Page 1236 - Saunders Comprehensive Review For NCLEX-RN

4. Instruct the client to report signs of adverse effects to
the PHCP.
5. Monitoring plasma cortisol levels may be prescribed if
prolonged therapy is necessary.

In the adult, intact skin is generally impermeable to most

topical medications. However, medications should not be applied to
open areas unless prescribed, because undesired absorption and
adverse effects can occur.
IV. Medications to Treat Actinic Keratosis (Box 43-3)
A. Description
1. Actinic keratoses are caused by prolonged exposure to
the sun and appear as rough, scaly, red or brown
lesions usually found on the face, scalp, arms, and
back of the hands.
2. Lesions can progress to squamous cell carcinoma.
3. Treatment includes medications and therapies such as
excision, cryotherapy, curettage, and laser therapy.
B. Medications (see Box 43-3)
1. Diclofenac sodium
a. A nonsteroidal antiinflammatory
topical medication; it may take up to 3
months to be effective.
b. Side and adverse effects include dry
skin, itching, redness, and rash.
2. Fluorouracil
a. A topical medication that affects DNA
and RNA synthesis and causes a
sequence of responses that results in
healing; results are usually seen in 2 to
6 weeks but may take 1 to 2 months
longer for complete healing.
b. Side and adverse effects include itching,
burning, inflammation, rash, and
increased sensitivity to sunlight.
3. Imiquimod 5% cream
a. In addition to treating actinic keratoses,
this topical medication has been used
to treat venereal warts; it may take up
to 4 months to be effective.
b. Side and adverse effects include
redness, skin swelling, itching,
burning, sores, blisters, scabbing, and
crusting of the skin.
4. Ingenol mebutate
a. Indicated for the topical treatment of
actinic keratosis; application

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