Acitretin

INTRODUCTION

Indications

Severe psoriasis unresponsive to other therapies.

Action

Mechanism of action is not known. Therapeutic Effects: Improvement in psoriatic lesions.

Adverse Reactions/Side Effects

CNS: depression, fatigue, headache, pseudotumor cerebri (benign intracranial hypertension), rigors, sleep disorders. EENT: decreased night vision/night blindness, dry eyes, dry mouth, irritation, blurred vision, intolerance to contact lenses, loss of lashes and brows, photophobia, taste disturbances, tinnitus. CV: edema. GI: HEPATOTOXICITY, abdominal pain, anorexia, diarrhea, gingivitis, nausea, PANCREATITIS, stomatitis, vomiting. Derm: alopecia, dermatitis, dry skin, nail disorder, peeling, pruritus, rash, sunburn, sweating. GU: hematuria. Hemat: anemia. Metab: hyperglycemia, hypoglycemia, hyperkalemia, hyperlipidemia (↑ triglycerides, ↑ total cholesterol, ↓ HDL), hyper/hypomagnesemia, hypernatremia, hyperphosphatemia, hyperuricemia. MS: arthralgia, hyperostosis, myalgia. Misc: cheilitis, hot flashes, paresthesia. Resp: epistaxis.

PHYSICAL THERAPY IMPLICATIONS

Evaluation and Examination

• Be alert for signs of hepatotoxicity (anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, unusual bleeding or bruising), or signs of pancreatitis (upper abdominal pain after eating, indigestion, weight loss, oily stools). Report these signs to the physician immediately.

• Assess skin for any changes in psoriasis to help document the effects of drug therapy.

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

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Monitor signs of electrolyte imbalances, including high plasma potassium levels (bradycardia, fatigue, weakness, numbness, tingling), high phosphate levels (ectopic calcification), or any lethargy, irritability, insomnia, palpitations, muscle tremors, and confusion that might be due to other electrolyte imbalances. Notify physician of these signs.

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

• Be alert for signs of paresthesias (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Monitor depression, sleep disorders, or shivering-like reactions (rigors). Repeated or excessive symptoms may require change in dose or medication.

• 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

• Implement ultraviolet light therapy when indicated to help treat psoriasis and augment the effects of drug therapy.