antifungals

Question 1

Pseudomembranous Candidiasis

Answer 1

most superficial layer of the mucosa
white-yellow plaque, could reveal erythema if wiped off
has cellular debris, desquamated cells, fungus, and fibrin
acute, minimal symptoms

Question 2

Erythematous candidiasis

Answer 2

bright red flat lesions
areas of depapillation on tongue
can be associated w/ burning, dysphagia, tenderness
acute: after a single use of a broad spectrum AB or multiple narrow spectrum ABs
chronic (mostly): associated w/ xerostomia or dentures

Question 3

Angular cheilitis

Answer 3

ulcers and cracks in the corners of the mouth
associated with deep fissures and a collapsed OVD
could be associated with nutritional deficiencies

Question 4

hyperplastic candidiasis

Answer 4

keratotic

associated with immune deficiency

Question 5

linear gingival erythema (LGE)

Answer 5

associated with severe cases of HIV

linear band of erythema along the free gingival margin that doesn’t go away with plaque removal and good OH

Question 6

Candidia Auris

Answer 6

In hospitalized pts 
risk factors: immune compromised pts, use of broad spectrum ABs, nursing homes, use of invasive medical devices
capable of systemic infections
requires combination therapy
survives on env. surfaces 
needs special lab testing for ID

Question 7

Low potency AFs

Answer 7

Polyenes:
Mycostatin (topical)
Amphotericin B (IV & PO)

Question 8

Mid potency AFs:

Answer 8

Azoles: 
Imidazoles: 
- clotrimazole (topical)
- miconazole (topical) 
- Ketoconazole (topical and PO)
Triazoles: (used phrophylactically for immunosuppressed pts)
- fluconazole and itraconazole (strong inhibitor of CYP53 ) (PO IV)
second gen Triazoles: 
- voriconazole and posaconazole ( PO IV)

Question 9

high potency AFs:

Answer 9

Echinocandins:

Caspofungin, micafungin, anidulafungin (IV)

Question 10

Tx of mild oropharyngeal candidiasis:

Answer 10

mycostatin (nystatin) topical
only used on mild superficial infections
has high sugar content: could be an issue for pts with xerostomia
consider nystatin cream for denture candidiasis

Question 11

Tx of severe oropharyngeal candidiasis:

Answer 11

use potent topicals AKA imidazoles
clotrimazole lozenges
miconidazole buccal tablets
ketoconazole not usually used intraorally, only for cutaneous infections

Question 12

combination topical therapy

Answer 12

anti fungal and steroid
used for angular cheileitis
Nystatin and Triamcinolone
stronger: clotrimazole and betamethazone

Question 13

Tx for invasive oropharyngeal and mucocutaneous candidiasis

Answer 13

triazoles
associated with nausea, vomiting, gastric pain, and liver abnormalities
fluconazole: diflucan
itraconazole: sporanox. strong inhibitor of CYP53

Question 14

in cases of azole resistance:

Answer 14

try a systemic polyene: amphotericin B (fungizone):
for severe systemic infections, usually IV
nephrotoxic:
- suspensions cause GI disturbances
- lipid complexes less toxic

Question 15

for refractory or non-albicans infections:

Answer 15

use second gen triazoles or systemic echinocandins