test 4 notes 8 - Antifungal Treatment Types of Fungal...

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Antifungal Treatment Types of Fungal Infections Requiring Therapy Fungal infections fall into three clinical groups: 1. CUTANEOUS (SUPERFICIAL) FUNGAL INFECTIONS Athlete's Foot (Tinea Pedis) "Jock Itch" (Tinea Cruris) Ring Worm of the body (Tinea Corporis) Ringworm of the scalp (Tinea Capitus) Tinea Versicolor [Note: These infections are typically caused by such fungal organisms as trichophyton, microsporum, epidermophyton, pityrosporum, and sporothrix. Collectively they are referred to as dermatophytes.] 2. CUTANEOUS YEAST (CANDIDA) INFECTIONS These infections occur in warm wet areas of the body, especially in skin folds like the axillae, groin, and inframammary areas. They can also occur in the digital webs and the gluteal cleft areas. Other sites of candidal infections include the nails and the mucous membranes. 3. SYSTEMIC FUNGAL INFECTIONS Opportunists: candidiasis, aspergillosis, cryptococcosis, mucormycosis Non-opportunists: sporotrichosis, blastomycosis, histoplasmosis, coccidioidomycosis SELECTED ANTIFUNGAL AGENTS In this section we will review 3 classes of antifungal drugs: the "azole" drugs, echinocandins and terbinafine. Amphotericin B is an intravenous drug used for deep fungal infections in pregnant women but its use in other settings has largely been replaced by the 1
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Antifungal Treatment newer echinocandins, which have less toxicity, especially with the kidney. We will not discuss Amphotericin B further. "Azole" drugs - clotrimazole (Mycelex)(Gyne-Lotrimin) - fluconazole (Diflucan) - itraconazole (Sporanox) - ketoconazole* (Nizoral)* - miconazole (Monistat) - voriconazole (Vfend) *seldom used now because other azoles have fewer adverse effects Pharmacodynamics of the "azole" drugs All of the azole drugs work by the same mechanism. They inhibit the synthesis of a fatty acid (ergosterol) into fungal cell membranes. The cell membranes of fungal organisms become weakened and begin to leak essential ions (phosphorus and potassium). They are effective only on actively dividing fungal organisms. These agents are fungicidal. Pharmacokinetics of clotrimazole Clotrimazole is administered topically or vaginally. When administered in the mouth or vagina, there is some absorption through mucous membranes but there is negligible absorption when administered topically to skin. Any that is absorbed from use on mucous membranes is metabolized (presumably by the liver) and excreted in the urine. Advantages of clotrimazole - Fungicidal - Available in multiple formulations for topical use (cream, lotion, solution) and as a vaginal tablet or cream - Available over-the-counter - Very effective against both candida and the superficial dermatophytes - Fungal resistances are rare - Inexpensive - Can be used prophylactically in AIDS; oral candidal infections are common in these patients when they require antibiotics 2
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This note was uploaded on 05/19/2011 for the course NURSING 517/617 taught by Professor Lipstate during the Spring '11 term at University of Louisiana at Lafayette.

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test 4 notes 8 - Antifungal Treatment Types of Fungal...

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