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PodMed > Antifungals (Pod med) > Flashcards

Antifungals (Pod med) Flashcards

1
Q

Onychomycosis

1? infection of ?2

Accounts for 3? of all skin infections and 4? of all nail disease

Prevalance 5?

Most common cause of subungual onychomycosis is 6?

Tinea unguim is a 7? infection cause by 8?

A
  1. Fungal 2. Nail bed, matrix or plate
  2. 1/3 4. 1/2
  3. 2-14%
  4. T. Rubrum
  5. fungal infection
  6. dermotaphytes
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2
Q

What is the classification for onychomycosis?

  1. ?
  2. ?
  3. ?
A
  1. Distal Subungual Onychomycosis- T. Rubrum
  2. White superficial onychomycosis- T. mentagrophytes
  3. Proximal subungual onychomycosis
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3
Q

Diagnosis:

1? prep, 2? 3?

Differential diagnosis:

4.? 5.? 6.? 7.? 8.?

A
  1. KOH 2. Fungal 3. Yeast culture
  2. Yellow nail syndrome
  3. psoriasis
  4. Lichen planus
  5. Trauma
  6. Contact dermititis
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4
Q

If KOH is negative order 1?

A
  1. special staining such as

periodic-acid-Schiff (PAS)

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5
Q

What is the role of debridment prior to antifungal treatment?

1.

2.

3.

A
  1. debridement reduces antifungal load
  2. debridement reduces shoe-pressure and hence less trauma to the nail bed
  3. Thinning of the nail allows topical meds penetrate better
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6
Q

Amorolfine

1? in 5ml nail laquer

Interferes with 2?

Used for 3?

Penetrates 4?

5?

Active against 6?

Apply 7?

A
  1. Loceryl
  2. Fungal cell memebrane synthesis
  3. Distal and superficial onychomycosis
  4. Nail late and remains for several weeks
  5. Fungicidal
  6. Dermatophytes & Candida 7. Non-dermatophytes
  7. Apply once or twice a week for many months upto 12 months
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7
Q

Bifonazole

activity against 1?

Bifonazole has significant in-vitro activity against2?

Bifonazole use 3?

A
  1. dermatophytes
  2. Corynebacterium and gram positive
  3. 1% cream, solution, gel powder, once daily
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8
Q

Clotrimazole (Lotrimin)

In vitro, active against 1? 2? 3?

It is acitve as Nystatin aganist 4?

Some activity against 5?

Can combine with 6? or 7?

A
  1. Trichophyton 2. Microsporum 3. Epidermophyton
  2. Candida
  3. Gram positive bacteria
  4. Bethamethasone 7. hydrocortisone cream 1%
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9
Q

What ntifungal is good for interdigital infections?

A

Econazole

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10
Q

Ketaconazole

Active against A? B? C?

the 1? applied2?

A

A. Tricophyton B. Microsporum C. Epidermophyton

  1. 2% cream
  2. 2 times a day (BD)
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11
Q

Ketoconazole interacts with 1? to block 2?

thereby 3?

A
  1. C-14 alpha demethylase
  2. the demethylation of lanoserol to ergosterol
  3. disrupting membrane function and increasing permeability
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12
Q

Ketaconazole

High affinity for 1?

Absoprtion affected by 2?

3? intolerance

4? hepatitis

at high dose can cause 5?

complications 6?

A
  1. Keratin
  2. acidity
  3. GI
  4. Drug induced
  5. gynecomastia
  6. Long duration, significant relapse rate and hepatitis
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13
Q

What’s the drug choice for systemic fungal infections, oral thrush and vaginal candidiasis?

A

Fluconazole

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14
Q

Fluconazole

Active against 1? 2? 3?

Not 4? sensitive

Dose?

A
  1. Dermatopytes 2. candida 3. Non-dermatophytes
  2. PH

Once weekly dose of 300mg for 6 months

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15
Q

What are the pros/cons of Fluconazole?

1?

  1. Less?
  2. Used?
  3. Relatively ?
A
  1. Once weekly dosing (pro)
  2. Less drug interactions than other azoles
  3. Off label
  4. Relatively long duration of therapy

of 6 months or more

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16
Q

Griseofulvin

First oral 1?

Inhibits formation of 2?

Active against 3?

Normal dosage 4?

The problem with this is 5?

prolonged 6?

cure rate 7?

A
  1. antifungal since 1958
  2. Microtubule
  3. rmatophyte fungi
  4. 500 to 1000mg up to 2gr upto 2 months for upto 18 months
  5. Low affinity for Keratin
  6. treatment
  7. 30-40%
17
Q

What are the adverse reactions for

Griseoulvin?

