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superficial fungal infection Flashcards

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1
Q

what is the main pathogen responsible for vulvovaginal candidiasis ( yeast infection)?

A

1st- candida albicans**

2nd- candida glabrata (due to resistant VVC there gas been a shift)

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2
Q

what are the risk factors for VVC?

A

initial sexual activity
oral-genital contact
contraceptive agent
antibiotic use
DM -sglt2
immunosuppression
pregnancy

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3
Q

clinical presentation of VVC?

A

symptoms: intense inching, soreness, irritation, burning on urination, painful intercourse

signs: erythema, fissure, clumpy, thick, white cottage cheese like discharge with no foul odor, edema

normal pH (4-4.5)

culture only if reccurrent

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4
Q

non pharm treatment for VVC?

A

keep area dry and clean

avoid harsh or perfumed soaps and douching

avoid tight and constrictive clothing

discontinue any precipitating medications ( steroids)

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5
Q

when is self treatment recommended for uncomplicated VVC?

A

for women with multiple confirmed prior cases who report the same symptoms

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6
Q

Are there any difference in the cure rates between oral and topical azole for VVC?

A

no

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7
Q

what is the treatment day range for nonprescription patients in uncomplicated VVC?

A

1-7 days

pregnancy = 7 days

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8
Q

what dosage form is recommended for pregnant women and how many days if they have uncomplicated VCC?

A

topical 7days
avoid oral

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9
Q

uncomplicated VVC OTC products

A

Butoconazole
clotrimazole
miconazole (caution with warfarin)
tioconazole (ointment)

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10
Q

uncomplicated VVC prescription

A

nystatin 1 tab x 14d
terconazole
fluconazole 150mg 1 tabs x 1day (repeat in 3days if recurrent)

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11
Q

uncomplicated VCC number of tablets

A

one

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12
Q

complicated VCC treatment

A

oral fluconazole 150mg every 72hrs x 2-3 doses

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13
Q

what patients are included in complicated VVC

A

immunocompromised
uncontrolled DM
pregnancy

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14
Q

what is the duration of treatment for uncontrolled DM and immunocompromised (complicated )

A

10-14 days

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15
Q

what topical VVC should pregnant women receive ?

A

topical imidazole for 7days

can’t take fluconazole

bee honey and yogurt may beneficial as adjunct therapy

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16
Q

for pregnancy if VCC worsens and exceeds 7 days

A

IV amp B

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17
Q

recurrent VVC

A

having >= 3 episodes < 12 months

10- 14 days oral or topical followed by fluconazole 150 mg weekly x 6 months

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18
Q

antifungal resistent VVC infection

A

generally c. glabrata

boric acid 600 intravaginally daily x 14 days, followed by one capsule twice weekly

toxic if taken orally

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19
Q

new VCC treatment for acute VCC

A

ibrexafungerp (brexafemmeO

MOA: triterpenoid fungal that inhibits glucan synthase

SE: diarrhea, nausea, abdominal pain

CI pregnancy, strong CYP3A4 inhibitors

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20
Q

new VVC treatment for for reducing the incidence or recurrent VCC

A

oteseconazole (vivjoa)

MOA: antifunal that inhibits 14a demethylase

SE: Nausea, HA

CI: pregnancy and lactation

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21
Q

what is the most common pathogen in oropharyngeal and esophageal candidiasis (thrush)

A

c. albicans

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22
Q

risk factors of oropharyngeal and esophageal candidiasis

A

medications (corticosteroids, cytotoxic agents, PPI, antibiotics)

environmental changes
poor dental hygiene
xerostomia
smoking
immunosupressant therapy
young infants , elderly
HIV/AIDS
DM
thyroid, parathyroid, adrenal dysfunction
cancer and radiation therapy
nutritional deficiencies

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23
Q

treatment for mild for oropharyngeal candidiasis

A

clotrimazole troche 10 mg
-hold in the mouth for 15-20 mins until dissolve

miconazole mucoadhesive buccal tab 50 mg daily x 7-14days

nystatin suspenpension 1000 units/ml
- for dryer mouth
- nausea
- high in sugar (does not help DM pts)
-not preferred in HIV pts

