A 24-year-old female client is prescribed isotretinoin for severe cystic acne. Which instruction is most important for the nurse to reinforce?

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Isotretinoin (Accutane, Amnesteem) is prescribed for severe, disfiguring nodular acne that has been unresponsive to other therapies (eg, antibiotics). It works by decreasing sebum secretion and shrinking sebaceous glands (often permanently); one course of isotretinoin is typically very effective. However, isotretinoin is a teratogenic medication known to cause serious harm to a fetus if taken during pregnancy. Females prescribed isotretinoin must participate in a risk management program. Requirements generally include two negative pregnancy tests before initiating isotretinoin and two forms of contraception (ie, use 1 month prior to starting isotretinoin, during treatment, and for 1 month after discontinuing isotretinoin) (Option D). Refills can be only obtained after a negative pregnancy test (performed monthly during therapy). Blood donation is also discouraged for both males and females during therapy. (Option A) Dryness of the eyes, mouth, and skin are common side effects. Lubricating eye drops may be needed to wear contacts. Some clients are unable to wear contacts while taking isotretinoin. (Option B) Capsules should be swallowed whole with ≥8 oz of water or other fluid. Capsules should not be broken, crushed, or chewed as the contents could irritate the esophagus. (Option C) Isotretinoin sometimes causes photosensitivity. The nurse should teach the client to use sunscreen routinely. Educational objective: Isotretinoin is a teratogenic medication known to cause serious harm to a fetus if taken during pregnancy. The client must use two forms of contraception prior to, during, and after therapy. Negative pregnancy tests are required before initiating therapy and prior to refills.

A 24-Year-Old Female Client Is Prescribed Isotretinoin for Severe Cystic