wk 8- antifungals

Question 1

types of antimycotics

Answer 1

topical
1. azoles
2. allylamines
3. mopholines
4. polyene

oral
1. allylamines
2.mitosis inhibitors
3. azoles

Question 2

azole antifungals

Answer 2

topical:
bifonazole
ketoconazole
fluconazole (oral only)
clotrimazole

oral:
itraconazole
fluconazole

Question 3

allylamine antifungals

Answer 3

terbinafine

Question 4

MOA azole

Answer 4

fungistatic
can be fungicidal at larger doses

interrupt the synthesis from lanosterol to ergosterol

Question 5

MOA allylamines

Answer 5

fungicidal

interrupts the synthesis with an increase in squalene within the cell membrane and deficiency of ergosterol

Question 6

nystatin MOA

Answer 6

fungicidal
bind to ergosterol in fungal cell membrane and causes depolarization

Question 7

griseofulvin MOA

Answer 7

fungistatic

disrupts spindle formation during mitosis and arrests metaphase

Question 8

fungal species

Answer 8

1. trichophyton rubrum (76%)
2. trichophyton interdigitale
3. epidermophyton floccosum

Question 9

types of tinea pedia

Answer 9

• interdigital
• hyperkeratotic/moccasin
• inflammatory / vesticular
• ulcerative

Question 10

types of onychomycosis

Answer 10

tinea unguium

Question 11

diagnosising tinea pedis

Answer 11

microscopy and culture not generally needed when starting topical therapy

culture may take up to 6 weeks

Question 12

topical corticosteroid and fungal infections

Answer 12

used in conjunction initially if itching is severe- typically for inflammatory/vesticular tinea

removes redness but it allows the infection to spread as it decreases the immune response and therefore should not be used alone

signs of infection will return and be worse than before on withdrawal of corticosteroid - tinea incognito

Question 13

treatment for plantar/hyperkeratotic/moccasin tinea

Answer 13

oral- ETG

Question 14

treatment for inflammatory/vesicular tinea

Answer 14

oral

Question 14

oral therapy when

Answer 14

• widespread
• topical hasnt worked
• topical corticosteroid used inappropriately
• on scalp, palms or soles
• inflammatory, hyperkeratotic, vesicular in nature

Question 15

types of oral therapy

Answer 15

1. azole
   fluconazole
   itraconazole

2.allymadine
terbinafine

griseofulvin is effective and cheaper but a longer treatment course

Question 16

length of oral therapy

Answer 16

terbinafine/fluconazole :usually 4 week course

itraconazole: one week course but need to review 3-4 weeks after and repeat if cultures are positive

Question 17

types of onychomycoiss

Answer 17

1. white superficial onychomycosis
2. distal subungal onychomycosis
3. candida onychomycosis
4. proximal subungual onychomycosis

Question 18

diagnosis onychomyosis

Answer 18

microscopy and culture before treatment
positive in approx 80% of cases of OM

Question 19

what species causes white superficial onychomyococisis

Answer 19

usually trichophyton interdigitale

Question 20

treatment for white superficial

Answer 20

1. topical miconazole tincture
2. topical amorolfine

Question 21

when would u not use topical therapy on onychomyosis

Answer 21

distal subungal onychomyocosis or
proximal subungal onychomyosis

doesnt penetrate the nail to reach the source

Question 22

oral therapy for onychomycosis and success rate and length of treamtent for nails

Answer 22

1. terbinafine (70-80%)- 12 weeks or longer
2. azole (60-70%)
   itraconazole 3-4months
   fluconazole: 6-12 months
3. griseofulvin (30%) after 12 months and relapse common

Question 23

why would u use oral therapy for onychomyociss

Answer 23

-widespread
-topical not working
-the type, DSO, PSO unable to penetrate
-risk of infection, neuropathy, PAD, ulceration, complications (diabetic, immune suppressent, delayed healing)

Question 23

poor prognosis for onychomyocosis when

Answer 23

1. area of infection more than half the nail 2. significant lateral infection 3. subungal hyperkeratosis >2mm 4. white/yellow streaks 5. total dystrophic 6. non responsive organism 7. immunosuppressive patients 8. diminished peripheral circulation

Question 24

terbinafine contraindications- oral

Answer 24

1. hepatic -liver disease 2. psoriasis -need to diagnose infection first 3. children -rare to occur in children, tablet not recommended and cream not for children <12 4. antidepressents -TCA (increases side effects) -venlafaxine and paroxetine

Question 25

what can you use lamisil once for

Answer 25

interdigital tinea pedis only leave to dry to a film and dont wash area for 24 hours

Question 26

what can you use cream, gel or spray lamisil for

Answer 26

tinea corporis tinea cruris interdigital tinea pedis

Question 27

renal impairment and oral therapy

Answer 27

half dose

Question 29

terbinafine and monitoring liver function

Answer 29

liver function test at baseline, monitor if treating longer than 6 weeks it can cause elevated LFT and liver toxicity and blood dyscrasias symptoms of dark urine, tired, nauesous, etc

Question 30

formulations of topicals and what they suit

Answer 30

cream- dry scaling tinea tincture- nails spray- cant reach, hairy or painful on touch areas lotion- between toes for drying

Question 31

mixonazole has what for azoles

Answer 31

the most fromulation options cream lotion powder spray tincture solution

Question 32

bifonazole is

Answer 32

used once daily and has the shortest duration fo treatment 2-3weeks compared to other azoles

Question 33

hydrocortisone and antifungals

Answer 33

only used until inflammation subsides (max 7 days) and must be used with antifungal at least 2 times a day

Question 34

topical treatments for onychomycosis

Answer 34

1. amorolfine -nail licquer solution. once/twice weekly 2. miconazole - tincture 3. urea (2-3weeks) and bifonazole cream (4weeks) 4. ciclopirox -lacquer

Question 35

how long does it take for a nail to grow out

Answer 35

12 months or more

Question 36

what is not effective if nail matrix is infected

Answer 36

topical

Question 37

griseofulvin- oral tablet length of treatment and contraindications

Answer 37

12 months for nails 4-6 weeks for skin 1. pregnancy/lactation 2. heaptic dysfunction 3. lupus erythemateosus (burning with sun exposure side effect) 4. combined oral contraceptive 5. warfarin

Question 38

side effects of griseofulvin

Answer 38

1. skinburn 2. headache 3. dizziness