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Pharmacy Practice II > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

Risk Factors for Fungal Skin Infections

A
  • Trauma to the skin (blisters from ill-fitting footwear)
  • Diabetes mellitus
  • Obesity
  • Immunosuppression: drugs (glucocorticoids, chemotherapy), diseases (HIV)
  • Impaired circulation
  • Poor nutrition & hygiene
  • Occlusion of the skin
  • Climate: warm, humid climates
  • Some infections: spread by direct contact with infected fomites (combs, clothing, linens)
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2
Q

Clinical Presentation: Sign/Sx

A
  • Pruritus (most common), burning / stinging pain
  • Inflammation, redness, macerated skin
  • Foul odor: associated with hyperhidrosis and gram-negative bacterial infection
  • Weeping, oozing pus
  • Scaling
  • Fissures
  • Small vesicular lesions
  • Nail changes (brittle or discolored hypertrophied nail)
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3
Q

Exclusions for Self-Treatment

A
  • Causative factor unclear
  • Initial treatment unsuccessful/worsening
  • Involvement of face, mucous membrane, genitalia, nails or scalp
  • Signs of possible secondary infection
  • Excessive/continuous exudation
  • Extensive, debilitating, extreme inflammation
  • Diabetes, systemic infection, immune deficiency
  • Fever, malaise
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4
Q

Pathophysiology: Tinea

A

= fungal infection of skin caused by dermatophytes

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5
Q

Pathophysiology: Causative Organisms

A
  • Trichophyton
  • Microsporum
  • Epidermophyton
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6
Q

Pathophysiology: Stages of Infection

A
  • Inoculation (dermatophyte infects skin)
  • Incubation (fungal growth)
  • Refractory (epidural turnover, symptomatic phase)
  • Involution (immune response, resolution of sx)
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7
Q

Pathophysiology: Transmission

A

Contact with infected people, animals, soil, fomites (contaminated objects)

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8
Q

Infection named based on body part

A
  • Tinea pedis (feet) (most common)
  • Tinea corporis (body)
  • Tinea cruris (groin)
  • Tinea unguium (nails)
  • Tinea capitis (scalp)
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9
Q

Tinea Pedis (Athlete’s Foot)

A
  • Most prevalent cutaneous infection in humans
  • RF: communal areas, athletes

4 types:

  • Chronic intertriginous: most common, interdigital (can spread to sole), fissuring, scaling, maceration, malodor, pruritis, stinging
  • Chronic papulosquamous pattern: bilateral on both feet, mild inflammation, diffuse moccasin-like scaling on soles (+nails)
  • Vesicular: small vesicles near instep on mid-anterior plantar surface, skin scaling, summer
  • Acute ulcerative: macerated, denuded, weeping ulcerations on sole, odor, white hyperkeratosis, gram-negative bacteria
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10
Q

Tinea Corporis (Ringworm)

A
  • Most common in pre-pubescent children, hot/humid areas, stress/obesity, contact sports
  • On glaborous (smooth/bare) skin
  • Small, circular erythematous, scaly area with vesicles in borders spread peripherally, borders with pustules or vesicles
  • Pruritis
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11
Q

Tinea Cruris (Jock Itch)

A
  • Common in warm weather or if skin moist/wet for long periods (occlusive clothing)
  • More common in males
  • Bilateral infection: inside/upper thigh, pubic area
  • Lesions with very clear and slightly elevated margins, with erythema in central areas
  • Significant pruritis/pain
  • Generally spare penis/scrotum (can differentiate from Candida)
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12
Q

Tinea Unguium (Ringworm of Nails)

A
  • EXCLUDED from self-treatment
  • Older age, swimming, tinea pedis, immunodeficiency, diabetes, infected family members
  • Nails become thick, yellow, rough, etc., may become separated from nail bed, sublingual hyperkeratosis
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13
Q

Tinea Capitis (Ringworm of the Scalp)

A
  • EXCLUDED from self-treatment
  • Direct contact with infected individuals / fomites

4 variants

  • Non-inflammatory: small papules
  • Inflammatory: pustules -> kerion
  • Black dot: hair breaks off, leaves black dot
  • Favus: patchy hair loss, scutula -> atrophy, scars
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14
Q

Goals of Self-Treatment

A
  • Relieve symptoms
  • Cure the infection
  • Prevent future infections (use good hygiene)
  • Prevent complications
    a. Secondary infections
    b. Permanent hair loss
    c. Scarring
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15
Q

