may be unsafe)
F. Drug Interactions
Salicylic Acid & Retinoids : Increased skin irritation.Keratolytics & Tretinoin : Severe peeling.
G. Side Effects & Adverse Effects
Skin peeling, Redness, Burning Allergic reactions (rare)
H. Role of the Nurse ✅ Educate on proper application, avoid excessive use, and prevent irritation .
3. Antipruritic Agents A. Composition of Antipruritics Class Examples Formulation Topical Antihistamines Diphenhydramine Cream, Gel Corticosteroids Hydrocortisone Cream, Ointment Cooling Agents Calamine, Menthol, Camphor Lotion, Gel
B. Mechanism of Action
Antihistamines : Block histamine to reduce itching.Steroids : Reduce inflammation.Cooling Agents : Soothe itching by nerve desensitization.
C. Dosage & Route
Calamine Lotion : Apply as needed (topical).Hydrocortisone 1% : Apply twice daily (topical).Oral Diphenhydramine : 25-50 mg every 6-8 hours (oral).
D. Indications
Allergic reactions, Hives, Eczema Insect bites, Poison ivy, Pruritus
E. Contraindications
Skin infections (Steroids can worsen them) Glaucoma (Oral antihistamines can increase pressure)
F. Drug Interactions
Antihistamines & Alcohol : Increased sedation.
G. Side Effects & Adverse Effects
Drowsiness (Oral Antihistamines) Skin thinning (Steroids)
H. Role of the Nurse ✅ Educate patients on limited steroid use, avoid sedation risk with antihistamines .
4. Wound Healing Agents A. Composition of Wound Healing Agents Class Examples Formulation Antimicrobials Silver Sulfadiazine Cream Growth Factors Collagen Dressings Dressing, Gel
B. Mechanism of Action
Silver Sulfadiazine : Prevents bacterial infection in burns.Collagen Dressings : Promote new tissue growth.
C. Dosage & Route
Silver Sulfadiazine : Apply once or twice daily (topical).Collagen Dressing : Apply as needed .
D. Indications
Burns, Chronic ulcers, Wound infections
E. Contraindications
Sulfa allergy (Silver Sulfadiazine)
F. Drug Interactions
Silver Sulfadiazine & Enzymatic Debriders : May reduce effectiveness.
G. Side Effects & Adverse Effects
Skin discoloration Delayed healing with overuse
H. Role of the Nurse ✅ Monitor for infection, educate on proper dressing changes .
5. Immunosuppressants (Psoriasis, Eczema) A. Composition Drug Formulation Tacrolimus, Pimecrolimus Ointment Methotrexate Oral, Injection
B. Mechanism of Action
Tacrolimus : Suppresses immune response in eczema.Methotrexate : Slows cell division in psoriasis.
C. Dosage & Route
Tacrolimus (0.03-0.1%) : Apply twice daily (topical).Methotrexate : 7.5-25 mg once weekly (oral).
D. Indications
Psoriasis, Atopic dermatitis
E. Contraindications
Pregnancy, Immunocompromised patients
F. Side Effects & Adverse Effects
Skin burning, Increased infection risk Methotrexate: Liver toxicity, Bone marrow suppression
H. Role of the Nurse ✅ Monitor for infections, avoid sun exposure .
Drugs Used in the Treatment of Acne, Parasitic Infections, and Skin Cancer 1. Introduction The integumentary system is prone to conditions such as acne, parasitic infestations, and skin cancers . Various topical and systemic drugs help in reducing inflammation, eliminating infections, and treating malignancies . This guide details Anti-Acne Drugs, Anti-Parasitic Agents, and Chemotherapeutic Agents for skin disorders.
2. Anti-Acne Drugs A. Composition of Anti-Acne Drugs Class Examples Formulation Keratolytics & Antibacterials Benzoyl Peroxide Gel, Cream, Wash Retinoids (Vitamin A Derivatives) Isotretinoin, Tretinoin Oral, Topical Antibiotics Clindamycin, Doxycycline Oral, Topical Hormonal Agents Spironolactone, Oral Contraceptives Oral
B. Mechanism of Action
Benzoyl Peroxide : Kills acne-causing bacteria (P. acnes ) and unclogs pores.Isotretinoin : Reduces sebaceous gland activity and prevents acne formation.Clindamycin : Inhibits bacterial growth in acne lesions.Hormonal Agents : Reduce androgens that stimulate oil production .
