PHPR 202: ANTIFUNGAL THERAPY Andrew Schmelz, PharmD Post-Doctoral Teaching Fellow Purdue University...
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Transcript of PHPR 202: ANTIFUNGAL THERAPY Andrew Schmelz, PharmD Post-Doctoral Teaching Fellow Purdue University...
PHPR 202: ANTIFUNGAL THERAPY
Andrew Schmelz, PharmDPost-Doctoral Teaching Fellow
Purdue University School of Pharmacy
FUNGAL INFECTIONS
MYCOSES: an infection caused by fungi• Mild to severe
• Superficial or systemic
Candida albicans• Normal flora
• Overgrowth can lead to infections
• Agents can promote overgrowth
SUPERFICIAL INFECTIONS
Candida
• mucous membranes
• moist skin
Dermatophytes
• scalp
• skin
• nails
ORAL THRUSH
http://www.nhsdirect.nhs.uk/SelfHelp/conditions/oralthrushchild/_im027.asp
TINEA CORPORIS – RING WORM
http://www.emedicine.com/aaem/topic380.htm#section~pictures
TINEA CORPORIS
ATHLETES FOOT
http://botit.botany.wisc.edu/toms_fungi/feb98.html
ATHLETE’S FOOT
ATHLETE’S FOOT
ONYCOMYCOSIS
ONYCOMYCOSIS
AGENTS FOR SYSTEMIC & SUPERFICIAL INFECTIONS
AZOLE ANTIFUNGALS
THERAPEUTIC USES:• Vary with agents available
MECHANISM OF ACTION:• Damages the fungal cell membrane resulting
in a leakage of cellular components
ADVERSE EFFECTS
GI effects: nausea, vomiting, and diarrhea
Rash - (itraconazole)
Liver toxicity
MONITORING PARAMETERS
Drug interactions
Liver function tests
Jaundice, dark urine, and pale stools
Hydration
SUPERFICIAL AGENTS
GRISEOFULVIN
THERAPEUTIC USES:• Superficial fungal infection
• Onychomycosis
MECHANISM OF ACTION:• Stops the fungal cell growth cycle
ADVERSE EFFECTS
Transient headaches, nausea, vomiting,and diarrhea
Rash Drowsiness Liver toxicity (rare) Photosensitivity (rare)
NYSTATIN
THERAPEUTIC USE:• Treatment of local fungal infections
MECHANISM OF ACTION:• Binds to cell membrane components and
causes leakage of fungal cell components
NYSTATIN
ROUTES OF ADMINISTRATION:• oral
• topical
ADVERSE EFFECTS:• well tolerated
• nausea, vomiting, and diarrhea (large oral doses)
• local irritation (topical)
TERBINAFINE (Lamisil®)
INDICATION• Onychomycosis
• Topical/localized infections
MECHANISM OF ACTION• Interferes with cell wall synthesis and causes
fungal cell death
ROUTES OF ADMINISTRATION• Oral
• Topically
ADVERSE EFFECTS
Rash GI upset Hepatotoxicity Headache Neutropenia Dermatologic
TERBINAFINE (Lamisil®)
MONITORING PARAMETERS:• Liver function tests
PATIENT EDUCATION:• Complete full course of therapy
• May be taken with or without food
TOLNATATE (Tinactin®)
INDICATIONS:• Topical and localized infections
MECHANISM OF ACTION:• Unknown (may interfere with cell wall
synthesis)
TOLNATATE (Tinactin®)
ADVERSE EFFECTS:• Local irritation and burning
PATIENT EDUCATION:• For external use
• Clean and dry thoroughly before use
IMPLICATIONS FOR PHYSICAL THERAPY
DISEASE STATE• Systemic infections are serious
• Superficial infections occur commonly
• Educate patients
• Recognize symptoms
• OTC therapies can be considered
DRUG THERAPY• Monitor for adverse effects with systemic agents
• Minimal adverse effects with superficial treatment