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Pharmacology · chapter 40 · Dermatologic Disorder Drugs

Psoriatic Drugs

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. What psoriasis is

    Psoriasis is a T-lymphocyte–mediated autoimmune disease that mainly affects the skin. In many cases, however, it also affects the eyes, joints, and nails.

  2. Goals of psoriasis treatment

    Treatment of psoriasis involves combination systemic and topical therapies used to decrease inflammation, exfoliate skin plaques, and decrease the mitotic rate and maturation of skin cells.

  3. Methoxsalen and sun burns

    A safety concern with the use of this medication is that when clients are exposed to other sources of UV light, such as the sun, they may experience severe skin burns.

  4. Acitretin needs pregnancy screening

    Prescriptions cannot be given until pregnancy tests and other screenings have been completed and results verified (DailyMed, Acitretin, 2023).

  5. Retinoid contraindications

    These drugs are contraindicated in clients with pre-existing cardiac, renal, and hepatic conditions.

  6. Retinoids and pregnancy

    Retinoids, such as acitretin, are contraindicated for those who could become pregnant, are pregnant, or are breastfeeding.

  7. Clobetasol limits

    Application of clobetasol is limited to those areas that are not on the face, genitals, and axillae. It is important to remember that clients may experience systemic steroidal effects.

  8. Clobetasol for two weeks or less

    For this reason, clobetasol should be limited to use for 2 weeks or less.

  9. Protect skin around coal tar

    Coal tar, along with anthralin, should not be applied to the skin surrounding the psoriatic lesions. Petrolatum or zinc oxide ointments may be used to coat the normal surrounding tissues before medication administration to protect the normal tissue.

  10. Where topicals must not go

    Topical treatments for psoriasis are contraindicated for areas of open skin, mucous membranes, genitals, and the face.

  11. Too much or too often

    Applying too much or too often may cause excessive drying and irritation of the skin.

  12. Biologics raise infection risk

    Because these drugs suppress the immune system to reduce inflammation, they can increase a client’s risk for serious, often life-threatening infections. Additionally, the immunosuppressive effects can cause secondary malignancies to develop, especially lymphomas.

  13. Tuberculosis screening before biologics

    Ensure client received tuberculosis screening before initiation of therapy. Observe for hypersensitivity reactions during and after administration.

  14. Report fever and signs of infection

    Report temperature above 100.4°F, chills, productive cough, and symptoms of urinary tract or other infections immediately.

Terms to know

Plaque psoriasis
Plaque psoriasis is the subtype of psoriasis that affects the skin.
Calcipotriene
Calcipotriene, a vitamin D analog, blocks vitamin D receptors in the skin to decrease skin cell production.
Tumor necrosis factor
Etanercept and infliximab decrease inflammation in psoriasis by inhibiting the action of tumor necrosis factor (TNF), substances within the body that stimulate immune responses and produce inflammatory effects.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client is about to start adalimumab for plaque psoriasis. Which screening must the nurse confirm has been done before the first dose?

    1. Hearing test
    2. Eye pressure measurement
    3. Bone density scan
    4. Tuberculosis screening

    Answer: Tuberculosis screening

    Biologic psoriatic drugs suppress the immune system and increase the risk of serious infection, so the nurse ensures tuberculosis screening before therapy begins. The other tests are not described for biologics.

  2. A client receiving methoxsalen with UV light therapy plans a beach vacation. What should the nurse teach?

    1. Sunscreen is not needed with methoxsalen.
    2. Methoxsalen works best alone without UV therapy.
    3. Sun exposure will improve the results.
    4. Exposure to other UV sources such as the sun can cause severe skin burns.

    Answer: Exposure to other UV sources such as the sun can cause severe skin burns.

    Clients on methoxsalen who are exposed to other UV sources such as the sun may experience severe burns, and they should avoid UV exposure. Methoxsalen is not effective alone and is combined with controlled UV therapy.

  3. A client is prescribed clobetasol ointment for psoriasis. Which instructions are correct? Select all that apply.

    1. Apply only a thin layer to the affected areas.
    2. Do not cover the area with an occlusive dressing.
    3. Apply it generously several times a day for faster results.
    4. Do not apply it to the face, genitals or armpits.
    5. Limit use to 2 weeks or less.

    Answer: Apply only a thin layer to the affected areas., Do not cover the area with an occlusive dressing., Do not apply it to the face, genitals or armpits., Limit use to 2 weeks or less.

    Clobetasol is not used on the face, genitals and axillae, is limited to 2 weeks or less because of systemic steroid effects, and topical psoriatic drugs are applied thinly without occlusive dressings. Applying too much or too often causes excessive drying and irritation.

  4. Before applying coal tar to a client's psoriatic plaques, what should the nurse do?

    1. Cover the lesions with an occlusive dressing first.
    2. Apply it to open areas first.
    3. Coat the normal surrounding skin with petrolatum or zinc oxide.
    4. Apply it to the surrounding healthy skin as well.

    Answer: Coat the normal surrounding skin with petrolatum or zinc oxide.

    Coal tar should not be applied to the skin surrounding the lesions, and petrolatum or zinc oxide may be used to protect normal tissue. Topical psoriatic drugs are contraindicated on open skin and should not be covered with occlusive dressings.

  5. A client taking a biologic psoriatic drug calls the clinic. Which reports require immediate follow-up? Select all that apply.

    1. Mild dry skin that improves with lotion
    2. Chills
    3. Productive cough
    4. Temperature of 101°F
    5. Burning on urination

    Answer: Chills, Productive cough, Temperature of 101°F, Burning on urination

    Biologics increase the risk of serious, often life-threatening infections, so a temperature above 100.4°F, chills, productive cough and urinary tract symptoms are reported immediately. Mild dry skin that improves is not an infection sign.

  6. A client asks to start acitretin for severe psoriasis today. Which requirement must be met first?

    1. A normal hearing test
    2. A trial of sun exposure
    3. A negative pregnancy test and other screenings verified
    4. A tuberculosis skin test only

    Answer: A negative pregnancy test and other screenings verified

    Acitretin prescriptions cannot be given until pregnancy tests and other screenings have been completed and verified, because retinoids are contraindicated in pregnancy. Sun exposure is not required, and TB screening is emphasized for biologics.

Where every quote comes from

Section 40.3 Psoriatic Drugs of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.