Superficial Fungal Infections

Question 1

Dermatophytes

Answer 1

Fungi that invade hair, nails, skin

Treat with proper vehicle per area being treated. Head = systemic not topical

Question 2

Clotrimazole

Answer 2

IND: Candidiasis, Tinea corporis/cruris/capitis
BOX: n/a
MOA: Inhibition of ergosterol, damages cell wall, loss of intracellular elements
CON: OTC for vulvovaginal candidiasis do NOT use if a VVC hasn’t been diagnosed
ADR: Systemic use: elevated LFTs. Topicals: localized burning especially in the vag

Question 3

Miconazole

Answer 3

IND: VVC, variety of fungal infections
BOX: n/a
MOA: Inhibits ergosterol
CON: n/a
ADR: Topical rxns. Vaginal products: cramping, burning, irritation, and itching

Question 4

Efinaconazole

Answer 4

IND: Onychomycosis of the TOENAILS. Daily x48 weeks
BOX: n/a
MOA: Inhibits ergosterol
CON: n/a
ADR: None

Question 5

Ketoconazole

Answer 5

IND: Tinea corporis/cruris/pedis. Tinea versicolor.
BOX: n/a
MOA: Ergosterol inhibitor
CON: n/a
ADR: localized rxns

Question 6

Terbinafine

Answer 6

IND: Topical. Tinea pedis, cruris, corporis
BOX: n/a
MOA: Squalene epoxidase inhibitor; the enzyme responsible for sterol biosynthesis of ergesterol (barely different than azoles)
CON: It’s a topical, don’t use on nails or scalp
ADR: Local rxns

Question 7

Butenafine

Answer 7

IND: Tinea pedis, cruris, corporis, and tinea versicolor
BOX: n/a
MOA: Squalene epoxidase inhibitor
CON: n/a
ADR: None

Question 8

Naftifine

Answer 8

IND: Tinea x3
BOX: n/a
MOA: Squalene epoxidase inhibitor
CON: n/a
ADR: None

Question 9

Nystatin

Answer 9

IND: Cutaneous and mucocutaneous fungal infections caused by Candida species
BOX: n/a
MOA: Binds to sterols in the fungal cell membrane, changing cell wall permeability = leakage of contents.
CON: Topical products; not for opthalmic, oral, or intravaginal use
ADR: N/V/D, GI disturbances oral when swallowed
ROUTE: Oral suspension (swish/spit for oral, swish/swallow for deep esophageal)
Safe for kids; application at site of infection

Question 10

Tolnaftate

Answer 10

IND: Tinea x3, prevention of recurrence of tinea pedis
BOX: n/a
MOA: Distorts fungal hyphae and stunts mycelial growth
CON: n/a
ADR: local rxns

Question 11

Ciclopirox

Answer 11

IND: Tinea x3, versicolor, candidiasis. Onychomycosis in immunocompromised pts
BOX: n/a
MOA: Disrupts DNA, RNA, and protein synthesis in fungal cells by blocking transport of essential elements
CON: Avoid occlusive dressings
ADR: Hair discoloration (shampoo). Acne and other localized rxns

Question 12

Undecylenic Acid

Answer 12

IND: Tinea x3. NOT EFFECTIVE ON NAILS OR SCALP
MOA: Fungistatic fatty acid; prevents reproduction and also often contains zinc. Astringent action; reduces rawness and irritation
CON: n/a
ADR: NONE

Question 13

Tavaborole

Answer 13

IND: Onychomycosis of toenails daily x48 weeks
BOX: n/a
MOA: Inhibits AARS
CON: n/a
ADR: None

Question 14

Flucanazole

Answer 14

MC systemic antifungal
IND: Candidiasis; candida vulvovaginitis, systemic candida infections, cryptococcal meningitis
BOX: n/a
MOA:
CON: Co-administration with CYP 3A4 substrates. FLUCONAZOLE IS A STRONG CYP INHIBITOR.
ADR: More risk with longer therapy; QT prolongation, hepatotoxicity, arrhythmias

Question 15

Itraconazole; systemic

Answer 15

IND: Onychomycosis and lots of systemic infections. Different dosing for fingernails/toenails. Toes: 12 wks. Finger: 1 week on, 3 off, 1 on
BOX: Can cause or exacerbate CHF, avoid in pts with ventricular dysfunction.
Drug interactions with a lot of agents
MOA: Strong CYP inhibitor again
CON: Pregnancy, CHF, significant drug interactions
ADR: GI
Route: Oral caps: take on full stomach to absorb as much as possible
Suspension: Food decreases absorption, take on empty stomach

Question 16

Terbinafine; systemic

Answer 16

IND: Tinea Unguium (onychomycosis), tinea capitis
BOX: n/a
MOA: Squalene epoxidase inhibitor
CON: chronic or active hepatic dz
ADR: none

Question 17

Griseofulvin; systemic

Answer 17

IND: Tinea infections not adequately treated by topical therapy
BOX: n/a
MOA: inhibits fungal cell mitosis; stops replication
CON: Hepatic failure, porphyria, pregnancy
ADR: tastes awful. photosensitive, uticaria, erythema. GI. Hepatotoxicity

Question 18

Ketoconazole Oral

Answer 18

IND: Susceptible systemic fungal infection, off label for superficial infections in those that have failed all other available options.
BOX: LAST LINE; use only when all other therapies have been exhausted
Hepatotoxicity; resulting in death and transplants
Major drug interactions; QT prolongation
MOA: Inhibits Ergosterol
CON: Hepatic dz
ADR:
Substrate and inhibitor of CYP 3A4; increases it’s own concentration