ch 79 Flashcards
superficial mycoses fungal pathogens
Candida species
dermatophytes (epidermophyton, trichophyton, microsporum)
ringworm (dermatophytic infections)
Tinea pedis
tinea corporis
tinea cruris
tinea capitis
most common dermatophytic
tinea pedis
pt ed for tinea pedis
wear absorbent cotton socks
change shoes often
dry feet after bathing
tinea corporis treat
topical azole or allylamine
continue for 1 week after symptoms clear
severe may need systemic - griseofulvin
tinea cruris
treat continue for 1 week after dcleared,
severe wil need systemic – clotrimazole
tinea capitis
difficult to treat
topical not likely to work
oral griseofulvin for 6-8 weeks
oral terbinafine 2-4 weeks may be more effective
vulvovaginal candidiasis is caused by
candida albicans most of the time
Candida glabrata can also (esp in pt with HIV/AIDS)
factors that predispose to candida are
pregnancy obesity diabetes debilitation HIV infection use of certain drugs such as oral contraceptives systemic glucocorticoids anticancer agents immunosuppressants systemic abx
oral candidiasis
thrush
nystatin
clotrimazole
miconazole
all topical
in immunocompromised host
fluconazole
ketoconazole are usually needed
difficult to eradicate and requires prolonged treatment
can by from dermatophytes or candida
Onychomycosis
oral for onychomycosis
terbinafine (lamisil)
itraconazole (sporanox)
work against both dermatophytes and candida
treat for 3-6 months
cure rate is 50%
side effects for terbinafine and itraconazole
headaches
gi -n/v/abd pain
skin reactions - rash, itching
topical therapy for onychomycosis
ciclopirox (penlac nail lacquer)
ciclopirox (penlac nail lacquer)
topical
is only active against what
Trichophyton rubrum
applied once a day to nails and immediately adjacent skin
new coats are applied over old ones
once a week remove coats with alcohol
treats onychomycosis from dermatophytes T. Rubrum and Trichophyton mentagrophytes.
Tavaborole (Kerydin)
apply to entire nail surface and under the tip of affected toenails once daily for 48 weeks
azole for onychomycosis
Efinaconazole
cover the entire nail, including the folds, bed and undersurface of the toenail plate.
daily for 48 weeks
what should you not give st johns wort with and why
SSRI
SNRI
MAOI
TCAs (amitriptyline, clomipramine)
serotonin syndrome
St Johns is a CYP _____
what drugs does this effect
inducer
increases metabolism of those drug
digoxin
warfarin
what SERM given for prevention and treatment of osteoporosis protects against estrogen receptor positive breast cancer
Raloxifene (Evista)
Black box for Raloxifene (Evista)
increased r/o DVT and PE
someone with mild acne
tried salicylic acid
whats next?
Topical retinoid (Retin-A) Benzoyl peroxide (topical antibiotic and keratolytic)
mild fungal ear infection
acetic acid drops
prescribe someone tinolol
monitoring eye drops
bradycardia
hypotension
bronchospasm
DMARD with antimalarial actions RA
Hydroxychloroquine (Plaquenil)
pt ed with Hydroxychloroquine (Plaquenil)
eye dr every 6 mos to check for retinal damage
need a thorough eye exam prior to starting treatment
d/c first sign of retinal injury
also needs an EKG -Prolong QT
when taking Hydroxychloroquine (Plaquenil) what can you do for the GI distress
take with food or milk
how is Hydroxychloroquine (Plaquenil) metabolized
primarily by liver
mixing insulins
NPH and regular can be mixed
NPH can be mixed with short acting - regular, lispro, aspart, glulisine)
draw up short acting first
what insulin can you give without regard to meals
intermediate and long acting such as
NPH - intermediate
glargine (Lantus) - long acting
type of insulin - rapid, short, intermediate, long, ultralong
lispro (humalog)
rapid -
type of insulin - rapid, short, intermediate, long, ultralong
insulin aspart (novoLog)
rapid
type of insulin - rapid, short, intermediate, long, ultralong
insulin glulisine (apidra)
rapid
type of insulin - rapid, short, intermediate, long, ultralong
Humulin R, Novolin R (regular Insulin)
short acting
Hypoglycemia is uncommon when these drugs are used alone. what severe hypersensitivity reaction is possible but rare
Dipeptidyl Peptidase-4 inhibitors DPP4 - Gliptins
Sitagliptin (Januvia)
Saxagliptin (ONglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
