Nursing Pharmacology-Severe Contact Dermatitis example
Nursing Pharmacology-Severe Contact Dermatitis example
Case Overview
8-years old jimmy presents with a red rash on his arms and legs that is consistent with server contact dermatitis. Contact dermatitis is the inflammation of the skin due to an allergic reaction that causes a skin rash, itchiness, blisters, scaly skin, and tenderness. Causes of contact dermatitis are solvents, detergents, and rubbing alcohol. Nursing Pharmacology-Severe Contact Dermatitis example
What Will You Prescribe?
The therapeutic goals are to reduce the symptoms and prevent complications. Medications used in treating contact dermatitis are topical and oral corticosteroids, antihistamines, and immunosuppressive agents (Scheinman, et al, 2021). Therefore, when selecting the drug of choice, consider the location of dermatitis. For example, topical immunomodulators are mostly preferred in facial dermatitis compared to topical corticosteroids. I will prescribe; Nursing Pharmacology-Severe Contact Dermatitis example
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- Dexamethasone cream 0.05% twice daily for two weeks
- Prednisone 2mg/kg PO daily for ten days
- Hydroxyzine 12.5mg PO thrice daily for five days
- Tacrolimus topical ointment 0.03% apply once daily
Contraindications
Contraindications of dexamethasone are in bacterial skin infections because the vasoconstriction and anti-inflammatory effect masks infection, delays diagnosis, and treatment (Awad, N., & Preuss, C. V. 2021). Hydroxyzine is anti-histamine whose contraindications are in chronic heart failure and glaucoma. Prednisone is a corticosteroid contraindicated in herpes simplex, diabetes mellitus, and active tuberculosis (Puckett, et al, 2021). Tacrolimus is a topical immunosuppressive agent for treating eczema and contact dermatitis. However, it is contraindicated in bacterial skin infections, herpes skin infection, cancer, and shingles.
ADRs
Adverse drug reactions are unpleasant reactions resulting from medicinal products. The adverse drug reactions in dexamethasone cream are skin atrophy, striae, and perioral dermatitis (Awad, N., & Preuss, C. V. 2021). Prednisone adverse effects are hyperglycemia, increased infections, weight gain, and skin fragility. Hydroxyzine adverse drug reactions are drowsiness and dry mouth. Adverse drug reactions in tacrolimus are myocardial hypertrophy, hyperkalemia, and skin infections. Nursing Pharmacology-Severe Contact Dermatitis example
Monitoring
Drug monitoring is a treatment strategy that helps the care provider to achieve the maximum therapeutic effects. Special monitoring when co-administering drugs to avoid adverse reactions is necessary. For example, monitor tacrolimus for side effects when using alongside other creams. Additionally, monitor hydroxyzine when giving together with narcotics. Monitor the dexamethasone use up to four weeks to avoid local and systemic adverse events. Monitor the patient when tapering down on the dosage of prednisone to avoid adverse effects of abrupt withdrawal.
Patient Education
Patient education involves providing information for further contact, identifying the sources of contact, barrier protection, skincare, and hygienic measures. Educate the patient that the allergy does not disappear when the contact dermatitis disappears (Scheinman, et al, 2021). Additionally, educate the patient that the contact dermatitis takes longer to clear and recurrences are common unless the contact is avoided. The patient should use personal protective gear when getting into contact with the source of allergy. The patient should expect secondary bacterial infection in cases of chronic contact dermatitis. Patient education helps to prevent complications and maintain therapeutic goals. Nursing Pharmacology-Severe Contact Dermatitis example
References
Awad, N., & Preuss, C. V. (2021). Halobetasol Cream. In StatPearls [Internet]. StatPearls Publishing.
Puckett, Y., Gabbar, A., & Bokhari, A. A. (2022). Prednisone. StatPearls [Internet].
Scheinman, P. L., Marc, V., Thyssen, J. P., Johansen, J. D., Nixon, R. L., Dear, K., … & Goldminz, A. M. (2021). Contact dermatitis (Primer). Nature Reviews: Disease Primers, 7(1).
A topical corticosteroid preparation with low to intermediate potency applied twice a day is the appropriate first-line therapy. If improvement does not occur, a higher-potency topical corticosteroid may be tried rather than increasing the time of administration of the lower-potency agent. Occlusive dressings and application to moist skin may be efficacious in treating the acute phase. Low-potency topical corticosteroids are used on the face and intertriginous areas. Oral antihistamines are used to relieve pruritus and reduce the response to the cause.
Mrs. Keen brings in 8-year-old Jimmy with a red rash on his arms and legs that is consistent with severe contact dermatitis. What will you prescribe? Include contraindications, ADR’s, monitoring, and patient education. Arcangelo V. P., Peterson A. M., Wilbur V., & Reinhold J. A. (2016). Pharmacotherapeutics for Advanced Practice. [Yuzu]. Retrieved from https://reader.yuzu.com/#/books/9781496374066/ is the book we are using for this course if you can access if not please make sure all references are professional and references are apa with doi thanks Nursing Pharmacology-Severe Contact Dermatitis example
