Pharmacology Skin Meds #1

Question

Which needs to be performed, if appropriate, before initiation of systemic biological medications for treatment of psoriasis? Select all that apply.

Answers

  1. Tuberculous testing
    • Rationale:

      This answer is correct because testing for tuberculous (TB) and other infections should be performed because systemic biological medications alter the immune system increasing susceptibility to TB and other infections.

  2. Pregnancy testing
    • Rationale:

      This answer is correct because safety of systemic biological medications in pregnancy and breast-feeding for the treatment of psoriasis has not been determined. Therefore, females should have pregnancy tests and a more in-depth discussion about the unknown risks of the medication in pregnancy and breast-feeding.

  3. Schirmer’s testing
    • Rationale:

      This answer is not correct because the Schirmer’s test is used for individuals with dry eyes to determine if treatment should occur. It determines if there are enough tears in the eye to keep it moist enough.

  4. Varicella immunization
    • Rationale:

      This answer is correct because systemic biological medications alter the immune system so any live virus immunizations should be received before receiving the medication. These live virus immunizations include mumps, measles, rubella (MMR) and varicella.

  5. Magnetic resonance imaging
    • Rationale:

      This answer is not correct because magnetic resonance imaging would not routinely be performed prior to initiation of systemic biological medications. Unnecessary radiation exposure is not recommended.

  6. Complete blood count test
    • Rationale:

      This answer is correct because systemic biological medications alter the immune system increasing susceptibility to infections. White blood cell (WBC) count is part of a complete blood count blood test. Elevation of the WBCs indicates a current infection, therefore, placing an individual taking a systemic biological medication in danger of sepsis or septic shock.

Overview

Psoriasis is a noninfectious skin condition involving remissions and exacerbations of psoriatic patches on the skin. Systemic biological medications are considered if other treatments have not been successful but they have several serious side effects, including infection and unknown risks during pregnancy.

Explanation

Learning Outcomes

Psoriasis is a noninfectious skin condition involving remissions and exacerbations of psoriatic patches on the skin. Various treatments and medications are used to control the chronic condition, including phototherapy, topical treatment, and systemic medications. Systemic medications have serious side effects, including risk for infection, sepsis, and septic shock; therefore, these are only considered after topical treatments have been unsuccessful. Live vaccines should be given before treatment is started to reduce infection. Furthermore, safety with pregnancy has not been established with use of systemic medications. Therefore, the nurse should expect orders from the healthcare provider to provide any live virus immunizations and medical testing to establish if the client has an infection before treatment is begun.

Test Taking Tip

Understanding the pathophysiology of a condition and how medications attempt to treat those conditions can help guide students to the correct response in NCLEX-style questions.

Video Rationale