  1. ?
  2. ?
  3. ?
  4. ?
  5. ?
  6. ?
  7. ?
  8. ?
  9. ?
A
  1. Headaches upto 15%
  2. Diziness
  3. GI intolerance
  4. Less common: urticeria and photosensitivity
  5. Leukopenia and neutropenia
  6. Hepatotoxicity
  7. increase metabolism of Warfarin
  8. Cross-sensitivy with Penicillin
  9. Should be avoided in patients on birth control
18
Q

Pros/Cons of Griseoulvin

Effective short course for 1?

2?

3?

4?

5 low?

A
  1. Tinea Pedis
  2. Low cost, Long duration
  3. It’s got a bad reputation
  4. Fungistatic
  5. Low efficacy
19
Q

Itraconazole

Specific to 1? found in 2?

3? soluble

Usual dosage 4?

A
  1. Cytochrome P450 2. Fungal cells
  2. Lipid soluble, penetrates nail bed: better penetration to nail matrix
  3. 200mg daily for 12 weeks
20
Q

Itraonazole (Spornox)

Beside dermatophytes active against 1? & 2?

Good 3? effect

4? dosage with fatty meals and Coke

A
  1. Asperigillus 2. Candida
  2. Reservior effect
  3. 100mg bd
21
Q

What are the pros for Itraconazole?

  1. ?
  2. ?
  3. ?
  4. Must be taken with ?
A
  1. Pulse dosing great for patients who don’t like to take pills and economicly better
  2. Broader spectrum than Lamisil
  3. single pulse dose effective treatment against tinea pedis
  4. Food
22
Q

Terbinafine (Lamisil)

1? group

Fungicidal against 2? and 3?

  1. Inhibits?
  2. Doesn’t interfere
  3. DOSAGE
A
  1. Allylamine antifungal group
  2. Dermatophytes 3. C.albicans
  3. Fungal enzyme squalene epoxidase
  4. cytochrome P450
  5. one tablet 250mg daily for 3 months
23
Q

what are the precautions for Lamisil (Terbinafine)?

1? may worsen

if 2? reduce the dose

3? safe to use

4? low concentration

A
  1. Psoriasis
  2. CrCl<50ml/min
  3. pregnancy safe to use
  4. breastfeading
24
Q

what are the side-effects for Terbinafine?

1?

2?

3?

4?

A
  1. Skin Rashes
  2. low incidence of liver enzymes
  3. rare but serious conditions such hepatitis
  4. Loss of taste
25
Q

What is the dose for Onychomycosis for Terbinafine (Lamisil)?

Adult 1?

Children 2?

Renal impairment 3?

A
  1. 250mg once daily for 12 weeks
  2. 10-20kg: 62.5 mg once daily

20-40kg: 125mg once daily

  1. 125mg once daily if CrCl<50ml/min
26
Q

What are some of the pros/cons of Lamisil (Terbinafine)?

  1. ?
  2. ?
  3. ?
  4. ?
  5. ?
  6. ?
  7. ?
A
  1. More effective than Sporanex against dermatophytes
  2. No significant drug-drug interactions
  3. Once daily dose easier for patients to remember
  4. Less need for lab tests
  5. 2-4 weeks for tinea pedis
  6. Its expensive
  7. can’t give to chiefs
27
Q

Lamisil topical

Dosage 1?

A
  1. Cream 2 times a day application for 14 days
28
Q

Chemical Avuslion with urea nail lacquer

40% 1? mixed with 1% of 2?

A
  1. Urea ointment 2. bifonazole, amorolfine
29
Q

What are the tx options for tinea pedis based on the theraputic guidlines?

  1. ?
  2. ?
  3. ?
A
  1. Terbinafine 1% cream or gel topically applied once daily for 1 week
  2. Bifoconazole 1% cream topically once daily for 2-3 weeks
  3. Clotrimazole 1% cream or solution topically BID for 2-4 weeks
30
Q

What are the oral therapy for tinea?

  1. ?
  2. ?
  3. ?
A
  1. Terbanifine, 250 mg , 4 times a day for 6 weeks
  2. Flucanozole, 150 mg, once a week
  3. Itraconozole, 200 mg two times a day for 1 week
31
Q

Onychomycosis (EXAM)

For superficial and distal involvment 1?

If Distal subungual and total dystrophic onychomycosis then 2?

A
  1. Amorolfine nail lacquer topically once a week for 12 months
  2. Terbinafine: 250mg , orally 4 times a day for 2 weeks

Itraconazole: 200mg, orally 2 times for one week every month upto 3-4 months

Fluconazole: 150 mg to 300mg orally once a week for 24 to 52 weeks

PodMed (29 decks)

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