Pharm, part 50: Integumentary Medications - Topical Antibacterial and Antifungal

by Cathy Parkes September 27, 2021 Updated: April 07, 2022 6 min read 1 Comment

This article begins our coverage of integumentary system medications, specifically topical ointments to treat infections. These antibiotic ointments, topical antifungal agents, and topical medications used for burns are indicated for the surface of the skin, as opposed to the systemic versions of these antibiotic and antifungal medications, which we covered previously.

The Nursing Pharmacology video series follows along with our Pharmacology Second Edition Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

The integumentary system is the skin. More specifically, it is the set of organs forming the outermost layer of the body, i.e., the skin and its appendages, which act as a physical barrier between the external environment and the body’s internal environment.

Topical medications for bacterial skin infections

Two topical antibiotic ointments to be familiar with are bacitracin and mupirocin. These are used to treat localized bacterial infections and are effective against staphylococci and streptococci.

Note that many topical medications used to treat bacterial infections end in -cin.

Bacitracin

Bacitracin is used for minor skin injuries like cuts, scrapes, or minor burns.

Mode of action of bacitracin

Bacitracin inhibits cell wall synthesis.

Side effects of bacitracin

Side effects of bacitracin can include burning or stinging upon application, as well as pruritus (itchy skin). It is also possible that the patient may experience allergic contact dermatitis upon application.

Nursing care when applying bacitracin

Clean and dry the affected area before applying a small amount of medicine.

Bacitracin should be applied one to three times a day.

Mupirocin

Mupirocin is used to treat skin infections, including impetigo and beta-hemolytic streptococci. Mupirocin is thought of as the gold standard for treating impetigo, which is an infection that requires contact precautions.

Mode of action of mupirocin

Mupirocin inhibits bacterial protein synthesis.

Side effects of mupirocin

As with bacitracin, mupirocin can cause burning or stinging upon application, as well as pruritus.

Nursing care when applying mupirocin

Clean and dry the affected area before applying a small amount of medicine.

Mupirocin should be applied three times a day.

Topical medications for fungal skin infections

Cool Chicken That “azole” touched me with his athlete’s foot. Now I might need clotrimazole. Many end in -azole.

Topical antifungal agents include clotrimazole (Lotrimin), miconazole (Monistat, Vagistat), and nystatin. They are used to treat tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea corporis (ringworm), and cutaneous candidiasis.

Mode of action of clotrimazole, miconazole, and nystatin

These ointments affect the integrity of the fungal cell wall.

Side effects of clotrimazole, miconazole, and nystatin

Side effects are usually minimal and can include stinging or redness.

Nursing care when applying clotrimazole, miconazole, and nystatin

Patients should apply BID for 1-4 weeks (“BID” stands for “bis in die,” which is Latin for “twice a day”).

For patients diagnosed with tinea capitis (fungal infection on the scalp), a selenium sulfide (antifungal) shampoo may be used.

Topical medications for burns

Cool Chicken Mafenide is like the mafia takin’ down the eschar!

Silver sulfadiazine and mafenide acetate are topical medications used to treat second- and third-degree burns. They may also be used to prevent wound sepsis.

Silver sulfadiazine (Silvadene)

Mode of action of silver sulfadiazine

Silver sulfadiazine provides broad antibacterial and antifungal activity through DNA disruption.

Side effects of silver sulfadiazine

Side effects can include leukopenia. Other side effects include rash, burning and itching, and possible skin necrosis.

Nursing care when administering silver sulfadiazine

Because of the side effect of leukopenia, monitor the patient’s CBC levels during therapy.

You can learn about CBCs and more with our Lab Values Study Guide & Flashcard Index, a list of lab values covered in depth in our Lab Values Flashcards for nursing students.

Mafenide acetate

Mode of action of mafenide acetate

This medication is a bacteriostatic; it can help penetrate eschar (necrotic tissue, usually brown or black), which can occur with certain burns.

Side effects of mafenide acetate

Side effects of mafenide acetate can include pain, burning and itching, as well as metabolic acidosis.

Nursing care when administering mafenide acetate

Because of the potential for metabolic acidosis, it is important to monitor the patient’s acid-base balance.

If you'd like in-depth studying on ABGs and to learn how to interpret ABGs, we have Arterial Blood Gas Interpretation Flashcards and a video series on ABG Interpretation.


Full Transcript

Hi, I'm Cathy, with Level Up RN. In this video, I'm going to begin my coverage of integumentary system medications. So specifically in this video, I'll be covering topical antibiotic ointments, topical antifungal agents, and topical medications used for burns. At the end of the video, I'm going to provide you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video. So definitely stay tuned for that. If you have our pharmacology flashcards which are available at leveluprn.com, definitely pull those out so you can follow along.

Two topical antibiotic ointments to be familiar with include bacitracin and mupirocin.

So bacitracin is used for minor skin injuries like cuts, scrapes, or minor burns. You would apply it one to three times a day, and it's possible that the patient may experience allergic contact dermatitis upon application.

Mupirocin is used for skin infections, which include impetigo. So this is kind of the gold standard for treating impetigo.

Side effects can include some burning or stinging upon application, and then we are going to apply mupirocin three times a day.

Next, we have our topical antifungal agents, which include clotrimazole, miconazole as well as nystatin.

We would use these medications to treat tinea infections, including jock itch, athlete's foot, and ringworm.

Side effects are usually pretty minimal, but can include stinging or redness.

We should advise our patients to apply these topical agents twice a day for two to four weeks. If your patient has tinea capitis, which is a fungal infection on their head, they can use a selenium sulfide shampoo to help treat that.

So selenium sulfide shampoo is an antifungal shampoo.

Our little cool chicken hint here on this card is kind of PG-13. So the drug names, or at least a couple of them, end in azole. So that azole touched me with his athlete's foot. Now I might need clotrimazole. So that azole clotrimazole. Hopefully, that helps you to remember these medications and one of the things it is used to treat, which is athlete's foot.

Next, we have two topical agents which are used to treat second and third-degree burns and to prevent wounds sepsis.

The first is silver sulfadiazine, and this medication provides broad antibacterial and antifungal activity.

Side effects can include leukopenia, and because of that side effect, we're going to want to closely monitor the patient's CBC levels during therapy. Other side effects include rash, burning and itching, and possible skin necrosis.

Our second topical agent we can use for burns is mafenide acetate. So this medication is bacterial static, and it can help penetrate eschar which can occur with certain burns.

Side effects can include pain, burning and itching, as well as metabolic acidosis. So for that reason, we're going to want to closely monitor our patients acid-base balance to check for the presence of metabolic acidosis.

So our little cool chicken hint here on the card is that mafenide is like the mafia taking down the eschar. So hopefully you enjoyed that little hint.

All right, time for quiz. First question, what topical antibiotic can be used to treat impetigo? The answer is mupirocin. Second question, what topical medication used to treat burns can cause leukopenia? The answer is silver sulfadiazine. Third question, mafenide acetate can cause what acid-base imbalance? The answer is metabolic acidosis.

All right. That's it for this video. I hope you found it helpful. If so, be sure to like this video and leave me a comment, and I'll see you in the next video, which is the last video in our pharmacology playlist. Thank you so much for watching.


1 Response

Emily
Emily

February 21, 2022

For mafenide acetate, you could expand on your chicken hint by saying the MAFenide is like the mafia who use acid (ACETate) to take down eschar.. that way you know it’s linked with metabolic acidosis. You can remember the metabolic because mafenide starts with an M.

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