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YR3S2- clinical therapeutics > wk 9- skin and nail infections > Flashcards

wk 9- skin and nail infections Flashcards

(57 cards)

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1
Q

types of antibiotic therapy

A

directed
empirical
prophylactic

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2
Q

bacterial infection that has green colouration to is is caused by what organism

A

pseudomonas infection

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3
Q

infection with white/creamy pus is typically what bacterial infection

A

streptococcus infection

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4
Q

if pus is golden, runny and straw coloured then its likely what bacterial infection

A

staphloccocus infection

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5
Q

vesticular bullous tinea pedis is caused by what fungal infection

A

trichophyton rubrum and
trichophyton mentagrophytes

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6
Q

chronic hypertrophic appearance with dusty scale like nail is caused by what fungal infection

A

moccasin tinea pedis

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7
Q

whos at risk of fungal infection

A

older people
diabetes
pregnant women
biologics - immunosuppressant

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8
Q

fungal infections can be caused by

A

dermatophytes and yeasts, different treatment for these organisms

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9
Q

why to treat tinea pedis

A
  1. comfort- itching, scaling, etc
  2. appearance/cosmetic
  3. secondary infections, especially in those who are at risk/immunocompromised
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10
Q

dermatophytes
What can it infect
What types of

A

can infect skin, har, nails

tinea pedis is what we’re interested in

most common:
1. trichophyton rubrum
2. trichophyton interdidigitale
3. epidermophyton floccosum

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11
Q

yeast
What can it infect
Most common species

A

candidiasis (candida albicans) most common species

can infect
1. mucuous membranes,
2. nails (paronchyia),
3. skin (skin fold, chronic paronchyia)

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12
Q

clinical features of tinea pedis

A

hyperkertotic- patchy, fine dry scaling on sole of foot
maceration in webspace
clusters of blisters/pustules on side of feet
round patches on top of foot

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13
Q

predisposing factors of tinea pedis

A
  1. exposure to spores (environment)
  2. lower production of fatty acid
  3. occlusive footwear
  4. not changing socks/shoes
  5. excessive sweating
  6. immunodeficiency
  7. poor ciruclation
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14
Q

non pharmacological advice to manage tinea pedis

A

dry feet
wear shoes in communal areas
wash socks/jocks at a high heat
dry clothes in sun, UV light kills
moisture/cotton socks

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15
Q

onychomycosis caused by what pathogens and what species

A

dermatophytes (tinea unguium)

often occurs from untreated tinea pedis

can be caused by yeast- candida albicans

and moulds

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16
Q

if you have onychomyosis what happens with tinea pedis

A

recurring issue

constant secondary infections

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17
Q

types of onychomyosis

A
  1. distal OM
  2. lateral OM
  3. subungal onychomycosis
  4. superficial white onychomycosis
  5. total dystrophic onychomycosis
  6. proximal subungal OM
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18
Q

Chronic paronychia v acute

A

inflammation of the nail fold that can be caused by yeast/moulds

acute is caused by bacteria

different presentations.
acute has more inflammation/pus

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19
Q

do you need to confirm tinea pedis

A

no

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20
Q

if youre going to prescribe oral therapy should you confirm diagnosis

A

yes

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21
Q

where to take samples from

A

leading edge of the lesion after cleaning- tinea pedis

as proximal as possible - OM

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22
Q

microscopy and culture

A

M- comes back quickly
C- can take weeks

high false negative rate up to 40%

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23
Q

topical treatment for tinea pedis

Study These Flashcards
A
  1. terbinafine 1% cream/gel applied once or twice daily for 1-2weeks
    -fungicidal
  2. azoles applied twice daily for 2-4 weeks
    -fungistatic
24
Q

