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YR3S2- clinical therapeutics > wk 9- skin and nail infections > Flashcards

wk 9- skin and nail infections Flashcards

1
Q

types of antibiotic therapy

A

directed
empirical
prophylactic

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2
Q

bacterial infection that has green colouration to is is caused by what organism

A

pseudomonas infection

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3
Q

infection with white/creamy pus is typically what bacterial infection

A

streptococcus infection

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4
Q

if pus is golden, runny and straw coloured then its likely what bacterial infection

A

staphloccocus infection

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5
Q

vesticular bullous tinea pedis is caused by what fungal infection

A

trichophyton rubrum and
trichophyton mentagrophytes

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6
Q

chronic hypertrophic appearance with dusty scale like nail is caused by what fungal infection

A

moccasin tinea pedis

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7
Q

whos at risk of fungal infection

A

older people
diabetes
pregnant women
biologics - immunosuppressant

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8
Q

fungal infections can be caused by

A

dermatophytes and yeasts, different treatment for these organisms

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9
Q

why to treat tinea pedis

A
  1. comfort- itching, scaling, etc
  2. appearance/cosmetic
  3. secondary infections, especially in those who are at risk/immunocompromised
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10
Q

dermatophytes
What can it infect
What types of

A

can infect skin, har, nails

tinea pedis is what we’re interested in

most common:
1. trichophyton rubrum
2. trichophyton interdidigitale
3. epidermophyton floccosum

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11
Q

yeast
What can it infect
Most common species

A

candidiasis (candida albicans) most common species

can infect
1. mucuous membranes,
2. nails (paronchyia),
3. skin (skin fold, chronic paronchyia)

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12
Q

clinical features of tinea pedis

A

hyperkertotic- patchy, fine dry scaling on sole of foot
maceration in webspace
clusters of blisters/pustules on side of feet
round patches on top of foot

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13
Q

predisposing factors of tinea pedis

A
  1. exposure to spores (environment)
  2. lower production of fatty acid
  3. occlusive footwear
  4. not changing socks/shoes
  5. excessive sweating
  6. immunodeficiency
  7. poor ciruclation
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14
Q

non pharmacological advice to manage tinea pedis

A

dry feet
wear shoes in communal areas
wash socks/jocks at a high heat
dry clothes in sun, UV light kills
moisture/cotton socks

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15
Q

onychomycosis caused by what pathogens and what species

A

dermatophytes (tinea unguium)

often occurs from untreated tinea pedis

can be caused by yeast- candida albicans

and moulds

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16
Q

if you have onychomyosis what happens with tinea pedis

A

recurring issue

constant secondary infections

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17
Q

types of onychomyosis

A
  1. distal OM
  2. lateral OM
  3. subungal onychomycosis
  4. superficial white onychomycosis
  5. total dystrophic onychomycosis
  6. proximal subungal OM
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18
Q

Chronic paronychia v acute

A

inflammation of the nail fold that can be caused by yeast/moulds

acute is caused by bacteria

different presentations.
acute has more inflammation/pus

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19
Q

do you need to confirm tinea pedis

A

no

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20
Q

if youre going to prescribe oral therapy should you confirm diagnosis

A

yes

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21
Q

where to take samples from

A

leading edge of the lesion after cleaning- tinea pedis

as proximal as possible - OM

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22
Q

microscopy and culture

A

M- comes back quickly
C- can take weeks

high false negative rate up to 40%

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23
Q

topical treatment for tinea pedis

A
  1. terbinafine 1% cream/gel applied once or twice daily for 1-2weeks
    -fungicidal
  2. azoles applied twice daily for 2-4 weeks
    -fungistatic
24
Q

oral treatment for tinea pedis

A
  1. terbinafine 250mg, once daily 2 weeks
  2. fluconazole 150mg, once daily 6 weeks
  3. itraconazole 100mg once daily 4 weeks
  4. griseofulvin 500mg, once daily for 8-12 weeks
25
Q

what doesnt get recommended in AMH for OM

A

topical therapy

success rate is around 8% and costs are around 70% for a bottle or more

25
Q

oral treatment for OM

A

1.terbinafine 250mg once daily until clearance

  1. fluconazole 150-300mg once weekly until clearance
  2. itraconazole 100-200mg twice daily for 1 week every month until clearance
  3. griseofulvin 500-1000mg once daily until clearance
26
Q

comparison of azoles and griseofulvin

A

similar effectiveness but griseofulvin is longer treatment and more side effects

27
Q

other options for OM

A
  1. laser - UV rays/heat to destroy
  2. photodynamic - “
  3. iontophoresis delivery - electric charge to drive topical medications deeper into the nail plate
    OR
    drill holes into nail plate to get topicals to the nail plate
  4. surgery- avulsion apply topical treatment
28
Q

what is onycholysis

A

nail separation

29
Q

treatment for onycholysis

A

if candida confirmed
1. fluconazole 150-300mg once weekly for 3 months / clearance

