Isotretinoin

INTRODUCTION

Indications

Management of severe nodular acne resistant to more conventional therapy, including topical therapy and systemic antibiotics. Not to be used under any circumstances in pregnant patients.

Action

A metabolite of vitamin A (retinol); reduces sebaceous gland size and differentiation. Therapeutic Effects: Diminution and resolution of severe acne. May also prevent abnormal keratinization.

Adverse Reactions/Side Effects

CNS: SUICIDE ATTEMPT, behavior changes, depression, PSEUDOTUMOR CEREBRI, psychosis, suicidal ideation. EENT: conjunctivitis, epistaxis, blurred vision, contact lens intolerance, corneal opacities, decreased night vision, dry eyes. CV: edema. GI: cheilitis, dry mouth, nausea, vomiting, abdominal pain, anorexia, hepatitis, pancreatitis, increased appetite. Derm: pruritus, palmar desquamation, photosensitivity, skin infections, thinning of hair. Hemat: anemia. Metab: decreased high-density lipoproteins, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, hyperuricemia. MS: arthralgia, back pain, muscle/bone pain (↑ in adolescents), hyperostosis. Misc: SEVERE BIRTH DEFECTS, increased thirst.

PHYSICAL THERAPY IMPLICATIONS

Evaluation and Examination

• Be alert for signs of intracranial swelling caused by pseudotumor cerebri. Signs include headache, dizziness, ringing in the ears, nausea, vomiting, pain in the neck/back/shoulders, and vision disturbances (blurred vision, double vision, flashes of light, brief periods of blindness). Notify physician of these signs immediately.

• Be alert for signs of depression and changes in behavior that suggest suicidal thoughts. Notify physician promptly if these signs develop (See Appendix D).

• Monitor signs of anemia, including unusual fatigue, pallor, shortness of breath with exertion, and bruising. Notify physician immediately if these signs occur.

• Assess any muscle, joint, or bone pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

Interventions

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Remind patient about the risk of birth defects, and that pregnancy must be avoided when using this medication. Instruct patient to consult physician about adequate forms of contraception, and remind patient that adherence to contraceptive strategies is essential.

• Advise patient about the likelihood of vision problems, including eye inflammation, blurred vision, and decreased night vision. Instruct patient to report severe or unexpected vision disturbances.

• Advise patient about the likelihood of GI reactions such as nausea, vomiting, abdominal pain, and a change in appetite. Instruct patient to report severe or prolonged GI problems, signs ...