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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
Brand name and MOA for: Oteseconazole
Vivjoa Inhibits 14a demethylase (an enzyme involved in the formation of components of the fungal cell membrane)
26
Oteseconazole dosing
- 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
Oteseconazole SE & CI
- HA and nausea - CI in pregnancy and lactation
28
Oropharyngeal candidiasis
- "thrush" - effects the mouth and throat, often presenting with white patches - can be treated with topical options
29
Esophageal candidiasis
- effects the esophagus, causing symptoms like pain with swallowing - requires systemic treatment
30
Oropharyngeal candidiasis moa/sx
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
Most common fungi resulting in oropharyngeal candidiasis
C. albicans
32
Fungi that can cause oropharyngeal candidiasis
C. elaborate, C. tropicalis, C. krusei, C. dubliniensis, and C. parapsilosis
33
oropharyngeal and esophageal candidiasis presentation
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
oropharyngeal and esophageal candidiasis risk factors
- 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
oropharyngeal and esophageal candidiasis treatment
- minimize risk factors when possible - drug selection depends on: adherence, age, adequate saliva, drug itxns, med conditions, location and severity of the infection
36
Oropharyngeal Treatment mild infections
- 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
Oropharyngeal Treatment moderate to severe
- 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
What are Mycotic infections generally caused by:
Trichophyton Epidermphyton Microsporum some Candida species
39
mycotic infection risk factors
prolonged sweating poor hygiene skin folds sedentary lifestyle bed-bound HIV, DM, immunocompromised steroid use impaired circulation
40
Tinea pedis
"athletes foot" - most common
41
tinea manuum
superficial fungal infection of one or infrequently both hands
42
tinea cruris
"jock itch" more common males
43
tinea corporis
"ringworm"
44
tinea capitis
scalp
45
tinea barbae
beard
46
tinea versicolor/pityriasis versicolor
discoloration on the skin
47
tinea unguium - Onychomycosis
nails
48
Terbinafine MOA
inhibits squalene epoxidase enzyme needed in fungi sterol biosynthesis, leading to accumulation of squalene within the cells and ultimately cell death
49
Butenafine MOA
inhibit squalene epoxidase enzyme needed in fungi sterol biosynthesis, leading to accumulation of squalene within the cells and ultimately cell death
50
Tolnaftate
unknown but proposed to distort the hyphae and stunt mycelial fungi growth
51
Aluminum salts
- no antifungal activity - Used solely for astringent properties ti relieve inflammation

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