C. Dosage & Route Drug Dosage Route Benzoyl Peroxide (2.5-10%) Apply once or twice daily Topical Isotretinoin 0.5-2 mg/kg/day Oral Clindamycin (1%) Apply twice daily Topical Doxycycline 100 mg once daily Oral
D. Indications
Mild to severe acne vulgaris Cystic acne (Isotretinoin) Hormonal acne (Oral contraceptives, Spironolactone) Inflammatory acne with bacterial infection (Antibiotics)
E. Contraindications Drug Contraindications Benzoyl Peroxide Hypersensitivity, severe dry skin Isotretinoin Pregnancy (teratogenic ), liver disease Antibiotics Allergies, drug-resistant cases Hormonal Agents Pregnancy, clotting disorders
F. Drug Interactions Interacting Drug Effect Isotretinoin & Vitamin A Supplements Increased toxicity Tretinoin & Benzoyl Peroxide Severe skin irritation Doxycycline & Dairy Products Reduced antibiotic absorption
G. Side Effects & Adverse Effects Drug Common Side Effects Serious Adverse Effects Benzoyl Peroxide Dryness, Peeling Severe skin irritation Isotretinoin Dry lips, Nosebleeds Birth defects, Depression, Liver toxicity Clindamycin Skin irritation Pseudomembranous colitis Doxycycline Nausea, Photosensitivity Esophagitis
H. Role of the Nurse ✅ Before Administration
Assess pregnancy status (Isotretinoin is highly teratogenic). Check for drug allergies (especially antibiotics). Educate on sun protection (Retinoids & Doxycycline increase photosensitivity).
✅ During Administration
Apply topical agents on clean, dry skin. Advise avoiding harsh soaps and cosmetics during acne treatment. Monitor for mood changes (Isotretinoin may cause depression).
✅ After Administration
Educate on contraception use with Isotretinoin. Monitor for dryness and adjust moisturizer use. Encourage dietary modifications (Avoid dairy with Doxycycline).
3. Anti-Parasitic Agents A. Composition of Anti-Parasitic Agents Class Examples Formulation Scabicides Permethrin Cream, Lotion Lice Treatment Agents Ivermectin, Malathion Lotion, Oral Oral Antiparasitics Ivermectin Tablets
B. Mechanism of Action
Permethrin : Paralyzes and kills lice and scabies mites by acting on their nervous system.Ivermectin : Disrupts neurotransmission in parasites, leading to paralysis and death.
C. Dosage & Route Drug Dosage Route Permethrin (5%) Apply overnight Topical Ivermectin 200 mcg/kg once weekly Oral
D. Indications
Scabies, Pediculosis (lice infestation) Resistant scabies (Ivermectin) Crusted scabies in immunocompromised patients
E. Contraindications
Pregnancy & lactation (Ivermectin) Children under 2 years (Permethrin 5%) Neurological disorders (Ivermectin may cause worsening of seizures)
F. Drug Interactions Interacting Drug Effect Ivermectin & Warfarin Increased bleeding risk Permethrin & Corticosteroids Reduced effectiveness
G. Side Effects & Adverse Effects Drug Common Side Effects Serious Adverse Effects Permethrin Itching, Skin burning Rare allergic reaction Ivermectin Nausea, Fatigue Neurotoxicity, Liver toxicity
H. Role of the Nurse ✅ Before Administration
Confirm diagnosis of scabies or lice. Check for history of seizures before giving Ivermectin.
✅ During Administration
Apply Permethrin to all affected areas and leave overnight. Ensure proper hair treatment with lice shampoo.
✅ After Administration
Educate on washing bedding and clothing to prevent reinfestation. Monitor for neurological side effects with Ivermectin.
4. Chemotherapeutic Agents (Skin Cancer) A. Composition of Chemotherapeutic Agents Class Examples Formulation Topical Chemotherapy 5-Fluorouracil (5-FU) Cream Systemic Chemotherapy Cisplatin, Methotrexate Injection
B. Mechanism of Action
5-Fluorouracil : Blocks DNA synthesis, causing cancer cell death.
C. Dosage & Route Drug Dosage Route 5-FU (5%) Apply twice daily for 4-6 weeks Topical Methotrexate 15-25 mg weekly Oral, Injection
D. Indications
Actinic keratosis, Basal cell carcinoma Squamous cell carcinoma (early-stage)
E. Contraindications
Pregnancy & breastfeeding Immunosuppression Severe liver/kidney disease
F. Drug Interactions Interacting Drug Effect 5-FU & NSAIDs Increased toxicity Methotrexate & Alcohol Liver damage risk
G. Side Effects & Adverse Effects
Skin redness, Peeling, Photosensitivity Bone marrow suppression (Methotrexate)
H. Role of the Nurse ✅ Apply 5-FU only to affected areas. ✅ Educate on sun protection. ✅ Monitor for signs of infection (Methotrexate suppresses immunity).
Topical Applications for Skin: Benzyl Benzoate, Gamma BHC, Clotrimazole, Miconazole, Silver Sulfadiazine 1. Introduction Topical skin applications are used for treating parasitic infections, fungal infections, and burns . They provide localized action , reducing systemic side effects . The main classes of topical medications include antiparasitic agents, antifungals, and burn treatment agents .
2. Benzyl Benzoate (Anti-Parasitic Agent) A. Composition of Benzyl Benzoate
Benzyl Benzoate 25% (Lotion) Available in lotion and emulsion form.
B. Mechanism of Action
Kills scabies mites and lice by neurotoxicity .Penetrates the exoskeleton of parasites, causing their death.
