Antifungals

Question 1

How are fungal infections started?

Answer 1

Usually opportunistic infections

Question 2

What is the clinical presentation of fungal infections?

Answer 2

• Cottage cheese appearance
• Pseudomembranous appearance
• Atrophic tongue
• Hyperkeratotic appearance
• Symptomatic geographic tongue
• Angular cheilitis

Question 3

What are the ways to treat fungal infections (therapy)?

Answer 3

Topical (local candidiasis) or Sytemic (chronic, extensive mucocutaneous candidiasis)

Question 4

Which treatment of fungal infections is preferred?

Answer 4

Topical

Treat for a min of 48 hours after symptoms subside - re-evaluate at 14 days after therapy

Question 5

What methods can be used to help topical antifungal therapy last longer in the mouth?

Answer 5

• Troches - sweetened vaginal preps with cocoa butter (caution with diabetes)
• Pastilles - lozenge-type delivery
• Consider - chlorhexidine and Listerine

Question 6

In treating a patient with diabetes that has a funal infection in their mouth (oral candiasis) what type of topical method could be used?

Answer 6

Pastilles - Troches are sweetened with sugar which will be problematic with diabetes

Question 7

What different “vehicles” do topical antifungals come in?

Answer 7

• Liquids
• Troches
• Pastilles
• Powders

Question 8

What is the mechanism of nystatin (Mycostatin)?

Answer 8

Binds to sterols in fungal cell membrane, changing cell wall permeability allowing for leakage of cellular contents

Question 9

Does nystatin (Mycostatin) get absorbed very easily?

Answer 9

No it stays in the GI tract

Question 10

What are some of the forms nystatin (Mycostatin) comes in?

Answer 10

• Pastilles/troches
• Oral suspension
• Ointment/cream
• Powder

Compliance will be low - a lot for people to do 4-5 times per day.

Question 11

What is another topical antifungal when nystatin is not effective in the patient?

Answer 11

clotrimazole (Mycelex)

Question 12

What is the main adverse effect of clotrimazole?

Answer 12

Abnormal liver function

Question 13

How are systemic antifungal drugs named?

Answer 13

“…azole” antifungals

Question 14

Why would we want to avoid systemic (azole) antifungals?

Answer 14

• They promote resistance of fungal organisms
• Many dangerous drug interactions
• Hepatoxic

Question 15

What antifunal was big in dentistry and is no longer FDA approved for treatment of candidiasis due to hepatotoxicity (July 2013)?

Answer 15

ketoconazole (Nizoral)

Question 16

What antifungal is used to treat Valley Fever, that must be monitored very closely due to possible liver damage?

Answer 16

fluconazole (Diflucan)

Question 17

What is a parenterally (IV) administered antifungal drug, and is almost always used for fungal infections associated with HIV?

Answer 17

amphotericin

Question 18

When treating angular cheilitis why is there two different medications to treat the fungal infection? And what are the drugs?

Answer 18

Combines an antifungal with a steriod - to promote healing

• iodoquinol and hydrocorisone cream
• nystatin and triamcinolone acetonide ointment