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ID > Superficial Fungal Infections > Flashcards

Superficial Fungal Infections Flashcards

1
Q

intense vaginal itching, soreness, irritation, burning on urination, painful intercourse
clumpy, thick, white (cottage cheese like) discharge w/ no foul odor

A

Vulvovaginal candidiasis

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2
Q

Exclusion criteria for treating VVC

A
  • pregnancy
  • girls younger than 12 yrs
  • concurrent sx: fever or pain in the pelvic area, lower abdomen, back, or shoulder
  • meds that can predispose to VVC: corticosteroids, antineoplastics
  • medical disorders that can predispose to VCC: DM, HIV infection
  • recurrent VVC (more than 3 vaginal infections/yr or in the past 2 months)
  • first vulvovaginal episode
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3
Q

non-pharm treatment

A
  • keep area clean and dry
  • avoid harsh or perfumed soaps and douching
  • avoid hot tub use and constrictive clothing
  • d/c precipitating meds
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4
Q

Uncomplicated VVC Treatment OTC

A

self-treatment is only recommended in women with multiple confirmed prior cases who report the same symptoms
- no difference in cure rates between oral and topical azole treatments
- non-Rx products w/ treatment range from 1-7 days

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5
Q

Which DOT is recommended for pregnant patients?

A

7-day regimens

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6
Q

Which azole is not used in pregnancy?

A

Butoconazole

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7
Q

Which OTC treatment options are used for 1 day?

A

Butoconazole 2% cream
Miconazole 1200 mg suppository
Tioconazole 6.5% ointment

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8
Q

Which OTC treatment options are used for 3 days?

A

Clotrimazole 2% Cream
Miconazole 200 mg suppository
Miconazole 4% cream

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9
Q

Which OTC treatments options are used for 7 days?

A

Clotrimazole 1% cream
Clotrimazole 100 mg tablet
Miconazole 100 mg suppository
Miconazole 2% cream

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10
Q

Should be cautioned when taking Warfarin

A

Miconazole 100 mg suppository (Monistat 7)

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11
Q

Uncomplicated VVC Treatment - Rx
- Vaginal

A
  • Nystatin 100,000 unit tablet
  • Terconazole 0.4%, 0.8%, 80 mg supp
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12
Q

Uncomplicated VVC Treatment - Rx
- oral

A

Fluconazole 150 mg

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13
Q

What disease states determine a VVC case to be complicated?

A

uncontrolled DM
immunocompromised patients
pregnant

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14
Q

Which Rx treatment option is not used in pregnancy?

A

Fluconazole

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15
Q

Complicated VVC treatment

A
  • Same ingredients can be used to treat complicated VVC as uncomplicated. only increase the DOT to 10-14 day
  • Fluconazole 150 mg q72h x 2-3 doses
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16
Q

Pregnancy treatment Rx

A
  • topical Imidazole x7
    — avoid oral therapy
  • POSSIBLY Nystatin tablet but no definite
  • Bee honey and yogurt may be beneficial as adjunct therapy in pregnant pts
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17
Q

Recurrent VVC presentation

A
  • having 3 or more episodes for less than 12 months
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18
Q

Recurrent VVC Treatment

A

induction therapy for 10-14 days with either oral (Diflucan 150 q72h) or topical azole followed by fluconazole 150 mg weekly x6 months

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19
Q

Which fungi is generally the cause of anti-fungal resistant VVC infections?

A

C. glabrata

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20
Q

Anti-fungal resistant VVC Treatment

A
  • boric acid (TOXIC IF TAKEN ORALLY)
    —-600 mg PV daily x14, followed by 1BIW
  • Nystatin tablet 100,000 units PV daily x14
  • Flucytosine cream 1g PV x7
  • Flucytosine cream 17% w/ or w/o Amphotericin B 3% cream nightly x14 - NOT PREFERRED
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21
Q

Brand name and MOA for:
Ibrexafungerp

A

Brexafemme
Triterpenoid anti-fungal that inhibits glucan synthase (an enzyme involved in the formatted of components of the fungal cell wall)

22
Q

Ibrexafungerp facts

A
  • more responsive than Fluconazole
  • CI in pregnancy
  • major substrate of CYP3A4; avoid in patients taking moderate or strong CYP3A4 inhibitors
23
Q

Ibrexafungerp dosing

A

Orally
300 mg q12h x2 doses for ACUTE VVC
300 mg q12h x2 doses monthly x6m for RECURRENT VVC

24
Q

Ibrexafungerp SE

A

diarrhea/loose stools, nausea, abdominal pain

25
Q

Brand name and MOA for: Oteseconazole

A

Vivjoa
Inhibits 14a demethylase (an enzyme involved in the formation of components of the fungal cell membrane)

