Fungal skin infections

Question 1

What are superficial mycotic infections of the skin called

Answer 1

dermatophytosis

Question 2

what is dermatophytosis also known as

Answer 2

ring worm

Question 3

Where do fungi live

Answer 3

keratin layers of the epidermis, in nails, and in hair

Question 4

what are infections of the skin typically caused by

Answer 4

Trichophyton, Epidermophyton, or microsporum

Question 5

when does infections usually occur after

Answer 5

exposure to a reservoir (humans, animals, soil) if an environment conducive to fungal growth is also present

Question 6

what are risk factors of fungal infections

Answer 6

• maintain a moist environment
• poor hygiene
• compromised immune system (HIV and chemotherapy)

Question 7

What are the non pharm treatments for fungal treatments

Answer 7

• keep area dry and clean

- limit exposure to infected reservoir

Question 8

what are treatment options for fungal infections

Answer 8

topical agents and or oral agents

Question 9

What is tinea capitis

Answer 9

scalp

Question 10

What is onychomycosis (tinea unguium)

Answer 10

nail

Question 11

T/F tinea capitis is more common in children than adults

Answer 11

true

Question 12

How does tineae capitis present

Answer 12

grey patch

black dot

Question 13

what are the non pharm treatments of tineae capitis

Answer 13

• clean all combs/brushes/ other styling tools
• Daily shampoos to remove scales
• treat family members who are colonized

Question 14

what are the pharmacologic treatments for tineae capitis

Answer 14

oral therapy +/- topical therapy is recommended

Question 15

T/F topical therapy MUST be given in combination with oral therapy

Answer 15

true

Question 16

what are the topical treatments for tineae capitis

Answer 16

Shampoos

• selenium sulfide
• zinc pyrithione
• Povidone iodine
• ketoconazole

Question 17

what are the oral (systemic) therapy options for tineae capitis

Answer 17

• Fluconazole (Diflucan)
• Griseofulvin
• Itraconazole (sporanox)
• Terbinafine

Question 18

what is the gold standard oral therapy for tineae capitis

Answer 18

griseofulvin

Question 19

where is tinea unguium most common

Answer 19

toenails

Question 20

what are the risk factors for tineae unguium

Answer 20

• age (>40 years)
• family history
• Immunodeficiency
• DM
• Psoriasis
• PVD
• smoking
• nail trauma (damage to nail bed)
• tinea pedis (infection of foot)

Question 21

What is the clinical presentation of tinea unguium

Answer 21

• discolored (yellow or white), thickened nails
• infection typically starts at the distal edge of the nail and progresses proximally
• nails become brittle and may begin to crumble

Question 22

what are the topical treatment option for tinea unguium

Answer 22

• Ciclopirox (Penlac)
• Efinaconazole (Jublia)
• Tavaborole (Kerydin)

Question 23

what are the systemic treatment options for tinea unguium

Answer 23

• fluconazole
• griseofulvin
• itraconazole (1st line)
• terbinafine (1st line)

Question 24

what is the MOA of ciclopirox

Answer 24

inhibits fungal synthesis of DNA, RNA, proteins

Question 25

what is ciclopirox

Answer 25

nail lacquer for mild to moderate onychomycosis

Question 26

what are the side effects associated with ciclopirox

Answer 26

minimal erythema

Question 27

what the MOA of Efinaconazole

Answer 27

Inhibits synthesis of ergosterol which is essential for cell membranes

Question 28

what is the side effect of efinaconazole

Answer 28

dermatitis

Question 29

what is the MOA of Tavaborole

Answer 29

inhibits aminoacyl-transfer ribonucleic acid (tRNA) synthetase (AARS) which inhibits fungal protein synthesis

Question 30

what side effects are associated with tavaborole 5% solution

Answer 30

- erythema, dermatitis, ingrown toenails

Question 31

T/F oral therapy can be used alone

Answer 31

true

Question 32

Is fluconazole fungistatic or fungicidal

Answer 32

fungistatic

Question 33

what is the MOA of fluconazole

Answer 33

highly selective inhibitor of fungal cytochrome P450 dependent synthesis of ergosterol

Question 34

If fluconazole is used for otitis capitis what is the duration of treatment

Answer 34

daily for 20 days

Question 35

If fluconazole is used for tinea unguium what is the duration of treatment

Answer 35

3-6 months (fingernail) | 6-12 months (toenail)

Question 36

what precaution should be taken when a patient is given fluconazole

Answer 36

hepatoxicity

Question 37

what side effects are associated with fluconazole

Answer 37

N/V, diarrhea, abdominal pain, dyspepsia, headache

Question 38

If crcl is < 50 mL/min when given fluconazole what needs to happen with the dose

Answer 38

50% dose reduction

Question 39

is griseofulvin fungistatic and fungicidal

Answer 39

fungistatic

Question 40

in tinea capitis is griseofulvin the gold standard treatment

Answer 40

yes

Question 41

what are the side effects of griseofulvin

Answer 41

photosensitivity, headache, GI upset

Question 42

is itraconazole fungistatic or fungicidal

Answer 42

fungistatic

Question 43

is itraconazole lipophilic, keratinophilic, or both

Answer 43

both

Question 44

how long can itraconazole remain in the nail after therapy

Answer 44

up to 27 weeks after therapy for shorter duration use

Question 45

how should itraconazole capsules be administered

Answer 45

immediately after food. gastric acid improves absorption

Question 46

what heart burn medication should be avoided with itraconazole

Answer 46

antacids

Question 47

how should itraconazole solution be given

Answer 47

on empty stomach for better absorptioin

Question 48

what patients is itraconazole contrindicated in

Answer 48

heart failure

Question 49

what type of drugs cause a drug interaction with itraconazole

Answer 49

CYP3A4

Question 50

what side affects are associated with itraconazole

Answer 50

- N/V/D, abdominal pain, edema, headache, rash, abnormal LFTs

Question 51

Is terbinafine fungicidal or fungistatic

Answer 51

fungicidal

Question 52

is terbinafine lipophilic, keratinophilic, or both

Answer 52

both

Question 53

how long can terbinafine remail in the nail after therapy

Answer 53

up to 30-36 weeks after therapy allowing for shorter duration of therapy

Question 54

what is the MOA of terbinafine

Answer 54

negatively affects fungal cell membrane; blocks synthesis of ergosterol

Question 55

what are the warnings/precautions associated with terbinafine

Answer 55

- neutropenia | - not recommended in chronic/ active hepatic disease or CrCl < 50 mL/min

Question 56

what drugs interact with terbinafine

Answer 56

potent CYP2D6 inhibitor

Question 57

what side effects are associated with terbinafine

Answer 57

rash, pruritus, diarrhea, dyspepsia, abnormal pain, nausea, headache, liver enzyme abnormality, taste disturbance

Question 58

what should be monitored when taking terbinafine

Answer 58

CBC, LFTs