Integumentary Medications — Topical & Systemic Treatments, Sunscreen Education, and NCLEX Pharmacology Review | Chapter 40: Saunders NCLEX-PN Review

Integumentary Medications — Topical & Systemic Treatments, Sunscreen Education, and NCLEX Pharmacology Review | Chapter 40: Saunders NCLEX-PN Review

Chapter 40 of Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri provides a complete overview of medications used to treat integumentary disorders. Covering everything from poison ivy remedies to biologics for psoriasis, this chapter ensures nursing students are prepared for safe, effective pharmacologic management of skin conditions and related NCLEX questions.

Watch the video above for a concise review, then explore the expanded written breakdown below. Subscribe to Last Minute Lecture for more NCLEX-PN pharmacology and nursing care guides.

Book cover

Poison Ivy and Contact Dermatitis

Treatment includes calamine lotion, oatmeal baths, topical corticosteroids, and oral antihistamines for itching. Education should focus on avoiding re-exposure and recognizing infection signs in open lesions.

Atopic Dermatitis Medications

Moderate to severe cases may require topical immunomodulators like tacrolimus or pimecrolimus, or systemic agents such as cyclosporine. Nurses must educate patients on infection risk, sun protection, and adherence to therapy.

Topical Glucocorticoids

Used for anti-inflammatory and antipruritic effects, topical steroids vary in potency. Risks include systemic absorption (especially on thin skin areas like face or axilla), skin atrophy, and adrenal suppression. Apply with gloves and avoid occlusive dressings unless prescribed.

Actinic Keratosis Treatments

  • Fluorouracil cream: causes local irritation, applied for several weeks.
  • Imiquimod: immune response modifier, applied several times weekly.
  • Diclofenac gel: topical NSAID for precancerous lesions.
  • Photodynamic therapy agents: activated by specific light sources.

Sunscreen Education

Sunscreens are categorized as chemical (absorbing UV rays) or physical (reflecting UV rays, e.g., zinc oxide). Nurses should teach patients to choose SPF 15+ for daily use and SPF 30+ for prolonged outdoor exposure, applying 15–30 minutes before sun exposure and reapplying every 2 hours or after swimming/sweating.

Psoriasis Therapies

  • Topical: Coal tar, salicylic acid, tazarotene.
  • Systemic: Methotrexate, acitretin.
  • Biologics: Adalimumab, etanercept, ustekinumab — require infection screening before initiation.

Acne Treatments

  • Mild: Benzoyl peroxide, topical antibiotics, retinoids (tretinoin, adapalene).
  • Moderate to severe: Oral antibiotics, hormonal agents (oral contraceptives, spironolactone).
  • Severe cystic: Isotretinoin — requires iPLEDGE compliance, monthly pregnancy tests, lipid monitoring, and avoiding vitamin A supplements.

Burn Medications

  • Silver sulfadiazine: Broad-spectrum antimicrobial; monitor for leukopenia and sulfa allergy.
  • Mafenide acetate: Penetrates eschar; monitor for metabolic acidosis.

Apply with sterile gloves, using the prescribed thickness, and monitor for systemic absorption effects.

Special Nursing Considerations

Always assess for allergies, monitor lab values for systemic medications, teach proper application techniques, and emphasize adherence to therapy. For photosensitizing drugs, stress the importance of sunscreen and protective clothing.

Conclusion

Understanding integumentary pharmacology equips nurses to provide safe, effective, and patient-centered care. Mastery of topical and systemic treatments, combined with strong patient education skills, is essential for NCLEX-PN success.

If you found this breakdown helpful, be sure to subscribe to Last Minute Lecture for more chapter-by-chapter textbook summaries and academic study guides.

Explore the full playlist for Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) here: Complete NCLEX-PN Review Playlist

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