Antifungals (Exam 2)

Question 1

What are clinical risk factors that predispose patients to developing fungal infections?

Answer 1

1) Occur as a result of upset in the balance of oral flora, immunosuppression or systemic disease
2) Associated with use of antibiotics, hormones, and chemotherapy
3) Opportunistic infections (Candida albicans)

Question 2

What is the clinical appearance of oral fungal infections like?

Answer 2

1) “Cottage-cheese appearance”

2) Pseudomembranous
appearance

3) Atrophic tongue
4) Hyperkeratotic appearance
5) Symptomatic geographic tongue
6) Angular cheilitis

Question 3

What are the 3 anti fungal agents useful against Candida albicans

Answer 3

1) nystatin (Mycostatin) * know this one
2) clotrimazole (Mycelex) * know this one
3) amphotericin (Amphocin, Fungizone) * know this one

Question 4

What is the different dosage forms of anti fungal agents?

Answer 4

1) TOPICAL vs systemic therapy is preferred

2) Systemic drugs are problematic for 3 reasons:
a) Cause dangerous drug interactions with commonly prescribed medications
b) Promote resistance among fungal organisms
c) Toxicities

3) Efficacy of topicals depends upon contact w/ oral tissues
- Troches = vaginal preps with sugar
- Pastilles = lozenge-type delivery
- Liquids
- Topical agents
- Powders = Sprinkled onto dentures & worn like a denture adhesive; denture keeps medication in contact w/ tissues longer

4) Consider chlorhexidine & Listerine for preventive therapy in at risk patients, as both kill 7 species of Candida

Question 5

What is the mechanism of action of nystatin?

Answer 5

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

Question 6

What are two reasons why dentists should avoid prescribing the systemic azole anti fungal medications for oral fungal infections?

Answer 6

1) Promote resistance of fungal organisms
2) Many dangerous drug interactions
3) Hepatotoxic
4) Itraconazole = severe cardiovascular side effects; neuropathy

Question 7

What is the course of therapy for treating oral fungal infections?

Answer 7

1) Topical treatment is used for a minimum of 48 hours after symptoms subside (usual treatment period is for 1-2 weeks)
2) Re-evaluate at 14 days after therapy

Question 8

What are some important patient education strategies that can reduce risk for oral fungal infections?

Answer 8

1) Compliance can be problematic, as topical agents must be used 5 times per day for a 1 to 2 week period of time
2) Patients must also treat anything else that they put into their mouths, or they will re-infect themselves:
3) Dentures, mouth guards, appliances
4) Dispose of toothbrushes & other oral hygiene aids to avoid cross-contamination