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PMP-201 > Management of fungal infections > Flashcards

Management of fungal infections Flashcards

1
Q

fungal infections come from

A

fungal infections

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2
Q

antifungal agents

A

antifungal kill and stop growth of fungi
called antimyotic agents

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3
Q

Azole antifungals

A
  1. triazoles
  2. Imidazoles
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4
Q

Triazoles

A
  • fluconazole; well absorbed (oral), good penetration into cerebrospinal fluid, excreted uncharged in urine and used to treat candiduria
  • Itraconazole; active against dermatophytes, capsules an acid enviroment in stomach for optimal absorption, liver damage (associated)

(posaconazole + voriconazole)

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5
Q

Imidazoles

A

Clotrimazole, econazole nitrate, ketoconazole, and tioconazole - local treatment of vaginal candidiasis and for dermatophyte infections

Miconazole; ured locally for oral infections, effective in infections, systemic absorption may follow use of miconazole oral gel and may result in significant drug interactions

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6
Q

Polyene antifungals

A
  1. Amphotericin B
  2. Nystatin
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7
Q

Amphotericin B

A
  • not absorbed when given by mouth
  • intravenous infusion used for treatment of systemic fungal infections
  • highly protein bound and penetrates poorly into body fluids and tissues
  • given PARENTALLY amphotericin B is toxic into body fluids and side-effects are common

Lipid formulations are less toxic
- test dose is advisable before a new vourse of treatemnt
- small amount administred for 10 mins and stopped

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8
Q

Nystatin

A

Not absorbed when given by mouth
Used for oral, orpharyngeal, perioral infections by local application in mouth
used for candida albicans infection of skin

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9
Q

Echinocandin antifungals

A

Anidulafungin, caspofungin and micafungin

Only active agaist aspergillus and candida

andiulafungin and micafungin are not used for treatment of aspergillosis

echinocandins are not effective against fungal infections of CNS

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10
Q

Other antifungals

A
  1. Flucytosine
  2. Griseofluvin
  3. Terbinafine
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11
Q

Flucytosine

A

used with amphotericin B in synergistic combination

Bone marrow depression can occur which limits its use, paticularly with HIV-+ive patients, weekly blood counts are necessary during prolonged therapy

resistance to fluctosine can develop during therapy and sensitivity testing is essential before and during treatment

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12
Q

Griseofluvin

A

effective fro widespread or intractable dematophyte infections

superseded by newer antifungals, paticularly for nail infections

during therapy dependant on site of infection and may extend to number of months

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13
Q

terbinafine

A

drug of choice for fungal nail infections also used for ringworm infections where oral treatment is considered appropriate

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14
Q

Aspergillosis

A

Aspergillus species - found in soil
Inhalation of aerosolised spores causes infection

Affects immunocompromised patients

symptoms include; fever cough, pleuritic pain

1st line; Voriconazole = initially every 12 hrs for 2 doses, then 100mg every 12 hrs (inc if>40kg
2nd line; amphotericin B 3mg/kg OD

early diagnosis and therapy significantly imporve prognosis

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15
Q

Candidiasis

A

Candida > normal flora in GI and genitorinary tracts in humans, capable of loical infection of mucus membranes and also CNS infections

Oral and vaginal infection

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16
Q

Oral thrush

symptoms
refer?
treatment

A

symptoms:
can be asymptomatic, loss of taste or unpleasant taste, white patches and can be wiped off leaving behind red patches

refer if: symptoms NOT resolved after 7 days
person has pain swallowing
no obvious precipitant
poorly controlled diabetes
person with a single red/ white plaque that cannot be rubbed off

treatemnt; miconazole
nystatin oral suspension 100u/ml

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17
Q

counselling for oral thrush

A

maintain good dental hygiene
stop smoking
provide person with inhaler technique

18
Q

Vaginal candiasis

A

common yeast infection, thrush

Caused by candida albicans
NOT an sti

if infection - parter may also need treatment

19
Q

Vaginal candidiasis - management

A

managed with azole antifungals
1. topical vaginal cream
2. Pessary
3. Oral capsule

some oTC products avail. as mixture of formulations to treat infection and provide symptomatic relief

