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Dermatology pharm > Tinea and onchomycosis > Flashcards

Tinea and onchomycosis Flashcards

Tx of infections; MOA; Elim and dose mod in dysfxn; drugs producing hepatic or CV dysfxn; CYP interactions; teratogenic actions; immune suppression

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Dermatology Board Prep flashcards
1
Q

For widespread tinea infections, what can be used?

A

terbinafine; itraconazole; fluconazole;

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2
Q

localized tinea infection Tx

A

Azoles; terbinafine; naftifine; ciclopirox

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3
Q

Tx for onychomycosis

A

terbinafine; itraconazole; fluconazole

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4
Q

Tx for onchomysis topical

A

ciclopirox; amorolfine

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5
Q

What is the MOA for ciclopirox?

A

blocks fungal transmembrane transport and depletes essential substrates thus interfering with DNA/RNA synthesis (high [ ] cause intracellular leakage)

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6
Q

does Ciclopriox have effects on the fungal cell wall?

A

NO=> does not inhibit synthesis or cause lysis

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7
Q

What are significant toxicities with systemic Azole admin?

A

organ dysfxn; contraindication in concurrent disease or drug (CYP) interactions

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8
Q

What are the advantages and disadvantages of topical tx of azoles?

A

Tx occurs w/o significant systemic toxicity but not suitable for all infections

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9
Q

Ketoconazole use is limited for what reasons?

A

Hepatoxicity; adrenal insuffiency; DDI with CYP

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10
Q

What is a DDI of fluconazole, posaconazole and voriconazole?

A

CYP 3A4 interactions

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11
Q

Which drugs affect 2C9 and 2C19?

A

fluconazole; voriconazole

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12
Q

Posaconazole affects what type of activity?

A

P-gp activity

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13
Q

What are ADEs associated with fluco, posacon and voricon -azoles?

A

QT prolongation and dysrhythmias; hepatotoxicity; elevated LFTs

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14
Q

What are specific ADEs of voriconazole?

A

visual disturbances (optic neuritis: color change, photophobia); photosensitizes the skin in SCC and melanoma

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15
Q

Can flucon, posacon and voricon reach the CSF?

A

yes (dep on molec weight and P-gp affinity):

Flucon > voricon > itracon

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16
Q

What is significant for administration with posaconazole?

A

MUST be with full meal or acidic carbonated drink for adequate bioavailability

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17
Q

What is the effect of flucon, posacon and voricon in pregnancy?

A

contraindicated in pregnancy (Cat C)

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18
Q

What is the elimination of fluconazole?

A

renal

19
Q

Dose adjustment with fluconazole?

A

yes with organ dysfxn

20
Q

Metabolism of flucon, posacon and voricon

A

extensie hepatic metab

21
Q

Terbinafine metabolism

A

hepatic (long half life)

22
Q

terbinafine elimination

A

renal

23
Q

What ADEs are associated w/ oral terbinafine usage

A

lymphopenia and neutropenia

24
Q

What patients should avoid taking terbinafine?

A

immunosuppressed => cause opportunistic infections

25
Q

admin of amorolfine

A

topical only with limited absorption

26
Q

Terbinafine use in pregnancy

A

category B so risk is very little

27
Q

MOA for naftifine?

A

anti-inflam via inhibition of inflam mediators such as PG, LTs and histamines => causes vasoconstriction

28
Q

Naftifine static or cidal

A

locally cidal against G+ and G-

29
Q

Metabolism of naftifine (topical)

A

hepatic

30
Q

elimination of naftifine (topical)

A

renal

31
Q

Contraindications for naftifine use

A

Hx of hypersensitivity to drug or co-formulated materials

32
Q

What should naftifine not be used with?

A

topical azoles

33
Q

Why cant topical azoles and naftifine be used together?

A

pharmacodynamic interference=> inhibits sterol production at earlier points so will diminish effectiveness

34
Q

DDI with naftifine

A

no systemic DDI

35
Q

Ciclopirox admin

A

topical only but limited absorption

36
Q

Possible ADE with ciclopirox or amorolfine

A

hypersensitivity/allergy to drug or co-formulation materials; irritate if on skin abrasions

37
Q

MOA of amorolfine

A

inhibits ergosterol synthesis

38
Q

What are BBW with itraconazole?

A

heart failure; ventricular dysfunction; co-admin w/ drugs

39
Q

MOA of itraconazole?

A

negative inotropic action (decrease force of heart contraction)

40
Q

Metabolism of itraconazole

A

extensive hepatic

41
Q

elimination of itraconazole

A

renal

42
Q

Contraindications of itraconazole

A

concurrent drugs with CYP interaction;
liver dysfxn/hepatic toxicity => monitor LFTs;
post-partum

43
Q

Pregnancy and itraconazole

A

Cat C but congenital deformities present

44
Q

Post-partum and itraconazole

A

distributed in breast milk

Dermatology pharm (10 decks)

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