C. Dosage & Route Formulation Dosage Route Benzyl Benzoate 25% Lotion Apply thinly at bedtime , wash off after 24 hours Topical
D. Indications
Scabies (Sarcoptes scabiei) Lice (Pediculosis)
E. Contraindications
Infants & children under 2 years (risk of neurotoxicity).Pregnant & lactating women .Broken or inflamed skin (causes irritation).
F. Drug Interactions
No significant systemic drug interactions.
G. Side Effects & Adverse Effects
Skin irritation, Redness, Itching Burning sensation on sensitive skinAllergic reactions (Rare: Rash, Swelling, Difficulty breathing)
H. Role of the Nurse ✅ Before Administration
Assess for scabies or lice infestation .
Trim nails to prevent reinfestation.
✅ During Administration
Apply to the whole body (except face and scalp in adults). Avoid mucous membranes (eyes, nose, mouth, genitals).
✅ After Administration
Advise washing clothes and bedding in hot water to prevent reinfestation.Reapply if needed after one week .
3. Gamma Benzene Hexachloride (Gamma BHC) / Lindane (Anti-Parasitic Agent) A. Composition of Gamma BHC
Gamma Benzene Hexachloride (Lindane) 1% Lotion or Shampoo .
B. Mechanism of Action
Neurotoxic to lice and scabies mites , causing paralysis and death.Absorbed through the exoskeleton of parasites .
C. Dosage & Route Formulation Dosage Route Gamma BHC (1% Lotion) Apply once, leave for 8-12 hours, wash off Topical Gamma BHC (Shampoo) Apply for 4 minutes , then rinse Topical (Hair)
D. Indications
Scabies Head lice (Pediculosis capitis) Body lice
E. Contraindications
Pregnant & lactating women (teratogenic).Children under 2 years .Neurological disorders (Epilepsy, Seizures) .
F. Drug Interactions Interacting Drug Effect CNS Depressants (Alcohol, Sedatives) Increased neurotoxicity risk
G. Side Effects & Adverse Effects
Mild skin irritation, itching Seizures (Rare, in overdose cases) Neurotoxicity in infants & elderly
H. Role of the Nurse ✅ Before Administration
Assess neurological history (Epilepsy risk) .Check for skin breaks (avoid use on irritated skin).
✅ During Administration
Apply to dry skin, cover all affected areas .Do not use more than once (toxic with repeated applications).
✅ After Administration
Advise on washing clothes, towels, and combs. Monitor for seizures or neurological symptoms.
4. Clotrimazole & Miconazole (Antifungal Agents) A. Composition of Clotrimazole & Miconazole Drug Composition Clotrimazole (1%) Topical Cream, Lotion, Powder Miconazole (2%) Cream, Gel, Powder
B. Mechanism of Action
Inhibits ergosterol synthesis , disrupting fungal cell membranes.Prevents fungal growth and replication .
C. Dosage & Route Formulation Dosage Route Clotrimazole 1% Cream Apply twice daily for 2-4 weeks Topical Miconazole 2% Cream Apply twice daily for 2-4 weeks Topical
D. Indications
Ringworm (Tinea corporis) Athlete’s foot (Tinea pedis) Vaginal yeast infections Candidiasis (Oral thrush, skin infections)
E. Contraindications
Hypersensitivity to azole antifungals .Open wounds (risk of systemic absorption).
F. Drug Interactions Interacting Drug Effect Clotrimazole & Warfarin Increased bleeding risk Miconazole & Statins Increased statin toxicity
G. Side Effects & Adverse Effects
Redness, Itching, Burning Sensation Allergic Reactions (Rare: Rash, Swelling, Difficulty Breathing)
H. Role of the Nurse ✅ Before Administration
Assess for fungal infection symptoms (redness, scaling, itching). Educate on hygiene to prevent reinfection.
✅ During Administration
Apply a thin layer over affected areas. Use separate towels for infected areas.
✅ After Administration
Continue full course (even if symptoms disappear early). Advise on keeping skin dry to prevent fungal growth.
5. Silver Sulfadiazine (For Burns) A. Composition of Silver Sulfadiazine
Silver Sulfadiazine 1% Cream .
B. Mechanism of Action
Releases silver ions , which kill bacteria and fungi .Prevents wound infection and promotes healing .
C. Dosage & Route Formulation Dosage Route Silver Sulfadiazine (1%) Apply once or twice daily Topical
D. Indications
Second and third-degree burns Infected wounds Pressure ulcers
E. Contraindications
Sulfa allergy .Pregnancy (Third trimester, risk of kernicterus). Premature infants & newborns (risk of jaundice).
F. Drug Interactions
Warfarin (Increased bleeding risk).Enzymatic Debriders (Collagenase, Papain) (Reduced wound healing).
G. Side Effects & Adverse Effects
Temporary burning sensation Skin discoloration Delayed wound healing if overused
H. Role of the Nurse ✅ Before Administration
Assess burn severity and signs of infection .
✅ During Administration
Apply a thick layer without rubbing .Cover with a sterile dressing .
✅ After Administration
Monitor for signs of systemic absorption (rash, fever, low WBC count). Change dressings as advised by the physician .