20
Q

external Clotrimazole 2% cream (canesten)

A

used for immediate symptomatic relief of itch

apply thin layer to vulva and surounding area BD-TDS until symptoms disappear

common s.e = itching/burning sensation

can damage condoms

21
Q

Internal clotreimazole 10% cream

A

administer intravaginally using applicator supplied

one-off treatment, best administred at night

side-effects; itching/ burning senstion

convenient but some women uncomfortable with formulation

can damage condoms

22
Q

Pessary

A

500mg
200mg
100mg

s.e itching/ burning sensation

can damage condoms

23
Q

oral capsule

A

fluconazole 150mg oral capsule

one-off dose, swollowed whole

take 12-24 hrs for symptoms tom improve

interactions: warfarin, statins, phenytoin, rifampicin, ciclosporin and theophylline

s.e = mild and transient; nsusea, abdo discomfort, flatulence and diarrhoea

24
Q

Systemic candidasis

A

infection of blood or other normally sterile sites

incl. retina, kidney, liver and spleen adn CNS

symptoms; fever, trachycardia or tachypnoea

1st line; caspofugin

alternatively; fluconazole

2nd line; amphotericin B

25
Q

Cryptococcosis

A

caused by cryptococcus species - found in bird

lungs are primarly affected
symptomatic involvement may occur in brain

symptoms - include pyrexia, productive cough, dyspnoea, chest pain, weight loss and fatigue

26
Q

What are the treatment options for cryptococcosis?

A

flucanazole, itraconazole or amphotericin B

27
Q

Cryptococcal meningitis

A

progressive, chronic

occurs in immunosuppressed individuals

symptoms; headache, severe headache, meningismus

28
Q

Treatment for Cryptococcal meningitis?

A

amphotericin B by IV infusion and fluctosine by IV infusion for 2 weeks, fluconazole by mouth 8 weeks

29
Q

Histoplasmosis

A

fungus proliferates - soil contaminated with bird or bat dropping

symptoms - fever, headache or dyspnoea

treatement - itraconazole

in severe infections: amphotericin B

30
Q

histoplasmosis

A

fungus spreads to eyes
abnormal blood vessels - affect vision

care does not incl antifungal medications
fungus causes ocular histopolasmosis, not having a fungal infections

31
Q

how are skin and nail infections treated

A

normally over counter

32
Q

more severe scalp and nail

A

treated with POM

scalp - Tinea capitis (systemically); reduce transmission
oral griseofulvin
ketocanazole 2% shampoo

Nail
onychomycosis treated systemically

1st line terbinafine
2nd line itracinazole

33
Q

Skin infections (fungal) list:

A

ringworm - spread perosn to person/ person to animal

ringworm of scalp

fungal nail infections - should b referred as system antibioticsn usually required

athlete’s foot - fungal food infection - person to person, contact of shared towels, changing rooms

34
Q

Skin infections - treatment?

A

OTC topical antifungsal (ringworm)

Imidazoles e.g. micronazole cream (daktarin)

Itraconazole and terbinafine OTC in athelete’s foot treatment

Powder and spray formulations used fro athlete’s foot

refer?
treatment failure
bacterial infection
diabetic patients
involvment of nail

35
Q

Commpn signs of fubgal skin infections

A
  • folds of skin (not washed often, warm and damp)
  • asymmetrical
  • red, scaly advancing edge and clear central area
36
Q

What are the differential diagnosis of ringworm?

A

eczema
pityriases
psoriasis

37
Q

body and groin diagnossi of common fungal skin infections?

A

history of scaly, itchy skin

folds of skin

single or multiple red or pink, flat or slightly raised ring-shaped patches

38
Q

treatment of fungal skin infections

A

topical antifungal cream (may need repeating)

mildy-potent corticosteroid, if there is inflammation (hydrcortisone 1% cream to be applied once daily for max 7 days

severe infection - Terbinafine 1st line

39
Q

What to do with immunocompromised patients?

A

give them prophylaxis

40
Q
A

PMP-201 (34 decks)

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