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superficial fungal infection Flashcards

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
Q

refactory treatment for severe oropharyngeal candidiasis

A

IV enchinocandins
IV amphotericin B

not highly rec

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26
Q

for treatment of esophageal candidiasis and what is always required

A

systemic treatment

fluconazole 200-400 mg daily

alternative
-IV fluconazole,
-IV echinocandins (c,m,a) ,
-IV ambB

general treatment 14-21 days

27
Q

esophageal candidiasis treatment for fluconazole refectory disease

A

itraconazole 10/mg/ml solution 200 mg daily

21-28 days

28
Q

topical preparations decrease the efficacy of

A

latex condoms

29
Q

itraconazole can cause or worsen

A

heart failure

30
Q

itraconazole is a potent

A

CYP3A4 inhibitor

31
Q

what is preferred in pregnant patients with esophageal candidiasis

A

amphotericin B

32
Q

what should be used if xerostomia exists

A

suspension or buccal mucoadhesive

33
Q

monitoring parameters for oropharyngeal candidiasis/esphogeal candidasis

A

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
Q

mycotic infections ( ringworms) are caused by what dermatophytes

A

trichophyton
epidermophyton
microsporum
some species of candida involved

35
Q

risk factors for mycotic infections

A

prolong sweating
poor hygiene
skin folds
sedentary lifestyle
bed bound
HIV, DM, immunocommpromised
steroid use

36
Q

what type of mycotic infections must be treated with prescription product?

A

tinea capitis
tinea barber
tinea unguium -onychomycosis

37
Q

what type of mycotic infections can be treat with OTC products?

A

tinea pedis- athletes foot - most common
tinea manuum- hands
tinea cruris- jock itch in males
tinea vericolor/pityriasis

38
Q

non-pharmacological therapy for mycotic infections

A

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
Q

what are some important exclusion factors for fungal infections?

A

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
Q

what is the most efficient and effective formula for mycotic infections?

A

cream/solutions

41
Q

clotrimazole and miconazole MOA

A

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
Q

Terbinafine MOA and duration

A

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
Q

Butenafine MOA and duration

A

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
Q

MOA of tolnaftate and duration

A

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
Q

what OTC medication can be usedfpr prophylaxis and treatment

A

tolnaftate

46
Q

MOA and duration for aluminum salts

A

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
Q

Aluminum acetate for tinea pedis

A

Diluted with 10-40 parts water, 20 minutes TID until symptom reduction (acutely, no more than 1 week)

48
Q

Aluminum chloride for tinea pedis:

A

BID until symptom reduction, then QD to prevent re-infection (acutely, no more than 1 week)

49
Q

what is the treatment for tinea capitis

A

terbinafine 250 mg/ day x 4-8 weeks

shampoo in conjunction with oral therapy or treatment of asymptomatic carriers

50
Q

treatment for tinea barbae

A

removal of the facial hair is recommended

terbinafine 250 mg/ day x 4-8 weeks

51
Q

what is tinea versicolor caused by and what is the treatment

A

malassezia genus yeast

Ketoconazole 2% shampoo twice weekly x 4 weeks (topical is usually enough)

rare oral therapy:
fluconazole
itraconazole

52
Q

is the cure rate for tinea unguium high or low

A

low

53
Q

what is tinea unguium caused by

A

Caused by dermatophytes most frequently
-Trichophyton rubrum
-Trichophyton mentagrophytes

Can be caused by non-dermatophytic
-molds and C. albicans

54
Q

risk factors for tinea unguium

A

Age >40
Family history
Immunodeficiency
Diabetes/neuropathy
Psoriasis*
Peripheral vascular disease
Smoking
Prevalence of tinea pedis
Sports like swimming

55
Q

nail lacquer - cicloporox 8% solution
Topical tinea unguium therapy

A
  • 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
Q

Tavaborolee (kerydin) 5% solution
Topical tinea unguium therapy

A

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
Q

efinaconazole (julia) 10% solution
Topical tinea unguium therapy

A

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
Q

what is the most effective for systemic tinea unguium therapy

A

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
Q

Terbinafine and itraconazole are ________ agents that penetrate the nail and are slowly eliminated so drug concentrations persist after end of treatment

A

lipophilic

60
Q

terbiunafin SE and monitoring

A

-GI, rash, urticarial, itching, headache; *SJS (although rare)
-Absolute lymphocyte counts (CBC); LFTs

61
Q

itraconazole SE and monitoring

A

LFTs, especially in pts receiving daily therapy

62
Q

what are preferred during pregnancy in

A

Topical azoles and terbinafine

63
Q

what is the preferred treatment for tinea unguium, tinea capitis, and tinea barbae

A

Terbinafine

64
Q

what is the most efficacious topical product for tinea unguium although it is costly and has a low cure rate?

A

Efinaconazole

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