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24
Q

treatment for moderate to severe oropharyngeal candidiasis

A

fluconazole tablet 100-200 mg daily 7-14 days

itraconazole 10 mg/ml solution x up to 28 days

general duration of therapy 7-14 days

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25
refactory treatment for severe oropharyngeal candidiasis
IV enchinocandins IV amphotericin B not highly rec
26
for treatment of esophageal candidiasis and what is always required
systemic treatment fluconazole 200-400 mg daily alternative -IV fluconazole, -IV echinocandins (c,m,a) , -IV ambB general treatment 14-21 days
27
esophageal candidiasis treatment for fluconazole refectory disease
itraconazole 10/mg/ml solution 200 mg daily 21-28 days
28
topical preparations decrease the efficacy of
latex condoms
29
itraconazole can cause or worsen
heart failure
30
itraconazole is a potent
CYP3A4 inhibitor
31
what is preferred in pregnant patients with esophageal candidiasis
amphotericin B
32
what should be used if xerostomia exists
suspension or buccal mucoadhesive
33
monitoring parameters for oropharyngeal candidiasis/esphogeal candidasis
avoid drinking/ smoking dentures must be brushed (chlorhexidine gluconate) monitor liver enzymes with extended azoles use daily monitoring with amphotericin B due to nephrotoxicity
34
mycotic infections ( ringworms) are caused by what dermatophytes
trichophyton epidermophyton microsporum some species of candida involved
35
risk factors for mycotic infections
prolong sweating poor hygiene skin folds sedentary lifestyle bed bound HIV, DM, immunocommpromised steroid use
36
what type of mycotic infections must be treated with prescription product?
tinea capitis tinea barber tinea unguium -onychomycosis
37
what type of mycotic infections can be treat with OTC products?
tinea pedis- athletes foot - most common tinea manuum- hands tinea cruris- jock itch in males tinea vericolor/pityriasis
38
non-pharmacological therapy for mycotic infections
improve hygiene breathable clothing and non occlusive shoes keep area dry avoid contact with infected persons wash contaminated clothing in hot water and hot dryer setting spinkle or spray medicated or non medicated powders in shoes
39
what are some important exclusion factors for fungal infections?
Causative factor unclear signs of secondary bacterial infection, excessive and continuous exudation, condition extensive, uncontrolled diabetes, involves genitalia, face, mucous membranes (“sensitive areas”), nails, or scalp, fever, malaise, unsuccessful initial treatment or worsening of condition
40
what is the most efficient and effective formula for mycotic infections?
cream/solutions
41
clotrimazole and miconazole MOA
inhibit the product of sterols found on the fungi cell walls inhibit peroxidative abd oxidative enzyme activity Tinea pedis/corpis: BIDx 4 weeks Tinea cruris: BID x 2 weeks
42
Terbinafine MOA and duration
inhibit squalene expoxidase reeded in the fungi sterol biosynthesis, leading to accumulation of squalene within the cells and ultimately cell death Tinea pedis: BID x 1-4 weeks Tinea cruris: QD x 1 week Tinea corporis: QD x 1 week
43
Butenafine MOA and duration
Inhibits squalene epoxidase enzyme needed in fungi sterol biosynthesis, leading to accumulation of squalene within the cells and ultimately cell death Tinea pedis: BID x 1 week OR QD x 4 weeks Tinea cruris: QD x 2 weeks Tinea corporis: QD x 2 weeks
44
MOA of tolnaftate and duration
Unknown, but proposed to distort the hyphae and stunt mycelial fungi growth Can be used to treat tinea pedis, corporis, and cruris BID x 2-4 weeks, up to 6 weeks in severe cases
45
what OTC medication can be usedfpr prophylaxis and treatment
tolnaftate
46
MOA and duration for aluminum salts
No antifungal activity Used solely for astringent properties to relieve inflammation CI: Contraindicated with severe erosion or deeply fissured skin Tissue necrosis with extended use Child poisoning if ingested
47
Aluminum acetate for tinea pedis
Diluted with 10-40 parts water, 20 minutes TID until symptom reduction (acutely, no more than 1 week)
48
Aluminum chloride for tinea pedis:
BID until symptom reduction, then QD to prevent re-infection (acutely, no more than 1 week)
49
what is the treatment for tinea capitis
terbinafine 250 mg/ day x 4-8 weeks shampoo in conjunction with oral therapy or treatment of asymptomatic carriers
50
treatment for tinea barbae
removal of the facial hair is recommended terbinafine 250 mg/ day x 4-8 weeks
51
what is tinea versicolor caused by and what is the treatment
malassezia genus yeast Ketoconazole 2% shampoo twice weekly x 4 weeks (topical is usually enough) rare oral therapy: fluconazole itraconazole
52
is the cure rate for tinea unguium high or low
low
53
what is tinea unguium caused by
Caused by dermatophytes most frequently -Trichophyton rubrum -Trichophyton mentagrophytes Can be caused by non-dermatophytic -molds and C. albicans
54
risk factors for tinea unguium
Age >40 Family history Immunodeficiency Diabetes/neuropathy Psoriasis* Peripheral vascular disease Smoking Prevalence of tinea pedis Sports like swimming
55
nail lacquer - cicloporox 8% solution Topical tinea unguium therapy
- cure rate: 32-65% as low at 8% - duration 1 yr -will not penetrate the if nail plate is intact -no systemic side effects or interactions
56
Tavaborolee (kerydin) 5% solution Topical tinea unguium therapy
Rate of cure ~15-18%, with better cure rate in mild to moderate cases Apply to clean dry nails, cover the nail completely as well as the skin under the nail. Wipe away any excess and allow to dry completely. Apply once daily for 48 weeks. AE: local irritation, redness, excoriation, dermatitis
57
efinaconazole (julia) 10% solution Topical tinea unguium therapy
Rate of cure ~17%, with better cure rate in mild to moderate cases wait 10 min after bathing or showering, apply 1 drop (2 drops if it is the big toe) and spread over the entire nail and the hyponychium with the applicator, let dry completely. Apply once daily for 48 weeks avoid pedicures, nail polish, or other cosmetic nail products Product is flammable – no smoking while applying AE: Application site dermatitis, pain
58
what is the most effective for systemic tinea unguium therapy
First line: Terbinafine Alternatives: Itraconazole capsule/tablet, fluconazole (less preferred) Fluconazole:150 to 450 mg once weekly x 3-6 months (fingernails) or 6-12 months (toenails)
59
Terbinafine and itraconazole are ________ agents that penetrate the nail and are slowly eliminated so drug concentrations persist after end of treatment
lipophilic
60
terbiunafin SE and monitoring
-GI, rash, urticarial, itching, headache; *SJS (although rare) -Absolute lymphocyte counts (CBC); LFTs
61
itraconazole SE and monitoring
LFTs, especially in pts receiving daily therapy
62
what are preferred during pregnancy in
Topical azoles and terbinafine
63
what is the preferred treatment for tinea unguium, tinea capitis, and tinea barbae
Terbinafine
64
what is the most efficacious topical product for tinea unguium although it is costly and has a low cure rate?
Efinaconazole

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