Non-Pharmacologic Therapies

A
  • Good hygiene: cleanse daily with soap and water and pat dry
  • Keep the area dry: allow shoes to dry before wearing, limit use of occlusive (wool/synthetics) or wet clothing
  • Prevent spread: launder in hot water, do not share towels/personal articles, use a separate towel to dry affected area
  • Prevent acquisition of infection: avoid close contact with infected individuals, protective footwear in shared areas
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16
Q

OTC Antifungal Dosage Forms

A
  • Creams: penetrate stratum corneum well (good for dry/cracked skin), adheres well
  • Solutions: ideal for moist/oozing areas, easily applied, but must allow to air dry
  • Creams and solutions: most efficient and effective in delivering drug to epidermis*
  • Ointments: oil-based, occlusive, greasy, not ideal for wet/macerated tissues
  • Sprays: convenient, no touch (spray 6–10 inches away), caution with eyes
  • Powder/Spray Powder: use for large areas, Tolnaftate powder contains cornstarch and talc to absorb moisture
  • Sprays/powders: less effective (not rubbed in), however may improve adherence since they are easy to apply*
17
Q

Terbinafine

A

Squalene-epoxidase inhibitor:
- Depletes egosterol, prevents fungal growth (fungistatic)

  • Causes accumulation of intracellular squalene, kills fungus (fungicidal)
  • For age >= 12 yo
  • All 1% concentration
  • Shortest acting treatment for TP

FOR TP BETWEEN TOES:

  • Spray: BID x 2 weeks
  • Solution: BID x 2 weeks
  • Cream: BID x 1 week
  • Gel: Once daily x 1 week

FOR TP BOTTOM/SIDE:
- Cream: BID x 2 weeks

FOR T cruris/corporis:
- ^ALL: Once daily x 1 week

18
Q

Butenafine

A

Squalene-epoxidase inhibitor:
- Depletes egosterol, prevents fungal growth (fungistatic)

  • Causes accumulation of intracellular squalene, kills fungus (fungicidal)
  • For ages >= 12 yo
  • 1% concentration cream

FOR TP BETWEEN TOES:
- Once daily x 4 weeks* or BID x 7 days

FOR T cruris/corporis:
- Once daily x 2 weeks

19
Q

Azoles

A

• Prevent de-methylation of lanosterol, stop synthesis of cell wall (fungistatic)

• Clotrimazole AND Micronazole Nitrate Topicals 
- Both: Age >= 2 yo
- BOTH FOR TP AND T corporis:
• Solution/Cream/Oint: BID x 4 weeks
- FOR T cruris:
• Solution/Cream/Oint: BID x 2 weeks
20
Q

Tolnaftate

A

Thiocarbamate antifungal
- Exact MOA not reported: distort hyphae, stunt mycelial growth of fungi species

FOR TP/TC/TC:
- ALL versions: BID x 2-4 weeks

AE: stinging

Note: Tolnaftate powder may not be effective as monotherapy

21
Q

Undecylenic acid and Undecylenate salts

A
  • Unsaturated fatty acids that impact fungal growth (fungistatic), similar efficacy to tolnaftate
• Undecylenic Acid: Age >= 2 yo 
FOR TP AND T corporis 
- 25% Liquid/Oint: BID x 4 weeks 
FOR T cruris: 
- 25% Oint: BID x 2 weeks
22
Q

Salts of Aluminum (MOA/AE/W)

A
  • Al acetate (Burow’s solution)
  • Al sulf tetradecahydrate + Ca acetate Monohydrate (Domeboro®)

^BOTH for acute inflammatory, wet/soggy TP

  • MOA: astringent and antibacterial
  • Uses: combo therapy for TP, relief of inflammatory conditions of skin

• AE: skin dryness, burning, stinging, irritation, tissue necrosis
• Warnings:
- External use only, avoid eye contact
- Accidental child poisoning
- Prolong use can cause tissue necrosis (don’t use more than 1 week)
- Discontinue if lesions appear/worsen

23
Q

Patient Education

A
  • Clean and pat dry the affected area (do not share towels)
  • Apply antifungal sparingly twice daily (AM and PM)
  • Massage medication into the affected area
  • Avoid touching the eyes
  • Wash hands thoroughly with soap and water
  • Expect improvement within 1 week, if not see provider
  • Continue therapy for entire directed course (up to 6 weeks)

Pharmacy Practice II (25 decks)

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