TRETINOIN NURSING IMPLICATIONS

TRETINOIN

(tret′i-noyn)

Atralin, Avita, Refissa, Renova, Retin-A, Retin-A Micro, Retinoic Acid, Tretin-X Vesanoid

Classifications: ANTINEOPLASTIC; ANTIACNE (RETINOID); ANTIPSORIATIC

Therapeutic: ANTINEOPLASTIC; ANTIACNE; ANTIPSORIATIC

Prototype: Isotretinoin

Pregnancy Category: D (oral form); C (topical form)

AVAILABILITY

Cream; gel; capsule

ACTION & THERAPEUTIC EFFECT

Antiacne activity: Reverses retention hyperkeratosis and micro comedo formation in acne pathology.

Antineoplastic activity: Induces cellular differentiation in malignant cells. Its exact mechanism of action is unknown. Effective in early treatment and control of acne vulgaris grades I–III. Effective in treatment of (Acute Promyelocytic Leukemia) APL.

USES

Topical treatment of acne vulgaris grades I–III, especially during early stages when number of comedones is greatest; adjunctively in management of associated comedones and in treatment of flat warts; oral for remission induction treatment of acute promyelocytic leukemia; cream as adjunctive therapy for mitigation of fine wrinkles.

UNLABELED USES

Psoriasis, senile keratosis, ichthyosis vulgaris, keratosis palmaris and plantaris, basal cell carcinoma, photodamaged skin (photoaging), and other skin conditions. Orphan drug: For squamous metaplasia of conjunctiva or cornea with mucous deficiency and keratinization.

CONTRAINDICATIONS

Hypersensitivity to retinoid; eczema; exposure to sunlight or ultraviolet rays, sunburn; pregnancy (oral: category D).

CAUTIOUS USE

Patient in an occupation necessitating considerable sun exposure or weather extremes; hepatic disease; pregnancy (topical: category C); lactation; children younger than 18 y.

ROUTE & DOSAGE

Acne

Adult: Topical Apply once/day at bedtime

Acute Promyelocytic Leukemia

Adult: PO 45 mg/m2/day

Antiwrinkle Cream

Adult: Topical (0.05% cream) Apply to face once daily at bedtime

TRETINOIN NURSING IMPLICATIONS

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ADMINISTRATION

Topical

• Cleanse using a mild bland soap, and thoroughly dry areas being treated before applying drug. Avoid use of medicated, drying, or abrasive soaps and cleansers.
• Wash hands before and after treatment. Apply lightly over affected areas. Do not apply to nonaffected skin area.
• Avoid contact of drug with eyes, mouth, angles of nose, open wounds, mucous membranes.
• Store gel and liquid formulations below 30° C (86° F) and solution below 27° C (80° F).

ADVERSE EFFECTS (≥1%)

Body as a Whole: Note: Listed adverse effects occur primarily with oral administration; only skin effects with topical administration. Bone pain, malaise,

shivering, hemorrhage, peripheral edema, pain, chest discomfort, weight gain or loss, DIC. CNS: Dizziness, paresthesias, anxiety, insomnia, depression, headache, fever, weakness, fatigue, cerebral hemorrhage, intracranial hypertension, hallucinations. CV: Arrhythmias, flushing, hypotension, hypertension, CHF. Special Senses: Visual disturbances, ocular disturbances, change in visual acuity, earache. GI: Nausea, vomiting, abdominal pain, diarrhea, constipation, dyspepsia, GI hemorrhage. Respiratory: Dyspnea, respiratory insufficiency, pneumonia, rales, pleural effusion, wheezing. Skin: Local inflammatory reactions, transient stinging or warmth on site, redness, scaling, severe erythema, blistering, crusting and peeling, temporary hypopigmentation or hyperpigmentation, increased sweating. Urogenital: Renal insufficiency, dysuria, acute kidney failure.

INTERACTIONS

Drug: TOPICAL ACNE MEDICATIONS (including sulfur, resorcinol, benzoyl peroxide, and salicylic acid) may increase inflammation and peeling; topical products containing alcohol or menthol may cause stinging.

PHARMACOKINETICS

Absorption: Minimally absorbed from intact skin, Topical; 60% absorbed, PO. Elimination: About 0.1% of topical dose is excreted in urine within 24 h; 63% excreted in urine and 31% in feces, PO. Half-Life: 45 min, Topical; 2–2.5 h, PO.

NURSING IMPLICATIONS

Assessment & Drug Effects

Topical

• Be aware that topical treatment to dark-skinned individuals may cause unsightly postinflammatory hyperpigmentation; that is reversible with termination of drug treatment.
• Clinical response to topical treatment should be evident in 2–3 wk; complete and satisfactory response (in 75% of the patients) may require 3–4 mo.
• Be aware that erythema and desquamation during the first 1–3 wk of topical treatment do not represent exacerbation of the skin problem but a probable response to the drug from deep previously unseen lesions.

Patient & Family Education

Topical

• As treatment is continued, lesions gradually disappear, leaving an inflammatory background; scaling and redness decrease after 8–10 wk of therapy.
• Wash face no more often than 2–3 × daily.
• Be aware that drug is not curative; relapses commonly occur within 3–6 wk after treatment has been discontinued.
• Avoid exposure to sun; when cannot be avoided, use a SPF 15 or higher sunscreen.
• Do not self-medicate with additional acne treatment because of danger of drug interactions.

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Ditulis oleh Unknown pada tanggal Tuesday, September 29, 2015