EENT: Mouth/throat- Viral-Herpes simplex, oral candidiasis Flashcards
(22 cards)
Primary outbreak of oral herpes
Herpetic gingivostomatitis
Primarily on gingiva
What lesion is described as “gray base with red halo”
Aphthous ulcers (Canker sores)
Graph showing comparison b/w recurrent intraoral herpes (RIH) and Recurrent Aphthous stomatits (RAS)—> which side is which?
–Prodrome of burning, pain, tingling
–Burning erythematous papules–>vesicles that rupture–>superficial ulcers that form scabs
Mouth/throat: Viral-Herpes Simplex
–>HSV 1 or 2
***Acyclovir*** within 3 days of onset (cheap option, take TID)
***Valacyclovir (prodrug of acyclovir)*** (expensive option, but BID instead of TID)
Famciclovir (No RCTs, so not standard)
Treatment options for oral HSV 1 or 2
–For comfort care, consider suggesting patients use
- ice, popsicles,
- or rinse and expectorate every two hours with diphenhydramine 12.5/5 cc mixed with magnesia-aluminum 1:1
- Topical lidocaine
- Fluids as tolerated given after pain management
Supportive care/ pain and fluid management for oral HSV
Side effects:
1.***malaise***
2. ***headache***
- nausea, vomiting, diarrhea
Adverse events/Side effects of antiherpetic
Efficacy/Monitoring:
–Urinalysis, BUN, serum creatinine, liver enzymes, CBC
-note: Adjust dose in renal impairments
Efficacy and monitoring for the use of antiherpetics
Drug interactions:
****_____, ____, and ___may diminish the therapeutic effect of Zoster Vaccine
•*****discontinue antiviral agents with anti-zoster activity ( i.e. _____)for at least 24 hours prior to and 14 days after receiving a live attenuated zoster vaccine
–may enhance the CNS depressant effect of Zidovudine (HIV tx)
Acyclovir-Valacyclovir, Famciclovir
What is the main tx for Aphthous ulcers?
***Pain management****
***Pain management****
–For comfort care, consider suggesting patients use:
- ice, popsicles,
- or rinse and expectorate every two hours with diphenhydramine 12.5/5 cc mixed with magnesia-aluminum 1:1
- Topical lidocaine
Treatment for Aphthous ulcers
Which condition has the following clinical presentation:
•Painful creamy-white curd-like patches overlying erythematous mucosa
–Easily rubbed off –only the underlying irregular erythema may be seen
Fungal-oral candidiasis
Diagram of Antifungal MOA
Antifungals disrupt the membrane
–***Nystatin Suspension 1:100,000***
–Clotrimazole troches
–Itraconazole Suspension (Second line to fluconazole)
***First line topicals to treat Fungal-oral Candidiasis***
These have less adverse events and drug interactions
***Fluconazole***
Fungal-oral candidiasis: treatment with “azole” antifungal
***oral prototype: Fluconazole***
What medication has the following mechanism?
•Mechanism: Binds to sterols in fungal cell membrane, changing the cell wall permeability allowing for leakage of cellular contents
Oral prototype: Fluconazole (medication that can be used to treat fungal-oral candidiasis)
Which medication has the following adverse effects/side effects:
–Anaphylactic reactions
–Angioedema (rare)
–Headache, dizziness
–Rash
–Nausea, abdominal pain, vomiting, diarrhea, dysgeusia, dyspepsia
–***Increased Alkaline phosphatase, ALT, AST, hepatic failure (rare), hepatitis, jaundice***
“azole” antifungal: fluconazole (treatment for oral candidiasis)
Which medication has the following Efficacy/Monitory?
–***Periodic liver function tests (AST, ALT, alkaline phosphatase)
–***Renal function tests: baseline SrCr
- Potassium levels
–***QT prolongation
“azole” antifungal: fluconazole (treatment for oral candidiasis)
Which medication has the following interactions? (Note, all of the following was red in the powerpoint)
•Interactions:
–Inhibits CYP1A2 (weak), CYP2C19 (strong), CYP2C9 (strong), CYP3A4 (moderate)
- Increase the serum concentration of Atorvastatin, simvastatin, Citalopram, Phenytoin, Proton Pump Inhibitors, Sulfonylureas, Vitamin K Antagonists
- May decrease the metabolism of Benzodiazepines, Carbamazepine, Losartan
- May enhance the adverse/toxic effect of Calcium Channel Blockers
–etc, etc, etc
****Main idea: -azoles have a lot of interactiosn so look them up!
“azole” antifungals: Fluconazole (a treatment for fungal-oral candidiasis)
What is the pregnancy category for “azole” antifungals like Fluconazole
Pregnancy category C (single does for vaginal candidiasis)
Category D for all other indications
True or false, dosage adjustment in renal impairment is requried for “azole” antifungals (Fluconazole)
True
What is unique about Ketaconazole?
This is another “azole” that is unique because you have to take with breakfast because it requires acidic gastric environment
