-
topical agents are active only against...
dermatophytes
-
inhibit fungal cell mitosis at metaphase.
A) griseofulvin
-
MoA of butenafine.
- Lotrimin.
- inhibit ergosterol by blocking squalene
-
MoA of Lamisil.
- terbinafine
- inhibit ergosterol synth by blocking squalene.
-
MoA of clotrimazole (Lotrimin)
- bind to phospholipid in cell memb altering permeability.
- thus losing intracell elements.
-
MoA of Micatin (miconazole)
- bind to phospholipid on cell membrane so alters permeability.
- thus losing intracell elements.
-
bind to phospholipid on cell membrane so alters permeability. thus losing intracell elements.
D) clotrimazole
-
blocks fungal CYP450 so alters permeability to cell wall.
A) ketoconazole
-
inhibit transfer of essential elements in fungal cell wall and disrupts synth of DNA, RNA and protein.
A) ciclopirox
-
astringent property.
A) undecylenic acid (Cruex)
-
distorts hyphae adn stunts mycelial growth.
B) tolnaftate (Tinactin)
-
tinea pedis: scaling in btwn toes.
C) chronic intertriginous
-
tinea pedis: both feet mocassin like scalring ont he soles of the feet.
C) chronic papulosquamous
-
tinea pedis: vesicles or pustules by the instep and plantar.
B) vesicular
-
tinea pedis: macerated weeping ulceration on the sole.
A) acute ulcerative
-
if superficial infxn of athelete's foot, how long do you treat with topical?
2-4 weeks.
-
what to do if athlete's foot with cracks or breaks in the skin or nail involvement?
need oral therapy!
-
how is the recurrent rate with athlete's foot?
about 70% so prolonged therapy is needed.
-
Lotrimin Ultra generic?
butenafine 1%
-
Lamisil generic and availability?
terbinafine 1%
-
Lotrimin AF generic?
clotrimazole 1%
-
Cruex generic?
clotrimazole
-
Micatin AF generic?
miconazole 2%
-
Nizoral A-D generic?
ketoconazole 1%
-
what are the oral agents for athelete's foot and when do you use them?
- fluconzole 150mg once wkly x 1-4 wk
- ketoconazole 200mg daily x 4 wk
- itraconazole 200-400 mg daily x 1 wk
- terbinafine 250mg daily x 2wk
- use when cracks or breaks in the skin or nail is involved.
-
how to treat tinea cruris?
- treat with topical tx for 1-2 wk after resolution of sympts.
- severe infxn needs oral therapy.
-
what topical agents to use for tinea cruris?
- lotrimin ultra 1% daily x 2 wk
- lamisil AT 1% daily-bid x 1-4 wk (cr); daily x 1 wk (gel)
- micantin jock itch 2% bid x 4 wk
- nizoral a-d 1% daily x 2 wk
-
oral therapy for tinea cruris?
- lamisil 250mg qd x 2wk
- nizoral 250mg qd x 4 wk
- diflucan 150mg wkly x 2-4 wk
- griseofulvin 500mg q24h x 4-8 wk
-
tinea capitis: gray scaling on the hair shaft.
A) non-inflamm
-
tinea capitis: pustules with exudate
A) inflam
-
tinea capitis: hair braeks off and leaves a black dot on scalp.
C) black dot
-
tinea capitis: pathcy areas of hair loss and yellowish crusts and scales. (scutula)
D) favus
-
oral agents used for tinea capitis?
- Lamisil 250mg daily 4-8 wk
- Sporanox 3-5mg/kg/d x 30 d
- Diflucan 8mg/kg/d x 8-12wk
- griseofulvin 500mg daily 4-6 wk
-
is topical tx successful for tinea unguinum?
nope
-
oral agents used for tinea unguinum fingernail vs. toenail duration.
- lamisil 250mg qd: 6 wk vs. 12wk
- sporanox 200mg daily: 6 wk vs. 12 wk
- itraconazole 200mg bid x 1 wk/mo: 2 mo vs. 3-4 mo
- diflucan 150-300mg wkly: >6mo vs. >12mo
-
7 exclusions for self treatment for tinea infection?
- causative factor unclearunsuccessful initial tx or worsening
- nails, scalp, genitalia involved
- signs of secondary bacterial infxn (oozing, purulent material)
- excessive and continuous exudation, extensive, serious inflamm, debilitating
- DM, asthma, immune deficiency, systemic infxn
- fever, malaise
-
common cause of vulvovaginal candidiasis?
c.albican!
-
what disease states would put VVC as complicated?
- uncontrolled DM
- debilitation
- pregnancy
- immunosupp (HIV)
-
if non-albican, VVC would be...
a) uncomplicated
b) complicated
b) complicated
-
typical symptoms of VVC
pruritis, vaginal discharge, soreness, burning, extrenal dysuria
-
you have yeast cx (+) without symptoms. do you have VVC?
- NO!
- cx without sympt is NOT indication for therapy b/c yeast is a normal flora in vagina
- do cx to see if yeast and non-albican (complicated) are present
-
how long do you treat uncomplicated VVC?
1-3 days short course or single dose topical
-
for uncomplicated VVC, what is more effective?
azole vs. nystatin
azole (80-90%)
-
when do you recomm self med with OTC for uncompl VVC?
when previously dx who present with same sympts
-
when to seek med care wtih uncompl vvc?
when sympt persist or recur within 2 mo
-
what regimen to use for uncompl VVC?
- intravaginal agents: butoconazole, clotrimazole, miconazole, terconazole, nystatin
- oral: fluconazole
-
Mycelex-3 generic?
butoconazole
-
Monistat generic?
miconazole
-
Vagistat generic?
tioconazole
-
clinical presentation of severe VVC
extensive vulvar erythema, edema, excoriation, fissure formation
-
can you do short course tx for severe VVC?
no, poor result
-
how to treat severe VVC?
- topical azole x 7-14 days
- fluconazole 150mg po x 2 doses (3 days apart; 72h)
-
what defines recurrent VVC?
equal to or > 4 sympt outbreaks within 1 year
-
what should you do if you suspect recurrent vvc?
- do cx to confirm causative pathogen
- c. glabrata etc.
-
how to treat recurrent vvc?
- longer duration:
- topical for 7-14 d
- fluconazole 100mg, 150mg or 200mg q 3rd day x 3 doses
- maintenance:
- fluconazole 100mg, 150mg, or 200mg po q wk x 6 mo
- clotrimazole 200mg top twice wkly
- clotrimazole 500mg supp weekly
-
what candida would it be if patient has exposure to azole antifungal and still has candida?
glabrata
-
topical treatment for oropharyngeal candidiasis
- clotrimazole troche 10mg 4-5 daily x 7-14 days
- nystatin 100,000 units 5 ml QID x 7-14 days
- nystatin 200,000 units troche QID x 7-14 days
-
drug of choice systemic treatment for oropharyngeal candidiasis
- fluconazole
- LD 200mg
- MD 100mg/day
-
when you have severe oro candidiasis or worried about non-albican spp, what do you use?
systemic echinocandin.
-
what to use for refractory oropharyngeal candidiasis?
- posaconazole 400mg bid x 7 days
- itraconazole 100mg bid
-
what is systemic treatment for esophageal candidiasis?
- fluconazole
- LD 200mg
- MD 100mg daily (up to 400mg daily)
- (same as oropharyngeal)
- itra, vori, posa
-
what do you give for esopharyngeal candidiasis if the pt cannot swallow?
- IV fluconazole
- caspofungin 50mg daily
- mycafungin 150mg daily
- anidulafungin LD 100mg, MD 50mg
- AmBd
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