oral treatment for tinea pedis

Study These Flashcards
A
  1. terbinafine 250mg, once daily 2 weeks
  2. fluconazole 150mg, once daily 6 weeks
  3. itraconazole 100mg once daily 4 weeks
  4. griseofulvin 500mg, once daily for 8-12 weeks
25
what doesnt get recommended in AMH for OM
topical therapy success rate is around 8% and costs are around 70% for a bottle or more
25
oral treatment for OM
1.terbinafine 250mg once daily until clearance 2. fluconazole 150-300mg once weekly until clearance 3. itraconazole 100-200mg twice daily for 1 week every month until clearance 4. griseofulvin 500-1000mg once daily until clearance
26
comparison of azoles and griseofulvin
similar effectiveness but griseofulvin is longer treatment and more side effects
27
other options for OM
1. laser - UV rays/heat to destroy 2. photodynamic - " 3. iontophoresis delivery - electric charge to drive topical medications deeper into the nail plate OR drill holes into nail plate to get topicals to the nail plate 5. surgery- avulsion apply topical treatment
28
what is onycholysis
nail separation
29
treatment for onycholysis
if candida confirmed 1. fluconazole 150-300mg once weekly for 3 months / clearance 2. intaconazole 200mg, twice daily for 1 week every month for a total of 3 months or until clearance if pseudomoas confirmed 1. acetic acid / vinegar soak the nails for 5-10min twice daily for 3-4 weeks
30
what do you need to consider with topical therapy
can they reach feet compliance?
31
what to consider with oral therapy
-interactions? -ADRs -compliance -dose adjustments? -renal/ hepatic impairments? -success rate
32
what needs to be done when terbinafine is started
baseline blood test of renal function full blood count liver function follow up tests every 6 weeks
33
commonside effects of terbinafine
headache muscle aches (myalgia) joint pain nausea
34
griseofulvin important notes
lots of side effects suspected teratogen- contraindicated in pregnancy or wanting to become pregnant (1 month before) OR 6 months to prospective fathers
35
fluconazole itraconazole
oral form- pods cant prescribe not on formulary
36
what needs to be done when starting oral therapy for infection
shared decision making with GP and ensure systemic symptoms are monitored by GP
37
what does M and C do
-diagnose pathogen -show the virulence (how fast its growing) -what antibiotics can treat it (resistant/susceptible)
38
if you've send off for a M and C after empirical didn’t work what do you need to do
state what antibiotic has been used as it will change the way the pathogen grows
39
Review antibiotics
-types -MOA -considerations -cidal/static
40
treating infections stpes
1. wound swab and send for M and C 2. have an idea what pathogen we suspected based off symptoms and nature 3. empiracal therapy based off EBP 4. within 48-72 hours review progress and make changes if required (stop, continue, change therapy)
41
what is the difference between oral and IV/IM antibiotics
first pass effect/bioavailability -it can be faster acting via IV/IM -It isnt stronger
42
when to use IV antibiotics
depends on the risk of sepsis or complications
43
thinks to think about when prescribing antibiotics
ADRs interactions resistance dose adjustments route with/without food
44
what EBP to use for empiracal therapy
therapeutic guidelines
45
when would people use prophylatic antibiotics
orthopaedic surgry when theres a strong risk of a problematic infection (into a joint)
46
what pathogen causes acute paronychia
staphloccocus pyogenes
47
what is non therapeutic treatment of acute paronychia
drainage
48
antibiotic therapy of acute paronychia
that doesnt respond to drainage 1. dicloxacillin 2. flucloxacillin 6hourly for 5 days in the case of a delayed nonsevere penicillin allergy 3. cefafexin 12 hourly 5 days in the case of a immediate nonsevere/severe or delayed severe penicillin allergy 3. clindamycin 8 hourly 5 days
49
impetigo is
highly contagious
50
treatment for impetigo
topical: mupirocin (bactroban) 2% if theres extensive involvement or recurrence then oral antibiotic therapy instead
51
what therapy can be used on minor superficial infected wounds
povodine iodine antiseptics
52
pitted keratolysis
bacterial infection affecting plantar skin white, cater like lesions associated with hyperhidrosis which should be managed
53
therapy for pitted keratolysis
clindamycin twice daily for 10 days in conjunction with hygiene, reducing hypehidrosis etc
54
transgradient means
affecting multiple borders of the foot eg redness aruond heel, dorsum, lateral , medial , plantar aspects
55
types of tinea
tinea vesticular bullus tinea interdigitale
56

YR3S2- clinical therapeutics (12 decks)

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