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Pharmaco For Pod > wk 8- antifungals > Flashcards

wk 8- antifungals Flashcards

1
Q

types of antimycotics

A

topical
1. azoles
2. allylamines
3. mopholines
4. polyene

oral
1. allylamines
2.mitosis inhibitors
3. azoles

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2
Q

azole antifungals

A

topical:
bifonazole
ketoconazole
fluconazole (oral only)
clotrimazole

oral:
itraconazole
fluconazole

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3
Q

allylamine antifungals

A

terbinafine

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4
Q

MOA azole

A

fungistatic
can be fungicidal at larger doses

interrupt the synthesis from lanosterol to ergosterol

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5
Q

MOA allylamines

A

fungicidal

interrupts the synthesis with an increase in squalene within the cell membrane and deficiency of ergosterol

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6
Q

nystatin MOA

A

fungicidal
bind to ergosterol in fungal cell membrane and causes depolarization

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7
Q

griseofulvin MOA

A

fungistatic

disrupts spindle formation during mitosis and arrests metaphase

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8
Q

fungal species

A
  1. trichophyton rubrum (76%)
  2. trichophyton interdigitale
  3. epidermophyton floccosum
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9
Q

types of tinea pedia

A
  • interdigital
  • hyperkeratotic/moccasin
  • inflammatory / vesticular
  • ulcerative
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10
Q

types of onychomycosis

A

tinea unguium

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11
Q

diagnosising tinea pedis

A

microscopy and culture not generally needed when starting topical therapy

culture may take up to 6 weeks

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12
Q

topical corticosteroid and fungal infections

A

used in conjunction initially if itching is severe- typically for inflammatory/vesticular tinea

removes redness but it allows the infection to spread as it decreases the immune response and therefore should not be used alone

signs of infection will return and be worse than before on withdrawal of corticosteroid - tinea incognito

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13
Q

treatment for plantar/hyperkeratotic/moccasin tinea

A

oral- ETG

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14
Q

treatment for inflammatory/vesicular tinea

A

oral

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14
Q

oral therapy when

A
  • widespread
  • topical hasnt worked
  • topical corticosteroid used inappropriately
  • on scalp, palms or soles
  • inflammatory, hyperkeratotic, vesicular in nature
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15
Q

types of oral therapy

A
  1. azole
    fluconazole
    itraconazole

2.allymadine
terbinafine

griseofulvin is effective and cheaper but a longer treatment course

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16
Q

length of oral therapy

A

terbinafine/fluconazole :usually 4 week course

itraconazole: one week course but need to review 3-4 weeks after and repeat if cultures are positive

17
Q

types of onychomycoiss

A
  1. white superficial onychomycosis
  2. distal subungal onychomycosis
  3. candida onychomycosis
  4. proximal subungual onychomycosis
18
Q

diagnosis onychomyosis

A

microscopy and culture before treatment
positive in approx 80% of cases of OM

19
Q

what species causes white superficial onychomyococisis

A

usually trichophyton interdigitale

20
Q

treatment for white superficial

A
  1. topical miconazole tincture
  2. topical amorolfine
21
Q

when would u not use topical therapy on onychomyosis

A

distal subungal onychomyocosis or
proximal subungal onychomyosis

doesnt penetrate the nail to reach the source

22
Q

oral therapy for onychomycosis and success rate and length of treamtent for nails

A
  1. terbinafine (70-80%)- 12 weeks or longer
  2. azole (60-70%)
    itraconazole 3-4months
    fluconazole: 6-12 months
  3. griseofulvin (30%) after 12 months and relapse common
23
Q

why would u use oral therapy for onychomyociss

A

-widespread
-topical not working
-the type, DSO, PSO unable to penetrate
-risk of infection, neuropathy, PAD, ulceration, complications (diabetic, immune suppressent, delayed healing)

23
Q

poor prognosis for onychomyocosis when

A
  1. area of infection more than half the nail
  2. significant lateral infection
  3. subungal hyperkeratosis >2mm
  4. white/yellow streaks
  5. total dystrophic
  6. non responsive organism
  7. immunosuppressive patients
  8. diminished peripheral circulation
24
Q

terbinafine contraindications- oral

A
  1. hepatic
    -liver disease
  2. psoriasis
    -need to diagnose infection first
  3. children
    -rare to occur in children, tablet not recommended and cream not for children <12
  4. antidepressents
    -TCA (increases side effects)
    -venlafaxine and paroxetine
25
Q

what can you use lamisil once for

A

interdigital tinea pedis only

leave to dry to a film and dont wash area for 24 hours

26
Q

what can you use cream, gel or spray lamisil for

A

tinea corporis
tinea cruris
interdigital tinea pedis

27
Q

renal impairment and oral therapy

A

half dose

28
Q
A
29
Q

terbinafine and monitoring liver function

A

liver function test at baseline, monitor if treating longer than 6 weeks

it can cause elevated LFT and liver toxicity and blood dyscrasias

symptoms of dark urine, tired, nauesous, etc

30
Q

formulations of topicals and what they suit

A

cream- dry scaling tinea
tincture- nails
spray- cant reach, hairy or painful on touch areas
lotion- between toes for drying

31
Q

mixonazole has what for azoles

A

the most fromulation options

cream
lotion
powder
spray
tincture
solution

32
Q

bifonazole is

A

used once daily and has the shortest duration fo treatment 2-3weeks compared to other azoles

33
Q

hydrocortisone and antifungals

A

only used until inflammation subsides (max 7 days) and must be used with antifungal at least 2 times a day

34
Q

topical treatments for onychomycosis

A
  1. amorolfine -nail licquer solution. once/twice weekly
  2. miconazole - tincture
  3. urea (2-3weeks) and bifonazole cream (4weeks)
  4. ciclopirox -lacquer
35
Q

how long does it take for a nail to grow out

A

12 months or more

36
Q

what is not effective if nail matrix is infected

A

topical

37
Q

griseofulvin- oral tablet length of treatment and contraindications

A

12 months for nails
4-6 weeks for skin

  1. pregnancy/lactation
  2. heaptic dysfunction
  3. lupus erythemateosus (burning with sun exposure side effect)
  4. combined oral contraceptive
  5. warfarin
38
Q

side effects of griseofulvin

A
  1. skinburn
  2. headache
  3. dizziness
39
Q
A

Pharmaco For Pod (10 decks)

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