Page 1244 - Saunders Comprehensive Review For NCLEX-RN

abnormalities. If prescribed, the client needs to follow strict rules of the
iPLEDGE program. It must not be used if the client is pregnant.
F. iPLEDGE program

1. A risk management program that ensures that no
woman starting isotretinoin is pregnant and that no
woman taking this medication becomes pregnant;
refer to American Academy of Dermatology
Association at
https://www.aad.org/public/diseases/acne-and-
rosacea/isotretinoin-treatment-for-severe-acne
2. Access to the medication is controlled through a
central automated system.
3. Strict rules must be followed by the client, PHCP
prescribing the medication, pharmacist dispensing
the medication, and wholesaler of the medication to
ensure safety and to ensure that no woman is
pregnant on initiation of therapy or becomes pregnant
while taking the medication.
4. Also see iPLEDGE® program at
https://www.ipledgeprogram.com/iPledgeUI/home.u
G. Hormonal medications
1. Hormonal medications such as oral contraceptives and
spironolactone may be prescribed to treat acne in
female clients.
2. These medications decrease androgen activity,
resulting in decreased production of sebum.
3. Spironolactone is teratogenic; therefore, contraception
during its use is necessary.
4. Side and adverse effects of spironolactone include
breast tenderness, menstrual irregularities, and
hyperkalemia.
VIII. Burn Products: (Box 43-6) Refer to Chapter 69 for information on Caring
for the Burn Client
A. Silver sulfadiazine
1. Has broad spectrum of activity against gram-negative
bacteria, gram-positive bacteria, and yeast
2. Silver is released slowly from the cream, which is
selectively toxic to bacteria.
3. Used primarily to prevent sepsis in clients with burns
4. Not a carbonic anhydrase inhibitor; does not cause
acidosis
5. Apply 1⁄16-inch film (keep burn covered at all times
with silver sulfadiazine).
6. Side and adverse effects include rash and itching,
blue-green or gray skin discoloration, leukopenia, and
interstitial nephritis.
7. Monitor complete blood cell count, particularly the

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