  1. intaconazole 200mg, twice daily for 1 week every month for a total of 3 months or until clearance

if pseudomoas confirmed
1. acetic acid / vinegar soak the nails for 5-10min twice daily for 3-4 weeks

30
Q

what do you need to consider with topical therapy

A

can they reach feet
compliance?

31
Q

what to consider with oral therapy

A

-interactions?
-ADRs
-compliance
-dose adjustments?
-renal/ hepatic impairments?
-success rate

32
Q

what needs to be done when terbinafine is started

A

baseline blood test of
renal function
full blood count
liver function

follow up tests every 6 weeks

33
Q

commonside effects of terbinafine

A

headache
muscle aches (myalgia)
joint pain
nausea

34
Q

griseofulvin important notes

A

lots of side effects
suspected teratogen- contraindicated in pregnancy or wanting to become pregnant (1 month before) OR 6 months to prospective fathers

35
Q

fluconazole itraconazole

A

oral form- pods cant prescribe not on formulary

36
Q

what needs to be done when starting oral therapy for infection

A

shared decision making with GP and ensure systemic symptoms are monitored by GP

37
Q

what does M and C do

A

-diagnose pathogen
-show the virulence (how fast its growing)
-what antibiotics can treat it (resistant/susceptible)

38
Q

if you’ve send off for a M and C after empirical didn’t work what do you need to do

A

state what antibiotic has been used as it will change the way the pathogen grows

39
Q

Review antibiotics

A

-types
-MOA
-considerations
-cidal/static

40
Q

treating infections stpes

A
  1. wound swab and send for M and C
  2. have an idea what pathogen we suspected based off symptoms and nature
  3. empiracal therapy based off EBP
  4. within 48-72 hours review progress and make changes if required (stop, continue, change therapy)
41
Q

what is the difference between oral and IV/IM antibiotics

A

first pass effect/bioavailability
-it can be faster acting via IV/IM
-It isnt stronger

42
Q

when to use IV antibiotics

A

depends on the risk of sepsis or complications

43
Q

thinks to think about when prescribing antibiotics

A

ADRs
interactions
resistance
dose adjustments
route
with/without food

44
Q

what EBP to use for empiracal therapy

A

therapeutic guidelines

45
Q

when would people use prophylatic antibiotics

A

orthopaedic surgry when theres a strong risk of a problematic infection (into a joint)

46
Q

what pathogen causes acute paronychia

A

staphloccocus pyogenes

47
Q

what is non therapeutic treatment of acute paronychia

A

drainage

48
Q

antibiotic therapy of acute paronychia

A

that doesnt respond to drainage

  1. dicloxacillin
  2. flucloxacillin

6hourly for 5 days

in the case of a delayed nonsevere penicillin allergy

  1. cefafexin 12 hourly 5 days

in the case of a immediate nonsevere/severe or delayed severe penicillin allergy

  1. clindamycin 8 hourly 5 days
49
Q

impetigo is

A

highly contagious

50
Q

treatment for impetigo

A

topical: mupirocin (bactroban) 2%

if theres extensive involvement or recurrence then oral antibiotic therapy instead

51
Q

what therapy can be used on minor superficial infected wounds

A

povodine iodine antiseptics

52
Q

pitted keratolysis

A

bacterial infection affecting plantar skin

white, cater like lesions

associated with hyperhidrosis which should be managed

53
Q

therapy for pitted keratolysis

A

clindamycin twice daily for 10 days

in conjunction with hygiene, reducing hypehidrosis etc

54
Q

transgradient means

A

affecting multiple borders of the foot

eg redness aruond heel, dorsum, lateral , medial , plantar aspects

55
Q

types of tinea

A

tinea vesticular bullus
tinea interdigitale

56
Q
A

YR3S2- clinical therapeutics (12 decks)

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