26
Q

Oteseconazole dosing

A
  • Day 1: 600mg; Day 2: 450 mg; Beginning day 14: 150 mg QW x11wks
    — with fluconazole -
  • day 1,4,&7: fluconazole 150 mg
  • days 14-20: oteseconazole 150 mg daily x7d
  • beginning day 28: 150 mg 1QW x11 wks
27
Q

Oteseconazole SE & CI

A
  • HA and nausea
  • CI in pregnancy and lactation
28
Q

Oropharyngeal candidiasis

A
  • “thrush” - effects the mouth and throat, often presenting with white patches
  • can be treated with topical options
29
Q

Esophageal candidiasis

A
  • effects the esophagus, causing symptoms like pain with swallowing
  • requires systemic treatment
30
Q

Oropharyngeal candidiasis moa/sx

A

infection of the oral mucosa
immunocompromised conditions are at a higher risk bc can cause a rapid conversion to a pathogen that causes infection

31
Q

Most common fungi resulting in oropharyngeal candidiasis

A

C. albicans

32
Q

Fungi that can cause oropharyngeal candidiasis

A

C. elaborate, C. tropicalis, C. krusei, C. dubliniensis, and C. parapsilosis

33
Q

oropharyngeal and esophageal candidiasis presentation

A

Sx: diverse, usually include sore, painful mouth/throat, metallic taste, difficulty swallowing, painful swallowing
S: erythema and white patches on the buccal mucosa, tongue, throat, or gums
—–in EPC, the plaques can ulcerate and narrow the lumen
- lab tests: not usually needed with OPC, but upper GI endoscopy used with EPC

34
Q

oropharyngeal and esophageal candidiasis risk factors

A
  • Meds: corticosteroids, cytotoxic agents, PPIs, abx
  • environmental chemicals (benzene/pesticides)
  • poor dental hygiene
  • dentures
  • zerostomia
  • smoking
  • immunosuppressant therapy
  • infants (<18 mo) and the elderly (>60yrs)
  • HIV/AIDS
  • DM
  • Thyroid. parathyroid, adrenal dysfunction
  • cancer and radiation therapy
  • nutritional deficiencies
35
Q

oropharyngeal and esophageal candidiasis treatment

A
  • minimize risk factors when possible
  • drug selection depends on: adherence, age, adequate saliva, drug itxns, med conditions, location and severity of the infection
36
Q

Oropharyngeal Treatment
mild infections

A
  • Clotrimazole troche 10 mg (hold in mouth x15-20 minutes until dissolved 5x/day x7-14 days
  • Miconazole mucoadhesive buccal tablet 50 mg daily x7-14 days
  • Nystatin suspension (mild) 100,000 units/mL (swish and swallow 4-6 mL QID x7-14 days)
37
Q

Oropharyngeal Treatment
moderate to severe

A
  • Fluconazole tab 100-200 mg daily x7-14 days
  • Itraconazole 10mg/mL sol’n; 200mg daily for up to 28 days
  • Posaconazole 40mg/mL; 400mg BID x3 then 400mg daily up to 28 days
  • Voriconazole tab 200 mg BID
  • Amphotericin B deoxycholate suspended 100 mg/mL “swish and swallow” 1mL QID x7-10 days
    –general DOT 7-14 days; longer for refractory
38
Q

What are Mycotic infections generally caused by:

A

Trichophyton
Epidermphyton
Microsporum
some Candida species

39
Q

mycotic infection risk factors

A

prolonged sweating
poor hygiene
skin folds
sedentary lifestyle
bed-bound
HIV, DM, immunocompromised
steroid use
impaired circulation

40
Q

Tinea pedis

A

“athletes foot” - most common

41
Q

tinea manuum

A

superficial fungal infection of one or infrequently both hands

42
Q

tinea cruris

A

“jock itch” more common males

43
Q

tinea corporis

A

“ringworm”

44
Q

tinea capitis

A

scalp

45
Q

tinea barbae

A

beard

46
Q

tinea versicolor/pityriasis versicolor

A

discoloration on the skin

47
Q

tinea unguium - Onychomycosis

A

nails

48
Q

Terbinafine MOA

A

inhibits squalene epoxidase enzyme needed in fungi sterol biosynthesis, leading to accumulation of squalene within the cells and ultimately cell death

49
Q

Butenafine MOA

A

inhibit squalene epoxidase enzyme needed in fungi sterol biosynthesis, leading to accumulation of squalene within the cells and ultimately cell death

50
Q

Tolnaftate

A

unknown but proposed to distort the hyphae and stunt mycelial fungi growth

51
Q

Aluminum salts

A
  • no antifungal activity
  • Used solely for astringent properties ti relieve inflammation

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